Protocol for Treatment of Oral Verrucous Carcinoma - A Systematic Review and Meta-Analysis.

Background: The objective of this study is to provide a structured protocol for the treatment of verrucous carcinoma (VC) based on size, bone invasion, recurrence and whether neck dissection is necessary or not. In addition, the study evaluates the probability of a wrong histopathological diagnosis. Data Sources: A search was conducted in the Cochrane Library, PubMed and Google from January 1962 to October 2022 by using MeSH terms and keywords. Studies reporting treatment modalities for VC and different histopathological diagnoses after excision of the lesion were selected except case reports and review articles. Study Eligibility Criteria: Thirteen articles were selected. Six hundred and thirty cases of VC were treated by surgery, surgery + neck dissection, radiotherapy, chemotherapy and combination therapy. Statistical analysis revealed surgical treatment as a preferred option. Despite being enlarged, the lymph node was negative for metastasis. So, in OVC cases neck dissection adds only unnecessary morbidity to patients. Participants and Interventions: Radiotherapy or chemotherapy can be used to downstage the disease. 23.3% of cases reported wrong histopathology diagnosis. Study Appraisal and Synthesis Methods: Patients treated for squamous cell carcinoma (SCC) will only experience unnecessary morbidity unless the correct diagnosis is made between VC and hybrid VC. Irrespective of size VC does not metastasise until there are no foci of SCC. Conclusions: Surgical excision of T1- and T2-sized lesions can be performed under local anaesthetic as a biopsy procedure. T3 or T4 lesion can be resected with a safe margin. If it comes as hybrid VC or VC with close margin (0.5 cm, <0.5 cm), neck dissection and further margin should be excised as a second procedure respectively.

Ultrafine particle number concentration and its size distribution during Diwali festival in megacity Delhi, India: Are 'green crackers' safe?

Since the air pollution and noise generated from fireworks are related to air quality and human health, the regulatory bodies had implemented the eco-friendly "Green Crackers" in megacity Delhi, India, to celebrate Diwali 2019 with the permission of a specific time slot (8:00 p.m. to 10:00 p.m.). The present study was conducted on a residential educational institute campus to evaluate the particle number size distribution (PNSD) of green cracker emissions. During the Diwali event period, the high peak of particle number concentration (PNC) reached 1.7 × 105 # cm-3 with a geometric mean diameter (GMD) of ∼44 nm. The average PNC increment on Diwali day was 138% and 97% compared to pre (October 26, 2019) and post (October 28, 2019) Diwali period, respectively, including 468%, 142%, 65%, 75% on pre-Diwali and 485%, 110%, 32%, 26% on post- Diwali 2019 period in terms of Nucleation mode (10 nm < Dp < 20 nm), Small Aitken mode (20 nm < Dp < 50 nm), Large Aitken mode (50 nm < Dp < 100 nm), and Accumulation mode (100 nm < Dp < 1000 nm), respectively. Unlike traditional firework emissions, green crackers had a high UFP/Ntotal ratio of 0.72, including Nucleation mode-0.35, Aitken mode-0.30, and Accumulation mode 0.35, distinguishing it from other pre-and post-Diwali particle number size distribution-dN/dlogDp curves. These observations indicate that green crackers emit more particles with smaller diameters than traditional crackers. Recommendations for using green crackers for Diwali celebrations may be an option if lower size-diameter particle emission could be controlled by changing the material composition of the green crackers. More research studies need to be conducted to assess atmospheric emissions of green crackers and their health impacts to evaluate whether they are better or worse than traditional crackers.

Progress in Diagnosis and Treatment of Neonatal Sepsis: A Review Article.

Neonatal sepsis is a serious condition in which the pathogens infiltrate the bloodstream, multiply and produce toxins causing deleterious effects to the health of neonates. It is divided into two types on the basis of the time of onset. Early onset sepsis occurs within 72 hours of birth and late onset sepsis begins after 72 hours of delivery. Neonatal sepsis continues to be a common and significant health care burden, especially in very low birth weight infants (with birthweight less than 1500 grams). Though intrapartum antibiotic prophylaxis has decreased the incidence of early-onset group B streptococcal infection dramatically, it still remains a major cause of neonatal sepsis. As the signs and symptoms of neonatal sepsis are nonspecific, early diagnosis and prompt treatment remain a challenge. Keywords: cytokines; immunoglobulin; neonatal sepsis; procalcitonin.

Depredation loss drives human-wildlife conflict perception in the Trans-Himalayas.

Communities in and around protected areas are exposed to a higher level of human-wildlife interactions. The conservation practice with persistently adverse local livelihood outcomes can potentially aggravate such interactions leading to conflict. In our study, we examined how perceptions of HWC have formed in a protected area of the Trans-Himalayas whose conservation program collides with a centuries-long tradition of transhumance pastoralism. To examine determinants of depredation and how conflict perception has developed there, along with the socioeconomic and ecological interactions underlying those trends, we collected data using household surveys, key informant interviews, and focus group discussions. We employed Poisson-logit maximum-likelihood hurdle, binary logit, and multinomial ordered logit regressions in order to explore the determinants of annual livestock depredation, predator attacks on the shed, and household-level perceptions of HWC, respectively. Depredation and encounters with wildlife were the principal causes of perceived HWC, and depredation caused an average household-level loss of US $422.5, up to 23.28% of annual income in some households. Predators' attacks on high-quality sheds were relatively infrequent but more common in areas with perceived habitat degradation. Social customs, pastoral practices, and the present compensation mechanism were identified as being antithetical to conflict reduction and sustainable pastureland management. Further analysis revealed that a diversity of livelihoods, however, lowered conflict perception formation. The identified socio-ecological factors will continue to increase depredation, exacerbate perceived HWC, and degrade pastureland unless local conservation authorities take appropriate remedial measures.

Assessment of the effect of the judicial prohibition on firecracker celebration at the Diwali festival on air quality in Delhi, India.

Diwali (the festival of lights and crackers) is celebrated grandly, resulting in a significant drop in the city's air quality. To study the impact of the judicial prohibition in Delhi to improve air quality, a comprehensive and comparative analysis was conducted over two consecutive years, namely 2015-2016 (when no significant regulations on the sale or usage of firecrackers were imposed) and 2017-2018 (when radically different regulations were implemented). Data on PM10, PM2.5, NOx, and CO were analysed, and their trends and levels with various regulations in place were compared. In 2017, the concentrations of PM10, PM2.5, NOx, and CO were reduced by 50%, 50%, 71%, and 64%, respectively, compared to 2016. However, in 2018, there was an increase of 32% in PM10 and PM2.5 concentrations, as well as a 25% increase in CO concentrations, with the exception of NOx, which decreased to 25% on Diwali day. The data was also examined in conjunction with the entire timeline of the various court rulings and regulations imposed in Delhi. The questionnaire survey study revealed that, despite the legislation in place, ambient air quality continued to deteriorate, necessitating a deeper dive into the policy's structure and implementation to fine-tune its feasibility and applications. Air pollution-related health effects were recognized by 82% of participants. Despite this, only 13% of people were observed without a mask, and only 12% of people were aware of green crackers as of 2018. To combat this deteriorating situation, the national capital must enact radical and well-thought-out legislation and regulations governing firecrackers, as well as raise public awareness amongst its citizens.

Hypothyroidism Induced Hyponatremia: A Case Report.

Thyroid hormones have various effects on the body which include electrolyte and water hemostasis. It is also involved in renal development and physiology. Hyponatremia is a serious electrolyte imbalance that can be associated with the involvement of different body systems and a wide range of deleterious changes. We report a case of a 62-years-old female with the symptoms of severe hyponatremia like altered mental sensorium with a serum sodium level of 110 meq/l. After ruling out other causes, a final diagnosis of hypothyroidism was made. On treating hypothyroidism the symptoms of hyponatremia were resolved. Therefore, thyroid stimulating hormone determination is mandatory during the evaluation of hyponatremia. And, those patients should be treated with fluid restriction and treatment of hypothyroidism.

Status Dystonicus with Atypical Presentation in Developmentally Delay Child: A Case Report.

Status dystonicus is characterised by involuntary sustained or intermittent muscle contractions of muscles causing repetitive twisting movements, abnormal postures of the body, or both is a rare but life-threatening movement disorder. Early diagnosis and management of status dystonicus prevent serious complications. We report a 2 years old previously developmental delay diagnosed girl who presented with generalised contractions of the whole body. Tightening of limbs is aggravated by touching her backside which is a very unique feature. Dystonia is associated with severe sweating and was confused with a seizure event. The patient was treated with midazolam, clonidine, phenytoin, gabapentin, pyridoxine, baclofen, and trihexyphenidyl. She was admitted to the intensive care unit for monitoring. The patient partially recovered after 10 days of treatment. Keywords: aspiration; children; dystonia; epilepsy; pneumonia.

Case Report: Ovarian fibroma: typical presentation with Meigs's Syndrome.

Meigs's syndrome is characterized by a triad of ovarian fibroma, ascites, and pleural effusion which can be managed surgically. Pleural effusion and ascites are usually transudative. Ovarian fibroma is an uncommon tumor. We herein report a case of Meigs's syndrome in a 61-year-old woman who presented with complaints of abdominal pain for two-three months along with decreased appetite and constipation. On examination, there was decreased air entry in the right side of the chest, generalized abdominal distention, and a firm irregular mass was felt which was mobile and extending from upper border of symphysis pubis to just above the umbilicus on abdominal palpation. Chest X ray showed right sided pleural effusion, ultrasonogram (USG) abdominal and pelvis showed gross ascites, and a very large complex right ovarian cyst was confirmed by computed tomography (CT) scan. She underwent staging laparotomy with total abdominal hysterectomy, bilateral salpingo-oophorectomy and omental resection for biopsy. Biopsy showed right ovarian fibroma.