To determine the accuracy of Pederson and Parant Scale for predicting the difficulty level of mandibular third molar extraction. Prospective cross-sectional, 6 months from January 2012 to June 2012. All consecutive patients who presented for the extraction of impacted third molars were included in the study. Orthopantomograms (OPGs) were advised and on these OPGs third molars were classified as easy, moderate or difficult according to standard Pederson scale. Similarly modified Parant scale was utilized to predict the difficulty of removal of third molars. Root pattern was also noted on the OPG. These parameters were then compared with peri-operative parameters like time taken for extraction and need for crown or root sectioning using Chi Square test. A p value of <0.05 was taken as significant. A total 50 patients were included in the study. Out of these 24 were males and 26 females with a male to female ratio of 1:1.08. The age ranged from 18-38 years with a mean of 26.32±5.43 years. The pre operative predictions for Pederson’s and Modified Parant’s Score were compared with per operative findings using Chi-Square test. The results were insignificant in terms of Pederson Scale (p value>0.05) while significant results were obtained in case of Parant Scale (p value<0.05). Statistically significant results were seen for root pattern and level of difficulty (p value<0.05). These scales failed to predict difficulty level of tooth removal accurately especially in cases of distoangular impactions. When combined with root pattern, the accuracy of prediction gets significantly better.

The present study describes the frequency of Foot and Mouth Disease (FMD) virus serotypes (O,A and Asia-1) in major regions (all provinces) of Pakistan using Indirect Sandwich ELISA.Also,spatial distribution of various FMD serotypes and their comparison is discussed.A total of 590 samples (Epithelial tissue) have been analyzed during a period of five years (2005-2009).Out of 590 samples,180 were found positive,giving an overall confirmation of FMDV about 33.2 ％.Of the prevalent serotypes,FMDV ‘O’ serotype caused most outbreaks (20.7 ％),followed by serotype A (6.6 ％) and serotype Asia-1 (4.6 ％) while there was no positive case oftype ‘C’.The study clearly showed that the disease was more frequent in the agro-climatic zones than in hilly areas.Based on the data of 590 samples (＞50 outbreaks),the overall prevalence of FMDV in cattle and buffaloes in Pakistan was 33.2 ％,while in cattle alone,it was 37.1％,higher than in buffalo (28.7 ％).There were eight cases of mixed serotypes infection,indicating the presence of endemic state of disease.Another significant feature was the change over time.In phase-I (2005-2007),there was an overall prevalence of 29.4 ％,while the occurrence of the serotype O,A and Asia-1 was 20.4 ％,2.9 ％ and 4.7 ％,respectively.During phase-II (2008-2009),the overall prevalence was 59.21％,while those of serotype O,A and Asia-1 were 22.4 ％,31.6 ％ and 4.0 ％,respectively.This clearly indicated a shift from serotype O to A,which may help to explain the occurrence of more severe outbreaks,despite vaccination.

Acute promyelocytic leukemia (APML) is considered to be sensitive to all-trans-retinoic acid (ATRA) which acts as a differentiating agent. ATRA is considered to be a well-tolerated agent and is known to achieve complete remission in acute promyelocytic leukemia. However, a few cases on long term all-trans-retinoic acid (ATRA) use can develop pseudotumor cerebri. Out of 32 patients with APML who were treated in our Centre over a 4-year-period, we encountered 6 patients who developed ATRA-related pseudotumor cerebri while on maintenance treatment. The patients ranged from 12 to 40 years of age. 3 patients complained of unbearable headache, 2 of diplopia and 1 of gross reduction in visual acuity. CT scans and MRI did not reveal any intracranial lesions. Cerebrospinal fluid (CSF) examination was normal with CSF manometry revealing a high CSF pressure (average of 345mmH2O). Fundoscopy revealed papilledema in 5 patients and optic atrophy in 1 patient. The patients were successfully managed with decrease dose/discontinuation of ATRA, use of acetazolamide, corticosteroids and therapeutic CSF drainage.

OBJECTIVETo assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondylar fractures of the humerus in children.

METHODSWe prospectively followed 52 children who presented with Gartland type 3 displaced supracondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing (n=23), followed by fall from height (n=20), road traffic accidents (n=5) and fall from standing height (n=2). In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn's criteria.

RESULTSLateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn's criteria, 90.4% patients showed satisfactory results.

CONCLUSIONLateral approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function. The approach is easy and familiar to most orthopedic surgeons in our setup.

Bone Wires ; Child ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Humeral Fractures ; surgery ; Male ; Prospective Studies

OBJECTIVE: Depression is a prevalent condition that is costly to individuals and society. In view of a role of tryptophan (TRP), selenium (Se), vitamin D (Vit D), magnesium (Mg) and serotonin in depression, the present study concerns to evaluate the circulating levels of TRP, Se, Vit D, Mg and serotonin in depression as well as the correlation between TRP and other serum analytes is also established.METHODS: Healthy (n=48) and depressed (n=48) subjects were recruited and their blood samples were obtained after an overnight fast of 12 h, serum was stored for the determination of levels of TRP, Se, Vit D, Mg, and serotonin.RESULTS: show that levels of TRP, Se, Vit D, Mg, and serotonin were decreased in the depressed patient when compared to normal subjects. There is a direct correlation between TRP and Vit D, and TRP and Se while the inverse correlation between TRP and Mg, and TRP and serotonin in depressed subjects. The association among TRP and other biomarkers is non-significant.CONCLUSION: In conclusion, depression is associated with deficiency of TRP, Se, Vit D, Mg, and serotonin displays the characteristics of biomarkers. The correlation between TRP and other biomarkers/trace elements is also important in depression.
Biomarkers ; Depression ; Humans ; Magnesium ; Selenium ; Serotonin ; Trace Elements ; Tryptophan ; Vitamin D

The unprecedented healthcare demand due to sudden outbreak of coronavirus disease 2019(COVID-19)pandemic has almost collapsed the health care systems especially in the developing world.Given the disastrous outbreak of COVID-19 second wave in India,the health system of country was virtually at the brink of collapse.Therefore,to identify the factors that resulted into breakdown and the challenges,Indian healthcare system faced during the second wave of CO VID-19 pandemic,this paper analysed the health system challenges in India and the way forward in accordance with the six building blocks of world health organization(WHO).Applying integrated review approach,we found that the factors such as poor infrastructure,inadequate financing,lack of transparency and poor healthcare management resulted into the overstretching of healthcare system in India.Although health system in India faced these challenges from the very beginning,but early lessons from first wave should have been capitalized to avert the much deeper crisis in the second wave of the pandemic.To sum-up given the likely future challenges of pandemic,while healthcare should be prioritized with adequate financing,strong capacity-building measures and integration of public and private sectors in India.Likewise fiscal stimulus,risk assessment,data availability and building of human resources chain are other key factors to be strengthened for mitigating the future healthcare crisis in country.

Nucleotide-binding and oligomerization domain (NOD)-like receptors (NLRs) play important role in immune responses by regulating nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kappaB), type I interferon and inflammasomes. Nod-like receptor pyrin domain-containing protein 6 (NLRP6) is vital for protection of mice from colitis and colorectal tumorigenesis. However, the role of NLRP6 in microbial infection remains unclear. NLRP6 was recently reported as negative regulator of inflammatory signaling and demonstrated that how it hinders clearance of bacterial pathogens.
Animals ; B-Lymphocytes ; Cell Transformation, Neoplastic ; Colitis ; Cytoskeletal Proteins ; Immunity, Innate ; Inflammasomes ; Interferon Type I ; Listeria monocytogenes ; Mice

Detection of pathogen by pattern recognition receptors leads to activation of inflammasome which plays a crucial role in immune system. The inflammasome regulates the release of cytokines, such as interleukin (IL)-1beta, IL-18 and high-mobility group box 1 (HMGB1). Double-stranded RNA-dependent protein kinase (PKR) is a critical component of an inflammatory complex. Recently, the critical role of PKR was reported in regulation of multiple inflammasomes.
Cytokines ; eIF-2 Kinase ; Immune System ; Inflammasomes ; Interleukin-18 ; Interleukins ; Receptors, Pattern Recognition

Murine caspase-11 is orthologus to human caspase-4 and caspase-5, and is required for the response to cholera toxin B and infection with Escherichia coli, Citrobacter rodentium or Vibrio cholerae. Caspase-11 rather than caspase-1 is the main offender involved in sepsis. Hence, caspase-11 plays an essential pro-inflammatory role in innate immune response to bacterial infections.
Bacterial Infections ; Cholera Toxin ; Citrobacter rodentium ; Criminals ; Escherichia coli ; Humans ; Immunity, Innate ; Sepsis ; Vibrio cholerae

Cyclic guanosine monophosphate-adenosine monophosphate (cGAMP) synthase (cGAS) is a cytosolic DNA sensor that plays an important role in innate immunity. Transfection of DNA or DNA virus infection results in the induction of type I interferon production in fibroblasts, macrophages, and dendritic cells which is dependent on cGAS. Recently, cGas (-/-) mice have been reported to be more vulnerable to fatal infection with herpes simplex virus 1 (HSV1) as compared to wild-type mice.
Animals ; Cytosol ; Dendritic Cells ; DNA ; DNA Virus Infections ; Fibroblasts ; Guanosine ; Herpesvirus 1, Human ; Immunity, Innate ; Interferon Type I ; Macrophages ; Mice ; Transfection