Study of anatomical variations of mental foramen in dry adult human mandible

Background: Mandible also known as the largest and inferior, primary facial bone of the face giving a curved shape to it. It changes its shape and gives variations to the bony structure of the face from birth till older age. Mental foramen is known as the ventage of the mandible and is an important mark of the face for carrying out many diagnostics and surgical processes along with anesthetic procedures of the face. Thus, the present study is designed with an aim to get insight knowledge of position and shape of mental foramen in dry adult human mandible.Methods: Totally, 60 bones were studied in 2 years duration. The study was carried out in the Department of Anatomy of Geetanjali Medical College and Hospital and Rabindranath Medical College. The position of mental foramen was studied using an instrument known as digital Vernier Calliper (in mm) while shape was analyzed visually. Position of mental foramen was calculated using Statistical package for social sciences (SPSS) software.Results: The present study showed that the position of mental foramen from symphysis menti and posterior border of ramus of mandible was more from right side than left side and found to be insignificant while position of mental foramen from inferior border of body of mandible was more from left side than right side and found to be insignificant for right side while significant for left side. The shape of mental foramen from right side was found to be (Oval shape- 68.33% and round shape – 31.66%) while for left side was found to be (Oval shape- 71.66% and round shape – 28.33%).Conclusions: Hence, mental foramen plays a pivotal role in performing major facial surgeries and is an important landmark for several facial procedures performed.

Indications for Caesarean Section and its Fetal and Maternal Outcome in a Teaching Hospital, Province Five, Nepal

Introduction: Cesarean section (CS) is an operative technique by which a fetus is delivered through an abdominal and uterine incision and is effective in saving maternal and infant lives but caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates. The objective of the study was to find out the indications for caesarean section and its fetal and maternal outcomes in a Teaching Hospital, Province Five, Nepal. Methods: A descriptive, cross-sectional study was conducted in a teaching hospital, Nepal. A total of 150 purposively selected postnatal mothers after caesarean section were interviewed by face to face technique using a structured interview schedule. Analysis and interpretation of the findings were done with the help of descriptive and inferential statistics. Results: The study showed that the majority (93.3%) of mothers had undergone an emergency caesarean section and the majority (92%) had maternal indications for caesarean section. Among them, one third had previous caesarean section followed by 14.5% obstructed labour. Fetal indications include breach (44.4%), fetal distress (29.6%), big baby (11.1) and twins and triplets (3.7%). Only (10.7%) had an unfavorable fetal outcome which includes the need for Neonatal Intensive Care Unit (NICU) (31.2%) followed by neonatal death (25%). Only three mothers (2%) had unfavorable maternal outcome which includes Post-Partum Hemorrhage (PPH); need for blood transfusion and fever respectively. There was no statistically significant association between socio demographic characteristics and type of caesarean section. There was statistically significant association between the previous history of caesarean section and type of caesarean section (P= .005). Conclusions: Previous caesarean section was the most common indication for caesarean section. Unfavorable   outcome after caesarean section was considerably present which need to be addressed

A comparative study of effect on reducing pain, inflammation and side effect of combination of enzymes (bacterial proteases, papain, bromelain, vitamin C and rutin) versus conventional non-steroidal anti-inflammatory drugs (diclofenac) in patients of closed fracture lower end radius coming at orthopaedic department of a tertiary care hospital

Background: Diclofenac and oral systemic enzymes both are commonly used for control of pain and inflammation in fracture lower end radius as well as other such conditions. Some studies have shown that combination of enzymes like bacterial proteases, papain, bromelain, vitamin C and rutin can reduce pain and Inflammation which is comparable to diclofenac but it still not definite.Methods: Total 50 patients with closed fracture lower end radius were enrolled and randomly divided in to two groups. Group-1 with 25 patients received oral diclofenac and group-2 with 25 patients received oral preparation which contains combination of enzymes bacterial proteases, papain, bromelain, vittamin C and rutin. Effect of drug was assessed by improvement in wrist function which was evaluated by patient rated wrist evolution (PRWE) and reduction in oedema on day 1, day 3 and day 5. Both the groups were compared by unpaired Z test.Results: Mean reduction in PRWE score was 132.08±5.01 in Group 1 and 104.4±11.78 in group 2. Mean of percentage reduction of oedema for group 1 was 8.22 while for group 2 it was 17.8. Both were statistically significant (p<0.05). Total 5 patients out of 25 complained of gastritis in group 1 patients while there was no side effect reported in group 2 patients.Conclusions: Diclofenac was better in reducing pain, while combination of enzymes used in the study was better in reducing oedema. Combination of the enzymes used in this study is safer than diclofenac in cases of the closed fracture lower end radius

Analytical evaluation of drug package inserts in India

Background: A drug package insert or prescribing information is a document provided along with a prescription medication to provide additional information about that drug. Drug package inserts are approved by the administrative licensing authority. A package insert is intended to provide information for the safe and effective use of the respective drug. Product information provided by pharmaceutical companies has been determined to be far from adequate and not conforming with requirement of Indian regulatory. Hence, it was decided to conduct a study to assess the presentation and completeness of clinically important information provided in the currently available package inserts in India.Methods: Package inserts were provided by five pharmacies on request. The package inserts were collected in 10 weeks’ period and then they were analyzed for presentation and completeness of clinical information according to heading mentioned in Section 6.2 and 6.3 of schedule D of Drug and Cosmetic Rule, 1945. If the information was present under relevant heading, it was scored as one. Otherwise as score of zero was assigned. Total score for each heading was calculated by adding the score from the individual package inserts.Results: 70 package inserts were included in the study. None of the reviewed package inserts contained all the sections as required by the Drugs and Cosmetics Act. Total 15 headings were evaluated under both Section 6.2 and 6.3, highest value for the presence of heading were 12 out of 15 heading evaluated. That shows the best value of compliance was 80%.Conclusion: Accurate drug product information is important for the safe and effective use of medicines. Hence, pharmaceutical companies and regulators should ensure that accurate and up to date product information is provided in the package inserts

Effects of Extrusion Cooking Over Roasting on Retention of Nutritional Quality of Composite Flour Prepared From Soyabean, Millet, Corn and Rice Blend

The objective of this study was to compare the effects of extrusion cooking and roasting on the nutritional composition of the blend obtained from rice, soybean, millet and corn flours. Two different flour compositions with different proportions of ingredients were prepared. Roasting process was conducted at 160°C for a duration of 30 minutes, whereas extrusion cooking was performed at 129°C for approximately 5 minutes. Chemical analysis was carried out on all four samples. The findings revealed that the moisture and carbohydrate content in the extrusion-cooked samples (A and B) were higher than in the roasted samples (A’ and B’). In contrast, crude fat content, crude fiber content, and ash contents were higher in roasted samples (A’ and B’) compared to extrusion-cooked samples (A and B). The protein content of samples A, A’, B and B’ was found to be 10.67%, 8.47%, 14.64% and 9.18%, respectively. This proven protein content is higher in extruded composite flours (A and B). Additionally, calcium and iron contents were higher in the roasted samples, with sample B’ having the highest calcium and iron contents. Tannin content and phytic acid content was also higher in the roasted samples, with sample B’ having the highest tannin and phytic acid content. In conclusion, extrusion cooking increased nutritional content while reducing anti-nutritional components in the composite flour, suggesting its potential as a preferred processing method to maintain nutritional quality

Evaluation of antioxidant and neuroprotective effect of Ocimum sanctum on transient cerebral ischemia and long-term cerebral hypoperfusion

Free radicals are implicated in causation of cerebral reperfusion injury and chronic cerebral hypoperfusion in rats is associated with functional and histopathological disturbances. Ocimum sanctum (OS), a plant widely used in Ayurveda, has been shown to possess anti-inflammatory, antioxidant and cognition-enhancing properties. In the present study, we investigated the effect of methanolic extract of OS leaves in cerebral reperfusion injury as well as long-term hypoperfusion. Occlusion of bilateral common carotid arteries (BCCA) for 30 min followed by 45 min reperfusion caused increase in lipid peroxidation and up-regulation of superoxide dismutase (SOD) activity accompanied by fall in tissue total sulfhydryl groups (TSH) in rat forebrains. Ascorbic acid levels were unchanged, however. OS pretreatment (200 mg/kg/day for 7 days) prevented this reperfusion-induced rise in lipid peroxidation and SOD activity. OS pretreatment also stabilized the levels of TSH during reperfusion. Long-term cerebral hypoperfusion (a model of cerebrovascular insufficiency and dementia) induced by permanent occlusion of BCCA for 15 days demonstrated altered exploratory behavior in open-field testing and memory deficits as tested by Morris' water maze. Histopathological examination of hypoperfused animals revealed reactive changes, like cellular edema, gliosis and perivascular inflammatory infiltrate. OS treatment (200 mg/kg/day for 15 days) significantly prevented these hypoperfusion-induced functional and structural disturbances. The results suggest that OS may be useful in treatment of cerebral reperfusion injury and cerebrovascular insufficiency states

Nimodipine attenuates biochemical, behavioral and histopathological alterations induced by acute transient and long-term bilateral common carotid occlusion in rats

Restoration of blood flow to an ischemic brain region is associated with generation of reactive oxygen species with consequent reperfusion injury. Chronic cerebral hypoperfusion induced by permanent occlusion of bilateral common carotid arteries in rats is associated with behavioral and histopathological alterations. Nimodipine, a dihydropyridine calcium channel antagonist, has potent vasodilatory effect on cerebral vessels and increases cerebral blood flow. We analyzed whether nimodipine reduces injury caused by transient forebrain ischemia and long-term cerebral hypoperfusion. Bilateral common carotid occlusion for 30 min followed by 45 min reperfusion resulted in a two-fold increase in lipid peroxidation and superoxide dismutase activity. Nimodipine pretreatment (4 mg/kg, i.p.) brought down these levels by 30 and 23%, respectively. Long-term cerebral hypoperfusion in rats caused a propensity towards anxiety and listlessness (open field paradigm) accompanied by deficits of learning and memory (Morris’ water maze testing). Additionally, histopathological observation in hypoperfused brains revealed reactive changes in the form of perivascular inflammation, gliosis and astrocytosis. Nimodipine treatment significantly alleviated these changes in behavioral and histopathological parameters. Our data confirm the protective role of nimodipine in ischemia reperfusion injury. Moreover, it suggests the beneficial role of nimodipine in cerebrovascular insufficiency states and dementia

Neuroprotective effect of Azadirachta indica on cerebral post-ischemic reperfusion and hypoperfusion in rats

We assessed the effect of Azadirachta indica ( A. indica), a plant that has been reported to possess antioxidant, anti-inflammatory and anxiolytic properties, on cerebral reperfusion injury and long term cerebral hypoperfusion. When blood flow to brain region that has undergone critical period of ischemia is re-established, additional injury is to be expected from the reperfusion. In the present study, bilateral common carotid artery (BCCA) occlusion for 30 min followed by 45 min reperfusion resulted in increase in lipid peroxidation, superoxide dismutase (SOD) activity and fall in total tissue sulfhydryl (T-SH) groups. A. indica pretreatment (500 mg/kg/day × 7 days) attenuated the reperfusion induced enhanced lipid peroxidation, SOD activity and prevented fall in T-SH groups. Moreover, A.indica per se increased brain ascorbic acid level, which was unchanged during reperfusion insult. Long-term cerebral hypoperfusion induced by permanent BCCA occlusion has been reported to cause behavioral and histopathological abnormalities. In the present study, as tested by open field paradigm and Morris' water maze, a propensity towards anxiety and disturbances of learning/memory were observed in animals subjected to hypoperfusion for 2 weeks. A. indica (500 mg/kg/day × 15 days) significantly reduced these hypoperfusion induced functional disturbances. Reactive changes in brain histology like gliosis, perivascular lymphocytic infiltration, recruitment of macrophages and cellular edema following long term hypoperfusion were also attenuated effectively by A. indica. We conclude that our study provides an experimental evidence for possible neuroprotective potentiality of A. indica

To study the utility of COX-2 as immunohistochemical prognostic marker in comparison to various histopathological parameters and TNM staging in breast carcinoma: an observational, cross-sectional study protocol [version 2; peer review: 2 approved]

Background Breast cancer is the most prevalent cancer among women worldwide and is a well-known cause for cancer mortality in females. COX-2 (cyclooxygenase) plays a vital role in development of some human cancers such as lung, colon and breast. It is a potent enzyme that is important for the conversion of arachidonic acid into prostaglandins. These prostaglandins mediate cellular proliferation, apoptosis and angiogenesis which contributes to carcinogenesis. Overexpression of COX-2 has been detected in several malignancies including breast cancer. COX-2 overexpression is regarded as a poor prognostic marker of breast cancer. The present study will aim to study the immunohistochemical expression of COX-2 in breast cancer and compare it with known histopathological parameters thus assessing its prognostic value. Methods This will be an observational study conducted in the Department of Pathology, JNMC, Wardha (Sawangi). Radical mastectomy specimens will be studied for COX-2 expression by immunohistochemistry in patients diagnosed with breast carcinoma. COX-2 expression will be quantified as immunohistochemical score and results will be correlated with various histopathological parameters. Results The expected result of our study will suggest an association of COX-2 expression to the factors associated with poor prognosis in breast carcinoma. A positive correlation is expected between larger tumor size, positive lymph node status, higher T stage and N stage and lymphovascular invasion. Conclusions Conclusions will be drawn from the obtained results of the immunohistochemical study by using COX-2- for detection of overexpression of COX-2 when evaluated with TNM staging, histological grading and molecular types of breast cancer

Comparison of Cytokeratin Expression Vis-à-Vis Bloom–Richardson Grading of Breast Carcinoma in Resource-limited Setup: A Cross-sectional Study

Background: Breast cancer is the most common malignant tumor and the leading cause of female mortality. Its incidence and prevalence are rapidly increasing worldwide. Age <35 years, multiple nodal involvements, ad increased size and grade are the bad prognostic factors indicating a higher risk of recurrence. Early diagnosis of breast cancer is one of the best approaches to prevent this disease. Aim: The aim of this study is to develop an understanding of the relationship between cytokeratin (CK) 5/6 and CK 8/18 expression and the Bloom–Richardson (BR) grading of carcinoma breast. Materials and Methods: The present observational, analytical, and cross-sectional study investigated CK 5/6 and CK 8/18 expression in relation to the BR grade in 50 cases of infiltrating ductal carcinoma. Hematoxylin and eosin staining for BR grade and immunohistochemistry for CK 5/6 and CK 8/18 was carried out in the histopathology and immunohistochemistry sections of the Department of Pathology, Jawaharlal Nehru Medical College, Sawangi (M). Results: Out of 50 cases, CK 5/6 expression was observed in the majority of BR Grade III cases (87.50%) indicating a basal phenotype, and CK 8/18 expression was seen in the majority of BR Grade I cases (92.86%) signifying a luminal phenotype. The P value interpretation was found to be statistically significant (<0.05). Conclusions: CKs along with BR grading can be used as an alternative tool for predicting the endocrine status of carcinoma breast instead of employing an expensive panel of markers