Comparative outcome of single versus two double-pigtail stents for endoscopic drainage of pancreatic fluid collections with minimal necrosis: a retrospective analysis.

Background: Endoscopic ultrasound (EUS)-guided cystogastrostomy is the treatment of choice for managing symptomatic pancreatic fluid collections (PFC). However, studies on the number of stents for optimal drainage of PFCs are limited. Hence, the present study was conducted to compare the outcome of single versus two double-pigtail stents for endoscopic drainage of PFCs. Methods: This is a single-center, retrospective analysis of patients undergoing endoscopic drainage of PFCs with minimal necrosis (pseudocyst or walled-off necrosis with <30% solid content) at a tertiary center in South India from October 2020 to October 2022. Post-procedure, patients were followed up for clinical improvement, and stents were removed after documentation of cyst size reduction on imaging. Results: Sixty-three patients (82.5% males, median age: 34 years) fulfilling the selection criteria were included. For single stent placement (n = 47), stents of size 8.5 Fr or 10 Fr were used, while for placement of two stents (n = 16), 7 Fr stents were used. The technical success rate was 100%. Intraprocedural and early postprocedural adverse events (all mild to moderate) were comparable between the groups (17.0% with single stent vs. 25.0% with two stents, p = NS). Clinical success was achieved in 93.6% of patients, with no difference between both groups. Three patients in the single stent group required additional procedures. All patients underwent successful stent removal after a median follow-up of 14 weeks. Conclusion: A single pigtail stent of 8.5 Fr or 10 Fr size for EUSguided cystogastrostomy provides efficacy and safety similar to that of two stents.

Evaluation of wound healing property of Caesalpinia mimosoides Lam.

ETHNOPHARMACOLOGICAL RELEVANCE: Caesalpinia mimosoides Lam. is one of the important traditional folk medicinal plants in the treatment of skin diseases and wounds used by healers of Uttara Kannada district of Karnataka state (India). However scientific validation of documented traditional knowledge related to medicinal plants is an important path in current scenario to fulfill the increasing demand of herbal medicine. AIM OF THE STUDY: The study was carried out to evaluate the claimed uses of Caesalpinia mimosoides using antimicrobial, wound healing and antioxidant activities followed by detection of possible active bio-constituents. MATERIALS AND METHODS: Extracts prepared by hot percolation method were subjected to preliminary phytochemical analysis followed by antimicrobial activity using MIC assay. In vivo wound healing activity was evaluated by circular excision and linear incision wound models. The extract with significant antimicrobial and wound healing activity was investigated for antioxidant capacity using DPPH, nitric oxide, antilipid peroxidation and total antioxidant activity methods. Total phenolic and flavonoid contents were also determined by Folin-Ciocalteu, Swain and Hillis methods. Possible bio-active constituents were identified by GC-MS technique. RP-UFLC-DAD analysis was carried out to quantify ethyl gallate and gallic acid in the plant extract. RESULTS: Preliminary phytochemical analysis showed positive results for ethanol and aqueous extracts for all the chemical constituents. The ethanol extract proved potent antimicrobial activity against both bacterial and fungal skin pathogens compared to other extracts. The efficacy of topical application of potent ethanol extract and traditionally used aqueous extracts was evidenced by the complete re-epithelization of the epidermal layer with increased percentage of wound contraction in a shorter period. However, aqueous extract failed to perform a consistent effect in the histopathological assessment. Ethanol extract showed effective scavenging activity against DPPH and nitric oxide free radicals with an expressive amount of phenolic and moderate concentration of flavonoid contents. Ethyl gallate and gallic acid were found to be the probable bio-active compounds evidenced by GCMS and RP-UFLC-DAD analysis. CONCLUSION: The study revealed the significant antimicrobial, wound healing and antioxidant activities of tender parts of C. mimosoides and proved the traditional folklore knowledge.

Medico Legal Awareness:Where are we? – A Survey among Health Professionals in Maharashtra and Haryana

Medicine is a noble profession but there is also growing anxiety both within the medical profession and in the community regarding increasing trends of complaints and lawsuits against doctors. Knowledge about medical ethics is as fundamental to the practice of medicine as clinical skills. To assess the knowledge of health care professionals regarding medico-legal issues. The questionnaire study consisted of questions pertaining to basic knowledge of COPRA (Consumer Protection Act 1984), informed consent and Medico-legal courses. A total of 325 health care professionals enrolled for the study. Most of the health care professionals were able to answer questions about informed consent. Almost 80% of health professionals were aware about informed consent, 41.84% of health professionals were not aware about consumer protection act 92%of health professionals don’t know about the courses regarding Medico-legal issues. The participants were knowledgeable about medical ethics and informed consent but when it came to Consumer Protection act, professional indemnity claim and medico- legal courses their information was basic, they lacked knowledge about finer details hence showed an immediate need to update the understanding of these issues to be on legally safer side.​

Ethnomedicinal plants to cure skin diseases-an account of the traditional knowledge in the coastal parts of Central Western Ghats, Karnataka, India.

ETHNOPHARMACOLOGICAL RELEVANCE: Documentation of ethnomedicinal knowledge pertaining to the treatment of different types of skin diseases from the Central Western Ghats of India, a rich habitat of different ethnic communities. MATERIALS AND METHODS: Frequent field surveys were carried out to invent the 'key informants' in the treatment of skin diseases in the study area. The information was collected through semi-structured open ended interviews with questionnaire in their local Kannada language. All medicinal plants recorded for the treatment of skin diseases were photographed in the field; voucher specimens were made subsequently and are deposited in the Herbarium, P.G. Department of Botany, Karnatak University, Dharwad. The information such as botanical name, status, family, vernacular name, habit and habitat, analysis like percentage of parts used, percentage of drug preparations, use value (UV), informants consensus factor (ICF), fidelity level (FL) and correlation between UV and use mention (Np) of the plants are provided. RESULTS: In all, 48 informants were interviewed. Amongst which 38 were the 'key informants' who gave the information exclusively about the treatment of skin diseases. Among 102 plant species collected, seven species are endemic to India and eleven species have their nativity outside India. Twelve species could be considered as new claims for skin diseases as their use has not been mentioned in Ayurveda or any other research articles surveyed. Of all the drug formulations, paste is the most preferred method (50%) followed by oil extraction (18.89%), juice (14.44%), ash (4.44%) etc. The highest UV is for Pongamia pinnata, Naregamia alata, Randia dumetorum and Girardinia diversifolia (1.50 each). The treatment for different types of skin diseases by the herbal healers are classified into 13 categories, out of which ringworm scored the highest ICF value. Similarly, the 100% FL value scored was in the order of 10 plants for boils, 4 plants for different types of sore, 2 plants for ringworm, intertrigo, eczema and pruritus respectively. As Caesalpinia mimosoides and Basella alba in the treatment of boils, Hygrophila schulli for inter trigo, Cissus discolor for ringworm, Mammea suriga for eczema scored high FL and high Np value, they can be considered as important species. CONCLUSIONS: The documentation and data analysis of the ethnomedicinal knowledge in the coastal regions of Uttara Kannada district of Central Western Ghats have provided the information about important plants in the treatment of different types of skin diseases. Further scientific analysis of such plants may provide novel compounds for the treatment of skin diseases.

A new technique to determine vertical dimension of occlusion from anthropometric measurements of fingers.

PURPOSE: The purpose of this study was to find the correlation between vertical dimension of occlusion (VDO) and length of fingers. MATERIALS AND METHODS: A cross-sectional study was conducted on 400 dentate subjects comprising of 200 males and 200 females. Anthropometric measurements of VDO, length of index finger, length of little finger, and distance from tip of thumb to tip of index finger of right hand were recorded clinically using modified digital vernier caliper. Correlation between VDO and length of fingers was studied using Spearman's coefficient. For the execution of regression command and preparation of prediction equations to estimate VDO, Statistical Package for Social Sciences Software Version 11.5 was used. RESULTS: VDO was significantly and positively correlated with all the parameters studied. In males, correlation of VDO was strongest for length of index finger (r-0.406) whereas in females, it was strongest for length of little finger (r-0.385). VDO estimation using regression equation had a standard error of ± 3.76 in males and ± 2.86 in females for length of index finger, ±3.81 and ± 2.74 in males and females respectively for length of little finger, ±3.99 and ± 2.89 in males and females respectively for distance from tip of thumb to tip of index finger. CONCLUSIONS: Since the variations between VDO and finger lengths are within the range of 2-4 mm, VDO prediction through this method is reliable, and reproducible. Also the method is simple, economic, and non-invasive; hence, it could be recommended for everyday practice.

Biometric ratio in estimating widths of maxillary anterior teeth derived after correlating anthropometric measurements with dental measurements.

OBJECTIVE: To correlate dental measurements i.e. combined mesiodistal width of six maxillary anterior teeth with facial measurements i.e. inner canthal distance, interpupillary distance and intercommissural width and acquire a biometric ratio to serve as a preliminary guide in selection of the maxillary anterior teeth. BACKGROUND: In the absence of pre-extraction records, the resultant denture can lead to patient dissatisfaction towards the aesthetic appeal of their dentures. The maxillary anterior teeth play a pivotal role in denture aesthetics. Various techniques and biometric ratios have been described in literature for selection of the maxillary anteriors. This study derives a biometric ratio for the same, obtained after correlating anthropometric measurements with dental measurements. MATERIALS AND METHODS: Two standardized digital photographs of the face were generated; one, when the facial muscles were relaxed and the other, when the subject was smiling; thereby, revealing the maxillary anterior teeth upto the canine tip. Inner canthal distance, interpupillary distance, intercommissural distance, distance between the tips of the maxillary canines and distance between the distal surfaces of the canines were measured. On the cast, the distance between tips of maxillary canines and distance between distal surfaces of maxillary canines were noted. The data was analysed using Spearman's rank correlation coefficient. RESULTS: A high correlation was found between the intercommissural measurement with distance between the tips of the canines on the photograph and between the tips of the canines on the cast with the interpupillary distance, giving a biometric ratio of 1:1.35 and 1:1.41 respectively. The least correlation was between the inner canthal distance and the tips of the canines measured on the photograph. CONCLUSIONS: Extra oral anthropometric measurements of the interpupillary distances and the intercommissural distances with the help of standardised photographs can help us determine the combined widths of the anterior teeth accurately, thus aiding their selection in the absence of pre-extraction records.

Two-step impression for atrophic mandibular ridge.

BACKGROUND: The clinical difficulties encountered while treating edentulous patients with atrophic mandibular ridges are legion. Capturing tissue details while making an impression of a resorbed mandibular ridge poses a great clinical challenge. Extending the denture bases adequately to cover all of the available supporting tissues is one of the prime requisite. Surgical approach is necessary only when the patient is incapable of wearing a conventional denture. This article describes a technique of making an impression of an atrophic mandibular ridge by the use of monophase and light-bodied impression material where surgical options such as implants, vestibuloplasty or ridge augmentation may not be feasible. This procedure results in improved stability and retention of the denture base.

Efficacy of various spray disinfectants on irreversible hydrocolloid impression materials: an in vitro study.

BACKGROUND: Most of the materials (casts, impressions, etc.) that are sent to the dental laboratories show the presence of numerous pathogenic microorganisms. All the spray disinfectants are not equally effective against these microorganisms. AIMS AND OBJECTIVES: The aim was to compare the effectiveness of different spray disinfectants on irreversible hydrocolloid impressions and to find out the most effective dilution, contact time, and effect against each microorganism studied. MATERIALS AND METHODS: The effects of four spray disinfectants, 5.25% sodium hypochlorite, 0.525% sodium hypochlorite, 1:213 (1 part in 213 parts of water) povidone iodine, and 2% glutaraldehyde along with control (distilled water) on irreversible hydrocolloid impressions contaminated with Staphylococcus aureus, Bacillus subtilis and Streptococcus viridans were studied. RESULTS: Sodium hypochlorite, 5.25%, showed 1-min exposure time which was able to effect a 4 log 10 reduction in bacterial counts against S. aureus and S. viridans followed by 0.525% sodium hypochlorite and 2% glutaraldehyde for 10 min. None were able to effect a 4 log10 reduction against B. subtilis. CONCLUSION: Sodium hypochlorite with a concentration of 5.25% was the most effective disinfectant and required the shortest contact time (1 min). Not all ADA-approved concentrations of surface disinfectants work equally well on irreversible hydrocolloid impression materials.

Comprehensive prosthetic rehabilitation of a patient with partial finger amputations using silicone biomaterial: A technical note.

Finger and partial finger amputations are some of the most frequently encountered forms of partial hand loss. A high quality aesthetic prosthesis with passive function can be helpful to the patient since loss or congenital absence or malformation have both a social and psychological impact on the patient. Prosthetics is an art and science which provides a lifelike appearance to the lost structures of the patient. This case report presents the fabrication of a silicone finger prosthesis which had good suspension, adequate function, was comfortable to use and aesthetically acceptable to the patient.

Micropropagation of Dendrobium nobile from shoot tip sections.

Successful shoot regeneration of Dendrobium nobile was achieved using thin shoot tip sections and triacontanol (TRIA) for the first time. Protocorm-like bodies (PLBs) or proliferating shoot buds were observed when thin shoot tip sections were cultured on the basal medium of Mitra et at. (Indian J. Exp. Biol. 14 (1976) 350) supplemented with 4.0 microg L(-1) TRIA. The highest percentage of explants (93%) produced PLBs or proliferating shoot buds (21) at 4.0 microg L(-1) TRIA-supplemented basal medium. All the newly formed PLBs or proliferating shoot buds survived and ultimately produced healthy shoots with 2-3 leaves. Shoots produced roots when cultured on basal medium supplemented with 2.0 microg L(-1) TRIA. The well-rooted shoots were transferred to pots containing charcoal chips, coconut husk and broken tiles (2:2:1), and a 92% survival rate was achieved. This work reveals that TRIA can be used as an effective growth regulator in the micropropagation and conservation of D. nobile.

Skull base osteomyelitis secondary to malignant otitis externa.

PURPOSE OF REVIEW: Skull base osteomyelitis secondary to malignant otitis externa was first described in 1959. Since then, advances have been made in the diagnosis, treatment, and clinical outcomes of this condition. RECENT FINDINGS: This review discusses the pathophysiology and microbiology of malignant otitis externa. The review highlights the sometimes subtle presenting symptoms and recent advances in imaging and their practical application to diagnosing and monitoring the disease. Therapy for malignant otitis externa has changed since this entity was first described; this article reviews the medical, surgical, and adjuvant therapies and the relevant controversies. SUMMARY: The review discusses the history, pathogenesis, diagnosis, and treatment of skull base osteomyelitis in the context of malignant otitis externa with particular emphasis on HIV, children, and other immunodeficient states.

Flexural strength of heat-polymerized polymethyl methacrylate denture resin reinforced with glass, aramid, or nylon fibers.

STATEMENT OF PROBLEM: Despite the favorable properties of conventional PMMA used as a denture base material, its fracture resistance could be improved. PURPOSE: This in vitro study was performed to determine whether the flexural strength of a commercially available, heat-polymerized acrylic denture base material could be improved through reinforcement with 3 types of fibers. MATERIAL AND METHODS: Ten specimens of similar dimensions were prepared for each of the 4 experimental groups: conventional acrylic resin and the same resin reinforced with glass, aramid, or nylon fibers. Flexural strength was evaluated with a 3-point bending test. The results were analyzed with a 1-way analysis of variance. RESULTS: All reinforced specimens showed better flexural strength than the conventional acrylic resin. Specimens reinforced with glass fibers showed the highest flexural strength, followed by aramid and nylon. CONCLUSION: Within the limitations of this study, the flexural strength of heat-polymerized PMMA denture resin was improved after reinforcement with glass or aramid fibers. It may be possible to apply these results to distal extension partial denture bases and provisional fixed partial dentures.

Validated HPLC method for determination of PAT-5A, an insulin sensitizing agent, in rat plasma.

A high performance liquid chromatographic method for the determination of PAT-5A (a potent insulin sensitizer) using DRF-2095 (a thiazolidinedione) as internal standard (I.S.) is described. A 1:1 v/v ethylacetate and dichloromethane solvent mixture was used for extraction of PAT-5A from plasma. A Kromasil KR100-5C18-250A, 5 microm, 4.6 x 250 mm SS column was used for the analysis. Mobile phase consisting of sodium dihydrogen phosphate (pH 4.0, 0.05 M) and methanol mixture (25:75, v/v) was used at a flow rate of 1.0 ml/min. The eluate was monitored using a UV detector set at 345 nm. Ratio of peak area of analyte to I.S. was used for quantification of plasma samples. Using this method the absolute recovery of PAT-5A from rat plasma was > 90% and the limit of quantification was 0.05 microg/ml. The intra-day relative standard deviation (RSD) ranged from 2.19 to 4.98% at 1.0 microg/ml, 1.05 to 3.68% at 10.0 microg/ml and 3.14 to 5.08% at 50 microg/ml. The inter-day RSD were 1.6, 2.24 and 1.54% at 1, 10 and 50 microg/ml, respectively. The method was applied to measure the plasma concentrations of PAT-5A in pharmacokinetic and bioavailability studies in male Wistar rats.

Characterization of leprosy based on the nasal lipid profile.

While extracting the M. leprae from the nasal flushings of leprosy patients it was found that these organisms were trapped in the waxy layer, between the aqueous and the chloroform layers. Thin layer chromotography (TLC) analysis of this layer, using chloroform-methanol-water system, revealed different spots when sprayed with acid alcohol and heated at 160 degrees C. The TLC profile of lipids of lepromatous and borderline (MB according to the WHO terminology) leprosy patients was distinctly different from that of tuberculoid leprosy patients and normal human volunteers. A simple, economical and fast procedure to characterize patients belonging to different spectra has been developed.