Multiple Interneural Communications of Brachial Plexus - Anatomical Description and Clinical Significance

Brachial plexus blockade requires efficient and thorough understanding of the detailed anatomy of the plexus and the variations associated with the plexus. Anomalies associated with the branches of the plexus may complicate attempts of nerve blockade for anesthesia. The present case report presents an unusual variation of brachial plexus noticed during routine cadaveric dissection. A rare neural communication between ulnar and radial nerves was observed in the left axilla at high humeral level proximal to the entry of the radial nerve into the radial groove. The communicating ramus also gave a branch to the medial head of triceps brachii 0.3 cm distal to the origin of the communication. Further, there was also a communication between the musculocutaneous and median nerves in the distal half of the arm after the musculocutaneous nerve pierced the coracobrachialis muscle.Though the variations of the brachial plexus have been described in the literature, yet studies regarding the communication between ulnar and radial nerves are rare and the coexistence of this variation along with median and musculocutaneous nerve communication is unique. Knowledge of such rare variations and anomalies is important to minimize the possible complications of regional anesthesia and surgery. Such an unusual variation, as noted in the present study, may prove useful in nerve grafting and neurophysiological evaluation to diagnose peripheral neuropathies. Further, their knowledge is of immense importance in traumatology of the shoulder joint, radial neck dissections and management of fracture of the surgical neck of humerus. Anatomic variations of peripheral nerves are important for Orthopedic surgeons, Neurophysicians, Physiotherapists and Radiologists. The present article is a humble attempt to reinforce awareness of such neural variations among clinicians

Dental caries in primary and permanent teeth in children's worldwide, 1995 to 2019: a systematic review and meta-analysis

Background: Early childhood caries (ECC) is a type of dental caries in the teeth of infants and children that is represented as one of the most prevalent dental problems in this period. Various studies have reported different types of prevalence of dental caries in primary and permanent teeth in children worldwide. However, there has been no comprehensive study to summarize the results of these studies in general, so this study aimed to determine the prevalence of dental caries in primary and permanent teeth in children in different continents of the world during a systematic review and meta-analysis. Methods: In this review study, articles were extracted by searching in the national and international databases of SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (ISI) between 1995 and December 2019. Random effects model was used for analysis and heterogeneity of studies was evaluated by using the I2 index. Data were analyzed by using the Comprehensive Meta-Analysis (Version 2) software. Findings: In this study, a total of 164 articles (81 articles on the prevalence of dental caries in primary teeth and 83 articles on the prevalence of dental caries in permanent teeth) were entered the meta-analysis. The prevalence of dental caries in primary teeth in children in the world with a sample size of 80,405 was 46.2% (95% CI: 41.6–50.8%), and the prevalence of dental caries in permanent teeth in children in the world with a sample size of 1,454,871 was 53.8% (95% CI: 50–57.5%). Regarding the heterogeneity on the basis of meta-regression analysis, there was a significant difference in the prevalence of dental caries in primary and permanent teeth in children in different continents of the world. With increasing the sample size and the year of study, dental caries in primary teeth increased and in permanent teeth decreased. Conclusion: The results of this study showed that the prevalence of primary and permanent dental caries in children in the world was found to be high. Therefore, appropriate strategies should be implemented to improve the aforementioned situation and to troubleshoot and monitor at all levels by providing feedback to hospitals

Herpes Simplex Encephalitis

A twenty five year old female patient presented with bilateral grouped vesicular lesions with altered sensorium. It was diagnosed as herpes simplex encephalitis (type II

Isolation and characterization of proteins involved in cryoprotection from cold resistant mutants of <i style="">Pseudomonas fluorescens </i>ATCC13525

378-381The proteins isolated from cold resistant mutants of Pseudomonas fluorescens ATCC13525 were biologically characterized. These proteins, designated as CRP-1 (41.6 kDa, from CRPF9) and CRP-2 (14.1 kDa, from CRPF8), were able to protect freeze-labile alkaline phosphatase (ALP) against freeze denaturation up to approximately 84% activity. Addition of BSA could not yield similar cryoprotection of ALP. However, 60% loss of enzymatic activity was recorded in absence of the proteins. Furthermore, the two proteins in combination protected the enzyme activity up to 86%. The freeze-thaw challenge given to the mutants and wild type cells revealed the mutant to be more resistant to freezing (-20°C). The survival percentage of the mutant cells after repeated freeze thaw was significantly higher (55.6%) than wild type (9.8%). Nevertheless, incubation at 10°C, prior to freezing (-20°C) resulted in a further increase in survival percentage of mutant cells (79.6%). The proteins isolated from these mutants possessed the cryoprotective ability, which could be correlated with increased freezing resistance of the mutants at low temperature

Lower genital tract infections in HIV-seropositive women in India

Objectives: The presence of STD facilitates shedding of HIV and increases HIV-1 disease progression, possibly by increasing plasma viremia. Our aim was to study the presence of various associated Sexually transmitted disease/Reproductory tract infections in HIV-seropositive women in India. Materials and Methods: The study included 40 HIV-seropositive women attending the antiretroviral therapy (ART) clinic at Lok Nayak Hospital. An informed consent was taken from all subjects. All cases were subjected to detailed gynecological examination and two types of swabs, i.e., a vaginal swab and a cervical swab were taken for STD/RTIs evaluation. The vaginal swabs were used for preparation of wet mount and KOH mount for diagnosis of trichomoniasis and candidiasis; to make a vaginal smear for Gram staining to diagnose bacterial vaginosis (BV) as per Nugent′s criteria; for culture of aerobic bacteria and Candida spp. The cervical swab was used for isolation of Neisseria gonorrhoeae by culture and for detection of Chlamydia trachomatis antigen by Chlamydia microplate enzyme immunoassay kit (BIORAD). All data were analyzed using appropriate statistical tests. Results: All 40 cases were evaluated for the presence of STD/RTIs associated with HIV infection. The women belonged to the reproductive age group (15-45 years) and majority (40%) of them were para 2. Most of the women (14 , 35%) were in World Health Organization (WHO) stage I and maximum number (28, 70%) had their CD4 cell count more than 200 cells/ml. There was no significant correlation between WHO stage of HIV-seropositive women and their CD4 cell count (P=0.092). Out of 40 cases, 15 (37.5%) were on ART with maximum cases (53.3%) in WHO stage III. The duration of ART was more than 6 months in 9 (60%) cases. The most common presenting complaint was vaginal discharge in women with WHO stage II and III and 27.5% women showed vaginitis on per speculum examination. Laboratory tests showed high prevalence of BV (30%), mixed infection (30%), and candidiasis (10%) among HIV-seropositive women (P<0.001 in both). Women with BV were mostly in WHO stage I (38.4%) and stage II (36.3%), while those with mixed infection were mainly in WHO stage III (36.3%) and stage IV (40%).Women with candidiasis were mainly in WHO stage III. C. trachomatis antigen was found only in one subject (prevalence 2.5%). Both WHO stage and CD4 cell count had no significant correlation with presence of BV (P=0.056 and 0.063, respectively) and candidiasis (P=0.492 and 0.530, respectively). Maximum number of patients on ART had mixed infection (53.3%), while most of the patients (36%) not on ART had BV. There was no significant association between duration of ART and the presence of vaginal infections. Conclusions: The prevalence of gynecological symptoms and RTIs in HIV-seropositive women is high enough to warrant routine gynecologic evaluation and RTI screening in these patients. However, larger studies and trials are needed to evaluate the effects of ART on these abnormalities as well as to choose the best screening tool in HIV-seropositive women

Orthogonally blocked mixture designs for Darroch and Waller model

Singh (2003) gave conditions and constructed optimal orthogonally blocked designs for Darroch and Waller quadratic model. Aggarwal et al. (2008) constructed optimal orthogonally blocked designs based on F-squares for Darroch and Waller quadratic model. Prescott (2000, 2004) has used augmented pair designs for the projection of response surface designs onto mixture space and obtained orthogonally blocked designs. In this paper, we have used definitive screening designs given by Jones and Nachtsheim (2011), Xiao et al. (2012), Nguyen and Stylianou (2012) and Phoa and Lin (2013) and obtained designs for mixture experiments. These designs are space filling designs as compared to the traditional designs. This paper explores the fitting of Darroch and Waller quadratic model to these mixture designs and compares them on the basis of uniformity and D-, A- and G- efficiency. These designs can also be orthogonally blocked