Case report on combined approach for delayed orbital floor repair.

"White-eyed blowout" fractures in pediatric patients can be presented with fewer clinical symptoms; therefore, immediate diagnosis and surgery is essential. In cases where early surgery was performed, rapid recovery and better postoperative outcomes were noted regardless of the configuration of fracture. In pediatric patients, due to changes in the orbital volume, autograft is recommended. Although there are different approaches to orbital floor, transantral approach provides enhanced illumination and accessibility to orbital floor. This case report portrays a pediatric case of white-eyed blow out fracture which went unnoticed for about 1 month and was managed at a later date. Combined mid-tarsal and transantral approaches using iliac crest graft was used to repair the orbital blow-out fracture.

Assessing the Quality of Long-Term Stored Tissues in Formalin and in Paraffin-Embedded Blocks for Histopathological Analysis.

Introduction: Formalin is the most commonly used fixative which enables for long-term storage of specimens and preserves morphologic features allowing the microscopic evaluation for future research analysis. Archival collections of the tissue serve as a reliable tool for diagnostic research purpose. They have an important role in on-going patient care, allows for evaluation of recurrent cases for diagnostic purpose and rare case specimens can also be used as an educational tool as well as for further biomedical research purposes. However, studies assessing quality and their usefulness for such purposes are scanty. Hence, the present study is aimed at evaluating and comparing the tissue changes after long-term storage in formalin as well as in paraffin-embedded blocks. Methodology: Three study groups include specimens stored in formalin for a minimum of 5 years (long-term fixed tissue) and their corresponding paraffin-embedded old tissue blocks along with freshly fixed tissues taken as controls which were subjected to routine histopathological procedures and were assessed for macroscopic and microscopic evaluation.Chi-square test and Z-proportion tests were considered for statistical analysis. Results: Prolonged storage of the tissues in formalin showed variation in color and consistency, difficulty in cutting during grossing with inadequate sectioning characters, loss of tissue integrity and architecture, and inadequate nuclear and cytoplasmic details. Conclusion: On histological analysis, prolonged formalin-stored specimens showed deleterious effects than archival blocks. Hence, it can be proposed that tissues are better preserved in paraffin blocks rather than in formalin for further biomedical research purposes.

Primary Reconstruction in Segmental Resection of Mandible-An Outcome Analysis of Different Reconstructive Techniques.

Functional and cosmetic defects in the maxillofacial region may result from trauma, inflammatory disease, benign or malignant tumors. There are several well established reconstructive options for restoring mandibular continuity and function. Traditionally, surgeons have used their past experience to determine the best way to perform the osteotomy, graft harvesting, and graft shaping procedures for mandibular reconstruction. Focus has now shifted to optimize functional and aesthetic outcomes in mandible reconstruction. Refinements in surgical techniques continue to improve patient's quality of life. The purpose of this study was to evaluate the outcome of a range of reconstructive techniques in 20 patients who underwent segmental resection of mandible during the period 2004-2017.

Consensus Statement on Holistic Management of Angina.

Worldwide, coronary heart disease (CHD), have assumed epidemic proportions. Increasing use of interventional therapy and a higher adherence to medical therapy have led to a 33% reduction in cardiac deaths at 5 years after hospital discharge. Angina pectoris is a common symptom of ischemic heart disease. The goals of anti-ischemia therapy in patients with stable coronary artery disease (CAD) include relieving angina symptoms, improving duration of exercise and quality of life, improving prognosis and preventing cardiovascular (CV) events. The consensus statement was devised with the help of multiple meetings held across India. Ten regional advisory board e-meetings were held in Mumbai, Delhi, Chennai, Kolkata, Ahmedabad, Cochin, Trivandrum, Lucknow, Bhopal and Varanasi. These meetings were attended by ten eminent experts from the field of cardiology from each region. Extensive literature review, intense discussions, and feedback from the cardiologists led to the development of the following consensus statements on definition, diagnosis, and management of angina, which have been reported in this article.

Cheiloscopy and dermatoglyphics in normal and obese individuals: A study in Indian subpopulation.

BACKGROUND: The prevalence of obesity has been steadily increasing worldwide. Reliable and noninvasive tools that can be used to diagnose such conditions may help us in mass screening and prevention. Finger prints and lip prints have been used as the genetic markers in some diseases such as diabetes mellitus. Studies to correlate a possible association of such markers among obese individuals have not been reported in India to date. The present study was conducted to determine and compare the lip print and finger print patterns in normal and obese individuals and also to evaluate any possible correlation between the lip prints and finger prints in both the study groups. METHODOLOGY: Lip and finger print patterns of 100 obese and equal number of age- and sex-matched healthy individuals were analyzed. Right thumb, right index, left thumb and left index finger prints were evaluated. Gender-wise comparison was also made. RESULTS: Lip prints revealed no significant difference between obese and nonobese individuals. Predominant Type I lip print was observed in both the study groups. Comparison of finger prints between obese and nonobese individuals revealed a highly significant results for all the fingers. Predominant finger print patterns in the right thumb, right index, left thumb and left index among obese individuals were whorl (51%), loop (83%), whorl (79%) and arch (74%), respectively. No correlation between the lip prints and finger prints was noted. CONCLUSION: Finger prints in the obese individuals showed significant differences when compared to the normal controls while lip prints failed to reveal any significant difference. Lip prints did not correlate with the finger prints. Right thumb revealed a significant gender difference among obese individuals.

An extremely rare pseudoaneurysm of posterior superior alveolar artery arising after orthognathic surgery.

Le Fort 1 osteotomy is one of the most versatile techniques in orthognathic surgery employed for the correction of dentofacial deformities and is considered technically safe. Pseudoaneurysms (PAs) which can cause life-threatening hemorrhage are rare after corrective jaw surgery. Here, we describe a clinical case of delayed postoperative epistaxis secondary to an extremely rare PA of the posterior superior alveolar artery followed by Le Fort 1 osteotomy subsequently managed with endovascular selective embolization.

Electrospun fibers based on botanical, seaweed, microbial, and animal sourced biomacromolecules and their multidimensional applications.

This review summarizes and broadly classifies all of the major sustainable natural carbohydrate bio-macromolecular manifestations in nature - from botanical (cellulose, starch, and pectin), seaweed (alginate, carrageenan, and agar), microbial (bacterial cellulose, dextran, and pullulan), and animal (hyaluronan, heparin, chitin, and chitosan) sources - that have been contrived into electrospun fibers. Furthermore, a relative study of these biomaterials for the fabrication of nanofibers by electrospinning and their characteristics viz. solution behavior, blending nature, as well as rheological and fiber attributes are discussed. The potential multidimensional applications of nanofibers (filtration, antimicrobial, biosensor, gas sensor, energy storage, catalytic, and tissue engineering) originating from these polysaccharides and their major impacts on the properties, functionalities, and uses of these electrospun fibers are compared and critically examined.

A critical review of synthesis procedures, applications and future potential of nanoemulsions.

Applications of nanotechnology in various spheres have increased manifold as it offers solution to unsolved problems with higher effectiveness. Nanoemulsions are one such system that are widely studied and have a very promising potential in solving various issues as those encountered in delivery of drugs, pesticides or any other biologically potent substance. Apart from this, nanoemulsions have wide applications in the field of food, cosmetics, skincare and agriculture. In this review, we have discussed and compared the methods of nanoemulsion preparation and various methods of synthesis, along with few major applications in various fields of science and technology. We sincerely hope that this review will help to understand the different aspects of nanoemulsions and help us to explore its potent applications in various fields.

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.

A new species of Alpheus (Crustacea, Decapoda, Alpheidae) from the Arabian Sea, Kerala, India.

A new species of Alpheus, A. samudra nov. sp., is described from the bycatch of trawlers operating between 275-375 m depth on the Quilon Bank (Kerala, India). The new species belongs to the brevirostris group, but can be easily distinguished from all but one species, by the extremely laterally compressed major cheliped. Alpheus samudra nov. sp. is very similar to A. leptocheles Banner Banner, 1975 in the form of the major cheliped, but the proportions of the fingers to the palm and the shape of the fingers easily separate both species.

Comparison of staining adequacy between tissues stored in formalin and paraffin embedded blocks for prolonged duration.

INTRODUCTION: Tissues submitted for histopathological diagnoses are routinely fixed in formaldehyde fixative which facilitates tissue storage for the extended period of time for further investigation or research purpose. The literature has reliable data relating to immunohistochemistry and molecular studies done using tissue fixed in formalin for longer duration and in paraffin-embedded tissue blocks. We have attempted to evaluate staining adequacy of archival specimens using hematoxylin and eosin (H&E) and trichrome stains. METHODOLOGY: We compared staining adequacy in tissues stored in formalin for a minimum period of 5 years labeled as long term fixed tissues (LFT) and corresponding 5-year-old paraffin-embedded tissue blocks of same cases available in the archives designated as old tissue blocks (OTB), along with freshly fixed tissues (FFT) used as controls. Fifty-one tissue sections in each study group were stained with H&E, Mallory's trichrome and Van Giesons' and microscopic evaluation was carried out using Research Microscope B × 51. RESULTS: Staining adequacy of the tissue sections was found to be superior in FFT, followed by OTB and LFT using all three stains. Staining for H&E, was found to be superior as compared to trichrome stains. CONCLUSION: Trichrome stains were poorly demonstrated in LFT indicating the possible alteration in protein structure and tissue architecture in LFT whereas H&E, stained LFT specimens showed relatively good staining character. Hence, OTB proved to be better as compared to LFT in terms of staining quality and hence archiving tissue in paraffin embedded tissue blocks serve as valuable bio-bank and source for prospective studies.

Initial choice of antibiotic in recurrent spontaneous bacterial peritonitis: A retrospective study.

CONTEXT: Spontaneous bacterial peritonitis (SBP) is a commonly encountered infection seen in the setting of ascites secondary to advanced liver disease. Recurrence of SBP is common and is associated with high mortality. This study was designed to recognize a better initial choice of antibiotic in case of recurrent SBP - a third-generation cephalosporin or a carbapenem. AIMS: This study aims to determine a better initial choice of antibiotic in case of recurrent SBP and to compare the all-cause mortality among two different groups of patients treated with a third-generation cephalosporin and a carbapenem. SETTINGS AND DESIGN: This study was conducted among fifty patients presenting with recurrent SBP visiting the emergency department (ED) at a tertiary care center and who were subsequently admitted in a gastroenterology intensive care unit, during a period of 1 year. SUBJECTS AND METHODS: This is a retrospective, observational study conducted among patients with chronic liver disease and diagnosed with recurrent SBP visiting the ED at a tertiary care center in South India treated with either of two classes of antibiotics - third-generation cephalosporins or carbapenems, and their outcomes were compared. Recurrence is defined as an episode of SBP after resolution of the first index case of SBP within 1 year. STATISTICAL ANALYSIS USED: Statistical analysis was done using IBM SPSS version 23.0 (SPSS Inc., Chicago, IL, USA). All categorical variables were represented as percentages, and all continuous variables were represented as mean ± standard deviation. To test the statistical significance of the association of categorical variables with the outcome, Chi-square test was used. P <0.05 was considered statistically significant. RESULTS: A total of fifty patients with recurrent SBP were included in the study, of which 44 (88%) patients were male and 6 patients were female (12%). Twenty-nine (58%) patients survived and 21 (42%) patients expired within 28 days. Twenty-seven (54%) patients were treated with third-generation cephalosporins and 23 (46%) were treated with carbapenems. It was observed that mortality was statistically significantly lower among patients treated with carbapenem (P = 0.001). The incidence of acute kidney injury was also lower among patients treated with a carbapenem than patients treated with a third-generation cephalosporin (40.7% vs. 59.25%, respectively). CONCLUSIONS: Initiation of a carbapenem significantly reduced the all-cause mortality when compared to a third-generation cephalosporin as an initial antibiotic of choice in recurrent SBP.

Bcl-2 expression in reactive oral lesions with atypical epithelium and in oral epithelial dysplasia associated with carcinogen exposure.

BACKGROUND: Reactive lesions of the oral cavity are nonneoplastic proliferations with very similar appearance to benign neoplastic lesions and are associated with chronic local irritation or trauma. Although these lesions are uncommonly associated with carcinogen exposure, at times, they present histopathologically with dysplastic epithelium, thus making it difficult to differentiate it from true potentially malignant disorders. Hence, the present study was conducted to evaluate the expression of Bcl-2 protein, an antiapoptotic marker, in reactive lesions with and without atypical epithelium and in true epithelial dysplasia, which clinically presents as premalignant disorders. MATERIALS AND METHODS: The samples included 15 cases each of normal oral mucosa (NOM), reactive lesions with and without dysplasia and oral epithelial dysplasia (OED) associated with carcinogen exposure. All the samples were subjected to immunohistochemical staining using Bcl-2 antibody. The total number of cells in the basal and parabasal layers in each field and total number of cells expressing Bcl-2 among them and the staining intensity were assessed. STATISTICAL ANALYSIS: Kruskal-Wallis ANOVA test was used to compare the number of positive cells among the four groups. The comparison of average percentage of positive cells between the study groups was done using Mann-Whitney U-test. RESULTS: The immunohistochemical staining for Bcl-2 protein was identified in few cells in the basal layers of NOM, reactive lesions without atypical epithelium and in the basal and parabasal layers in reactive lesions with atypical epithelium and OED, as a granular cytoplasmic staining and as an accentuation around the nuclear membrane. There was a gradual increase in the expression and intensity of staining from Group I to IV. INTERPRETATION AND CONCLUSION: The altered or increased expression of Bcl-2 oncoprotein in reactive lesions with atypical epithelium and in OED with carcinogen exposure may lead to prolonged cell survival and can be considered as an early molecular event in carcinogenesis, helping us in understanding the nature of dysplasia in reactive lesions, which was not considered during the histopathology reporting.

Detection of Skin Cancer Using SVM, Random Forest and kNN Classifiers.

Most common and deadly type of cancer is Skin cancer. The destructive kind of cancers in skin is Melanoma as well as it can be identified at the initial stage and can be cured completely. For the diagnosis of melanoma, the identification of the melanocytes in the area of epidermis is an essential stage. In this paper the watershed segmentation method is implemented for segmentation. The extracted segments are subjected to feature extraction. The features extracted are shape, ABCD rule and GLCM. The extracted features are then used for classification. The classifiers are kNN (k Nearest Neighbor), Random Forest and SVM (Support Vector Machine). Among different classifiers, the SVM classifier provided better results for the skin lesions classification.

The Eminence of Neutrophil-lymphocyte Count Ratio in Predicting Bacteremia for Community-acquired Infections at an Emergency Medicine Department in a Tertiary Care Setting.

INTRODUCTION: The changes in the white blood cells counts and other blood parameters are well-recognized feature in sepsis. A ratio between neutrophils and lymphocytes can be used as a screening marker in sepsis. Even though new markers such as Procalcitonin and adrenomedullin have been rolled out in the field, implementation of these markers has been hindered by cost, accessibility, and proper validation. We looked for the ability of simple neutrophil-lymphocyte count ratio (NLCR) when compared to the gold standard blood culture method in predicting bacteremia, on patients presented to emergency department (ED) with features of suspected community-acquired infections. MATERIALS AND METHODS: A comparative study done on 258 adult patients, admitted with suspected features of community-acquired infections. The study group included all patients who had positive blood culture results on index presentation at ED. Patients with hematological, chronic liver and retroviral diseases, patients receiving chemotherapy, and steroid medications were excluded from the study. The study group was compared with gender- and age-matched control group who were also admitted with a suspicion of the same, but in whom the blood culture results were negative. RESULTS: There was no statistically significant difference for predicting bacteremia by NLCR (>4.63) and culture positivity methods (P = 1.00). NLCR of > 4.63 predicts bacteremia with an accuracy of 84.9%. CONCLUSION: In our setting, NLCR performs equally well with culture positivity, in detecting severe infection at the early phase of disease. The NLCR may, therefore, be used as a suitable screening marker at ED for suspected community-acquired infections.

Electrocardiogram-guided Technique: An Alternative Method for Confirming Central Venous Catheter Tip Placement.

BACKGROUND: The current standard followed for assessing central venous catheter (CVC) tip placement location is through radiological confirmation using chest X-ray (CXR). Placement of CVCs under electrocardiogram (ECG) guidance may save cost and time compared to CXR. OBJECTIVE: The objective of this study is to compare the accurate placement of the CVC tip using anatomical landmark technique with ECG-guided technique. Another objective is to compare CVC placement time and postprocedural complications between the two techniques. METHODS AND MATERIALS: A total of 144 adult individuals, who were critically ill and required CVC placement in the Emergency Department, were included for the study. Study duration was 6 months. Anatomical landmark and ECG-guided groups were assigned 72 participants each. Analyses were performed using t and Chi square-tests. RESULTS: It was observed that 13 (18%) in the landmark technique were malpositioned as compared to none in the ECG-guided technique (P = 0.000). The landmark group had 22 (30.6%) participants with arrhythmias during the procedure, compared to none in the ECG-guided group (P = 0.000). The landmark group revealed that 30 (41.7%) of the CVC were overinserted and required immediate repositioning, compared to none in the ECG-guided group (P = 0.000). CONCLUSION: ECG-guided technique was found to be more accurate for CVC tip placement than the anatomical landmark technique. Furthermore, the ECG-guided technique was more time-effective and had less complications than the anatomical landmark technique. Hence, ECG-guided CVC placement is relatively accurate, efficient, and safe and can be considered as an alternative method to conventional radiography for confirmation of CVC tip placement.

Camphor Poisoning: A Rare Cause of Acute Symptomatic Seizures in Children.

Camphor is a toxic compound easily available over the counter, which can cause fatal seizures in children when ingested. It is available in several forms and is commonly used in Indian households, especially for religious rituals and for its cough-suppressive and nasal-decongestant effect. The toxic effect remains unknown in most homes. Seizures are usually well controlled with intravenous benzodiazepines, and recurrences of seizures are rarely reported.

A Case Report on Pregabalin-Induced Eosinophilia.

This is a case report on a 77-year-old diabetic patient with peripheral neuropathy and paresthesias in his feet, for which he was treated with pregabalin. During the therapy, his eosinophil level was high (60.3%). Pregabalin was stopped, and after one month his differential eosinophil had dropped dramatically, to 7.3%. Based on the Naranjo Adverse Drug Reaction scale, it is probable that the eosinophilia was induced by pregabalin, as the Naranjo probability score was calculated to be 8. BACKGROUND: Pregabalin, a structural derivative of the inhibitory neurotransmitter gamma amino butyric acid, has antiepileptic, analgesic, and anxiolytic properties; therefore, it is used for painful diabetic neuropathy, postherpetic neuralgia, fibromyalgia, and neuropathic pain associated with spinal-cord injury and as adjunctive therapy in refractory partial seizures. The common adverse side effects include somnolence, weight gain, dizziness, peripheral edema, abnormal constipation, thirst, and blurring of vision. CASE REPORT: This is a case report on a 77-year-old diabetic patient with peripheral neuropathy and paresthesias in his feet (with a nocturnal preponderance), for which he was treated with pregabalin. During the pregabalin therapy, his eosinophil level was high (60.3%). Pregabalin was stopped, and after one month his differential eosinophil had dropped dramatically, to 7.3%. Based on the Naranjo Adverse Drug Reaction scale, it is probable that the eosinophilia was induced by pregabalin, as the Naranjo probability score was calculated to be 8. CONCLUSION: The incidence of eosinophilia attributable to pregabalin is very rare and warranted discontinuation of the drug.

Estimation of salivary Candida albicans counts in asthmatic adult patients taking anti-asthmatic medication for 3-5 years.

BACKGROUND: Bronchial asthma is a chronic inflammatory disease of airways. The disease itself along with the principal medication used makes the oral cavity susceptible to most common opportunistic infection, i.e., oral candidiasis. There are many species of Candida causing oral candidiasis, but the most prevalent among them is Candida albicans. Hence, assessing C. albicans count in response to disease and its treatment is necessary. This enables us to educate asthma patients about side effects of medication and highlight the necessity for oral health care, thereby improving their quality of life. AIMS: The present study aims to evaluate the effects of asthma and its medication on C. albicans count in saliva samples of asthmatic adult patients taking medication for 3-5 years and compare C. albicans count in saliva samples among cases and controls. MATERIALS AND METHODS: Thirty asthmatic adults taking medication for asthma since 3-5 years' age ranging from 20 to 50 years and equal number of age- and sex-matched healthy participants were included in the study. In both groups, saliva was collected and inoculated on Sabouraud Dextrose Agar culture plates for estimation of C. albicans counts. C. albicans counts were assessed in colony-forming unit/milliliter. STATISTICAL ANALYSIS: Mann-Whitney U-test and Fisher's exact t-test were used. RESULTS: The C. albicans count is significantly higher among asthmatics than healthy individuals. CONCLUSIONS: The present study concludes that there is increased candidal growth among asthmatics as compared to their normal healthy counterpart.