Discriminant analysis – simplified

Background: Discriminant function analysis is the statistical analysis used to analyze data when the dependent variable or outcome is categorical and independent variable or predictor variable is parametric. Discriminant function analysis is used to find out the accuracy of a given classification system or predictor variable in predicting the sample into a particular group. Discriminant function analysis includes the development of discriminant functions for each sample and deriving a cutoff score. The cutoff score is used for classifying the samples into different groups. Aim: The aim of this review article is to simplify and explain the discriminant function analysis so that it can be used by medical and dental researchers whenever it is applicable. Conclusion: Discriminant function analysis is a statistical analysis used to find out the accuracy of a given classification system or predictor variables. This paper explains the basics of discriminant analysis and how to interpret the results along with one simple example of mandibular canine index for gender identification. Clinical significance: Whenever a new classification system is introduced or any predictor variable is identified, discriminant function analysis can be used to find out the accuracy with which the classification system or predictor variable can differentiate a sample into different groups. Thus, it is a very useful tool in dental and medical research

Overview of platelet-rich plasma: Orthodontics perspective

Background: Platelet-rich plasma (PRP) is an autologous concentration of human platelets in a small volume of plasma. It comprised several fundamental growth factors which actively work for the initiation of the wound healing process of both soft and hard tissues. PRP in dentistry is in use since 1998 for many reasons, one of which is the orthodontic tooth movement. Many studies have been performed to check the role of PRP in orthodontic tooth movement and most of them found it is an effective method with fewer drawbacks compared to other methods. Aim: This article aims to highlight the effects of PRP in orthodontic tooth movement. Conclusion: PRP is an effective and simplest method to accelerate orthodontic tooth movement. Clinical significance: It can be used to reduce the time for treatment by incorporating it into our routine treatment practice

Examination of the relation of localization of placenta at 18-24 weeks of gestation by ultrasonography with the development of preeclampsia later in pregnancy

Background: The aim of the study was to examine the relation of localization of placenta at 18-24 weeks of gestation by ultrasonography with the development of preeclampsia later in pregnancy.Methods: Hospital based Prospective observational Cohort study at department of Obstetrics and Gynecology, Dr. BSA Hospital Delhi. 150 pregnant women of gestational age18-24 weeks attending ANC clinic were enrolled for ultrasound examination and on the basis of ultrasonography (USG) findings placenta was classified as Group-A (patient found to have laterally located placenta). And Group-B (patients found to have centrally located placenta). All women in both the group were followed up regularly till term. Study duration was 1 year, June 2017-June 2018.Results: The overall risk of developing Preeclampsia with a late rally located placenta was 8.5(odds ratio) with 95% confidence interval (4.0339 to17.9108). This difference was highly statistically significant (p<.0001). Placental laterality has a sensitivity of 77.27%, beside that it has a good specificity of 71.43% and negative predictive value of 80%. Lateral localization of placenta by ultrasonography at mid trimester can be used as a screening test. The presence of urine albumin in group A was found in 70.67% as compared to 13.33% in group B. This difference was statistically significant. (p=0.0001). Around 72% of total complications were seen in Group-A as compared to 28% in Group-B. This difference was found to be statistically significant (p=0.028).Conclusions: Significant correlation exists between placental laterality and the development of preeclampsia and thus placental localization by ultrasonography in midtrimester (at 18-24 weeks) can be used for prediction of development of preeclampsia later in pregnancy

DEVELOPMENT AND EVALUATION OF CHRONOMODULATED DELIVERY SYSTEM OF METOCLOPRAMIDE HYDROCHLORIDE

Objective: Metoclopramide hydrochloride (meto) is indicated in the treatment of diabetic gastro paresis. It is also used in the treatment of pregnancy-induced morning sickness. Present work involved the development of a chrono-modulated delivery system of meto, intended to be taken at bedtime which would elicit the therapeutic response early in the morning when needed the most to prevent the symptoms of diabetic gastro paresis and morning sickness. Methods: Immediate release tablets of meto were prepared and optimized for disintegration time and in vitro drug release. Subsequently, these tablets were compression coated using various ratios of glyceryl dibehenate and diluents. The resulting tablets were evaluated for disintegration time and in vitro drug release. Optimized formulation was subjected to accelerated stability studies for 3 mo. Results: The optimized immediate release tablets exhibited disintegration time of 2-3 min and more than 90% drug release within 30 min. These tablets when compression coated with the optimized ratio of glyceryl dibehenate and di-calcium phosphate could delay the disintegration time to 251 min. In vitro release study of the tablets showed the lag phase of 4 h after which there was a complete drug release within 1 h. Accelerated stability studies indicated good physical and chemical stability of the formulation. Conclusion: Chrono-modulated formulation of meto could delay the release of the drug by four h. This lag in the release is expected to modulate the time of therapeutic response of meto early in the morning at 6-7 h interval after the administration of dosage form at bedtime

Oxidized cellulose: an unusual cause of post hysterectomy hemorrhage

Haemostatic material made of oxidized cellulose is a bio-absorbable fabric used widely for intraoperative haemostasis and adhesion prevention in surgery. The knit mesh facilitates platelet adhesion and aggregation during surgery. However, rarely it may cause a foreign-body reaction, which is indistinguishable from abscess or granuloma formation. This report describes a case of a local tissue reaction due to oxidized regenerated cellulose followed by vault erosion and vaginal bleeding, mimicking pelvic sepsis post hysterectomy. The signs and symptoms resolved completely following removal of the oxidized cellulose fabric

Primary abdominal pregnancy causing diagnostic dilemma: a case report

The aim of the study was to present a case of primary abdominal pregnancy, a rare entity and highlighting the diagnostic dilemma and importance of surgical management. Primigravida with an amenorrhea of 35 days presented to the casualty with acute abdomen, with faintly positive UPT test and USG pelvis was suggestive of ill-defined hypoechoeic mass lesion in right sided adnexal region abutting right ovary. Intra-operatively, blood clots with products of conception were found adherent to anterior layer of right broad ligament. Uterus, both fallopian tubes and both ovaries found intact with normal morphology. On histopathology, no chorionic villi was found inside the lumen of the fallopian tube. Presence of occasional ghost chorionic villi embedded in blood clots, scattered cytotrophoblast and syncytiotrophoblasts also seen in the sample obtained from the anterior leaf of broad ligament. Primary abdominal pregnancy is not only rare but the diagnosis is also a challenge. It can be diagnosed conclusively after laparotomy. There are no symptoms which are pathognomonic for abdominal pregnancy. The symptoms are akin to other types of ectopic pregnancy, so a high index of suspicion is highly necessary for diagnosis. The keys to management are an early diagnosis and prompt surgery

Pharmacokinetic Consideration to Formulate Sustained Release Drugs: Understanding the Controlled Drug Diffusion through the Body Compartment of the Systemic Circulation and Tissue Medium-A Caputo Model

الهدف من هذه الدراسة هو تقديم لمحة عامة عن النماذج المختلفة لدراسة انتشار الدواء لفترة طويلة في جسم الإنسان وداخله. تم التأكيد على نماذج المقصورة الرياضية باستخدام نهج المشتقة الجزئية (نموذج كابوتو) للتحقيق في التغير في تركيز الدواء المستدام في أجزاء مختلفة من نظام جسم الإنسان من خلال الطريق الفموي أو الطريق الوريدي. و تم استخدام قانون العمل الجماعي ، وحركية الدرجة الأولى ، ومبدأ الإرواء لفيك لتطوير نماذج المقصورة الرياضية التي تمثل انتشارا مستداما للأدوية في جميع أنحاء جسم الإنسان. للتنبؤ بشكل كافٍ بانتشار الدواء المستمر في أجزاء مختلفة من جسم الإنسان، وضعنا في الاعتبار(نموذج كابوتو (للتحقيق في معدل تغير التركيز اعتمادًا على التغيير في ترتيب التمايز الجزئي في جميع الأجزاء الممكنة من الجسم، أي الدوران الجهازي وحجرات الأنسجة. أيضا ، تم تعيين قيمة معلمة عددية لمعدل تدفق الدواء في مقصورات مختلفة لتقدير تركيز الدواء. تم حساب النتائج وتصوير الأرقام باستخدام برنامج MATLAB (الإصدار R2020a). التأثيرات الرسومية الموضحة للتغير في معدل التركيز بافتراض قيم وسيطة مختلفة وفقا للمشتقة الكسرية (نموذج كابوتو ). التأثيرات الرسومية الموضحة للتغير في معدل التركيز بافتراض قيم وسيطة مختلفة وفقا للمشتقة الكسرية (نموذج كابوتو). يخلص التمثيل البياني الناتج إلى أنه بالنظر إلى ترتيب قيم المعادلات التفاضلية ، يختلف تركيز الدواء اعتمادا على معدل الثوابت في المقصورات المتعلقة بالوقت.   النظر في الحالة الأولية للتقدير التقريبي حيث يشير الجسم كحجرة كاملة، بعد تقسيم الجسم إلى مقصورتين نموذجيتين. في حين أن النموذج الأول يمثل المعدة والكبد والدم الجهازي ؛ والنموذج الثاني يأخذ في الاعتبار الدم الشرياني وأنسجة الكبد والدم الوريدي.The aim of this study is to provide an overview of various models to study drug diffusion for a sustained period into and within the human body. Emphasized the mathematical compartment models using fractional derivative (Caputo model) approach to investigate the change in sustained drug concentration in different compartments of the human body system through the oral route or the intravenous route. Law of mass action, first-order kinetics, and Fick's perfusion principle were used to develop mathematical compartment models representing sustained drug diffusion throughout the human body. To adequately predict the sustained drug diffusion into various compartments of the human body, consider fractional derivative (Caputo model) to investigate the rate of concentration changing depending upon the change in the order of fractional differentiation in all the possible compartments of the body, i.e., systemic circulation and tissue compartments. Also, assigned a numerical parameter value to the rate of drug flow in different compartments to estimate the drug concentration. Results were calculated and figures were depicted by using MATLAB software (version R2020a). Illustrated graphical effects of change in concentration rate by assuming various intermediate values according to the fractional derivative (Caputo model). The resultant graphical representation concludes that considering the order of the differential equation values, the drug concentration varies depending upon its rate of constants in compartments concerning time. Considering the initial case for rough estimation where the body is indicated as a whole compartment, following division of the body into two model compartments. Whereas, the model I represents stomach, liver, and systemic blood, and model II consider arterial blood, liver tissue, and venous blood

Acute intermittent porphyria and pregnancy: an obstetric challenge

Acute intermittent porphyria is a rare autosomal dominant disease caused by a mutation in the gene coding for the porphobillinogen deaminase enzymes in heam biosynthesis. The disease manifests as acute attacks of neuropsychiatric dysfunction and neurovisceral manifestations presenting as acute abdomen. In pregnancy, 54% patient has exacerbation of attacks in the form of seizures and acute abdomen occurs due to hormonal changes. Prevalence of acute intermittent porphyria is 1-2/200000 in general. Here we report a case of 36 year old women, G4P1L2A2 presenting at 10+4 weeks of gestation requesting pregnancy termination. Patient was diagnosed as case of acute intermittent porphyria with porphyic polyneuropathy 6 months back. At that time her main symptoms were acute pain abdomen with numbness and weakness in all four limbs. Her urinary porphobillinogen and 5 ALA raised. Her CECT of brain and nerve conduction studies were normal. Since then she is on Tablet Gabapentin 300 mg H.S. She underwent successful pregnancy termination by suction and evacuation under spinal anesthesia and she refused for copper-T insertion. Only safe drugs were used for procedure and she was discharged with advice of barrier contraception

Sirenomelia-the mermaid syndrome: a rare invariably fatal congenital anomaly in a term unsupervised pregnancy

Sirenomelia is a rare congenital anomaly with an incidence of 0.8 to 1 case per 1,00,000 births. The prognosis is grim due to associated genitourinary and gastrointestinal anomalies. Antenatal registration in the first trimester and timely ultrasound go a long way in detection of the anamoly when termination can be still be offered and the mental agony of giving birth to a term neonate with a fatal congenital anomaly can be avoided.