Vascular anomalies are a serendipitous finding during surgeries and diagnostic angiography. Such variations are frequently encountered in the abdominal region. These anomalies are usually asymptomatic but the presence of hepatic arterial variations may lead to injuries of the liver during surgery. The present study was conducted on 35 adult embalmed cadavers, 31 males, 4 females from August 2015 to December 2021 in the Department of Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi. In this study of 35 cadavers, we present 3 variants: an accessory right hepatic artery, replaced common hepatic artery, replaced common hepatic artery anastomosis with accessory left hepatic artery and an arc of Buhler. One of our variants has not yielded a precedent in literature search. We have compared these variants with Michels and Hiatt classification. It is known that different variants arise at distinct stages of embryonic development. As specialists in anatomy, we have tried to correlate the variants in our study with their embryological origins.

Smart polymers have enormous potential in various applications. In particular, smart polymeric drug delivery systems have been explored as "intelligent" delivery systems able to release, at the appropriate time and site of action, entrapped drugs in response to specific physiological triggers. These polymers exhibit a non-linear response to a small stimulus leading to a macroscopic alteration in their structure/properties. The responses vary widely from swelling/contraction to disintegration. Synthesis of new polymers and crosslinkers with greater biocompatibility and better biodegradability would increase and enhance current applications. The most fascinating features of the smart polymers arise from their versatility and tunable sensitivity. The most significant weakness of all these external stimuli-sensitive polymers is slow response time. The versatility of polymer sources and their combinatorial synthesis make it possible to tune polymer sensitivity to a given stimulus within a narrow range. Development of smart polymer systems may lead to more accurate and programmable drug delivery. In this review, we discuss various mechanisms by which polymer systems are assembled in situ to form implanted devices for sustained release of therapeutic macromolecules, and we highlight various applications in the field of advanced drug delivery.

Background: Inappropriate use of intravenous and inhaled anesthetics may be dangerous in infants undergoing facial cleft surgeries. This study primarily aimed to compare the effect of infraorbital nerve block on sevoflurane requirement in infants undergoing cheiloplasty. Intraoperative opioid consumption, hemodynamics, blood glucose levels, extubation time, and delirium were also compared. Methods: This prospective, randomized, double-blinded study was conducted in 34 infants undergoing cheiloplasty under general anesthesia. After induction, group A received bilateral infraorbital nerve block with 0.5 mL of 0.5% bupivacaine and group B 0.5 mL saline. An increase in heart rate or blood pressure > 20% was managed by increasing sevoflurane by 2–2.5%, followed by fentanyl 0.5 µg/kg bolus. The chi-square test and independent-sample t-test were used where applicable. Results: Demographics, duration of surgery, and intravenous fluids used were comparable between the groups.Compared to group A, patients in group B had significantly higher consumption of fentanyl (14.2 ± 4.4 µg vs. 22.1 ± 6.2 µg) and sevoflurane (14.2 ± 4.8 mL vs. 26.8 ± 15.6 mL). Intraoperative hemodynamic parameters were significantly lower in group A, the number of times increases in hemodynamic parameters occurred, and fentanyl supplemental bolus was required remained significantly lower in group A than in group B. Intraoperative glycemic levels remained higher in group B, and the extubation time was significantly shorter in group A than in group B (4.40 ± 1.60 min vs. 9.2 ± 2.18 min). Group A had a lesser occurrence of postoperative delirium. Conclusion Supplemental infraorbital block in infants undergoing cheiloplasty under general anesthesia resulted in significantly decreased anesthetic requirements and optimal hemodynamic and glycemic levels with faster extubation and lesser delirium.

Background: In India, the absence of formal training in geriatric dentistry and the lack of recognition of it as a speciality contributes to the deterioration of oral health in the older adults. India lacks specific oral healthcare policies for older adults. Additionally, caregivers’ perspective in old age homes regarding oral healthcare services remains underexplored, necessitating further studies in this context. Methods: A mixed method study was conducted, and the quantitative component focused on assessing the oral health status of institutionalized older adults and caregivers’ perceptions using a questionnaire. The qualitative part evaluates caregivers’ perceptions of providing oral healthcare services for older adults through in-depth interviews. Results: Mean DMFT among institutionalized older adults was 15.52±8.23. More than 50% of caregivers perceived that the oral health status of institutionalized older adults was fair. Barriers to oral health services include autonomy, difficulty in traveling, lack of financial support, lack of knowledge and time. Approaches to enhancing oral health services for institutionalized older adults include oral health education for older adults and their caregivers, monthly dental visits to the institution, utilization of portable dental chair services, collaboration with dental colleges/dental clinics, distribution of oral health education materials, and provision of oral hygiene aids. Conclusion Findings from our study indicate the need to collaborate with dental institutions to provide oral health services in old age homes, to improve the oral health status of older adults and caregivers' knowledge.

BACKGROUND: Autoimmune hemolytic anemia (AIHA) is a less recognized, potentially fatal condition. There is a scarcity of data on clinicoserological characteristics and response to therapy concerning this disease from South India. METHODS: Data for 33 patients with primary AIHA recorded from July 2009 to June 2015 were retrospectively analyzed for clinical presentation, response to frontline therapy, durability of response, time to next treatment (TTNT), and response to second-line agents. RESULTS: The median follow-up period was 50 months. Among 33 patients, 48% of the cases were warm autoimmune hemolytic anemia (WAIHA), 46% were cold agglutinin disease (CAD), and 6% were atypical. Three-fourth of patients had severe anemia (<8 g/dL hemoglobin [Hb]) at onset; younger patients (age <40 yr) had more severe anemia. All of the patients who required treatment received oral prednisolone at 1.5 mg/kg/d as a frontline therapy, and the response rate was 90% (62% complete response [CR] and 28% partial response [PR]). The overall response to corticosteroids in WAIHA and CAD was 87% and 92%, respectively. The median corticosteroid duration was 14 months, and 50% of the patients required second-line agents. Fourteen patients received azathioprine as a second-line agent, and 11 of these patients responded well, with half of them not requiring a third agent. Four patients developed severe infections (pneumonia, sepsis, and soft tissue abscess) and two had life-threatening venous thrombosis. One case of death was recorded. CONCLUSION: AIHA is a heterogeneous disease that requires care by physicians experienced in treating these patients.
Adrenal Cortex Hormones ; Anemia ; Anemia, Hemolytic, Autoimmune* ; Azathioprine ; Follow-Up Studies ; Humans ; India* ; Prednisolone ; Retrospective Studies ; Sepsis ; Venous Thrombosis

We report a rare case of aneurysm of splenic artery arising anomalously from the superior mesenteric artery (SMA). The aneurysm was treated successfully by coil embolization of the splenic artery distal to aneurysm and then deploying a stent graft in the SMA. A combination of stent graft and coil embolization for the treatment of aberrant splenic artery aneurysm has been reported only once. We describe the imaging findings and the endovascular procedure in this patient.
Adult ; Aneurysm/radiography/*surgery ; Angiography/*methods ; *Blood Vessel Prosthesis ; Endovascular Procedures/*methods ; Humans ; Male ; Mesenteric Artery, Superior/radiography/*surgery ; *Splenic Artery ; *Stents ; Tomography, X-Ray Computed/*methods ; Treatment Outcome

We report here a case of a random synchronous male breast malignancy in a patient with a known base of tongue malignancy that was incidentally detected on a whole body 18-fluorine deoxyglucose positron emission tomography and computed tomography (18F-FDG PET/CT). Patient was referred to us for PET/CT staging and radiotherapy planning for a poorly differentiated squamous cell carcinoma of base of tongue. Histopathologically, the incidentally detected breast lesion was proven to be an invasive ductal carcinoma. 18F-FDG PET/CT being a whole body imaging modality is known to detect a considerable number of synchronous primaries. Synchronous malignancies in the head and neck area and the upper aerodigestive tract are well established. However, synchronous malignancy in male breast is reportedly uncommon. Our case is unique for the fact that a random synchronous dual malignancy of base of tongue and breast in a male patient was detected during a whole body 18F-FDG PET/CT imaging.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Squamous Cell ; Deoxyglucose ; Fluorodeoxyglucose F18 ; Head ; Humans ; Male* ; Neck ; Neoplasms, Multiple Primary ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography ; Radiotherapy ; Tongue ; Tongue Neoplasms ; Whole Body Imaging

18F-FDG PET/CT imaging is an established imaging modality for cancer staging and response assessment. Its role in identifying infective and inflammatory pathologies from malignancy is debated. Dual time - point imaging is a refined technique used to overcome this interpretational dilemma. We present a 59 year old male with an unknown primary malignancy who was referred for a 18F-FDG PET/CT imaging. Images revealed primary lung malignancy with co existing bilateral renal tuberculosis which otherwise would have gone amiss or would have been considered as metastases.
Fluorodeoxyglucose F18* ; Humans ; Immunocompromised Host* ; Lung ; Male ; Neoplasm Metastasis ; Neoplasm Staging ; Pathology ; Positron-Emission Tomography and Computed Tomography* ; Tuberculosis, Renal*

Awareness ; Curriculum ; Hospitals, Teaching ; India ; Tertiary Healthcare

BACKGROUND: Extracellular trap formation (ETosis) by various blood cells has been reported. This trap contains DNA, histones and granular proteins which can elicit an innate immune response by entrapping microorganisms. The trap thus formed has been reported to have an involvement in various pathogenic conditions as well. This review focusses on the trap formation by different blood cells, the immune response associated with trap formation and also its role in various clinical conditions.METHOD: An extensive literature survey on ETosis by blood cells from 2003 to 2019 has been done. After going through the literature throughly, in this review we focuses on the trap formation by different blood cell types such as neutrophils, macrophages, eosinophils, basophils, mast cells, plasmacytoid dentritic cells, and monocytes. The mechanism with which it releases trap, the immune response it elicits and ultimately its involvement in various pathogenic conditions are described here. This article extensively covered all the above aspects and finally comprehends in nutshell the various stimuli that are currently known in trigerring the ETosis, its effect and ultimately its role in disease process. RESULTS: A clarity about the extracellular trap formation by various blood cells, mechanism of ETosis, role of Etosis in microbial invasion and in various pathogenic situations by various blood cells have been described here. CONCLUSION The current understanding about the process of ETosis and its effects has been extensively described here. Along with lot of favourable outcomes, the process of ETosis will lead to lot of pathogenic situations including thrombosis, tumour metastasis and sepsis. Current understanding about ETosis is limited. Indepth understanding of ETosis may have great therapeutic potential in the diagnosis, guiding of therapy and prognostication in various pathogenic situations including infectious conditions, autoimmune disorders and tumors.