Validity of subjective assessment as screening tool for dry eye disease and its association with clinical tests

AIM: To determine the role of subjective assessment using Mc Monnies dry eye questionnaire in diagnosing dry eye disease and its association with clinical tests.METHODS: There were 500 patients screened for dry eye using Mc Monnies dry eye questionnaire between May to October 2013 at the outpatient Department of Ophthalmology of a medical college hospital. All 500 patients were subjected to clinical tests. Dry eye was defined as having one or more symptoms often or all the time. Positive signs were if one or both eyes revealed tear film breakup time(TBUT) of ≤10s, a Schirmer test score of ≤10 mm, a Rose Bengal staining score of ≥1, a Lissamine green staining score of ≥1 or existence of meibomian gland disease(≥grade 1). Statistical analysis was performed to describe the distribution of symptoms and signs, to assess the correlations between Mc Monnies score(MS) and variable clinical signs of dry eye, and to explore the association between dry eye symptoms and variable clinical signs. Analysis was performed using software package Epi info. A Probability(P) value using Chi-square test of 【0.005 was taken as significant.· RESULTS: Dry eye prevalence with symptoms(questionnaire), Schirmer test, TBUT, Rose Bengal staining and Lissamine green staining was 25.6%,15.20%, 20.80%, 23.60%, and 22.60% respectively. Among those with severe symptoms(MS】20), 75.86% had a low TBUT(【10s), 58.62% had a low Schirmer’s I test(≤10 mm),86.20% had Rose Bengal staining score of ≥1, 79.31%had Lissamine green staining score of ≥1. We found statistically significant associations between positive Schirmer test and arthritis(P 【0.002), dryness elsewhere(P 【0.001), contact lens use(P 【 0.002), systemic medication(P 【0.0001), sleeping with eyes partly open(P 【0.002), history of dry eyes treatment(P 【0.0001),environmental factors(P 【0.001), swimming(P 【0.001).· CONCLUSION: Subjective assessment plays an important role in diagnosing dry eye disease. There is strong correlation between MS and Schirmer test, TBUT,Rose Bengal staining and Lissamine green staining in normal as well as marginal and pathological dry eye.

Entropy generation analysis from the time-dependent quadratic combined convective flow with multiple diffusions and nonlinear thermal radiation

Diffusions of multiple components have numerous applications such as underground water flow, pollutant movement, stratospheric warming, and food processing. Particularly, liquid hydrogen is used in the cooling process of the aeroplane. Further, liquid nitrogen can find applications in cooling equipment or electronic devices, i.e., high temperature superconducting(HTS) cables. So, herein, we have analysed the entropy generation(EG), nonlinear thermal radiation and unsteady(time-dependent) nature of the flow on quadratic combined convective flow over a permeable slender cylinder with diffusions of liquid hydrogen and nitrogen. The governing equations for flow and heat transfer characteristics are expressed in terms of nonlinear coupled partial differential equations. The solutions of these equations are attempted numerically by employing the quasilinearization technique with the implicit finite difference approximation. It is found that EG is minimum for double diffusion(liquid hydrogen and heat diffusion)than triple diffusion(diffusion of liquid hydrogen, nitrogen and heat). The enhancing values of the radiation parameter R_(d) and temperature ratio θ_(w) augment the fluid temperature for steady and unsteady cases as well as the local Nusselt number. Because, the fluid absorbs the heat energy released due to radiation, and in turn releases the heat energy from the cylinder to the surrounding surface.

A Rare Case of Coronary Cameral Fistula from Left Circumflex Artery Draining into the Left Ventricular Apex Presenting as Angina Pectoris: A Case Report

Coronary cameral fistula (CCF) is a very rare coronary anomaly in which a communication exists between one of the coronaries and a cardiac chamber. Most of the times it is an incidental finding detected at the time of a coronary angiography. However, sometimes it can have serious presentation like unstable angina, coronary steal or ventricular arrhythmia. We present a rare case of coronary cameral fistula arising from left circumflex artery (LCx) draining in to left ventricular (LV) apex and presenting as unstable angina.

Advances in Zika virus vaccines and therapeutics:A systematic review

Zika virus(ZIKV)is the causative agent of a viral infection that causes neurological complications in newborns and adults worldwide.Its wide transmission route and alarming spread rates are of great concern to the scientific community.Numerous trials have been conducted to develop treatment options for ZIKV infection.This review highlights the latest developments in the fields of vaccinology and pharmaceuticals developments for ZIKV infection.A systematic and comprehensive approach was used to gather relevant and up-to-date data so that inferences could be made about the gaps in therapeutic development.The results indicate that several therapeutic interventions are being tested against ZIKV infection,such as DNA vaccines,subunit vaccines,live-attenuated vaccines,virus-vector-based vaccines,inactivated vaccines,virus-like particles,and mRNA-based vaccines.In addition,approved anti-ZIKV drugs that can reduce the global burden are discussed.Although many vaccine candidates for ZIKV are at different stages of development,none of them have received Food and Drug Authority approval for use up to now.The issue of side effects associated with these drugs in vulnerable newborns and pregnant women is a major obstacle in the therapeutic pathway.

Dyke Davidhoff Masson Syndrome Presenting in Adulthood: A Case Report

Dyke Davidhoff Masson syndrome (DDMS) was first described by Dyke Davidhoff and Masson in 1933 in a series of 9 patients [1]. It’s a very rare condition presenting in childhood ranging from infancy to late adolescence [2]. It is characterised by cerebral hemiatrophy, unilateral ventriculomegaly, calvarial thickening, skull and facial asymmetry, sometimes even contralateral hemiplegia in childhood and seizures [2]. An adult presentation is seen in late adolescence or teen age. However in literature the latest presentation reported so far is at 19 years of age [3]. We report a case of Dyke Davidhoff Masson syndrome who presented first time at the age of 28 years which is probably the oldest presentation of this rare entity reported in the literature.

A case of hemophagocytic syndrome as a complication of <i>Plasmodium</i>vivax malaria

Hemophagocytic lymphohistiocytosis syndrome (HPS) is a potentially fatal hyperinflammatory response characterized by a generalized histiocytic proliferation with marked hemophagocytosis in bone marrow [1]. Hemophagocytic syndrome has been associated with genetic mutations, autoimmune diseases, hematological malignancies or infections [2,3]. According to the data from Centre for Disease Control and prevention (CDC) Plasmodium falciparum has been associated with HPS but not the Plasmodium vivax [4-7]. We report a case of hemophagocytic syndrome as a complication of Plasmodium vivax malaria which is a rare presentation according to the data. This patient presented with high grade fever with chills (P. vivax positive), fever however did not respond to anti-malarials. The patient continued to have high grade fever with altered sensorium and deranged liver function with pancytopenia. Since she fulfilled the criteria of (HPS), patient was put on injectable steroids and responded dramatically. Hemophagocytic syndrome is a potentially fatal syndrome and therefore high index suspicion and early treatment is the key to reduce the mortatlity.

Analysis and Intervention of Severe Acute Malnutrition in Children at an Urban Public School in Mumbai, India

Background: There is a dearth of information regarding trends of malnutrition and weight status in children from rapidly developing economies like India. Objectives: The aim of this study is to analyze the dynamics of malnutrition in a group of school children from India, and then provide interventions for the children that have severe acute malnutrition. Methods: Children that were found to lie between &#8722;3 to &#8722;4 SD of parameters of BMI, height for age and weight for age were labeled as SAM. Children that were screened for wasting and fell between &#8722;2 to &#8722;4 SD were also included under the label of SAM. All participants were also given a prototype 1500-calorie diet to follow for the entire duration and 6 weekly sessions were taken for the parents on various topics on nutrition. Results: Quantitative analysis showed a great improvement in weights and heights of severely malnourished children. The average increase in weight of all children that participated in the study was 9.09% and the average increase in height was 1.39%. The weekly sessions given to the parents on various nutrition topics could be the cause of high compliance to the diet given to the children. Conclusion: Malnutrition is still a very big problem in developing countries like India. Basic interventions like an improvement in diet, education about micronutrients and balanced diet, and food-based interventions in severe malnutrition can lead to a great improvement in the health and development status of children.

Goldenhar Syndrome with Occipital Meningoencephalocele: A Rare Case

A 7-year-old male patient reported in our neurosurgery OPD with chief complaints of swelling in occipital region. The swelling was gradually increasing in size as per history given by patient’s attendant. Antenatal and birth history was uneventful. Developmental milestones were normal. Ear examination showed left sided pre auricular tag. Hearing was normal. Eye examination showed right eye limbal dermoid. Limbs examination showed syndactyly of 5th finger. Cardiovascular, respiratory and oral examination was normal. His height and weight were within normal limit. Chest X-ray was normal. Skeletal survey did not show any vertebral deformities. The karyotype was normal. The MRI brain showed a defect of size 1.3 cm in the occipital region through which cerebellum was seen herniating. The mass was surrounded by hypodense collection with multiple thickened septae within suggestive of CSF collection with thickened meninges. Patient underwent surgery and cystic portion was removed, with preservation of the occipital and cerebellar parenchyma and closure of defect was done. Patient responded well that there were no post operative complications and child was discharged on the 10th postoperative day. Hence, based on clinical and radiographic findings, a diagnosis of Goldenhar syndrome was made.

Novel insights on oral squamous cell carcinoma management using long non-coding RNAs

Oral squamous cell carcinoma(OSCC)is one of the most prevalent forms of head and neck squamous cell carcinomas(HNSCC)with a poor overall survival rate(about 50%),particularly in cases of metastasis.RNA-based cancer biomarkers are a relatively advanced concept,and non-coding RNAs currently have shown promising roles in the detection and treatment of various malignancies.This review underlines the function of long non-coding RNAs(lncRNAs)in the OSCC and its subsequent clinical implications.LncRNAs,a class of non-coding RNAs,are larger than 200 nucleotides and resemble mRNA in numerous ways.However,unlike mRNA,lncRNA regulates multiple druggable and non-druggable signaling molecules through simultaneous interaction with DNA,RNA,proteins,or microRNAs depending on concentration and localization in cells.Upregulation of oncogenic lncRNAs and downregulation of tumor suppressor lncRNAs are evident in OSCC tissues and body fluids such as blood and saliva indicating their potential as valuable biomarkers.Targeted inhibition of candidate oncogenic lncRNAs or overexpression of tumor suppressor lncRNAs showed potential therapeutic roles in in-vivo animal models.The types of lncRNAs that are expressed differentially in OSCC tissue and bodily fluids have been systematically documented with specificity and sensitivity.This review thoroughly discusses the biological functions of such lncRNAs in OSCC cell survival,proliferation,invasion,migration,metastasis,angiogenesis,metabolism,epigenetic modification,tumor immune microenvironment,and drug resistance.Subsequently,we addressed the diagnostic and therapeutic importance of lncRNAs in OSCC pre-clinical and clinical systems,providing details on ongoing research and outlining potential future directions for advancements in this field.In essence,this review could be a valuable resource by offering comprehensive and current insights into lncRNAs in OSCC for researchers in fundamental and clinical domains.

Techniques for otosclerosis surgery: Ear surgery from the microscope to the endoscope - A literature review

Stapes surgery is the gold standard for managing otosclerosis.It has become increasingly appreciated to perform endoscopic ear surgery worldwide as the field of endoscopy expands.In basic terms,a stapes surgery intends to restore ossicular mobility and therefore improve sound energy transduction into the inner ear,thereby improving communication and sound amplification and bringing hearing levels back to acceptable levels.The aim of the study is to analyze surgical techniques comparing microscopic and endoscopic approaches for stapes surgery.The perspectives of Surgical Pioneers in Early Stapes Surgery and the contemporary development of surgical technology will be explored as well.Specifically,this study compiles well-documented,reliable information concerning the surgical outcomes for the endoscopic approach to stapes surgery and the results of recent studies.

Squamous Papilloma:Case Report and Review of Literature

Squamous papillomas are common lesions of the oral mucosa with a predilection for the mucosa of the hard and soft palate. As an oral lesion,it raises concern because of its clinical appearance,which may mimic exophytic carcinoma,verrucous carcinoma or condyloma acuminatum. Its pathogenesis is related to human papilloma virus but there is controversy regarding its viral origin. We present a case of squamous papilloma presenting as oral lesion along with a review of the literature.

Dynamic role of myofibroblasts in oral lesions

Fibroblasts are the most abundant cellular components of connective tissue. They possess phenotypical heterogenicity and may be present in the form of smooth muscle cells or myofibroblasts(MFs). MFs are spindle-shaped cells with stress fibres and welldeveloped fibronexus,and they display α-smooth muscle actin immunohistochemically and smoothmuscle myofilaments ultrastructurally. MFs play a crucial role in physiological and pathological processes. Derived from various sources,they play pivotal roles not only by synthesizing and producing extracellular matrix components,such as other connective tissue cells,but also are involved in force production. In the tissue remodelling phase of wound closure,integrinmediated interactions between MFs and type I collagen result in scar tissue formation. The tumour stroma in oral cancer actively recruits various cell types into the tumour mass,where they act as different sources of MFs. This article reviews the importance of MFs and its role in pathological processes such as wound healing,odontogenic cysts and tumours,salivary gland tumours,oral preneoplasia,and oral squamous cell carcinoma. Research oriented on blocking the transdifferentiation of fibroblasts into MFs can facilitate the development of noninvasive therapeutic strategies for the treatment of fibrosis and/or cancer.

Quality of life and oral potentially malignant disorders: Critical appraisal and prospects

Quality of life(QoL) is a vital and often required health outcome measure that is relevant to patient care. A healthy oral cavity enables person to perform daily activities without any limitations. However, any disturbance may result in impaired QoL. The oral health-remains an essential element of people's health and well-being. In recent years, the tradition of clinical practice and research has been changed by incorporating QoL assessment, as it helps in assessment of patients' needs and monitoring treatment responses. Oral potentially malignant disorders(OPMDs) are a group of chronic disorders including oral leukoplakia(OL), oral lichen planus and oral submucous fibrosis(OSF). It is evident that patients with OPMDs experience significant health-related symptoms, functional limitations and psycho-social impairment, compromising their Qo L. Moreover, the worsening of Qo L has been associated with advanced stages of OPMDs. Despite of increasing number of OPMD cases in recent decades, limited literature is available regarding QoL in this population. Although, there is higher prevalence of habit-related OPMDs, particularly OSF and OL in Southern Asian countries, only a few studies have been performed in these populations. Moreover, these studies administered generic Qo L instruments, which offer less sensitivity to clinical changes. However, condition-specific instruments are more sensitive and allows better measurement of QoL. As the impacts of different conditions on OHRQoL may vary, the development and validation of a QoL instrument specific to each clinical entity of OPMDs is currently needed.

Dental knowledge and awareness among grandparents

AIM: To investigate grandparent's knowledge and awareness about the oral health of their grandchildren. METHODS: Grandparents accompanying patients aged 4-8 years, who were living with their grandchildren and caring for them for a major part of the day, when both their parents were at work were included in the study. A 20-item questionnaire covering socio-demographic characteristics, dietary and oral hygiene practices was distributed to them. The sample comprised of 200 grandparents(59 males, 141 females). χ2 analysis and Gamma test of symmetrical measures were applied to assess responses across respondent gender and level of education.RESULTS: Oral health related awareness was found to be low among grandparents. In most questions asked, grandparents with a higher level of education exhibited a better knowledge about children's oral health. Level of awareness was not related to their gender. CONCLUSION: Oral hygiene and dietary habits are established during childhood. There is a great need for dental education of grandparents as they serve as role models for young children.

Natural and artificial small RNAs:a promising avenue of nucleic acid therapeutics for cancer

Since the failure of traditional therapy, gene therapy using functional DNA sequence and small RNA/DNA molecules(oligonucleotide) has become a promising avenue for cancer treatment. The discovery of RNA molecules has impelled researchers to investigate small regulatory RNA from various natural and artificial sources and determine a cogent target for controlling tumor progression. Small regulatory RNAs are used for therapeutic silencing of oncogenes and aberrant DNA repair response genes.Despite their advantages, therapies based on small RNAs exhibit limitations in terms of stability of therapeutic drugs, precisionbased delivery in tissues, precision-based intercellular and intracellular targeting, and tumor heterogeneity-based responses. In this study, we summarize the potential and drawbacks of small RNAs in nucleic acid therapeutics for cancer.

Diffuse alveolar hemorrhage complicating dengue haemorrhagic fever in a 15-year-old boy:A case report

Rationale:Dengue fever is a viral infection that is spread through the bites of infected female Aedes mosquitos.It can cause life threatening complications,including dengue haemorrhagic fever(DHF)and dengue shock syndrome.Patient concerns:A 15-year-old male presented with fever and petechiae and later developed hemoptysis.Diagnosis:Dengue fever with DHF with diffuse alveolar hemorrhage.Interventions:Invasive ventilation with high positive end expiratory pressure,multiple transfusions of packed red blood cells,fresh frozen plasma,single donor platelets and inotropic support Outcomes:The patient was stabilized and discharged on minimal supplemental oxygen.Lessons:Diffuse alveolar hemorrhage,although very rare,should be considered in a patient with dengue who presents with hemoptysis.The treatment is directed at providing respiratory and circulatory support,and preventing the progression of microcirculation damage.

Complete oral rehabilitation in a case with severe dental fluorosis

The authors have presented a technique of full occlusal rehabilitation in a case of severe dental fluorosis. In this technique, maxillary and mandibular anterior teeth were simultaneously prepared and restored first. This was followed by simultaneous preparation of maxillary and mandibular posterior teeth that were restored in canine guided occlusion. The technique and sequence followed here is unique and is not available in dental literature. This technique reduces number of appointments while fulfilling all objectives. Periodontal followup over 3 years was satisfactory. A restorative treatment protocol has been devised for fluorosis which will act as a guide for the dental practitioners.

Mathematical model explaining iron change in patients with thalassemia

Dear Editor,Hemoglobin is an important biochemical pigment seen within erythrocytes.The hemoglobin is the most important content within the red cell.It functions for oxygen carrying,hence,it is very important for human beings.The abnormality of hemoglobin is common in medical practice.The low hemoglobin level from complete blood count is common problem

COVID-19 and oral cancer:Critical viewpoint

The outbreak of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) has marked the beginning of a new pandemic named coronavirus disease 2019(COVID-19). The World Health Organization has announced it as a health emergency that is of international concern. The disease has been reported to cause respiratory illness, pneumonia and even hinder the immunity of an individual. Individuals with disturbed immune responses have been found to be quite susceptible to this viral infection. Oral cancer patients are also at high risk in this pandemic situation and might encounter severe detrimental outcomes. Angiotensin receptors, documented in studies as the path of entry of this virus, are highly expressed in the epithelial cells of oral mucosa, making the group of individuals with oral cancers even more vulnerable. Extracellular matrix metalloproteinase inducer is another potential target for SARS-CoV-2. An exhaustion of angiotensin converting enzyme 2 cell receptors leads to protumoral effects, whereas a downregulation of extracellular matrix metalloproteinase inducer leads to antitumoral effects. Thus, it causes a variation of the biological behavior of the tumor. This article focusses on the molecular mechanisms, effects and pathophysiology of COVID-19 in oral squamous cell carcinoma patients. The different molecular changes in oral squamous cell carcinoma in the background of COVID-19 will modify various environmental factors for this pathology and have an effect on the carcinogenesis process. Understanding the behavior of the tumor will help plan advanced treatment strategies for oral squamous cell carcinoma patients in the background of COVID-19.

Post-COVID recurrent dyspnoea:A case report

Rationale:Post-COVID symptoms need aggressive evaluation.Patient’s Concern:A 29-year-old male patient who had suffered from COVID-19 eight weeks earlier,presented with an acute onset of breathlessness and right-sided chest pain due to pneumothorax.Emergency tube thoracostomy was performed.However,it failed to improve hypoxia.Diagnosis:High-resolution computed tomography of the thorax with computed tomography pulmonary angiography revealed pulmonary arterial thrombosis,ground-glass opacities,and bilateral pneumatoceles.Interventions:Hospital admission and treatment with low molecular weight heparin at a dose of 1.5 mg/kg every 24 h.Outcomes:The large pneumatocele showed significant resolution after three months of follow-ups.Lessons:Being increasingly reported after having a SARS-CoV-2 infection,pneumatocele formation,due to post-COVID lung scarring and late vascular thrombotic events,is a peculiar sequela and can present as acute dyspnoea.Long-term preventive anticoagulants after recovery from COVID-19 are necessary.Breathing exercises during recovery should be done with caution.