Objective: A cluster of leptospirosis and brucellosis cases in a semi-nomadic, pastoral community was reported in October 2023 from Village A, Uttarakhand State, India. This cluster was investigated to describe the epidemiology and potential exposures. Methods: Suspected cases were residents with sudden-onset fever or myalgia occurring from 1 August 2023 to 7 January 2024; confirmed cases were suspected cases with laboratory confirmation. Suspected cases were identified through a house-to-house case search and were interviewed regarding sociodemographic variables, symptoms and exposures. Those who consented were tested. Data were cleaned and analysed in Microsoft Excel. Results: Fifty suspected cases were identified among a total of 300 residents across 85 households. Among these, 27 agreed to be tested, and 25 were confirmed (13 with leptospirosis, 7 with brucellosis and 5 with both leptospirosis and brucellosis). The cases began in September 2023 following flooding and continued until January 2024, with no deaths. The median age (range) of cases was 30 (17–82) years for leptospirosis, 39 (25–56) years for brucellosis and 39 (22–50) years for coinfection. Altogether, females accounted for 92% (12/13) of leptospirosis cases, 57% (4/7) of brucellosis cases and 80% (4/5) of coinfections. Symptoms included fever, myalgia and arthralgia. All cases reported contact with floodwater and animal abortus. Discussion: This was a laboratory-confirmed co-occurring cluster of leptospirosis and brucellosis, including five cases of coinfection, following flooding, predominantly affecting female Van Gujjar dairy farmers. Education was provided to the community about the hygienic disposal of animal waste.

Background: Maxillary molars are commonly anesthetized via buccal infiltration. A patient’s mouth opening during maxillary buccal infiltration can influence dental treatment. Hence, this study aimed to evaluate and compare the influence of palatal root length on the efficacy of 2% lidocaine in 1:80000 adrenaline for maxillary buccal infiltration (MBI) between the open- and closed-mouth techniques. Methods: Sixty patients were selected based on inclusion and exclusion criteria. The intensity of pre-operative pain was measured using a visual analog scale (VAS). Samples were randomly divided using the chit method, with odd numbers in group 1 and multiples of two in group 2. In group 1 (n = 30), MBI was performed using the open-mouth technique, and in group 2 (n = 30), MBI was performed using the closed-mouth technique.Five minutes after injection, electric pulp testing was performed. For a negative response, patients were asked to rate their level of discomfort using the VAS. The palatal root length was measured after opening the access point using an apex locator. The groups were evaluated for patient discomfort using VAS. Results: Results were analyzed using the Wilcoxon signed-rank test and Mann–Whitney test. A comparison of MBI between the open- and closed-mouth techniques showed that the closed-mouth technique had significantly better efficacy than the open-mouth technique when the palatal root length was greater than 19 mm (P < 0.05). Conclusion Within the limitations of the study, when the palatal root length was greater than 19 mm, the closed-mouth technique resulted in less patient discomfort, improved visibility, and better needle penetration.

Introduction: Despite recent advances, management of distal tibial fractures is challenging, with high rate of complications. Fibula pro tibia plating technique fixes fibula and tibia together, via laterally placed fibular plate without disturbing the tibial soft tissue sleeve. We contemplated this pilot study to assess effectiveness of fibula pro tibia plating in management of distal tibia fibula fractures. Materials and methods: A total of 30 patients with distal tibia fibula fractures with fracture line extending within 5cm from tibial plafond were managed with fibula pro tibia plating, with or without minimal articular fixation. Outcome evaluation was done by union, union time, alignment and functional outcome as assessed by AOFAS score. Results: Mean age in the series was 39.4 years with male to female ratio of 3:2. Mean duration of surgery, blood loss and C arm exposure were 79 minutes (range 52 to 98min), 80ml (range 62 to 102ml) and 48 shoots (range 36 to 81 shoots), respectively. All fractures united in mean union time of 10.2 weeks (range 9 to 14 weeks) with acceptable alignment in all the patients except one. Mean AOFAS score was 86.3 (range 70 to 93) with 29 patients having good to excellent outcome. One patient had varus malunion and in one case infection was seen. Conclusion: Fibula pro tibia plating can be successfully used to manage complex distal tibia fractures which leaves the soft tissue and periosteal sleeve undisturbed, thus avoiding wound related problems and leading to early union.

Background: Maxillary molars are commonly anesthetized via buccal infiltration. A patient’s mouth opening during maxillary buccal infiltration can influence dental treatment. Hence, this study aimed to evaluate and compare the influence of palatal root length on the efficacy of 2% lidocaine in 1:80000 adrenaline for maxillary buccal infiltration (MBI) between the open- and closed-mouth techniques. Methods: Sixty patients were selected based on inclusion and exclusion criteria. The intensity of pre-operative pain was measured using a visual analog scale (VAS). Samples were randomly divided using the chit method, with odd numbers in group 1 and multiples of two in group 2. In group 1 (n = 30), MBI was performed using the open-mouth technique, and in group 2 (n = 30), MBI was performed using the closed-mouth technique.Five minutes after injection, electric pulp testing was performed. For a negative response, patients were asked to rate their level of discomfort using the VAS. The palatal root length was measured after opening the access point using an apex locator. The groups were evaluated for patient discomfort using VAS. Results: Results were analyzed using the Wilcoxon signed-rank test and Mann–Whitney test. A comparison of MBI between the open- and closed-mouth techniques showed that the closed-mouth technique had significantly better efficacy than the open-mouth technique when the palatal root length was greater than 19 mm (P < 0.05). Conclusion Within the limitations of the study, when the palatal root length was greater than 19 mm, the closed-mouth technique resulted in less patient discomfort, improved visibility, and better needle penetration.

Background: Maxillary molars are commonly anesthetized via buccal infiltration. A patient’s mouth opening during maxillary buccal infiltration can influence dental treatment. Hence, this study aimed to evaluate and compare the influence of palatal root length on the efficacy of 2% lidocaine in 1:80000 adrenaline for maxillary buccal infiltration (MBI) between the open- and closed-mouth techniques. Methods: Sixty patients were selected based on inclusion and exclusion criteria. The intensity of pre-operative pain was measured using a visual analog scale (VAS). Samples were randomly divided using the chit method, with odd numbers in group 1 and multiples of two in group 2. In group 1 (n = 30), MBI was performed using the open-mouth technique, and in group 2 (n = 30), MBI was performed using the closed-mouth technique.Five minutes after injection, electric pulp testing was performed. For a negative response, patients were asked to rate their level of discomfort using the VAS. The palatal root length was measured after opening the access point using an apex locator. The groups were evaluated for patient discomfort using VAS. Results: Results were analyzed using the Wilcoxon signed-rank test and Mann–Whitney test. A comparison of MBI between the open- and closed-mouth techniques showed that the closed-mouth technique had significantly better efficacy than the open-mouth technique when the palatal root length was greater than 19 mm (P < 0.05). Conclusion Within the limitations of the study, when the palatal root length was greater than 19 mm, the closed-mouth technique resulted in less patient discomfort, improved visibility, and better needle penetration.

Introduction: The objective of the current study was to test our hypothesis that older patients sustaining high energy trauma need to be evaluated for their comorbidities similar to geriatric patients sustaining low energy trauma. Materials and methods: This study was a retrospectiveprospective analysis of 173 patients of more than 50 years of age enrolled between November 2017 and December 2018. Herewith, we have compared retrospectively collected laboratory investigations of 124 fragility fracture patients with prospectively collected laboratory investigations of 49 patients with high energy trauma. The laboratory investigations, including the liver function tests, renal function tests, indices of calcium metabolism, serum electrolytes, complete blood counts, and bone mineral density (BMD) scores. Results: Both groups were similar to each other as far as baseline demographic characteristics were concerned. The proportion of female patients and patients with nonosteoporotic range BMD (T-score >-2.5) was significantly higher in the high-energy fracture group (P value <0.05). Hypoalbuminemia (<3.4gm/dl) 17.3%, abnormalities sodium (<135mmol/L or >148mmol/L) 23.2%, Anaemia (<10g/dl) 12.7%, Hypercalcemia (>10.4mg/dl) 16.3%, Vitamin D deficiency (<20ng/ml) 17.3% are the common laboratory abnormality found in study population. No statistically significant difference was found among the two groups in terms of laboratory investigation abnormalities. Conclusion: The laboratory investigation abnormality in an older patient with a clinical fracture is independent of the mechanism of injury. The results of the current study emphasise the need for a comprehensive laboratory workup in older patients with either high- energy fractures or fragility fractures.

Background/Aims: Evidence on predictors of primary nonresponse (PNR), and secondary loss of response (SLR) to anti-tumor necrosis factor (anti-TNF) agents in inflammatory bowel disease is scarce from Asia. We evaluated clinical/biochemical/molecular markers of PNR/SLR in ulcerative colitis (UC) and Crohn’s disease (CD). Methods: Inflammatory bowel disease patients treated with anti-TNF agents (January 2005–October 2020) were ambispectively included. Data concerning clinical and biochemical predictors was retrieved from a prospectively maintained database. Immunohistochemistry for expression of oncostatin M (OSM), OSM receptor (OSM-R), and interleukin-7 receptor (IL-7R) were done on pre anti-TNF initiation mucosal biopsies. Results: One-hundred eighty-six patients (118 CD, 68 UC: mean age, 34.1±13.7 years; median disease duration at anti-TNF initiation, 60 months; interquartile range, 28–100.5 months) were included. PNR was seen in 17% and 26.5% and SLR in 47% and 28% CD and UC patients, respectively. In CD, predictors of PNR were low albumin (P<0.001), postoperative recurrence (P=0.001) and high IL-7R expression (P<0.027) on univariate; and low albumin alone (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.03–0.28; P<0.001) on multivariate analysis respectively. Low albumin (HR, 0.31; 95% CI, 0.15–0.62; P=0.001) also predicted SLR. In UC, predictors of PNR were low albumin (P<0.001), and high C-reactive protein (P<0.001), OSM (P<0.04) and OSM-R (P=0.07) stromal expression on univariate; and low albumin alone (HR, 0.11; 95% CI, 0.03–0.39; P=0.001) on multivariate analysis respectively. Conclusions Low serum albumin at baseline significantly predicted PNR in UC and PNR/SLR in CD patients. Mucosal markers of PNR were high stromal OSM/OSM-R in UC and high IL-7R in CD patients.

Background: Nonhuman primates are used for research purposes such as studying diseases and drug discovery and development programs. Various clinical pathology parameters are used as biomarkers of disease conditions in biomedical research. Detailed reports of these parameters are not available for Indian-origin rhesus macaques. To meet the increasing need for information, we conducted this study on 121 adult Indian rhesus macaques (57 wild-sourced and 64 inhouse animals, aged 3–7 years). A total of 18 hematology and 18 biochemistry parameters were evaluated and reported in this study. Data from these parameters were statistically evaluated for significance amongst inhouse and wild-born animals and for differences amongst sexes. The reference range was calculated according to C28-A3 guidelines for reporting reference intervals of clinical laboratory parameters. Results: Source of the animals and sex appeared to have statistically significant effects on reference values and range. Wild-born animals reported higher WBC, platelets, neutrophils, RBC, hemoglobin, HCT, MCV, and total protein values in comparison to inhouse monkeys. Sex-based differences were observed for parameters such as RBCs, hemoglobin, HCT, creatinine, calcium, phosphorus, albumin, and total protein amongst others. Conclusions Through this study, we have established a comprehensive data set of reference values and intervals for certain hematological and biochemical parameters which will help researchers in planning, conducting, and interpreting various aspects of biomedical research employing Indian-origin rhesus monkeys.

Self-expanding metal stents play a crucial role in the management of patients with biliary obstruction. Endoscopic extraction of uncovered metal stents (UCMSs) and partially covered metal stents (PCMSs) could be challenging because of tissue ingrowth. No standardized technique can guarantee universal success. We present our technique and experience of endoscopic extraction of biliary stents in two patients with a UCMS and three patients with a PCMS. Three of the five patients had a previous failed attempt of stent extraction at an outside hospital. Overall, our composite success rate was 80% (4/5). The individual success rate was 100% (3/3) for PCMSs and 50% (1/2) for UCMSs. The stent-in-stent technique, in which a fully covered metal stent is placed through an existing UCMS/PCMS, was used in 60% (3/5) of the cases, with a success rate of 66.7% (2/3). We share our algorithmic approach to each case, with detailed emphasis on the technical aspects of the procedure.

Self-expanding metal stents play a crucial role in the management of patients with biliary obstruction. Endoscopic extraction of uncovered metal stents (UCMSs) and partially covered metal stents (PCMSs) could be challenging because of tissue ingrowth. No standardized technique can guarantee universal success. We present our technique and experience of endoscopic extraction of biliary stents in two patients with a UCMS and three patients with a PCMS. Three of the five patients had a previous failed attempt of stent extraction at an outside hospital. Overall, our composite success rate was 80% (4/5). The individual success rate was 100% (3/3) for PCMSs and 50% (1/2) for UCMSs. The stent-in-stent technique, in which a fully covered metal stent is placed through an existing UCMS/PCMS, was used in 60% (3/5) of the cases, with a success rate of 66.7% (2/3). We share our algorithmic approach to each case, with detailed emphasis on the technical aspects of the procedure.