Periprocedural Bridging Therapy in Patients With Mechanical Heart Valves

Mechanical heart valves (MHVs) are thrombogenic and require lifelong anticoagulation with vitamin K antagonists (VKAs) such as warfarin. Periprocedural bridging with unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) aims to reduce the risk of thromboembolic events in patients. Currently, there are no definitive class I recommendations for anticoagulation management in patients with MHVs. In this report, we present the case of a 77-year-old female who was perioperatively bridged with enoxaparin and subsequently developed an acute thrombus.

A Case of Entamoeba histolytica Liver Abscess in an Immigrant Patient

Entamoeba histolytica is a pathogenic protozoan endemic to Asia, Africa, and Central and South America. However, with increased travel and emigration, it is becoming a common parasitic infection leading to many worldwide deaths. We present a case of a young Hispanic male immigrant with an amebic liver abscess. This case report highlights the complexities of diagnosing and treating E. histolytica infection.

Unremitting Asthma as a Presentation of Pulmonary Nocardiosis: A Case Report

Severe, refractory asthma requires a combination of multiple maintenance inhalers and medications including high-dose inhaled corticosteroids and immunomodulators to achieve control of symptoms. The use of inhaled corticosteroids, however, increases the susceptibility of opportunistic bacterial infections, such as Nocardia, resulting in pulmonary nocardiosis. This case describes a 46-year-old patient with a history of severe, refractory asthma who presented with progressively worsening asthma exacerbation symptoms. She was treated with immunomodulators, high-dose inhaled corticosteroids and oral steroids, and several courses of antibiotics. CT imaging revealed bibasilar peri-bronchial thickening and tree-in-bud nodularity in the right lower lobe. Pulmonary cultures collected from bronchoscopy grew Nocardia nova complex. This was a rare case of persistent asthma exacerbation by N. nova complex bronchopulmonary infection. Broad differentials should be considered in patients with severe, refractory asthma who were previously controlled and were found to fail treatment therapies. Immunocompromised patients with chronic lung disease are at higher risk of severe infection with disseminated nocardiosis. These patients have a higher mortality and morbidity risk if early diagnosis of pulmonary nocardiosis does not occur.

ST-Segment Elevation Myocardial Infarction Caused by 5-Fluorouracil-Related Cardiotoxicity

5-Fluorouracil (5-FU) and its prodrug, capecitabine, are commonly used chemotherapeutic agents for solid tumor management. While these agents can present with adverse side effects such as nausea, vomiting, diarrhea, and myelosuppression, they can also, less commonly, cause cardiovascular toxicity. This toxicity may manifest as cardiac arrhythmias, myocarditis, heart failure, myocardial infarction, and even death. The management of 5-FU-related cardiotoxicity includes early recognition of symptom manifestation so that medication can be discontinued promptly and symptoms can be addressed appropriately. Here, we describe the case of a 72-year-old male who developed coronary vasospasm and ST-segment elevation myocardial infarction shortly after the initiation of chemotherapy with 5-FU.

Vanishing Lung Syndrome in a Young Male With Chronic Marijuana Use: A Case Report

Vanishing lung syndrome (VLS) also known as type I bullae disease or idiopathic bullous disease is characterized by giant emphysematous bullae that commonly develop in the upper lobes, occupying at least one-third of a hemithorax. It is a progressive and irreversible condition that involves pulmonary parenchymal destruction and alveolar dilation. It is commonly associated with middle-aged tobacco smokers, habitual marijuana users, and those with alpha-1-antitrypsin deficiency. This case involves an incarcerated male in his 30s with chronic marijuana smoking who presented with a three-month history of right-sided chest pain accompanied by cough, hemoptysis, fever, and weight loss. The patient reported month-long atypical chest discomfort associated with a cough productive of bloody sputum and was brought to the ED after developing acutely worsening right-sided chest pain. The patient underwent a chest X-ray that revealed a large pneumothorax on the left. Subsequently, CT chest imaging showed extensive bilateral bullous disease, left upper lobe consolidation, and enlarged mediastinal lymph nodes. This case illustrates a rare presentation of VLS in the setting of a young patient who other than reported regular marijuana use had no other risk factors and a negative workup for possible etiologies that could cause his severe bullous emphysema, including alpha-1 antitrypsin, HIV, Sjogren's syndrome, pulmonary Langerhans cell histiocytosis, two sputum Mycobacterium tuberculosis tests, and acid-fast bacteria sputum cultures, which were all negative. Identifying and assessing the degree of disease early in this progressive disease helps guide treatment while preventing further deterioration of lung parenchyma.

Effective heart disease prediction with Grey-wolf with Firefly algorithm-differential evolution (GF-DE) for feature selection and weighted ANN classification

In recent time, heart disease has become common leading to mortality of many individuals. Hence, early and accurate prediction of this disease is vital to reduce death rate and enhance people's lives. Concurrently, Artificial Intelligence has gained more attention at present as it permits deeper understanding of the healthcare data thereby providing accurate prediction results. This efficient prediction will solve complicated queries regarding heart diseases and hence assists clinical practitioners to adopt smart medical decisions. Hence, this study intends to predict heart disease with high accuracy by proposing an improved feature selection and enhanced classification approach. The paper employs Grey-wolf with Firefly algorithm for effective feature selection and using Differential Evolution Algorithm for tuning the hyper parameters of Artificial Neural Network (ANN). Hence, it is named as Grey Wolf Firefly algorithm with Differential Evolution (GF-DE) for better classification of the selected features. This proposed classification model trains the neural network to obtain optimal weights and tunes huge number of hyper parameters in an efficiently. To prove this, the proposed system is comparatively analysed with existing methods in terms of performance metrics like accuracy, precision, recall and F1 score for Cleveland and Statlog dataset. In addition, statistical analysis is also undertaken to analyse the significance of proposed system. Outcomes revealed the efficiency of proposed method which makes it highly suitable for heart disease prediction in an efficient manner.

Engineered glycomaterial implants orchestrate large-scale functional repair of brain tissue chronically after severe traumatic brain injury

Severe traumatic brain injury (sTBI) survivors experience permanent functional disabilities due to significant volume loss and the brain's poor capacity to regenerate. Chondroitin sulfate glycosaminoglycans (CS-GAGs) are key regulators of growth factor signaling and neural stem cell homeostasis in the brain. However, the efficacy of engineered CS (eCS) matrices in mediating structural and functional recovery chronically after sTBI has not been investigated. We report that neurotrophic factor functionalized acellular eCS matrices implanted into the rat M1 region acutely after sTBI significantly enhanced cellular repair and gross motor function recovery when compared to controls 20 weeks after sTBI. Animals subjected to M2 region injuries followed by eCS matrix implantations demonstrated the significant recovery of "reach-to-grasp" function. This was attributed to enhanced volumetric vascularization, activity-regulated cytoskeleton (Arc) protein expression, and perilesional sensorimotor connectivity. These findings indicate that eCS matrices implanted acutely after sTBI can support complex cellular, vascular, and neuronal circuit repair chronically after sTBI.

Socio-demographic study on extent of knowledge, awareness, attitude, and risks of zoonotic diseases among livestock owners in Puducherry region

AIM

This study was conducted to assess the extent of knowledge, awareness, attitude, and risks of zoonotic diseases among livestock owners in Puducherry region.

MATERIALS AND METHODS

A total of 250 livestock farmers were selected randomly from eight revenue villages. And each farmer was interviewed with a questionnaire containing both open- and close-ended questions on various aspects of zoonotic diseases, a total of 49 questionnaires were framed to assess the source and transmission of infection to the farmers and to test their knowledge and awareness about zoonotic diseases. The data collected were analyzed by chi-square test using software Graph pad prism, and results were used to assess the relationship between education level and zoonotic disease awareness; risk of zoonotic diseases and its relation with independent variables.

RESULTS

The present survey analysis represents that most of the respondents are belonging to the age group of 41-60 years. About 42.8% of respondents' household having a graduate. The most of the respondent are small-scale farmers and their monthly income was less than Rs. 10,000. About 61.2% of farmers were keeping their animal shed clean. About 29.6% of the respondents were ignorant about cleaning the dog bitten wound. Only 16.4% of respondents knew that diseases in animals can be transmitted to humans. Only 4.8%, 3.6%, 6.8%, and 22.4% of respondents knew about the zoonotic potential of diseases such as brucellosis, tuberculosis (TB), anthrax, and avian flu, respectively. Only 18% of the respondents were aware about zoonotic diseases from cattle. Regarding the list of zoonotic diseases contracted, 37.7% reported respiratory infection, 31.1% digestive disturbances, 15.5% had dermatological problem, and 15.5% reported indiscrete disease such as fever, body pain, and headache joint pain. From the respondent got the zoonotic disease (n=45), 51.2% of the respondent reported chronic infection and 48.8% of the respondent reported acute form of zoonotic infection. About 30% of the respondents' farm had an incidence of abortion. Our analyses showed that there was significant in educational level of respondents and treatment of dog bitten animals. Furthermore, there was statistical significance in occurrence of hand and foot lesions in the respondent and occurrence of foot-and-mouth disease outbreak in their animals.

CONCLUSION

From this study, it is concluded that involvement of educated family members in farming practices can create awareness and improve knowledge toward zoonotic disease. Further creation of awareness toward zoonotic diseases is of utmost important.

Two Body Wear of Newly Introduced Nanocomposite Teeth and Cross Linked Four Layered Acrylic Teeth: a Comparitive In Vitro Study

STATEMENT OF PROBLEM

Wear of complete denture teeth results in compromise in denture esthetics and functions. To counteract this problem, artificial teeth with increased wear resistance had been introduced in the market such as nanocomposite teeth.

PURPOSE

The purpose of this study was to compare the amount of wear between nanocomposite teeth and acrylic teeth.

MATERIALS AND METHODS

Fifteen specimens were chosen from each group namely the nanocomposite teeth (SR_-PHONARES) and the acrylic teeth (ACRY PLUS). Maxillary premolar was only chosen for testing and the samples were customized according to the specifications of the pin on disc machine. Pin on disc machine is a two body tribometer which quantifies the amount of wear under a specific load and time. Test samples were mounted on to the receptacle of the pin on disc machine and tested under a load of 0.3 kg for 1,000 cycles of rotation against a 600 grit emery paper. The amount of wear is displayed from the digital reading obtained from the pin on disc machine.

RESULTS

After statistical analysis, it was found that, the amount of wear is more in four layered acrylic teeth. The p value obtained is 0.002 (<0.005) thus implies that the difference in wear between nanocomposite teeth and acrylic teeth is statistically significant.

CONCLUSION

Though the nanocomposite teeth has less amount of wear than the four layered acrylic teeth, the difference is very less and adds only to a little clinical significance but the cost of the nanocomposite is four times that of the acrylic teeth. Further clinical studies must be performed to confirm our results.

Evaluation of Calretinin expression in Ameloblastoma and Non-Neoplastic Odontogenic Cysts - An immunohistochemical study

BACKGROUND

Calretinin a 29-kDa calcium binding protein is expressed widely in normal human tissue and tumours including amelobastoma. The objective of this study was to determine calretinin expression in heamatoxylin and eosin diagnosed cases of ameloblastoma and non-neoplastic odontogenic cysts.

MATERIALS & METHODS

The lining epithelium in 3 cases of radicular cysts, 5 cases of odontogenic keratocysts, 5 cases of dentigerous cysts and 11 cases of ameloblastomas were examined for expression of calretinin.

RESULTS

No positive epithelial staining was observed in radicular and dentigerous cysts. In comparison, however 100% of cases of ameloblastomas and 40% of cases of odontogenic karatocysts showed positive calretinin expression.

CONCLUSION

Calretinin may be a specific immunohistochemical marker for ameloblastoma. If there is any possible relation between calretinin expression and neural origin of the odontogenic epithelium and its neoplastic transformation and if calretinin could be used as an early marker to predict the tendency of neoplastic change of odontogenic epithelium could be answered through further researches. How to cite this article: D'Silva S, Sumathi MK, Balaji N, Shetty NK, Pramod KM, Cheeramelil J. Evaluation of Calretinin expression in Ameloblastoma and Non-Neoplastic Odontogenic Cysts - An immunohistochemical study. J Int Oral Health 2013; 5(6):42-8 .

Annexin v - affinity assay - apoptosis detection system in granular cell ameloblastoma

BACKGROUND

The aim of the study is to detect apoptosis in granular cell ameloblastoma by annexin v affinity assay, a novel technique.

MATERIALS & METHODS

Excitional biopsy of two patients with granular cell ameloblastoma were fixed in buffered formalin and later embedded in paraffin wax. Blocks were sliced into 3m thick sections for routine histological and subsequent immunohistochemical examinations. For electron microscopic examination tissues were fixed in 2.5% glutaraldehyde.electron microscopic examination was carried out to find the nature of granularity in granular cell ameloblastoma which was finally confirmed by annexin v technique.

RESULTS

Annexin v is a sensitive marker to detect early apoptosis. Fluorescence in granular cell clusters showed that apoptotic cell death is higher in granular cells. Both early and late events of apoptosis were identified in annexin v staining and electron microscopic study respectively.

CONCLUSION

Our study confirms that increased apoptotic cell death and subsequent phagocytosis is responsible for granular appearance of cells in granular cell ameloblastoma compared with that of conventional ameloblastoma. How to cite this article: Balaji N, Devy AS, Sumathi MK, Vidyalakshmi S, Kumar GS, D'Silva S. Annexin V - Affinity Assay - Apoptosis Detection System in Granular Cell Ameloblastoma. J Int Oral Health 2013; 5(6):25-30 .

Asymmetrical nostril axis angle in the post traumatic nose

BACKGROUND

Nasal tip reconstruction is a challenging part of septorhinoplasty in post-traumatic patients. Aesthetic appearance of the nose is dependent on adequate tip definition, projection and rotation. Our aim is to establish if caudal septal dislocation (secondary to fracture or subluxation) is a significant factor in causing asymmetry in nostril axis angle (NAA) to effect surgical intervention. In addition, to assess if there is an association between the side of dislocation and the magnitude of NAA.

METHODOLOGY

Photographic assessment of NAA was measured in a study group of 26 patients with caudal dislocation of the septum and a control group of 26 patients without caudal septal dislocation. All 52 patients were awaiting a septorhinoplasty procedure due to nasal trauma.

RESULTS

Caudal septal dislocation causes a mean difference in NAA of 7.95o compared to 1.38o difference in the control group. We also found there is a greater degree of upward tip rotation on the side of the dislocation resulting in a larger NAA.

CONCLUSION

Caudal dislocation of the septum causes a significant asymmetry in NAA, with a greater degree of rotation on the side of the dislocation. We should be aware of this fallacy prior to surgery.

Palatal rugoscopy among Puducherry population

BACKGROUND

Human identification is one of the most challenging subjects that man has been confronted with. The fingerprints and DNA comparison are the most commonly used techniques in human identification. Palatoscopy is one of the recently developing methods to identify a victim-based on the palatal rugae pattern.

AIMS AND OBJECTIVES

The aim of the study was to analyze the different rugae pattern in Puducherry population and to find whether palatoscopy is a useful tool in human identification and sex determination.

MATERIALS AND METHODS

The studies consist of 100 male and female patients between the age group of 20 to 35 years. The rugae pattern was divided assessed based on Kotze classification. Chi-square test and one-way analysis was used to study the statistical significance.

RESULTS

Wavy pattern appeared to be the most predominant pattern followed by curved, straight, branched and circular pattern in both male and female patients. The shape and number of rugae pattern is similar in male and females.

CONCLUSION

The present study concludes that wavy pattern appear to be most common rugae pattern among Puducherry population. No significant difference in rugae pattern was noted among the male and female group. Rugae pattern is unique to each individual and can be an effective tool in human identification.

Screening for glandular fever in patients with Quinsy: is it necessary?

Quinsy (peritonsillar abscess) is a common emergency seen in otolaryngology practice. These patients are often screened for glandular fever in addition to routine haematological tests. In our unit, we have screened 66 patients with quinsy for glandular fever over a period of 12 months. All these patients were screened for glandular fever by rapid immunoassay. Only one out of 66 patients was tested positive for glandular fever. Due to the extremely low incidence of glandular fever in quinsy patients, we do not see any relevance in screening for glandular fever in quinsy patients. Hence we recommend that routine screening for glandular fever in quinsy patients is an unnecessary invasive investigation for the patients and not cost effective for the hospital.

A prospective study comparing conventional methods against a structured method of gaining patients’ informed consent for tonsillectomy

OBJECTIVE

By providing junior members of medical staff with appropriate guidelines one can achieve an improved standard of informed consent for tonsillectomy, than is provided at present.

DESIGN

A prospective study of 138 consecutive patients.

SETTING

District General Hospital.

PARTICIPANTS

A total of 138 patients undergoing routine tonsillectomy split into two groups. Group A (n=87), the conventional group, gave consent in our unit's standard manner to various grades of doctors by using a hospital general surgical consent form. Most gave their consent as outpatients, while some consented on admission. Group B (n=51), the structured consent group, gave their consent in pre-admission clinic, to an SHO using a standardized tonsillectomy consent form and a structured interview technique.

MAIN OUTCOME MEASURES

A preoperative questionnaire regarding the knowledge of tonsillectomy.

RESULTS

Improvement of the awareness of the risks involved with tonsillectomy was achieved by the structured consent Group B; 82% of Group A were aware of postoperative pain compared with 94% of group B (P=0.04); 63% of group A were aware of infection compared with 82% of group B (P=0.02); 100% of group B had read the consent form before signing compared with 80% of group A (P<0.01). There was no statistical difference in the awareness of postoperative haemorrhage (91 versus 98%, P=0.15).

CONCLUSION

By providing junior medical staff with guidelines, senior staff retain responsibility for consent while improving the standard of informed consent for tonsillectomy.

Ginkgo biloba does not benefit patients with tinnitus: a randomized placebo-controlled double-blind trial and meta-analysis of randomized trials

The objective was to ascertain if Ginkgo biloba benefits patients with tinnitus. The study design was: 1. Randomized double blind trial of Ginkgo biloba versus placebo; 2. A meta-analysis of randomized placebo controlled double blind trials. Participants included 66 adult patients with tinnitus and six (including our study) randomized placebo controlled double blind trials were meta-analysed. The main outcome measures were the Tinnitus Handicap Inventory (THI), Glasgow Health Status Inventory (GHSI) and average of hearing threshold at 0.5, 1, 2, 4 kHz. In the meta-analysis the proportion of patients gaining benefit and an overall odds ratio were determined. The results showed the mean difference in change of the THI, GHSI and hearing between Ginkgo biloba (n = 31) and placebo group (n = 29) was 2.51 (CI -10.1, 5.1, P = 0.51), 0.58 (CI-4.8, 3.6, P = 0.38) and 0.68 db (CI -4.13, 2.8, P = 0.69). Meta-analysis revealed 21.6% of Ginkgo biloba treated patients (n = 107/552) gained benefit versus 18.4% (n = 87/504) of placebo treated patients with an odds ratio of 1.24 (CI 0.89, 1.71). In conclusion, Ginkgo biloba does not benefit patients with tinnitus.