Background & Objectives: Depression, anxiety and suicide are the main psychiatric comorbidities which are more prevalent among persons with epilepsy (PWE). This study aims to determine the prevalence of depression, anxiety and suicidal ideation/behaviour in PWE and to correlate their clinical profile with psychiatric comorbidities in a population in North India. Methods: This study was conducted at Pt. BD Sharma PGIMS, Rohtak Haryana among PWE attending outpatient clinic at the Department of Neurology. A total of 100 eligible PWE were included in this study. The demographic and clinical history was documented. All patients filled up the Hospital anxiety and depression scale (HADS) and Columbia-suicide severity rating scale (C-SSRS) questionnaire. Results: The prevalence of depression and anxiety among PWE was found to be 60% and 70% respectively and the prevalence of suicidal ideation and suicidal behaviour was 42% and 3% respectively among PWE. Female gender, longer duration of epilepsy, higher seizure frequency, temporal lobe epilepsy, polytherapy, uncontrolled epilepsy and drug resistant epilepsy were found to be positively correlated with these psychiatric comorbidities. Conclusion: This study shows that the prevalence of depression, anxiety and suicidal ideation/ behaviour is high among PWE in Haryana, North India. PWE should be screened for these psychiatric comorbidities to improve their quality of life

This study was carried out to analyse retrospectively the data of 1,349 patients receiving antiepileptic drugs (AEDs) distributed drug wise into subtherapeutic, therapeutic, toxic and not detectable ranges. Patients were divided into three groups based on the monotherapy they received. In Phenytoin group (n=1255), 26.4% were found to be in therapeutic range, 51.6% in the subtherapeutic range and 20.6% in the toxic range. For Carbamazepine (n=63), 52.4% were in the therapeutic range, 14.3% were in subtherapeutic range, 31.7% in the toxic range and 1.6% were undetectable. Phenobarbitone levels (n=31) were found to be 64.5% in therapeutic range, 22.6% in subtherapeutic range, 9.7% in toxic range and 3.2% in the undetectable range. In 100 patients of phenytoin analyses which were under good seizure control and free of adverse effects, 46% were found to be in therapeutic range, 31% were in subtherapeutic range and 23% were found to be in toxic range. On the basis of this data, it is recommended that therapeutic drug monitoring should be carried out in all patients receiving AEDs for better overall management and long term clinical outcome.

Background & Objective:Epilepsy may have an impact on bone health of the patients even before drug therapy is initiated, particularly in the developing countries. This is in view of long delay in diagnosis and lifestyle changes. Therefore, in this study, bone health markers like bone mineral density (BMD) and urinary hydroxyproline were assessed in newly diagnosed epilepsy patients. Methods: The BMD was assessed by DEXA scan, and 24 hour urine hydroxyproline was estimated colorimetrically in 25 newly diagnosed epilepsy patients. Other bone markers like calcium, phosphorus, vitamin D and alkaline phosphatase were also estimated. Results were compared with 25 age and sex matched healthy controls, and were analyzed statistically. Results: The BMD and vitamin D were found to be significantly decreased (p<0.05) while serum alkaline phosphatase and urine calcium and phosphorus were observed to be significantly increased p<0.05) in epilepsy patients as compared to healthy controls. The difference in urinary hydroxyproline and serum calcium/ phosphorus in the two groups was not found to be statistically significant (p>0.05). Conclusions: Bone health is found to be already compromised in epilepsy patients in this study from North India. BMD and urinary hydroxyproline may act as simple, non-invasive, convenient and inexpensive markers to assess bone health in these patients
Bone Density ; Epilepsy

CDRI compound no. 99/411 is a potent 1,2,4-trioxane antimalarial candidate drug under development at our Institute. An HPLC method for determination of CDRI 99/411 with its starting material and intermediates has been developed and validated for in process quality control and stability studies. The analytical performance parameters such as linearity, precision, accuracy, specificity, limit of detection (LOD) and lower limit of quantification (LLOQ) were determined according to International Conference on Harmonization ICH Q2(R1) guidelines. HPLC separation was achieved on a RP-select B Lichrospheres column (250 mm ? 4 mm, 5μm, Merck) using water containing 0.1%glacial acetic acid and acetonitrile as the mobile phase in a gradient elution. The eluents were monitored by a photo diode array detector at 245 and 275 nm. Based on signal to noise ratio of 3 and 10 the LOD of CDRI 99/411 was 0.55 mg/mL, while the LLOQ was 1.05 mg/mL. The calibration curves were linear in the range of 1.05-68 mg/mL. Precision of the method was determined by inter- and intra-assay variations within the acceptable range.

Background: There are diverse treatment modalities available for managing pediatric dentate mandibular fractures, ranging from various closed reduction techniques to open reduction methods. This systematic review and meta-analysis aim to evaluate the most appropriate and preferred management method for pediatric dentate mandibular fractures, focusing on outcomes such as wound infection and malocclusion. Methods: A systematic search was performed using the PubMed Central and Scopus databases from January 1980 to December 2022, following PRISMA guidelines. The inclusion criteria comprised case reports with more than 10 cases, clinical trials, and prospective and retrospective clinical studies addressing the management of displaced dentate-segment mandibular fractures in patients up to 15 years old using open and/or closed reduction techniques. Results: Six retrospective studies were included in the systematic review and meta-analysis. The primary outcomes assessed were wound infection and malocclusion. The pooled estimate for wound infection significantly favored the maxillomandibular fixation (MMF) group (p= 0.0007). In contrast, although the pooled estimate for malocclusion favored surgical treatment, the difference was not statistically significant (p= 0.86). Conclusion The risk of wound infection is significantly lower with MMF in pediatric mandibular fractures, while open reduction and internal fixation (ORIF) using miniplates is associated with a relatively lower risk of malocclusion, although this difference is not statistically significant. The authors conclude that, based on reduced wound infection rates, MMF should be the preferred management approach, whereas ORIF should be reserved for severely displaced and comminuted fractures. Future randomized controlled trials with larger sample sizes are needed to validate and strengthen these findings.

Background: There are diverse treatment modalities available for managing pediatric dentate mandibular fractures, ranging from various closed reduction techniques to open reduction methods. This systematic review and meta-analysis aim to evaluate the most appropriate and preferred management method for pediatric dentate mandibular fractures, focusing on outcomes such as wound infection and malocclusion. Methods: A systematic search was performed using the PubMed Central and Scopus databases from January 1980 to December 2022, following PRISMA guidelines. The inclusion criteria comprised case reports with more than 10 cases, clinical trials, and prospective and retrospective clinical studies addressing the management of displaced dentate-segment mandibular fractures in patients up to 15 years old using open and/or closed reduction techniques. Results: Six retrospective studies were included in the systematic review and meta-analysis. The primary outcomes assessed were wound infection and malocclusion. The pooled estimate for wound infection significantly favored the maxillomandibular fixation (MMF) group (p= 0.0007). In contrast, although the pooled estimate for malocclusion favored surgical treatment, the difference was not statistically significant (p= 0.86). Conclusion The risk of wound infection is significantly lower with MMF in pediatric mandibular fractures, while open reduction and internal fixation (ORIF) using miniplates is associated with a relatively lower risk of malocclusion, although this difference is not statistically significant. The authors conclude that, based on reduced wound infection rates, MMF should be the preferred management approach, whereas ORIF should be reserved for severely displaced and comminuted fractures. Future randomized controlled trials with larger sample sizes are needed to validate and strengthen these findings.

Background: There are diverse treatment modalities available for managing pediatric dentate mandibular fractures, ranging from various closed reduction techniques to open reduction methods. This systematic review and meta-analysis aim to evaluate the most appropriate and preferred management method for pediatric dentate mandibular fractures, focusing on outcomes such as wound infection and malocclusion. Methods: A systematic search was performed using the PubMed Central and Scopus databases from January 1980 to December 2022, following PRISMA guidelines. The inclusion criteria comprised case reports with more than 10 cases, clinical trials, and prospective and retrospective clinical studies addressing the management of displaced dentate-segment mandibular fractures in patients up to 15 years old using open and/or closed reduction techniques. Results: Six retrospective studies were included in the systematic review and meta-analysis. The primary outcomes assessed were wound infection and malocclusion. The pooled estimate for wound infection significantly favored the maxillomandibular fixation (MMF) group (p= 0.0007). In contrast, although the pooled estimate for malocclusion favored surgical treatment, the difference was not statistically significant (p= 0.86). Conclusion The risk of wound infection is significantly lower with MMF in pediatric mandibular fractures, while open reduction and internal fixation (ORIF) using miniplates is associated with a relatively lower risk of malocclusion, although this difference is not statistically significant. The authors conclude that, based on reduced wound infection rates, MMF should be the preferred management approach, whereas ORIF should be reserved for severely displaced and comminuted fractures. Future randomized controlled trials with larger sample sizes are needed to validate and strengthen these findings.

We conducted a retrospective study and reviewed the temporomandibular joint (TMJ)-related papers published in a leading international journal, Journal of Oral and Maxillofacial Surgery, between January 2014 and December 2015. The study was conducted to ascertain and compare the trends of articles being published in the years 2014 and 2015. A total of 28 articles were reviewed, of which most of the full-length articles were on clinical management and outcomes and the role of radiology. The bulk of the studies were prospective, and less interest was shown in experimental research. A thorough review and analysis thus gives the impression that there is a great need for well-designed clinical studies on TMJ.
Ankylosis ; Prospective Studies ; Retrospective Studies ; Surgery, Oral ; Temporomandibular Joint ; Temporomandibular Joint Disorders

PURPOSE: To study temporal pattern of serum liver enzymes levels in newborns with hepatic injury associated with birth asphyxia (BA). METHODS: Singleton term newborns with BA and < or =72 hours of age admitted to neonatal intensive care unit were prospectively enrolled. Term newborns with physiological jaundice and without BA were studied as controls. Serum liver enzymes were measured at <24 hours, 24-72 hours, and at 6-12 days of age for cases and at 1-6 days of age for controls. BA was defined by 1 minute Apgar score <7 or delayed or absent cry with hypoxic ischemic encephalopathy. BA-associated liver injury was defined as serum alanine aminotransferase (ALT) elevation beyond +2 standard deviation (ALT > +2 SD) above the mean of control subjects at any of the three time points. RESULTS: Sixty controls and 62 cases were enrolled. Thirty-five cases (56%) developed BA-associated liver injury (ALT>81 IU/L). They had higher serum levels of ALT, aspartate aminotransferase, lactate dehydrogenase than the control infants, with peak at 24-72 hours. In controls, serum liver enzyme levels were significantly higher in appropriate-for-date (AFD) babies than small-for-date (SFD) babies. Serum enzyme pattern and extent of elevation were comparable between SFD and AFD babies. Degree of serum liver enzyme elevation had no relationship with severity of hypoxic encephalopathy. CONCLUSION: Serum liver enzyme elevation is common in BA; it peaks at 24-72 hours followed by a sharp decline by 6-12 days of age. Pattern and extent of enzyme elevation are comparable between SFD and AFD babies.
Alanine Transaminase ; Apgar Score ; Aspartate Aminotransferases ; Asphyxia Neonatorum ; Asphyxia* ; Hepatitis ; Humans ; Hypoxia, Brain ; Hypoxia-Ischemia, Brain ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Ischemia ; Jaundice ; L-Lactate Dehydrogenase ; Liver* ; Parturition* ; Prospective Studies ; Transaminases

PURPOSETo evaluate the functional and radiological outcome of comminuted radial head fractures, which were not amenable for classical open reduction with internal fixation, treated by on-table reconstruction and fixation using low profile plates.

METHODSWe reviewed 6 patients of Mason type III radial head fractures treated by on-table reconstruction technique between 2011 and 2013. There were 5 men and 1 woman with a mean age of 35 years (range 25-46 years). All surgeries were carried out at our tertiary care level 1 trauma centre within a mean of 3 days (range 1-8 days) from date of injury using on-table reconstruction technique. The functional outcome was measured using elbow functional rating index described by Broberg and Morrey and the patient-based Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure.

RESULTSThe mean follow-up period was 25 months. The average elbow flexion was 135°(range 125°-140°) and theaverage flexion contracture was 5°(range 0-10°). The average supination and pronation was 75°(range 70°-80°) and 70°(range 65°-82°) respectively. According to Broberg and Morrey scoring system, the average score was 90 points (range 75-100). The mean DASH score was 2.49 points.

CONCLUSIONOn-table reconstruction and fixation of comminuted radial head fractures using low profile plates is a reasonable option. The reconstructed radial head acts as spacer and provides reasonably good results and no surgical intervention is required for asymptomatic nonunion of these fractures regardless of the radiological findings.

Adult ; Bone Plates ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Radius Fractures ; surgery ; Reconstructive Surgical Procedures ; methods