Prevalence of Anterior Inferior Cerebellar Artery Vascular Loop in Cerebellopontine Angle With Three-Dimensional Constructive Interference in Steady State (CISS) Sequence MRI.

Background The cerebellopontine angle (CPA) cistern houses vital neurovascular structures such as cranial nerves V, VII, and VIII and the anterior inferior cerebellar artery (AICA), often leading to neurovascular compression syndromes due to its complex anatomy. Although vascular compression is a recognized cause of certain neuralgias, its association with otologic symptoms such as tinnitus, hearing loss, and dizziness remains uncertain. Hence, this study aims to determine the prevalence of the AICA vascular loop in the CPA cistern on MRI in patients with asymptomatic audiovestibular symptoms. Methodology Adult patients who underwent MRI, including the posterior fossa's high-resolution volumetric T2 sequence (three-dimensional constructive interference in steady state (3D-CISS)), were assessed. Patients with a history of audiovestibular symptoms (tinnitus/dizziness/vertigo/sensorineural hearing loss), intracranial tumor, vascular lesions, intracranial surgery, brain radiation therapy, traumatic brain injury, poor image quality, and MRI scans without 3D-CISS sequences were excluded. Two radiologists independently reviewed 114 (228 sides) MRI studies for the vascular loop of AICA in the CPA cistern and the extension of the AICA loop into the ipsilateral internal acoustic meatus which was graded by Chavda's classification. Results The prevalence of vascular loop of AICA in the CPA cistern was as high as 47.6% in asymptomatic patients. Grade I Chavda vascular loop was the most common type followed by type II, with type III being the least common type. Conclusions Knowledge regarding the high prevalence of the AICA loop in the asymptomatic population and the lack of significant correlation between the presence of the AICA loop and otovestibular symptoms should be considered in preoperative planning for decompression procedures.

Natural orifice trans-oral, trans-vestibular endoscopic thyroidectomy: Surgical steps and technique.

ABSTRACT: Natural orifice scarless cosmetic surgeries are becoming a reality with increasing experience of advanced laparoscopic surgeries and availability of modern energy sources. Many techniques of minimally invasive video-assisted thyroidectomy through cervical and extra-cervical routes such as chest wall, trans-axillary, sub-mental, post-auricular and trans-luminal approach have been attempted. However, trans-oral trans-vestibular endoscopic thyroidectomy with its excellent cosmetic effect has become the more popular option among the surgical community with advantages such as decreased hospital stay and minimal complications. In this case report, we describe natural orifice trans-oral, trans-vestibular endoscopic thyroidectomy approach (NO-TOTVET) and add to literature the technique in which NO-TOTVET can be utilised, thus adding to the repertoire of the operating surgeon.

Titanium corrosion products from dental implants and their effect on cells and cytokine release: A review.

INTRODUCTION: Titanium is considered to be an inert material owing to the ability of the material to form a passive titanium oxide layer. However, once the titanium oxide layer is lost, it can lead to exposure of the underlying titanium substructure and can undergo corrosion. SUMMARY: The article explores the role of titanium ions and particles from dental implants on cells, cytokine release, and on the systemic redistribution of these particles as well as theories proposed to elucidate the effects of these particles on peri-implant inflammation based on evidence from in-vitro, human, and animal studies. Titanium particles and ions have a pro-inflammatory and cytotoxic effect on cells and promote the release of pro-inflammatory mediators like cytokines. Three theories to explain etiopathogenesis have been proposed, one based on microbial dysbiosis, the second based on titanium particles and ions and the third based on a synergistic effect between microbiome and titanium particles on the host. CONCLUSION: There is clear evidence from in-vitro and limited human and animal studies that titanium particles released from dental implants have a detrimental effect on cells directly and through the release of pro-inflammatory cytokines. Future clinical and translational studies are required to clarify the role of titanium particles and ions in peri-implant inflammation and the etiopathogenesis of peri-implantitis.

When the Gut Took a Wrong Turn to the Right: A Case Report of a Rare Complication of Closed Loop Small Bowel Obstruction With Small Bowel Volvulus in a Right Paraduodenal Hernia With Midgut Malrotation.

Internal hernias constitute 5.8% of all small bowel obstructions. The right paraduodenal hernia is a less common subtype of the paraduodenal hernia. Lack of specific signs and symptoms precludes its clinical diagnosis, which emphasizes the need for computed tomography in diagnosis. We present a case of a 24-year-old male patient with a right paraduodenal hernia and midgut malrotation causing closed loop small bowel obstruction and small bowel volvulus within the hernial sac who underwent laparoscopy-assisted reduction of hernia and adhesiolysis with closure of the peritoneal defect. Since the right paraduodenal hernia is associated with gut malrotation, risk of strangulation, closed-loop obstruction, and rarely volvulus, these patients need prompt radiological diagnosis and surgical intervention.

Health Status and Treatment Outcome of Tuberculosis with Diabetes Mellitus Cases, Rajkot City, Gujarat - A Longitudinal Study.

Background: India, with the highest number of tuberculosis (TB) cases in the world, is also facing epidemic growth in diabetes mellitus (DM). TB is curable while DM is a metabolic and incurable disease that if not controlled will affect the health status of a person. This study was conducted to assess the health status and treatment outcome of TB with DM cases. Materials and Methods: We selected a total of 64 newly registered pulmonary TB (PTB) with DM cases from five tuberculosis units (TUs) in Rajkot city from October 2019 to December 2020. At the end of treatment, 64 cases were analyzed for treatment outcome and 56 cases (5 deaths; 3 lost to follow-up) were followed up to observe progression in health status. The information was collected in pretested proforma by interview. Results: There was a significant improvement in TB symptoms (cough, weight loss, weakness, anorexia, evening rise of temperature, dyspnea, chest pain, hemoptysis), DM symptoms (frequent urination, excessive thirst and hunger, tingling and numbness), symptoms of mental health (fatigue, sleep disturbance, negative emotions, socially inactive), and adverse drug reactions (ADRs) on consecutive visits (McNemar's test, P < 0.001) and at the end of treatment (Cochran's Q test, P < 0.001). Improvement of nutritional status was also found statistically significant on consecutive visits (Wilcoxon test, P < 0.001) and at the end of treatment (Friedman's test, P < 0.001). The cure rate was 82.8% and 4.7% of cases had completed treatment. Conclusion: At the end of treatment, there was a significant improvement in health status and treatment outcome; also good cure rate was reported among cases.

Outcome of Submucosal Inferior Turbinoplasty in Perennial Allergic Rhinitis.

Pharmacotherapy forms mainstay of treatment for allergic rhinitis, and has adverse effects associated with it. Topical steroid therapy is the preferred medication and considered best for long term prophylaxis but with limited compliance. Submucosal turbinoplasty reduces the duration of treatment in comparison to topical steroid which has to be taken daily for a long time. The aim was to evaluate the outcome of submucosal inferior turbinoplasty in patients with perennial allergic rhinitis. A prospective interventional study was performed on 35 patients diagnosed with perennial allergic rhinitis, diagnosed as per ARIA criteria from July 2016 to July 2018. The severity of the disease was assessed using mini RQLQ scoring system. The patients were then subjected to bilateral submucosal inferior turbinoplasty under endoscopic guidance under local anesthesia. 50% significant improvement (p value < 0.05) seen in symptoms were need to blow nose, sneezing, nasal obstruction, nasal discharge, watery eyes, need to rub eye, regular house work, recreational activities, sore eyes, tiredness, irritability and thirst. 100% improvement (p value < 0.05) seen in symptoms were sleep, need to blow nose, sneezing, nasal discharge, watery eyes, need to rub eye, recreational activities and irritability. Nasal obstruction was not severe in 17 (48.5%) patients giving a very good symptom relief and improving quality of life. This is due to reduction in the erectile tissue and roominess in the nasal cavity. All patients with allergic rhinitis with associated hypertrophied turbinates should invariably be given option of inferior turbinoplasty along with proper counselling regarding its advantages and disadvantages.

Evaluation of effects of essential oil vapors on the bacterial count in bioaerosols.

Background: The aerosols generated during dental treatments contain bacteria and other microorganisms that penetrate the body through the respiratory system of dental surgeons and cause infectious diseases. Several studies have been done to reduce these hazards. The aim of the present study is to evaluate the effects of the plant extract essential oil (EO) vapors of Neem, Clove, Cinnamon bark, Thyme, Lemon Grass, and Eucalyptus on the bacterial count in bioaerosols near dental units. Materials and Methods: Sampling was taken on nutrient blood agar plates by placing them open near dental units using passive air sampling method, before commencement of treatment for 1 h, during treatments for 2 h, and after introducing EO vapors for 2 h. The collected samples were taken for incubation at 37°C for 48 h. The colonies formed were counted in colony-forming units per cubic meter and taken for statistical analysis. Results: After comparing the obtained results, it was found that there was a significant reduction (P < 0.05) in the bacterial count for about 43% near the dental units after the introduction of the EO vapours. Conclusion: It is concluded that natural extracts like EOs can reduce bacterial contamination near dental units in the vapourized state, thereby reducing the health hazards in Dental Health Professionals.

A New Anatomical Variation and Course of RLN Described: A Rare Case Report of a Lateral and Superiorly Placed Bilateral RLN Over the Thyrohyoid Muscle.

Ling XY described 3 variations of RLN in relation to Inferior thyroid artery (ITA), with the RLN either being anterior to ITA, in between the branches of ITA or posterior to ITA. We add to these variations and present a new anatomical variation and course of RLN in which it lies in a lateral position and descends from a superior position on the thyrohyoid muscle to enter the larynx medially.

A Dentigerous Cyst Arising from an Ectopic Supernumerary Tooth Lodged in the Posterolateral Wall of the Maxillary Sinus: A Rare Case Report and Treatment Modality.

The occurrence of a dentigerous cyst in relation to a supernumerary tooth in the maxilla is extremely rare. We in this case discussion present an even rarer case of a dentigerous cyst in relation to an ectopic supernumerary tooth in the posterolateral wall of the maxillary sinus. An endoscopically assisted multi speciality surgical approach was adopted to minimize morbidity in this complex bony lesion, with the residual bony defect reconstructed with the help of buccal fat pad.

Challenges for dental professionals during COVID-19 pandemic: Are we prepared?

BACKGROUND: With the emerging knowledge and understanding of novel coronavirus infection, dentists must be capable of resuming their practice with necessary precautions in near future; hence, the aim of the present study was to evaluate the knowledge, attitude, and practices along with felt challenges by the dentists concerning practicing dentistry during pandemic in India. MATERIALS AND METHODS: An online cross-sectional questionnaire study was conducted on the dental practitioners of Uttarakhand, India. The dentists were approached by obtaining their E-mail address from the heads of dental institutions or dental association branches in the state. The knowledge, attitude, and practices along with apparent challenges of practicing during pandemic were assessed using closed-ended questionnaire. The relationship between the mean scores and demographic variables was determined using Student's unpaired t-test by keeping the significance level below 0.05. RESULTS: Out of 759 respondents, a total of 458 respondents were male (60%), whereas 301 (40%) were female. The mean knowledge scores were higher in females (11.06 ± 2.12) compared to males (9.72 ± 4.53), which was statistically significant (P < 0.05). The mean practice score was lower in males (17.49 ± 6.47) compared to females (19.26 ± 6.69) and likewise lower scores were seen in graduates compared to specialists and these differences were again statistically significant (P < 0.05). Majority of the study participants felt that following various safety guidelines were not feasible (96.97%) and too expensive (96.44%) and considered them as a challenge. CONCLUSION: It is imperative that dentists should be fully prepared before resuming their services and reach the right kind of awareness to limit the spread of the disease.

Artificial neural networks modeling for lead removal from aqueous solutions using iron oxide nanocomposites from bio-waste mass.

Heavy metal ions in aqueous solutions are taken into account as one of the most harmful environmental issues that ominously affect human health. Pb(II) is a common pollutant among heavy metals found in industrial wastewater, and various methods were developed to remove the Pb(II). The adsorption method was more efficient, cheap, and eco-friendly to remove the Pb(II) from aqueous solutions. The removal efficiency depends on the process parameters (initial concentration, the adsorbent dosage of T-Fe3O4 nanocomposites, residence time, and adsorbent pH). The relationship between the process parameters and output is non-linear and complex. The purpose of the present study is to develop an artificial neural networks (ANN) model to estimate and analyze the relationship between Pb(II) removal and adsorption process parameters. The model was trained with the backpropagation algorithm. The model was validated with the unseen datasets. The correlation coefficient adj.R2 values for total datasets is 0.991. The relationship between the parameters and Pb(II) removal was analyzed by sensitivity analysis and creating a virtual adsorption process. The study determined that the ANN modeling was a reliable tool for predicting and optimizing adsorption process parameters for maximum lead removal from aqueous solutions.

Effect of Ocimum sanctum extract on leukemic cell lines: A preliminary in-vitro study.

BACKGROUND: Surge of cancer incidence, effects of chemotherapeutic agents and their cost and reduced survival and responsiveness to treatment have led to shift of attention of researchers toward herbal remedies to look for newer dimension in cancer therapy. Ocimum sanctum, Holy Basil or Tulsi, holiest herb well used in the Indian household, has drawn much attention toward its various health benefits, especially anti-cancer property. The present study was carried out to evaluate the cytotoxic effect of O. sanctum on leukemic cell lines K562. MATERIALS AND METHODS: Dry and aqueous extracts of two types of Tulsi leaves (Rama Tulsi and Krishna Tulsi) were evaluated for a dose-dependent cytotoxicity and anti-proliferative against K562 cell lines, leukoerythroid progenitor leukemic cell lines by 3-(4,5-dimethythiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay. Half-maximal inhibitory concentration was evaluated for each of the extracts. RESULTS: Both dry and aqueous extracts of both types of Tulsi leaves demonstrated a significant amount of cytotoxicity against the studied cell lines. CONCLUSION: This being preliminary study, we propose the initial finding of cytotoxic abilities of the herb against the leukemic cell lines and recommend a more detailed evaluation of the herb and its components.

Should dopamine be the first line inotrope in the treatment of neonatal hypotension? Review of the evidence.

AIM: To determine if dopamine is effective in treating neonatal hypotension and safe to use comparing to other inotropes. METHODS: This is a review of evidence on inotropic treatment of neonatal hypotension. Databases searched were MEDLINE and the Cochrane Library, a total of 134 studies were identified. Only studies with high quality evidence (level 1a and b and 2a) were included. After review, only eight studies were included in the final analysis. Pooled risk ratios derived for each outcome [Mantel-Haenzel (M-H) fixed effect] with CI, as reported in the Cochrane reviews were plotted in forest plot form. RESULTS: Eight articles met inclusion criteria, which all included treatment in preterm infants. Dopamine increased mean arterial blood pressure (BP) (n = 163; r = 0.88, 95%CI: 0.76 to 0.94) and systolic BP (n = 142; r = 0.81, 95%CI: 0.42 to 0.94) comparing to placebo. Dopamine has been shown overall to be statistically more effective in increasing BP than dobutamine (n = 251, r = 0.26, 95%CI: 0.20-0.32). However there were no differences in short term outcomes (periventricular leucomalacia, periventricular haemorrhage) and mortality between both drugs. There is no statistical evidence of dopamine being more effective than adrenaline or corticosteroids. There was no difference in morbidity and mortality outcomes when dopamine was compared to hydrocortisone (RR 1.81, 95%CI: 0.18 to 18.39) or adrenaline. CONCLUSION: In preterms, dopamine is the most studied drug, and we suggest it could be used as first line treatment in hypotension.

Caldwell Luc Surgery: Revisited.

Caldwell Luc surgery (CWS) is almost 120 years old now and it still enjoys an important place in ENT Surgeons armamentarium. The logic behind this surgery is to replace the diseased and scarred mucosa from maxillary sinus with new mucosa. In the initial period of this long journey the surgery gained many other important indications which also includes approach to surrounding structures which makes us to think if it's really a radical surgery as it is used just an approach to other structure. This was a retrospective study of CWS done during period of 2002-2014 in Sri Venkateshwara ENT Institute and Bowring & Lady Harding Hospital both of these attached to Bangalore Medical College & Research Institute. In this study we have tried to analyze the indications and surgical procedure adapted and complications. Even though it has synonym of radical antrostomy the complications were minor and temporary, except for permanent tooth anesthesia and nasal vestibular stenosis. With reasonable expertise if this surgery is done for proper indication: its worth to face these complications and it's a versatile surgery even today.

Adjunct ultrasonography in children with suspected acute appendicitis: identifying the optimal target group.

BACKGROUND: Role of ultrasonography in diagnosis of acute appendicitis in children is being debated. This study was conducted ahead of a clinical trial and aimed to evaluate the adjunctive role of ultrasonography in this group. METHODS: Retrospective chart review of consecutive children undergoing appendicectomy in an Australian tertiary children's hospital over 24 months. Two study groups were: clinical assessment and clinical assessment plus ultrasonography. The accuracy of diagnosis was compared by generating estimates for sensitivity and positive predictive value using histopathology of the appendix as the reference standard. The incremental value of ultrasonography was evaluated in subgroups of gender, age and clinical severity. RESULTS: Two hundred ninety-five children (170 boys, median age 10 years) were included in the study. Negative appendicectomy rate was 17.3%; 10.4% in the clinical assessment group (n = 134) and 23% in the ultrasonography group (n = 161). Overall sensitivity for diagnosis by clinical assessment (71.4%, 95% confidence interval (CI) 63.3-79.5) was not significantly different to that using adjunct ultrasonography (77.7%, 95% CI 69.7-85.7; P = 0.29). Adjunct ultrasonography was more sensitive between 7 and 11 years (81% versus 68%, P = 0.002) and possibly in girls (86% versus 73%, P = 0.1), but did not increase the sensitivity of the diagnosis in children who presented with milder symptoms and signs. CONCLUSIONS: Adjunct ultrasonography may not increase the overall accuracy of diagnosis of acute appendicitis in children but holds promise in certain subgroups viz. between 7 and 11 years and in girls. There is an increase in negative appendicectomies following a 'non-targeted' use of ultrasonography. Future prospective trials should take cognizance of these findings in designing the subgroup analysis.

Ethyl cellulose and hydroxypropyl methyl cellulose buoyant microspheres of metoprolol succinate: Influence of pH modifiers.

INTRODUCTION: Incorporation of pH modifier has been the usual strategy employed to enhance the dissolution of weakly basic drug from floating microspheres. Microspheres prepared using a combination of both ethyl cellulose (EC) and hydroxypropyl methylcellulose (HPMC) which shows highest release were utilize to investigate the effect of fumaric acid (FA), citric acid (CA), ascorbic acid (AA) and tartaric acid (TA) (all 5-20% w/w) incorporation on metoprolol succinate (MS) release. MATERIALS AND METHODS: EC, HPMC alone or in combination were used to prepare microspheres that floated in simulated gastric fluid and evaluated for a percent yield, drug entrapment, percent buoyancy and drug release. The higher drug release in combination (MS:HPMC:EC, 1:1:2) was selected for the evaluation of influence of pH modifiers on MS release. CA (5-20% w/w), AA (5-20% w/w), FA (5-20% w/w) and TA (5-20% w/w) were added and evaluated for drug release. Present investigation is directed to develop floating drug delivery system of MS by solvent evaporation technique. RESULTS: The microspheres of MS:HPMC:EC (1:1:2) exhibited the highest entrapment (74.36 ± 2.18). The best percentage yield was obtained at MS:HPMC (1:1) (83.96 ± 1.50) and combination of MS:HPMC:EC (1:1:2) (79.23 ± 1.63). CONCLUSION: MS release from the prepared microspheres was influenced by changing MS-polymer, MS-polymer-polymer ratio and pH modifier. Although significant increment in MS release was observed with CA (20% w/w), TA (20% w/w) and AA (20% w/w), addition of 20% w/w FA demonstrated more pronounced and significant increase in drug entrapment as well as release from MS:HPMC:EC (1:1:2) buoyant microspheres.

Cri du chat syndrome: a series of five cases.

The cri du chat syndrome (CdCS) is a chromosomal deletion syndrome associated with a partial deletion of the short (p) arm of chromosome 5. We describe five children who were diagnosed to have CdCS by conventional cytogenetic analysis. The deletion was at 5p15 in four patients, whereas the fifth had a larger, more proximal deletion at 5p14. Fluorescence in situ hybridization (FISH) analysis confirmed the deletion of the CdCS critical region at 5p15.2. All five children had global developmental delay and dysmorphism with microcephaly. The other clinical features were variable. Since the clinical diagnosis of CdCS may not always be evident because of the phenotypic heterogeneity, cytogenetic analysis is necessary to establish the diagnosis and confirm that the deletion involves the CdCS critical region. This will enable early intervention which plays an important role in improving the outcome.

Sexual dysfunction with the use of antidepressants in a tertiary care mental health setting - a retrospective case series.

Sexual dysfunction affects patients' quality of life. It can occur secondary to physical or mental disorders, substance abuse and treatment with prescription drugs like antidepressants. We wanted to study the prevalence of sexual dysfunction associated with antidepressant use in the psychiatric unit of a tertiary care hospital and assess for causality, severity and preventability. We did a retrospective data collection from case records of patients on antidepressants from the Psychiatry outpatient clinic of a tertiary care teaching hospital during the period 1(st) January 2006 to 31(st) December 2006, excluding those with complaints of sexual dysfunction prior to treatment. Data are presented as a case series. Documented adverse events were subjected to analysis for causality, severity and preventability using Naranjo's, modified Hartwig and Siegel and modified Schumock and Thornton's Preventability scales respectively. Out of 169 patients, four patients developed sexual dysfunction (2.36%) associated with duloxetine, mirtazapine, trazodone and sertraline. We observed a possible causal relationship of mild to moderately severe ADR (sexual dysfunction) which was not preventable. Prevalence of antidepressant associated sexual dysfunction was lower than quoted in Western literature probably due to the retrospective nature of our study design. Active monitoring and intervention can greatly improve the quality of life and compliance to treatment.