Empowering Little Fighters: Post-Cardiotomy Pediatric ECMO and the Journey to Recovery.

INTRODUCTION: Extra Corporeal Membrane Oxygenation (ECMO) has long been used for cardiorespiratory support in the immediate post-paediatric cardiac surgery period with a 2-3% success as per the ELSO registry. Success in recovery depends upon the optimal delivery of critical care to paediatric patients and a comprehensive healthcare team. METHODOLOGY: The survival benefit of children placed on central veno arterial (VA) ECMO following elective cardiac surgeries for congenital heart disease (n = 672) was studied in a cohort of 29 (4.3%) cases from the period of Jan 2018 to Dec 2022 in our cardiac surgical centre. Indications for placing these patients on central VA ECMO included inability to wean from cardiopulmonary bypass (CPB), low cardiac output syndrome, severe pulmonary arterial hypertension, significant bleeding, anaphylaxis, respiratory failure and severe pulmonary edema. RESULTS: The mean time to initiation of ECMO was less than 5 h and the mean duration of ECMO support was 56 h with a survival rate of 58.3%. Amongst perioperative complications, sepsis and arrhythmia on ECMO were found to be negatively associated with survival. Improvements in the pH, PaO2 levels and serum lactate levels after initiation of ECMO were associated with survival benefits. CONCLUSION: The early initiation of ECMO for paediatric cardiotomies could be a beacon of hope for families and medical teams confronting these challenging situations. Improvement in indicators of adequate perfusion and ventricular recoveries like pH and serum lactate and absence of arrhythmia and sepsis are associated with good outcomes.

A Cross-Sectional Survey to Assess the Preparedness of Healthcare Workers of Isolation Intensive Care Units for Anticipated Another Wave of the COVID-19 Pandemic in a Tertiary Care Center.

BACKGROUND: Our fight against coronavirus disease 2019 (COVID-19) has not ended yet. Another wave, possibly due to another variant, can put the healthcare system on its toes again. The outcome of the intensive care unit (ICU) depends on the teamwork of doctors, nursing staff, and care assistants (CAs). AIM: This survey was conducted to assess the level of preparedness of healthcare workers (HCWs) in isolation ICUs by recording and calculating the score of their responses, using a validated pre-formed questionnaire. METHODS: A cross-sectional survey was conducted on 200 HCWs in isolation ICUs by using a pre-validated questionnaire form as an assessment tool. HCWs in isolation ICUs included doctors, nurses, and CAs who have worked in ICUs dedicated to COVID-19 patients. The response was documented and scores as per the response were assessed by analog scale. RESULTS: Most of the HCWs were anxious (53%) and 96.5% were either bothered or scared. HCWs with adequate knowledge have higher generalized anxiety disorder scores (χ2 = 15.287, p = 0.015). Despite having adequate/average knowledge, most of the HCWs have insufficient knowledge of the correct steps of donning and doffing. CONCLUSION: HCWs were aware of the COVID-19 pandemic but were not prepared for the anticipated second wave.

Unveiling the contemporary progress of graphene-based nanomaterials with a particular focus on the removal of contaminants from water: a comprehensive review.

Water scarcity and pollution pose significant challenges to global environmental sustainability and public health. As these concerns intensify, the quest for innovative and efficient water treatment technologies becomes paramount. In recent years, graphene-based nanomaterials have emerged as frontrunners in this pursuit, showcasing exceptional properties that hold immense promise for addressing water contamination issues. Graphene, a single layer of carbon atoms arranged in a hexagonal lattice, exhibits extraordinary mechanical, electrical, and chemical properties. These inherent characteristics have led to a surge of interest in leveraging graphene derivatives, such as graphene oxide (GO), reduced graphene oxide and functionalized graphene, for water treatment applications. The ability of graphene-based nanomaterials to adsorb, catalyze, and photocatalyze contaminants makes them highly versatile in addressing diverse pollutants present in water sources. This review will delve into the synthesis methods employed for graphene-based nanomaterials and explore the structural modifications and functionalization strategies implemented to increase their pollutant removal performance in water treatment. By offering a critical analysis of existing literature and highlighting recent innovations, it will guide future research toward the rational design and optimization of graphene-based nanomaterials for water decontamination. The exploration of interdisciplinary approaches and cutting-edge technologies underscores the evolving landscape of graphene-based water treatment, fostering a path toward sustainable and scalable solutions. Overall, the authors believe that this review will serve as a valuable resource for researchers, engineers, and policymakers working toward sustainable and effective solutions for water purification.

DeepFreeze 3D-biofabrication for Bioengineering and Storage of Stem Cells in Thick and Large-Scale Human Tissue Analogs.

3D bioprinting holds great promise for meeting the increasing need for transplantable tissues and organs. However, slow printing, interlayer mixing, and the extended exposure of cells to non-physiological conditions in thick structures still hinder clinical applications. Here the DeepFreeze-3D (DF-3D) procedure and bioink for creating multilayered human-scale tissue mimetics is presented for the first time. The bioink is tailored to support stem cell viability, throughout the rapid freeform DF-3D biofabrication process. While the printer nozzle is warmed to room temperature, each layer solidifies at contact with the stage (-80 °C), or the subsequent layers, ensuring precise separation. After thawing, the encapsulated stem cells remain viable without interlayer mixing or delamination. The composed cell-laden constructs can be cryogenically stored and thawed when needed. Moreover, it is shown that under inductive conditions the stem cells differentiate into bone-like cells and grow for months after thawing, to form large tissue-mimetics in the scale of centimeters. This is important, as this approach allows the generation and storage of tissue mimetics in the size and thickness of human tissues. Therefore, DF-3D biofabrication opens new avenues for generating off-the-shelf human tissue analogs. It further holds the potential for regenerative treatments and for studying tissue pathologies caused by disease, tumor, or trauma.

Non-analgesic benefits of combined thoracic epidural analgesia with general anesthesia in on-pump pediatric cardiac surgery: A prospective observational study.

Background: The use of thoracic epidural analgesia in infants and children could attenuate the stress response and thereby improve the outcomes associated with cardiac surgery. Methods: This study is a prospective observational study conducted on 118 patients admitted for cardiac surgery. All patients received thoracic epidural analgesia. Laboratory investigations including inflammatory markers, markers for different organ functions, and intensive care unit parameters were collected at different time points (preoperative, immediate postoperative, on day 1, and day 2). Results: Inflammatory markers such as IL6, IL8, and metabolic response as measured by serum cortisol and blood sugar were significantly high in the immediate postoperative period, which later stabilized in the next 48 h. There was also a sharp increase in the anti-inflammatory marker IL-10 in an immediate postoperative period, which settled later on but continued to be higher than baseline in the next 48 h. All these markers showed lower values when compared to published literature. The baseline renal oxygen saturation using near infrared spectroscopy (NIRS) value in our study was 59.3 + 19, which increased to 76.4 + 12.7 on day 2. Serum neutrophil gelatinase associated lipocalin (NGAL) remained well below normal levels in the perioperative period. PF (pO2/FiO2) ratio and pO2 consistently improved postoperatively with the maximum on day 2. The median mechanical ventilation (MV) duration was 18 h, and the mean length of stay that included intensive care unit stay was 12 days. No epidural-related adverse events were noted. Conclusions: Apart from good analgesia, patients receiving thoracic epidural analgesia displayed a reduction in perioperative stress, superior postoperative glycemic control, reduction in inflammatory markers, postoperative acute kidney injury, and pulmonary complications.

Intracellular Iron Accumulation Induces Inflammatory and Oxidative Status of the Host After Japanese Encephalitis Viral Infection.

The factors mitigating the microglia/macrophage activation and inflammatory damage in Japanese encephalitis (JE) virus infected CNS are still being ascertained. We aim to characterize the changes in iron transporter and iron storage proteins along with inflammatory and oxidative stress-mediated signaling during the JE viral infection. Cortical tissue samples from mice with JE viral infection were processed for biochemical, histological, and molecular analysis. Iron storage protein, i.e., ferritin, was found significantly increased post-JE viral infection, and iron accumulation was noted in cortical tissue. Key proinflammatory associated markers, such as TNF-α, IL-6, and its regulator TLR4, were found to be increased, while SOCS1 (anti-inflammatory regulator) transcription decreased with increased levels of oxidative stress markers NOX2-mediated NF-ΚB/p65 and protein carbonyl. Furthermore, it is noted that hepcidin level increased and ferroportin level decreased, and iron transporter gene expression got imbalanced after JE viral infection. This observation was further confirmed by deferoxamine (DFO) treatment to JE viral infection mice model, where the decline in hepcidin transcription level and iron load in cortical tissue of JE viral infected animals was noted. However, no change was found in the ferroportin level compared to JE viral infected animals. Together, these findings suggest that iron overload and hepcidin-ferroportin regulation are involved in JE viral infection disease pathologies and associated with the inflammatory and oxidative status of the host during infection.

HIV cure: Are we going to make history?

BACKGROUND: At present, combination antiretroviral therapy (cART) is the mainstay for the treatment of people living with HIV/AIDS. cART can suppress the viral load to a minimal level; however, the possibility of the emergence of full-blown AIDS is always there. In the latter part of the first decade of the 21st century, an HIV-positive person received stem cell transplantation (SCT) for treatment of his haematological malignancy. The patient was able to achieve remission of the haematological condition as well as of HIV following SCT. Thorough investigations of various samples including blood and biopsy could not detect the virus in the person's body. The person was declared to be the first cured case of HIV. LITERATURE SEARCH: Over the next decade, a few more similar cases were observed and have recently been declared cured of the infection. A comprehensive search was performed in PubMed, Cochrane library and Google Scholar. Four such additional cases were found in literature. DESCRIPTION & DISCUSSION: These cases all share a common proposed mechanism for the HIV cure, that is, transplantation of stem cells from donors carrying a homozygous mutation in a gene encoding for CCR5 (receptor utilized by HIV for entry into the host cell), denoted as CCR5△32. This mutation makes the host immune cells devoid of CCR5, causing the host to acquire resistance against HIV. To the best of our knowledge, this is the first review to look at relevant and updated information of all cured cases of HIV as well as the related landmarks in history and discusses the underlying mechanism(s).

Excess Mortality Risk Due to Heat Stress in Different Climatic Zones of India.

India is at a high risk of heat stress-induced health impacts and economic losses owing to its tropical climate, high population density, and inadequate adaptive planning. The health impacts of heat stress across climate zones in India have not been adequately explored. Here, we examine and report the vulnerability to heat stress in India using 42 years (1979-2020) of meteorological data from ERA-5 and developed climate-zone-specific percentile-based human comfort class thresholds. We found that the heat stress is usually 1-4 °C higher on heatwave (HW) days than on nonheatwave (NHW) days. However, the stress on NHW days remains considerable and cannot be neglected. We then showed the association of a newly formulated India heat index (IHI) with daily all-cause mortality in three cities - Delhi (semiarid), Varanasi (humid subtropical), and Chennai (tropical wet and dry), using a semiparametric quasi-Poisson regression model, adjusted for nonlinear confounding effects of time and PM2.5. The all-cause mortality risk was enhanced by 8.1% (95% confidence interval, CI: 6.0-10.3), 5.9% (4.6-7.2), and 8.0% (1.7-14.2) during "sweltering" days in Varanasi, Delhi, and Chennai, respectively, relative to "comfortable" days. Across four age groups, the impact was more severe in Varanasi (ranging from a 3.2 to 7.5% increase in mortality risk for a unit rise in IHI) than in Delhi (2.6-4.2% higher risk) and Chennai (0.9-5.7% higher risk). We observed a 3-6 days lag effect of heat stress on mortality in these cities. Our results reveal heterogeneity in heat stress impact across diverse climate zones in India and call for developing an early warning system keeping in mind these regional variations.

Identification of Playa Lakes and tracking their evolution pathways using geochemical models in the Great Indian Thar desert.

Playa Lakes of the great Indian Thar desert are unique and intricate systems with pronounced scientific and ecological significance. In this study, the combined use of geospatial and field data assisted in depicting and understanding the changes within these natural systems. The purpose of this study is to provide a comprehensive dataset of Playa Lakes, which can help with an overall understanding of playas from a geochemical, ecological, and economic perspective. The 1163 surface depressions were accounted for as possible playas considering the threshold area of >5 km2. A total of 42 representative surface water samples were collected from the selected playas (Sambhar, Didwana, Pachpadra, and Pokhran) and hydrochemical analysis was carried out to identify the geochemical evolution of these playas. The major water types were Na-Cl and Na-Cl-SO4 type. Hardie and Eugster's model was used to explain the possible sequence of evolutionary pathways and brine shifts in the selected playas. Simulated evaporation modeling suggests precipitation of major evaporites (chlorides, carbonates, and sulphates) during progressive evaporation. Surface sediment analysis (X-ray diffraction) confirmed the presence of calcite, halite, and dolomite minerals in the playa sediments. The greatest economic value of these playas may be mineral production and providing food and habitat for migratory birds, though conservation and policy intervention is required for their sustainable utilization.

Redox and detox: Malate shuttle metabolism keeps exhausted T cells fit.

The malate shuttle is known to maintain the balance of NAD+/NADH between the cytosol and mitochondria. However, in Tex cells, it primarily detoxifies ammonia (via GOT1-mediated production of 2-KG in an atypical reaction) and provides longevity to chronic-infection-induced Tex cells against ammonia-induced cell death.

Genetic diversity of Potato virus M (PVM) in the major potato growing region in the Indo-Gangetic plain and characterization of a distinct strain of PVM occurring in India.

Potato virus M (PVM) is one of the most prevalent viruses infecting potatoes worldwide, showing a wide range of diversity in their populations; however, the diversity and genome information of PVM occurring in India is hardly known. The present study serologically detected the PVM in 22.8% of leaf samples collected from the potato fields, generated 13 coat protein (CP) genes and one complete genome sequence for the isolates from India, and identified four differential hosts confirming PVM-Del-144 as a distinct strain of PVM occurring in India. The phylogenetic analyses conducted based on the CP gene sequences (14 from India and 176 from other countries) suggested the existence of three evolutionary divergent lineages (PVM-o, PVM-d, and a new divergent group) in the PVM population, where isolates from India belong to only two clusters (PVM-o and PVM-d) within four sub-clusters. High levels of nucleotide diversity (0.124) and genetic distance (0.142) recorded among the isolates from India may be due to the deviation from the neutral evolution and experiencing population expansion in the past. The complete genome of the isolate Del-144 (KJ194171; 8,526 nucleotides) shared 92.2-93.9% nt sequence identity with the population of PVM-o, whereas it shared only 70.2-72.1% identity with PVM-d. In the phylogenetic analyses, Del-144 clustered with the isolates of PVM-o; however, it formed a separate branch away from all other isolates, indicating the diversity of the strain. Overall, this study revealed the diversity of the isolates of PVM from India and reported the first complete genome sequence of a distinct strain of PVM occurring in India.

Secondary metabolite induced tolerance to Fusarium oxysporum f.sp. cubense TR4 in banana cv. Grand Naine through in vitro bio-immunization: a prospective research translation from induction to field tolerance.

An innovative tissue culture mediated incorporation of metabolite-based biomolecule (Bio-immune) at in vitro stage itself in banana cv. Grand Naine was developed and validated for the production of Fusarium oxysporum f.sp. cubense TR4 tolerant plantlets. The novel bio-immune formulation developed by us, exhibited a significant antifungal potency against Foc TR4 with a high percent inhibition (100%) at a 2.5% concentration of bio-immune on the 5th, 7th, and 9th DAI. Bio-immune integrated during in vitro shoot proliferation stage in banana cv. Grand Naine recorded significant enhancement in the growth of roots and shoots. Bio-immune (0.5%) fortified media produced 12.67 shoots per clump whereas control registered only 9.67 shoots per clump. Similarly, maximum root numbers (7.67) were observed in bio-immune plants which were significantly higher over control (5.0). The bio-immunized banana transplants recorded a higher survival rate (97.57%) during acclimatization as compared to the control (94.53%). Furthermore, evaluation of the bio-immunized plants in pot experiments revealed that unimmunized plants treated with FocTR4 (TF) exhibited mortality between 60 and 90 days. On the 90th day after planting, a high mean disease severity index (DSI) of 3.45 was observed with unimmunized plantlets while the bio-immunized plants (TFBI) and ICAR-FUSICONT treated plants (TFTR) showed substantially reduced DSI (0.20 and 1.00) compared to FocTR4 treated control (TF). Significant increases in polyphenol oxidase (PPO), peroxidase (POD), ß-1,3-glucanase, phenylalanine ammonia-lyase (PAL), chitinase activities, and enhanced phenol contents were recorded in bio-immunized plants compared to unimmunized plants. Field experiments at two different locations in Bihar, India revealed that bunch weight, no. of hands/bunch, and no. of fingers/hand of bio-immune treated plants were significantly higher compared to the control.

Increased IL-6 Levels and the Upregulation of Iron Regulatory Biomarkers Contribute to the Progression of Japanese Encephalitis Virus Infection's Pathogenesis.

Integrated analysis of iron regulatory biomarkers and inflammatory response could be an important strategy for Japanese encephalitis viral (JEV) infection disease management. In the present study, the inflammatory response was assessed by measuring serum Interleukin-6 (IL-6) levels using ELISA, and the transcription levels of iron homeostasis regulators were analyzed via RT-PCR. Furthermore, inter-individual variation in the transferrin gene was analyzed by PCR-RFLP and their association with clinical symptoms, susceptibility, severity, and outcomes was assessed through binary logistic regression and classification and regression tree (CART) analysis. Our findings revealed elevated levels of IL-6 in serum as well as increased expression of hepcidin (HAMP), transferrin (TF), and transferrin receptor-1 (TFR1) mRNA in JEV infection cases. Moreover, we found a genetic variation in TF (rs4481157) associated with clinical symptoms of meningoencephalitis. CART analysis indicates that individuals with the wild-type TF genotype are more susceptible to moderate JEV infection, while those with the homozygous type are in the high-risk group to develop a severe JEV condition. In summary, the study highlights that JEV infection induces alteration in both IL-6 levels and iron regulatory processes, which play pivotal roles in the development of JEV disease pathologies.

Addressing Biases in Ambient PM2.5 Exposure and Associated Health Burden Estimates by Filling Satellite AOD Retrieval Gaps over India.

Ambient PM2.5 exposure statistics in countries with limited ground monitors are derived from satellite aerosol optical depth (AOD) products that have spatial gaps. Here, we quantified the biases in PM2.5 exposure and associated health burden in India due to the sampling gaps in AOD retrieved by a Moderate Resolution Imaging Spectroradiometer. We filled the sampling gaps and derived PM2.5 in recent years (2017-2022) over India, which showed fivefold cross-validation R2 of 0.92 and root mean square error (RMSE) of 11.8 µg m-3 on an annual scale against ground-based measurements. If the missing AOD values are not accounted for, the exposure would be overestimated by 19.1%, translating to an overestimation in the mortality burden by 93,986 (95% confidence interval: 78,638-110,597) during these years. With the gap-filled data, we found that the rising ambient PM2.5 trend in India has started showing a sign of stabilization in recent years. However, a reduction in population-weighted exposure balanced out the effect of the increasing population and maintained the mortality burden attributable to ambient PM2.5 for 2022 (991,058:798,220-1,183,896) comparable to the 2017 level (1,014,766:812,186-1,217,346). Therefore, a decline in exposure alone is not sufficient to significantly reduce the health burden attributable to ambient PM2.5 in India.

An overview of contemporary developments and the application of graphene-based materials in anticorrosive coatings.

Although graphene and graphene-based materials (GBMs) offer a wide range of possible applications, interest in their use as barrier layers or as reinforcements in coatings for the mitigation of corrosion has grown during the past decade. Because of its unique two-dimensional nanostructure and exceptional physicochemical characteristics, graphene has gotten a lot of attention as an anti-corrosion material. This enthusiasm is largely driven by the requirement to integrate more features, improve anti-corrosion effectiveness, and eventually prolong the service duration of metallic components. As barriers against metal corrosion, graphene nanosheets can be applied singly or in combination to create thin films, layered frameworks, or composites. Concurrently, over the past few years, significant advancements have been made in the establishment of scalable production methods for graphene and materials based on graphene. Since there is currently a wide variety of graphene material with various morphologies and characteristics, it is even more important that the production approach and the intended application be properly matched. This review gathers the most recent data and aims to give the reader a comprehensive overview of the most recent developments in the use of graphene and GBMs in various anti-corrosion strategies. The structure-property correlation and anticorrosion techniques in these systems are given special consideration. The current article offers a critical examination of this topic as well, stressing the areas that require more research.

India's photovoltaic potential amidst air pollution and land constraints.

India aims for ambitious solar energy goal to fulfill its climate commitment but there are limited studies on solar resource assessment considering both environmental and land availability constraints. The present work attempts to address this issue using satellite-derived air pollution, radiation, and land use data over the Indian region. Surface insolation over India has been decreasing at a rate of -0.29 ± 0.19 Wm-2 y-1 between 2001 and 2018. Solar resources over nearly 98%, 40%, and 39% of the Indian landmass are significantly impacted by aerosols, clouds, and both aerosols and clouds respectively. Only 29.3% of the Indian landmass is presently suitable for effective solar photovoltaic harnessing, but this is further declining by -0.21% annually, causing a presumptive loss of 50 GW solar potential, translating 75 TWh power generation. Lowering two decades of aerosol burden can make 8% additional landmass apt for photovoltaic use. Alleviating aerosol-induced dimming can fast-track India's solar energy expansion.

Prevalence and Determinants of Long COVID Among Patients Attending the Outpatient Department of a Subdistrict Hospital in Haryana.

INTRODUCTION: Growing evidence indicates that individuals recovering from COVID-19 may experience prolonged health consequences, resulting in notable morbidity even after the acute phase. Limited published literature exists concerning sequelae of COVID-19 among the Indian population. Therefore, we conducted this study at a subdistrict hospital (secondary level) in Haryana, aiming to estimate the prevalence of long COVID and its determinants. METHODS: This hospital-based study focused on outpatients who had a confirmed history of COVID-19, with a minimum of 28 days elapsed since the positive COVID-19 diagnostic test date. We administered a semi-structured questionnaire to gather sociodemographic information, a standardized symptom assessment checklist to identify long COVID symptoms, and the Patient Health Questionnaire (PHQ-9) to evaluate and grade depression severity. Additionally, we conducted pulmonary function tests, chest X-rays, complete blood counts, and kidney and liver function tests to assess the determinants of long COVID. STATA version 14 software (StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP) was used for data analysis, and the bivariate and multivariate analyses (p-value <0.2 in bivariate analysis) were conducted to determine factors associated with long COVID. RESULTS: A total of 212 participants (male 53%) were recruited in this study. Among the long COVID symptoms, fatigue, body pain, cough, joint pain, and breathlessness were the most frequently reported symptoms among the study participants. The prevalence of long COVID was found to be 37.3% (95%CI: 30.7-43.8%). In the multivariate model, depression (PHQ-9 scores) AOR-1.21 (95%CI:1.07-1.35) and severity of COVID-19 adjusted odds ratio (AOR)-2.22 (95%CI:1.05-4.69) came out to be statistically significant with long COVID. CONCLUSION: Findings show alarming rates of long COVID symptoms persisting in nearly 37% of COVID-19-recovered individuals. Establishing tailored guidelines is crucial to mitigate burdens and complications and enhance the quality of life for those affected.

Severe Cutaneous Adverse Reaction to Piperacillin-Tazobactam: A Case of Stevens-Johnson Syndrome.

Stevens-Johnson syndrome (SJS) is a rare condition characterized by an exaggerated immune system response to triggers such as infections or drugs. It is characterized by blistering and exfoliation of the skin and affects mucosal surfaces, including the eyes, buccal cavity, and genitals. We report a case of a 50-year-old male who developed symptoms of SJS following a recent hospital admission for acute appendicitis The patient presented with fever, erythematous patches on the palms, abdomen, groins, and oral mucosa. The onset of symptoms occurred approximately four days after discharge from the hospital, where the patient had received treatment including intravenous antibiotics (Piperacillin-Tazobactam), ranitidine, tramadol, and intravenous fluids. He was diagnosed with SJS based on clinical and histopathological findings and was treated with supportive care and corticosteroids. He recovered after one week of hospitalization. This case highlights the importance of recognizing the potential risk of developing SJS following drug administration and the need for prompt identification and management of the condition to prevent complications and improve patient outcomes.

Evaluation of Position of Mental Foramen in Dentulous Population by Digital Panoramic Radiography.

Need for the Study: The mental branch of the trigeminal nerve, which supplies sensation to the lower lip, originates in the mandibular canal, making it an essential anatomical structure for dentists and oral surgeons to access. It is not well known that there is a spectrum of normal that includes variants in which there may be more than one nerve entry site, which means that if the mental foramen is not protected, normal feeling in the lower lip may be lost permanently. The diagnostic value of global radiographic landmarks like the mandibular trench and the dental foramen in identifying skeletal problems has been investigated. Materials and Methods: Four hundred patients over 40 who fit the inclusion/exclusion criteria were chosen. Patients were recruited from Vananchal Dental College and Hospital, Garhwa's Out Patient section for Oral Medicine, Diagnosis, and Radiology. The following patients with their consent are subjected for digital orthopantomography (Cephalometric Device for Rotograph EVOD Ref 930790001, SN 14112930, Villa Sistem Medical) and the captured images are then interpreted for the variations in mandibular canal. Result: The results of our study are as follows: In this study, the mean age of the subjects was 47.27 years, with a range of 40-75 yearsMajority of cases were females (53.75%) and 46.25% were males.The top of the residual ridge, located between the mental foramen and the mandibular canal, is clearly visible to all observers (grade I).Only 1.75% of the people surveyed had a bifid canal, despite the fact that the majority of the people surveyed had a single mandibular canal on both sides (98.25%).Right side mean was 18,682.017, whereas left side mean was 16,331.851; nevertheless, this difference was not statistically significant (P = 0.0860 NS). Conclusion: The dental foramen was located close to where the mandible and the area housing the next premolar met. These findings may be utilized to improve the safety of peri-apical surgical procedures. Therefore, it is therapeutically relevant to get insight into the structural alterations of the mental foramen and locate its location in preoperative radiological scans.