Vilazodone is a serotonin transporter (SERT) and a partial agonist of HT1A. It has been approved by food and drug administration of United States (US FDA) for the treatment of major depressive disorder (MDD) in adults. This agent is considered as a new class of drug “serotonin partial agonist and reuptake inhibitor (SPARI)” by the World Health Organization (WHO). The authors planned to review the drug by using the key word of “vilazodone” on different data base and synthesize a working theory regarding the mechanism of selective serotonin reuptake inhibitor (SSRI) mediated serotonergic neurotransmision. The review also focuses on 5-HT1A autoreceptors. Due to its novel mechanism of action, initially it gave hope to the clinicians and researchers as majority of depressive patients are partial responders or treatment resistant to previously available antidepressants. But later research works suggested that the vilazodone is not much different than the drug available in market. Its side effects were found to be lower than other antidepressant but higher than placebo. It can be concluded that more comparative research between vilazodone and other antidepressant is required in making better opinion about this drug

Background: Asthma affects around 300 million people worldwide [1]. Asthma is characterized by chronic airway inflammation. The current treatment regimen is low dose inhaled corticosteroids plus long – acting beta agonist (LABA). Effective control is achieved by taking inhaled medication in proper technique which lead to effective drug deposition in lung. Compliance with inhaled respiratory medications is 40-50%. Low value of 15% also reported [7]. Objective: Determination of compliance towards inhaled medication in asthma patients one year after being prescribed and factors influencing patient’s compliance to inhaled medication in asthma. Methodology: Compliance to inhaled medication assessed by standard set of questionnaires in 260 Asthma patient who were above 18 years from both sex taking inhaled medication for one year. Patient who attended pulmonary Medicine OPD from March 2016 to March 2017 were assessed. Results and Discussion: Mean age of the patient was 57.67 years. 65% of the patients were female. Among the 260 patients, 40% of the patients were having elementary school education. Percentage of patients using inhaler regularly is 26.6%. Percentage of patients trained to use inhaler properly is 23.9%. Good technique of using inhalers has significant association with proper training to use inhalers (P value – 0.0001) and also with proper counselling. (P value – 0.0001). There is also significant association between counselling regarding use of inhalers and its regular usage. Conclusion: Factors affecting the patient’s compliance to inhaled medication is proper counselling regarding the use of inhalers and proper training to use inhaler. Compliance can be improved by providing adequate knowledge about disease and its control, teaching the patients about correct technique of using inhaled medications

Background: Water is an essential solvent and used daily by humans. Consumption of water contaminated with diesel has been shown to impact negatively on organs such as the brain, liver, spinal cord, kidney and others. The brain is a prime organ in the human body and responsible for general coordination and intelligence. Protecting the brain from harmful substances is necessary as this would mitigate neurodegenerative disorders which are obvious in our society. This study was carried out to determine the possible effects of diesel fuel on the histology of the brain of male albino wistar rate. Materials and Methods: A total of 20 rates were used to carry out this research. The animals were grouped in 2 groups; groups A (Control) and B. Group A was administered with good feed and clean water. Group B was administered with feed and water contaminated with diesel for varying periods of time ranging from 1 to 5 weeks. At the end of the given periods the brains were harvested and histopathological investigations for alteration in brain tissues was carried out using routine tissue processing methods and H and E staining methods. Results and Discussion: There was no histopathological alteration of brian tissues harvested from the control animals which were administered with clean water and uncontaminated feed. There was no alteration of brain tissues observed after week 2. The brain tissues harvested from animals whose feed and water were contaminated with diesel showed no histopathological changes when compared with that of the control (group A). A similar observation was made for weeks 3 through 5 for the animals in group B. Conclusion: There were no observed effects of diesel contaminated water on the histology of the brain tissues of male albino wistar rats which may be due to the active protecting effect of the blood-brain barrier

Background: Laparoscopic cholecystectomy has morbidity due to bile duct injuries about 0.3% to 0.5% [1]. The main technique used for gallbladder dissection is infundibulum technique. Critical view of safety method is identification of the cystic duct and cystic artery during laparoscopic cholecystectomy and it is used to minimize risk of bile duct injury. Several studies confirm the routine use of critical view of safety technique eliminate the chance of bile duct injury. First introduced by Steven Strasberg 1992 [1]. Materials and Methods: A retrospective study compared the critical view of safety with infundibular technique regarding operative time, and bile duct injuries. We had 487 patients with critical view of safety and 534 with infundibular technique done at Misurata cancer center between January 2012 and December 2015. Indication of surgery were acute cholecystitis and biliary colic. All operations done by both young and experienced surgeons. Results: There were 1021 laparoscopic cholecystectomy, 483 with critical view of safety technique, 538 patients with infundibular technique. The mean operative time in critical view of safety is 57 minutes while in infundibulum technique is 43 minute. Risk of cystic duct stump leak in critical view of safety is 0.4%, while in infundibulum technique is 0.6%. The risk of major bile duct injuries in critical view of safety in our study is 0%, while in infundibulum technique is 0.4%. Conclusion: The risk of bile duct injuries is the main concern in laparoscopic cholecystectomy. Critical view of safety technique in compared to infundibulum technique has a little increase in the operative time and less bile duct injuries

Cystatin C is a cysteine proteinase inhibitor belonging to type 2 cystatin superfamily produced endogenously. The main catabolic site of cystatin C is Kidneys. It has been shown that cystatin C is a better marker of kidney dysfunction compared to creatinine. We in the present study tried to evaluate the cystatin C and creatinine levels in normal and hypertensive subjects and correlate the cystatin C levels with blood pressure and kidney functions in this group of the population. Methods: This prospective cross-sectional study was conducted in the Department of Biochemistry and General Medicine, Rajiv Gandhi Institute of Medical Sciences, Adilabad. A total of 105 patients were included in this study 56 patients were allotted to cystatin C group for estimation of cystatin C and 49 patients were allotted to creatinine group for estimation of creatinine levels. The results were arranged as quintile of cystatin C (Q1 – Q5) subgroups based on levels in cystatin C and similarly quintile of creatinine (Q1-Q5) in creatinine group. The coefficient of correlation ‘r' values was estimated for cystatin C and creatinine with SBP and DBP. Results: Cystatin C levels of all the 5 sub-groups (Q1- Q5) the strong positive correlation was shown for SBP by Q4 with ‘r' values +5.48 and Q5 with ‘r' values +6.43 and DBP has positive correlation only in Q5 group value +0.44. Similarly, in the creatinine sub-groups, a positive correlation between SBP and creatinine levels found in Q4 and Q5 groups. The SBP in Q4 was with ‘r' value +0.31 and Q5 was with +0.49 the values of DBP did not show a significant positive correlation with creatinine levels in all the groups. Conclusion: it can be concluded that cystatin C is a better marker of kidney functions and can be used to evaluate the blood pressure changes affecting the kidneys. However, the cystatin C test is costly and may not be feasible in low resource settings. In such cases, the continuance of the use of creatinine may be done for monitoring the kidney functions in hypertension.

Interstitial lung diseases (ILDs) are a heterogeneous group of multiple pulmonary disorders. ILDs are characterized by an irreversible architectural distortion and impaired gas exchange; however, there is great variability in the clinical course. ILD diagnosis requires a combination of clinical data, radiological imaging and histological findings. It is necessary to find reliable predictors for the disease progression. Peripheral blood biomarkers offer the advantages of being readily obtained, non-invasive, and serially monitored. At the same time, successful management of ILD patients strictly depends on an accurate and confident diagnosis. In this context, the detection of reliable biomarkers able to identify ILD subtypes. This review focuses on selected validated and/or potentially interesting biomarkers investigated in the peripheral blood and lung tissue of patients with ILD associated with Connective tissue disease (CTD)

Introduction: Hurler syndrome is an autosomal recessive inborn error of metabolism, resulting from deficiency of a-liduronidase, a catabolic mucopolysaccharidase, which leads to excessive systemic storage of the glycosaminoglycans (GAGs) heparan sulphate and dermatan sulphate [1]. Affected children may appear normal at birth. However, progression of the disease results in characteristic facial changes, hepatosplenomegaly cardiomyopathy, major skeletal abnormalities and CNS damage, resulting in severe disability, intellectual regression and death, usually by the age of 10 years. We report the case of a 7-year-old girl who was consulting for a visual impairment with photophobia. The ophthalmologic examination showed corneal opacities associated with bilateral papilled edema with an eye tone of 18mmHG for the eye right and 19 mmHG for the left eye. The abdominal examination finds a protruding abdomen with a hepato splenomegaly. Cardiovascular examination with doppler echo objective thickening mitro-aortic and tricuspid valves. The diagnosis was evoked before facial dysmorphism and then confirmed biologically (MPStype I-H). A bilateral trabeculectomy was performed while waiting for a marrow allograft. The early diagnosis of MPS, before the formation of neurological deficits, has become essential, since the treatment can stop the evolution. Thus, a better knowledge of the clinical picture by ophthalmologists could improve the prognosis

Introduction: Retained foreign bodies during surgery are considered as completely avoidable events. There is a large body of literature that has attempted to identify risk factors and create protocols to prevent the occurrence of the same. Dislodgement of orthodontic fixed appliance components [OFAC] can occur during orthognathic surgery on account of the excessive forces that they may be subjected to during the procedure. Case Report: A 19-year-old female patient underwent a bi-jaw orthognathic surgery for a hypoplastic maxilla. A routine post-operative radiograph displayed an orthodontic molar tube within the right mid ramal region on the 3rd post-operative day. The molar tube was retrieved under general anesthesia with the assistance of an intra-operative c-arm for accurate localization of the bracket. The patient recovered well after the procedure. Conclusion: A potential long-term complication [e.g. space infections] was avoided as the molar tube was identified in the immediate post-operative phase. Pre, intra and post-operative measures has been suggested to prevent such complications. Possible risk factors that may contribute to retained foreign bodies in the surgical site have also been briefly been identified

A total of two hundred ears of CSOM cases in different age groups & sexes were subjected to bacteriological and clinical studies in the Department of Microbiology & ENT, Patna Medical College & Hospital. The ears were further subdivided into group I where ear swabs were studies for aerobic organisms and cultural & sensitivity pattern. In group II 50 swabs were studies for anaerobic organisms and culture and sensitivity pattern. The commonest organisms isolated in group I were Staphylococcus aureus followed by Pseudomonas aeruginosa while pepto-streptococci species were found in group II. Ciprofloxacin was found to be the drug of choice for most of the organisms followed by Norfloxacin,cefexime Cefoperazone & Gentamycin

Open apices are considered to be the most challenging cases in endodontics. The rationale of this case report was to observe the effect of MTA and biodentine on root end formation in the same patient. Mineral trioxide aggregate (MTA) and biodentine were used for formation of apical plug followed by further obturation with gutta percha. It was reported that the initial root end formation was better in the case where MTA was used as apical plug material as compared to Biodentine

This study was conducted to determine the association of Insertion-deletion Polymorphism in the Angiotensin-Converting Enzyme (ACE) Gene and Human Essential Hypertension among Sudanese in Al Nubba Village. A case-control community-based study was performed, Blood samples were collected from 54 subjects in a rural area around Khartoum (Al Nubba Village). The frequencies of the insertion (*I) and deletion (*D) alleles of the ACE gene were investigated, Polymerase chain reaction (PCR) was detected for the Insertion/Deletion polymorphism. Allele frequencies were calculated, our data indicated a preponderance of the *D allele among the Sudanese population. The percentage of Case/Control for Homozygous deletion DD, Homozygous insertion II and Heterozygous DI are almost the same. Further studies are recommended with a large sample size

Phosphoric acid etching is the gold standard method of enamel preparation before application of bonding resins for orthodontic brackets. With the recent introduction of erbium-doped yttrium aluminum garnet (Er:YAG) laser in dentistry for the ablation of hard tissues, including enamel and dentin, laser enamel preparation has been proposed as an alternative to phosphoric acid etching. Hence this study was conducted to evaluate the shear bond strength of bracket bonded to teeth etched by Acid, Er:YAG laser. The aim of the study is to “Compare the bond strengths of orthodontic bracket etched by acid, Er: YAG laser, and combined treatment on the enamel surface.” The objective of the study was to investigate methods that could obtain the maximal bond strength and to analyze the fracture mode of each method

Background: Chronic rhinosinusitis (CRS) is inflammation of the nasal cavity, and paranasal sinuses (PNS) persists for over three months. CRS can be differentiated into CRS with nasal polyps (CRSwNP) or without (CRSsNP). Aim: to determine the allergic cause of sinonasal polyps using the radiological findings of multi-slice Non-contrast computed tomography of the paranasal sinuses (NCCT-PNS) and histopathology results. Materials and Methods: A total of 41 patients with sinonasal polyps were involved in this study. Multislice NCCT-PNS for each patient was taken in coronal sections. Radiological diagnoses were made. Surgical samples were taken after Functional endoscopic sinus surgery (FESS). Histopathological results were collected. Comparison between the NCCT-PNS and histopathology results was made. Statistical analysis was done using the SPSS program. Results: Out of 41 patients involved in this study, 14 males and 27 females. The mean age was 37.4146 ± 16.65. Polyps predominantly were affecting the nose and paranasal sinuses together (p<0.001). Polyps were predominantly bilateral (p<0.001). Sinonasal polyposis was the most commonly diagnosed (58.5%) on CT (p<0.001). Allergic polyps were the most common type of polyps (p=0.003). No significant relationship between gender and allergic or non-allergic causes of polyps (p=0.32, OR= 1.7, 95% CI 0.460-6.280). No significant relationship between gender and specific cause of polyps (p=0.779) except in fungal cause that is more in female. Conclusion: Allergic polyps are the most common type in chronic rhinosinusitis with nasal polyps (CRSwNP). CRSwNP affects female twice as male. Most cases of CRSwNP are bilateral and involve the nose and paranasal sinuses

Dengue viral infection is an epidemic in tropical and subtropical countries including India. Epidemics are very common in areas of poor sanitation where there are substandard housing and the need for water storage Adilabad district is a backward district with poor tribal population and epidemics of dengue are very common in this region. Methods: This study was conducted in the Department of Pediatrics, Rajiv Gandhi Institute of Medical Sciences [RIMS], Adilabad the data was collected during the months of September 2018 to December 2018. There was an outbreak of dengue during this period and child patients reported to RIMS hospital with signs and symptoms of dengue fever according to WHO guidelines were included. Exclusion criteria were fevers of unknown origin, children positive for malaria, enteric fever and signs and symptoms not suggestive of dengue. A total of (n=67) patients were identified during the study period from September 2018 to December 2018 out of which (n=46) were male and (n=21) were female patients. 5ml of blood was obtained in a vacutainer by experienced technicians and CBP, Hematocrit, Dengue serology, were performed NS1Ag, IgM and IgG were performed. Results: In the present study a total of n= 67 patients were included as per the inclusion criteria. Out of the 67 (n=46) were male and (n=21) were female patients. The clinical signs and symptoms of the patients were assessed and the common presentation in all the dengue causes was a fever in n=67 (100%) cases. The range of temperature was from 101 °F to 105 °F at the time of admission. Myalgia and headache were present in n=35 (52.23%) cases. Leukocytopenia was seen in 2(2.9%) and leucocytosis was seen in 17 (25.37%) cases. The mean platelet counts were found to be between 50,000 to 100,000 37(55.22%) cases. ..

Introduction: Since the introduction of H2 blockers and PPIs they have become one of the most commonly prescribed classes of medications in the world. These drugs are often misused and overused, which may have significant implications in the elderly. Aim: To study prevalence of irrational use of H2 blockers and PPIs in geriatric population. Methods: A retrospective study over six months period was conducted from February 2017 to Auguest2017 at a tertiary care hospital. The clinical data of total 137 patients admitted for one or more concurrent disease are included in the study. Results: In this study out of 137 patients, 102(74.4%) cases were on H2 receptors antagonist and 34(24.8%) were on PPIs which were irrationally prescribed. Mean age of the patients was 68.9 ±11.9 years. Out of 137 patients 103(75.1%) were male and 34(24.4%) female. Concurrent drugs prescribed were Antiplalets 19(13.8%) cases, CCBs 12(10.4%), ferrous sulphate13 (8.7%), steroids 10(7.2%), Digoxin 4(2.9%), Warfarin 2(1.4%), phenytoin 2 (2.9%). Conclusion: Irrational use of H2 receptor antagonists and PPIs in elderly increased with advanced age, increase in number of medications, multiple diagnoses and increased length of hospitalization. Effects and interactions were commonly encountered in many cases. Acid suppression drugs are initiated or continued for prolonged periods of time, without sufficient evaluation of the need for therapy. Proper Guidelines for physicians and counseling for the patients is required in order to reduce overuse and to prevent long term adverse effects of the drugs

In cardiovascular pathology, cardiovascular magnetic resonance (CMR) has emerged over time as a test with single potential. This non-invasive, non-irradiating, with few contraindications, and economically reasoned examination, finds all its interest in aeronautical expertise of flight crew, in addition to first-line examinations, including electrocardiogram and echocardiography, which do not always allow to decide on the absence of underlying cardiac disease, which would have a consequent impact on the decision of aptitude either in admission or revisional visit. Through this work, we will focus on the technical aspects of CMR namely: different sequences, safety, physical principles, then its main indications according to international learned societies, and finally its interest in aeronautical expertise

The labial mucosa is an unusual site for basal cell carcinoma. Only a few cases have been reported in the literature. We present a case of basal cell carcinoma wich involved the vermilion of the lower lip. A 77-year-old man presented with an ulcer taking half of his lower lip and extending to the skin evolving for two years. There were no cervical lymph nodes. Diagnosis of infiltrative basal cell carcinoma was made by histological study which showed a tumoral proliferation starting from epidermal basal layers infiltrating the hypodermis with perineural infiltration. The pathogenesis of basal cell carcinoma of the vermilion lip is not clear. While basal cell carcinoma originates from pilar structures, the lack of pilosebaceous follicles in the normal lip mucosa has led to several hypotheses to explain the pathogenesis of mucosal basal cell carcinoma. Our case shows a very rare location of basal cell carcinoma. The ulcer that originally started in the vermilon, has extended and reached the mucosa and the skin areas. Therefore, basal cell carcinoma should be considered among the differential diagnosis of ulcerative lesions of the lip