Adjuvant Tool Research Articles

Development, validation and transfer to clinical practice of a mobile application for the treatment of smoking

ObjectiveThe main objective is to transfer to clinical practice a new smoking cessation application (“Vive sin Tabaco” a) in all health centers of the public Basque Health Service. DesignAn implementation study of a smoking cessation program previously validated. After implementation, a retrospective study has been carried out to evaluate its use under normal conditions. SiteThe process of transfer to clinical practice has been held in several phases; first a pilotage in four health centers of Alava and subsequently, when all reported incidents were resolved, it was extended to all health centers of the Basque Health Service. Intervention and main measurementDevelopment of “Vive sin Tabaco”; a corporate tool for smoking cessation, and its transfer to clinical practice. All interested health care workers received training on how to use the application. User manuals for both patients and professionals were developed. Smoking cessation rates at 12 months during implementation were also collected. ResultsThe percentage of patients of post pilot phase who quit smoking at 12 months was 14.1%. ConclusionsThe conception of “Vive sin tabaco” as a corporate tool for smoking cessation, available in all health centers of Basque Health Service, has been long and arduous, and has required the participation of health professionals and patients as end-users in order to obtain a tool that adapts to their expectations and guarantees greater usability and satisfaction. This application is being effective as an adjuvant tool to health advice.

A cross sectional study of correlation of serum ferritin levels with NIHSS scoring scale in patients of acute ischemic stroke

IStroke is one of the leading causes of mortality and morbidity in the world. The National Institutes of Health Stroke Scale (NIHSS) is one of the most common stroke scale used by neurologist around the world. Serum Ferritin is an acute phase reactant, which increases during acute conditions like inflammation and also in vascular events.This is a study that correlates the S.Ferritin levels with NIHSS scoring scale to assess the severity of stroke, which can also be used as an adjuvant tool for better assessment of severity of stroke in patients, which further helps in improving the management of patients with stroke.This study aims to estimate serum ferritin and the NIHSS stroke scale in patients with acute ischemic stroke, and then to correlate serum ferritin with NIHSS stroke scale.A cross sectional study was done during the period of November 2017-May 2019 in hospitals affiliated to Bangalore Medical College & Research Institute , Bangalore on 106 patients with acute ischemic stroke at the time of admission. NCCT brain was done and Serum Ferritin levels determined for patients who fit into the inclusion and exclusion criteria. Data was analyzed using SPSS 21.0 software by descriptive statistics in the form of mean values, standard deviation and percentages. Chi Square test was used for association of qualitative variables.There was linear increase of S.Ferritin with increase in severity of stroke ( As determined by NIHSS scoring scale). It was a found that male sex had a higher increase in S.Ferritin levels compared to females, with statistically significant correlation. It was also found that the maximum number of patients with increase in S.Ferritin levels belonged to severe stroke category.As there was a linear increase of S.Ferritin with increase in severity of stroke (NIHSS scoring scale), we can conclude that Serum Ferritin level had a positive correlation with the severity of ischemic stroke indicating that S.Ferritin levels can also be used as an adjuvant tool for assessing the severity of stroke along with other tools and facilitate adequate and timely management of these patients. S Ferritin can be used as a Prognostic marker in predicting the severity of Acute Ischaemic stroke.

Autofluorescence Imaging in the Long-Term Follow-Up of Scleral Buckling Surgery for Retinal Detachment.

Purpose To analyse fundus autofluorescence (AF) changes in retinal reattachment following primary scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD). Methods Prospective noninterventional chart review study. AF images were reviewed for peripheral and central changes and compared to clinical and OCT findings. Results A total of 73 eyes from 69 patients were included, four presenting with bilateral RRD. Mean age was 55 ± 12 years, male/female ratio 40/29, fovea-on/-off RRD 43/30, and mean follow-up time 376 ± 270 days, with a mean of 5 ± 3 postoperative visits. Preoperatively, RRD was seen as a hypofluorescent area with a hyperfluorescent leading edge. Immediately postoperatively, three types of cryopexy could be differentiated, gradually transforming to scleral hyperfluorescence. Buckle tightening produced alternating hyper-/hypofluorescent streaks, and demarcation lines showed a persistent rugged hyperfluorescent signal. Choroidal detachment led to transient hypofluorescence, whereas vortex vein compression induced persistent hypofluorescence. Peripheral retinal folds were hyperfluorescent and the drainage site was hypofluorescent. AF was highly sensitive in detecting even small amounts of hyperfluorescent persistent subretinal fluid (SRF) that showed a slow resolution during follow-up. A granular “salt-and-pepper-” like pattern in the central macula was seen in 80% of eyes with fovea-off RRD and alternating streaks in 10%. Findings from OCT imaging correlated well with AF regarding SRF, macular oedema, retinal pigment epithelial detachment, and presence of a subretinal scar, but only moderately in epiretinal membrane formation and choroidal folds. Conclusions AF is a useful, noninvasive, adjuvant tool in the long-term follow-up after SB surgery.

Raman Spectroscopy: A Personalized Decision-Making Tool on Clinicians' Hands for In Situ Cancer Diagnosis and Surgery Guidance.

Simple SummaryCancer still constitutes one of the main global health challenges. Novel approaches towards understanding the molecular composition of the disease can be employed as adjuvant tools to current oncological applications. Raman spectroscopy has been contemplated and pursued to serve as a noninvasive, real time, in vivo tool which may uncover the molecular basis of cancer and simultaneously offer high specificity, sensitivity, and multiplexing capacity, as well as high spatial and temporal resolution. In this review, the potential impact of Spontaneous Raman spectroscopy in clinical applications related to cancer diagnosis and surgical removal is analyzed. Moreover, the coupling of Raman systems with modern instrumentation and machine learning methods has been explored as a prominent enhancement factor towards a personalized approach promoting objectivity and accuracy in surgical oncology.Accurate in situ diagnosis and optimal surgical removal of a malignancy constitute key elements in reducing cancer-related morbidity and mortality. In surgical oncology, the accurate discrimination between healthy and cancerous tissues is critical for the postoperative care of the patient. Conventional imaging techniques have attempted to serve as adjuvant tools for in situ biopsy and surgery guidance. However, no single imaging modality has been proven sufficient in terms of specificity, sensitivity, multiplexing capacity, spatial and temporal resolution. Moreover, most techniques are unable to provide information regarding the molecular tissue composition. In this review, we highlight the potential of Raman spectroscopy as a spectroscopic technique with high detection sensitivity and spatial resolution for distinguishing healthy from malignant margins in microscopic scale and in real time. A Raman spectrum constitutes an intrinsic “molecular finger-print” of the tissue and any biochemical alteration related to inflammatory or cancerous tissue state is reflected on its Raman spectral fingerprint. Nowadays, advanced Raman systems coupled with modern instrumentation devices and machine learning methods are entering the clinical arena as adjunct tools towards personalized and optimized efficacy in surgical oncology.

Current status of augmented reality in cerebrovascular surgery: a systematic review.

Augmented reality (AR) is an adjuvant tool in neuronavigation to improve spatial and anatomic understanding. The present review aims to describe the current status of intraoperative AR for the treatment of cerebrovascular pathology. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following databases were searched: PubMed, Science Direct, Web of Science, and EMBASE up to December, 2020. The search strategy consisted of "augmented reality," "AR," "cerebrovascular," "navigation," "neurovascular," "neurosurgery," and "endovascular" in both AND and OR combinations. Studies included were original research articles with intraoperative application. The manuscripts were thoroughly examined for study design, outcomes, and results. Sixteen studies were identified describing the use of intraoperative AR in the treatment of cerebrovascular pathology. A total of 172 patients were treated for 190 cerebrovascular lesions using intraoperative AR. The most common treated pathology was intracranial aneurysms. Most studies were cases and there was only a case-control study. A head-up display system in the microscope was the most common AR display. AR was found to be useful for tailoring the craniotomy, dura opening, and proper identification of donor and recipient vessels in vascular bypass. Most AR systems were unable to account for tissue deformation. This systematic review suggests that intraoperative AR is becoming a promising and feasible adjunct in the treatment of cerebrovascular pathology. It has been found to be a useful tool in the preoperative planning and intraoperative guidance. However, its clinical benefits remain to be seen.

Prognostic scores in laryngeal cancer

To evaluate the utility of various pre-treatment prognostic scoring systems for overall survival (OS) in laryngeal cancer, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), modified Glasgow Prognostic Score (mGPS) and systemic immune-inflammatory index (SIII). We undertook a retrospective 5-year study of 220 patients with laryngeal squamous cell carcinoma undergoing active treatment. On multivariate analysis, low NLR (≤ 2.415, p = 0.001, OR 3.851), low PLR (≤ 269.855, p = 0.002, OR 5.520), high LMR (> 2.225, p < 0.001, OR 0.458) and low SIII (≤ 1144.465, p = 0.003, OR 3.673) were significantly associated with improved OS, accounting for confounding factors of tumour subsite, T-stage and performance status. C-reactive protein (CRP) alone (p = 0.264) and mGPS (p = 0.350) were not significantly associated with OS. NLR, PLR, LMR and SIII represent inexpensive, easily obtainable adjuvant decision-making tools which could help tailor individualised treatment regimes. Further investigation into the utility of combination scores and the role of different laryngeal subsites may be of interest.

The Reading the Mind in the Eyes Test, Iowa Gambling Task and Interpersonal Reactivity Index: Normative Data in an Italian Population Sample.

Social cognition and executive deficits are frequent in neurological and neuropsychiatric disorders. Yet, there is a paucity of standardized domain-specific psychometric tools for the assessment of complex decision-making, social cognition (i.e., Theory of Mind), and empathy. To this aim, this study intended at providing normative data in an Italian population sample for the Iowa Gambling Task, the Reading the Mind in the Eyes Test, and the Interpersonal Reactivity Index. The Iowa Gambling Task, the Reading the Mind in the Eyes Test, and the Interpersonal Reactivity Index were administered to 462 healthy Italian participants aged between 18 and 91years, considering demographic factors. A confirmatory factor analysis was run to test for unidimensionality. Normative values were derived by means of the Equivalent Scores method. Education predicted all tests' scores, age influenced scores at the Interpersonal Reactivity Index and the Reading the Mind in the Eyes Test, gender predicted empathic abilities only. The three tests did not underpin a unidimensional structure. The present work provides demographically adjusted Italian normative data for a set of tests assessing real-life decision-making, emotion recognition and empathy, filling a gap within II-level, domain-specific, neuropsychological testing. For the first time, the Interpersonal Reactivity Index is proposed as an adjuvant neuropsychological tool, while the standardization of the Iowa Gambling Task offers a new scoring system for advantageous/disadvantageous choices.

DCBs as an adjuvant tool to DES for very complex coronary lesions.

Drug eluting stents (DES) have revolutionised interventional cardiology and currently represent the standard for percutaneous coronary interventions (PCI). However, due to several limitations, new strategies are required, especially in very complex lesions. Drug-coated balloons (DCB) offer an attractive therapeutic alternative, and have already obtained a Class I recommendation for the treatment of in stent restenosis (ISR) with Level A of evidence. Moreover, the role of DCB has been tested in several other settings, such as de novo large vessel disease, multivessel disease or very complex lesions, with promising results regarding safety and effectiveness. In this context, a hybrid strategy consisting in the use of a DES and DCB with the aim of reducing the amount of metal implanted and minimising the risk of ISR and stent thrombosis could become the solution for very complex lesions. Several important studies already demonstrated very good angiographic results in terms of late lumen loss and restenosis for this approach in bifurcation lesions. Moreover, for long diffuse coronary disease similar rates of MACE, TVR, and TLR at 2-year follow-up in comparison to a DES-alone strategy were found. What is more, the use of this strategy in high-bleeding risk patients could safely permit the practitioners to reduce the DAPT duration, as data is suggesting. As our daily practice already strongly incorporated this strategy and with more data expected from important trials, it is our strong believe that the hybrid approach can become a standard treatment choice in the near future.

Neural Suppression Elicited During Motor Imagery Following the Observation of Biological Motion From Point-Light Walker Stimuli.

Introduction: Advantageous effects of biological motion (BM) detection, a low-perceptual mechanism that allows the rapid recognition and understanding of spatiotemporal characteristics of movement via salient kinematics information, can be amplified when combined with motor imagery (MI), i.e., the mental simulation of motor acts. According to Jeannerod’s neurostimulation theory, asynchronous firing and reduction of mu and beta rhythm oscillations, referred to as suppression over the sensorimotor area, are sensitive to both MI and action observation (AO) of BM. Yet, not many studies investigated the use of BM stimuli using combined AO-MI tasks. In this study, we assessed the neural response in the form of event-related synchronization and desynchronization (ERD/S) patterns following the observation of point-light-walkers and concordant MI, as compared to MI alone.Methods: Twenty right-handed healthy participants accomplished the experimental task by observing BM stimuli and subsequently performing the same movement using kinesthetic MI (walking, cycling, and jumping conditions). We recorded an electroencephalogram (EEG) with 32 channels and performed time-frequency analysis on alpha (8–13 Hz) and beta (18–24 Hz) frequency bands during the MI task. A two-way repeated-measures ANOVA was performed to test statistical significance among conditions and electrodes of interest.Results: The results revealed significant ERD/S patterns in the alpha frequency band between conditions and electrode positions. Post hoc comparisons showed significant differences between condition 1 (walking) and condition 3 (jumping) over the left primary motor cortex. For the beta band, a significantly less difference in ERD patterns (p < 0.01) was detected only between condition 3 (jumping) and condition 4 (reference).Discussion: Our results confirmed that the observation of BM combined with MI elicits a neural suppression, although just in the case of jumping. This is in line with previous findings of AO and MI (AOMI) eliciting a neural suppression for simulated whole-body movements. In the last years, increasing evidence started to support the integration of AOMI training as an adjuvant neurorehabilitation tool in Parkinson’s disease (PD).Conclusion: We concluded that using BM stimuli in AOMI training could be promising, as it promotes attention to kinematic features and imitative motor learning.

Pseudoeosinophilia on automated analyser (Sysmex XN-1000) a guide to malaria detection - An incidental finding

Rationale: Malaria is a protozoan disease which has a worldwide distribution in tropical and subtropical regions. The peripheral blood smear examination is a gold standard and an immunochromatographic rapid diagnostic test is an adjuvant diagnostic tool for the detection of malaria. For the past two decades, the utility of automated blood cell counters for the detection of malarial infection is growing in the presumptive diagnosis of malaria in developing countries. Patient Concerns: Here, we report a case in which a young male came for surgical evaluation for inguinal hernia surgery. On routine haemogram evaluation, malaria was suspected with the help of flow cytometry based haematology analyser (Sysmex XN 1000) generated histogram showing erroneously high eosinophil count (pseudoeosinophilia) and atypical white blood cell scattergram. Diagnosis: Peripheral smear and malarial antigen examinations confirmed Plasmodium vivax species. Outcomes: Patient was treated with antimalarial medications and elective surgery to repair inguinal hernia was planned after 10 days. Lessons: Here, we hope to increase the awareness of laboratory physicians to explore the possibilities of diagnosing malaria through hints provided by automated haematology analyser generated histograms.

Toward the Identification of Neurophysiological Biomarkers for Alzheimer's Disease in Down Syndrome: A Potential Role for Cross-Frequency Phase-Amplitude Coupling Analysis.

Cross-frequency coupling (CFC) mechanisms play a central role in brain activity. Pathophysiological mechanisms leading to many brain disorders, such as Alzheimer's disease (AD), may produce unique patterns of brain activity detectable by electroencephalography (EEG). Identifying biomarkers for AD diagnosis is also an ambition among research teams working in Down syndrome (DS), given the increased susceptibility of people with DS to develop early-onset AD (DS-AD). Here, we review accumulating evidence that altered theta-gamma phase-amplitude coupling (PAC) may be one of the earliest EEG signatures of AD, and therefore may serve as an adjuvant tool for detecting cognitive decline in DS-AD. We suggest that this field of research could potentially provide clues to the biophysical mechanisms underlying cognitive dysfunction in DS-AD and generate opportunities for identifying EEG-based biomarkers with diagnostic and prognostic utility in DS-AD.

Fractal dimension analysis on CBCT scans for detecting low bone mineral density in postmenopausal women.

PurposeThe aim of this study was to compare the fractal dimension (FD) measured at 2 bone sites (second cervical vertebra and mandible) on cone-beam computed tomography (CBCT). The research question was whether FD could serve as an accessory tool to refer postmenopausal women for densitometric analysis. Therefore, the reliability and accuracy of FD were evaluated.Materials and MethodsIn total, 103 postmenopausal women were evaluated, of whom 52 had normal bone mineral density and 51 had osteoporosis, according to dual X-ray absorptiometry of the lumbar spine and hip. On the CBCT scans, 2 regions of interest were selected for FD analysis: 1 at the second cervical vertebra and 1 located at the mandible. The correlations between both measurements, intra- and inter-observer agreement, and the accuracy of the measurements were calculated. A P value less than 0.05 was considered to indicate statistical significance for all tests.ResultsThe mean FD values were significantly lower at the mandibular region of interest in osteoporotic patients than in individuals with normal bone mineral density. The areas under the curve were 0.644 (P=0.008) and 0.531 (P=0.720) for the mandibular and vertebral sites, respectively.ConclusionFD at the vertebral site could not be used as an adjuvant tool to refer women for osteoporosis investigation. Although FD differed between women with normal BMD and osteoporosis at the mandibular site, it demonstrated low accuracy and reliability.

Manual Reduction of Incarcerated Abdominal Wall Hernias. A Feasible Option during COVID-19 Pandemic: A Prospective Study.

Background Incarcerated hernia is a common surgical emergency with considerable morbidity or even mortality. Manual reduction (taxis) and elective surgery could be an alternative management approach. This study examines the role of taxis with the adjuvant use of the visual analogue scale (VAS) score in treating incarcerated hernias and thereby decreasing the emergency surgery rate, especially during the novel coronavirus disease 2019 (COVID-19) pandemic. Methods All adult patients admitted to the emergency department of our hospital with incarcerated hernias of anterior abdominal wall were prospectively submitted to hernia manual reduction. The VAS score was used as an adjuvant tool for monitoring the success of this maneuver. Patients with successful taxis and low VAS score were hospitalized for a 24-hour period of observation. On their discharge, they were scheduled for an elective hernia repair. Patients with unsuccessful taxis or with less than a 50% reduction in VAS score after successful taxis were submitted to emergency surgical repair. Age, sex, type of hernias, time until taxis, VAS scores before and after taxis, length of hospital stay, and adverse events for both groups were recorded. Results Between September 2018 and September 2020, 86 patients with incarcerated hernias were included. The types of hernias were incisional in 8 patients, umbilical in 15 patients, inguinal in 56 patients, and femoral in 7 patients. Taxis was successful in 66% of patients with a mean reduction in VAS score from 83 to 17 mm. Following successful taxis, patients were hospitalized for a 24-hour period of observation. No taxis-related complications were observed. Fifty-two patients were safely discharged from hospital and scheduled for an elective repair during the first month. Thirty-four patients were operated emergently. Five patients had successful taxis but with a reduction of posttaxis VAS score less than 50% (a mean reduction from 86 to 62 mm), while taxis failed in twenty-nine patients. Patients with emergency surgery had longer time until reduction and longer stay of hospitalization. In this group, two patients required admission to the intensive care unit while one patient died. Conclusion In this protocolized approach, taxis is a safe and feasible option for most patients with incarcerated hernias. It should be kept in our armament, especially in times when emergency surgery capabilities are under strain like the ongoing COVID-19 pandemic.

The Value of Thermal Imaging for Knee Arthritis: A Single-Center Observational Study.

PurposeTo compare (non-contact) thermal imaging with power Doppler (PD) for the evaluation of knee arthritis with joint effusion.Materials and MethodsWe enrolled patients with knee arthritis who were scheduled to undergo an arthrocentesis of the knee from April to December 2020 at a single tertiary hospital. A thermography camera, FLIR ONE Pro, was used to obtain both thermographic and digital images on subjects. For each subject, thermography, ultrasonography, arthrocentesis, and blood tests were conducted at the same study visit. Thermal imaging findings and clinical characteristics were compared by dividing the subjects into PD-positive and PD-negative groups on ultrasound. The receiver operating characteristic (ROC) curve analysis was used to determine the accuracy of PD positivity.ResultsA total of 30 knee arthritis patients were enrolled in this study. Knee temperature was significantly higher in PD-positive group compared to PD-negative group [maximum temperature (T max): 33.2℃ vs. 30.5℃, p=0.025; minimum temperature (T min): 30.7℃ vs. 27.0℃, p=0.015; average temperature (T ave): 32.1℃ vs. 29.1℃, p=0.016]. Also, the joint fluid white blood cell count was considerably higher in PD-positive group than in PD-negative group (24556 cells/mm3 vs. 7840 cells/mm3, p=0.010). The area under the ROC curve of the point measurement of T max, T min, and T ave ranged between 0.764 and 0.790.ConclusionIn this study, we found that high thermographic temperatures of the knee suggest a positive PD signal. Thus, thermography might be used as an adjuvant tool of PD for non-invasive evaluation of knee arthritis.

Deranged hematological profile in patients presenting with malarial parasitaemia

Background: Alterations in the hematological parameters are thought to have the capacity to act as an adjuvant tool in strengthening the suspicion of malaria, thereby prompting a more meticulous search for malaria parasites.Methods: 186 cases with malaria positive for immunochromatographic test (ICT) malaria presenting with fever ≥101 °F, confirmed on peripheral blood film, of 20-60 years were included. Patients with coagulopathy and bleeding disorders such as hemophilia, brain tumors, tuberculosis meningitis, viral or bacterial encephalitis and multiple sclerosis were excluded. Sample was taken to the laboratory, for routine investigations like ICT malaria and complete blood count (CBC) to diagnose anemia and low platelet count.Results: Patients of 20 to 60 years of age with mean 41.80±8.51. Out of 186 patients, 101 (54.30%) were male and 85 (45.70%) were female with 1:2:1 ratio. Mean duration of disease was 4.91±1.32 days. Frequency of derangement in hematological parameters was anemia in 27 (14.52%) patients and 142 (76.34%) with thrombocytopenia. 127 cases were of Plasmodium vivax and 59 cases were of Plasmodium falciparum. Patients were more anemic as disease period prolonged. Patients infected by Plasmodium vivax showed more tendencies towards anemia and reduction in platelet count as compare to Plasmodium falciparum.Conclusions: The frequency of derangement in hematological parameters i.e. anemia and low platelet count, among malarial patients is quite high and more cases were of Plasmodium vivax and it showed anemia and thrombocytopenia was more pronounced in Plasmodium vivax.

Moxifloxacin Concentrations in the Knee Joint, Tibial Bone, and Soft Tissue When Combined with Rifampicin: A Randomized Porcine Microdialysis Study.

Peri and postoperative antibiotics are key adjuvant treatment tools in the management of periprosthetic joint infection (PJI). The aim of this study was to evaluate the effect of rifampicin on the area under the moxifloxacin concentration-time curve from 0 to 24 hours (AUC0-24) in the synovial fluid of the knee joint, tibial bone, and adjacent subcutaneous tissue under steady-state conditions using microdialysis in a porcine model. Twenty female pigs were randomized to receive oral treatment with moxifloxacin monotherapy (Group A, n = 10) of 400 mg once daily for 3 days or a combination therapy (Group B, n = 10) of 400 mg of moxifloxacin once daily for 3 days and 450 mg of rifampicin twice daily for 7 days. Microdialysis was used for sampling the synovial fluid of the knee joint, tibial cancellous and cortical bone, and adjacent subcutaneous tissues. Plasma samples were taken as a reference. Measurements were obtained for 24 hours. Coadministration of moxifloxacin and rifampicin resulted in reductions of the moxifloxacin AUC0-24 in all targeted tissue compartments by 67% to 85% (p < 0.05). The corresponding change in plasma was 20% (p = 0.49). For both groups, the tissue penetration (the ratio of tissue free fraction AUC0-24 to plasma free fraction AUC0-24 [fAUCtissue/fAUCplasma]) was incomplete in all investigated compartments. The highest moxifloxacin tissue penetration was in the knee joint synovial fluid: 0.59 (Group A) and 0.24 (Group B). The lowest tissue penetration was in the cortical bone: 0.17 (Group A) and 0.03 (Group B). We found a significant reduction of the moxifloxacin concentration, expressed as the AUC0-24, in tissues relevant to acute PJI treatment when coadministered with rifampicin. The concentrations within the targeted tissue compartments were reduced significantly more than the concentrations in plasma, which may be particularly important as plasma concentrations are used in clinical practice to assess moxifloxacin treatment sufficiency.

Cheiloscopy - A Tool For Identification in Twins

Introduction : Lip prints are an adjuvant tool for identification in forensic medicine. The grooves onthe lips have discrete characteristics to make it different from one other. This study was conductedon 24 pairs of twins out of which 22 pairs were Monozygotic twins and 2 pairs were Dizygotictwins. Dizygotic twins are unique in all aspects while Monozygotic twins are similar phenotypicallyand genotypically. The objective of this study is to find the most common pattern in the twins , thecommonest pattern among the male and female twins and to know the variations in the pattern of lipprints among Monozygotic and Dizygotic twins.Materials and Methods: A lipstick, drawing chart and magnifying lens were the materials used torecord the imprints of the lips. A four compartment method with a clockwise direction approach wasused and the analysis was done based on Suzuki and Tsuchihashi classification.Results: The present study shows Type 1’ was the most common lip prints observed among the 24pairs of twins. This pattern was predominantly present in the right lower lip quadrant. Out of the studysubjects of 24 pairs of twins, 38 were males and 10 were females in which Type I ‘ is common in malesand type I is common in females. Among the monozygotic twins those which had &lt; 50 % resemblancewere 14 pairs, 50% resemblance were 6 pairs, &gt;50% resemblance were 2 pairs in which Type is thecommonest. Among the dizygotic twins, both the pairs were totally different from each other yet Typewas the common pattern.Conclusion: Based on the analysis of the lip print patterns among monozygotic twins, though similaritieswere prevailing between them , they are not identical .Whereas among dizygotic twins both the pairs oftwins are unique. Hence Lip print can be utilized as a differentiating tool for identification.

Effectiveness of the Conservative Surgical Management of the Ameloblastomas: A Cross-Sectional Study.

Ameloblastoma is a benign, but locally aggressive odontogenic neoplasm, whose appropriate therapeutic management remains highly debatable. The aim of this study was to evaluate the reliability and effectiveness of the two conservative surgical therapeutic protocols (curettage with peripheral ostectomy only and curettage plus cryotherapy) for the management of ameloblastomas. About 53 cases of the ameloblastomas treated in 9 years were retrospectively analyzed regarding their clinical, histopathologic, radiographic, and therapeutic data. The results and the postoperative complications related to both the therapeutic protocols were also statistically investigated. A slight female preponderance was seen (1.12:1.0) with a mean age of 27.1 years. The posterior mandible was the most affected site and dental involvement was frequently found. Multilocular lesions causing the alterations of the bone cortices were the most common radiographic findings. Recurrences were seen in 9.4% of the cases and although the patients submitted to curettage plus cryotherapy have shown an increased incidence of wound dehiscence, infection, and paresthesia, only bone sequestration proved to be significantly more frequent in this group compared to the patients treated by curettage with peripheral ostectomy only. The incidence of the recurrences following the conservative management is low and cryotherapy use as an adjuvant tool must be rationally considered.

Cerebellar Intermittent Theta-Burst Stimulation Reduces Upper Limb Spasticity After Subacute Stroke: A Randomized Controlled Trial.

Objective: This study aims to explore the efficacy of cerebellar intermittent theta-burst stimulation (iTBS) on upper limb spasticity in subacute stroke patients.Methods: A total of 32 patients with upper limb spasticity were enrolled and randomly assigned to treatment with cerebellar iTBS or sham stimulation before conventional physical therapy daily for 2 weeks. The primary outcomes included the modified Ashworth scale (MAS), the modified Tardieu scale (MTS), and the shear wave velocity (SWV). The secondary outcomes were the H-maximum wave/M-maximum wave amplitude ratio (Hmax/Mmax ratio), motor-evoked potential (MEP) latency and amplitude, central motor conduction time (CMCT), and the Barthel Index (BI). All outcomes were evaluated at baseline and after 10 sessions of intervention.Results: After the intervention, both groups showed significant improvements in the MAS, MTS, SWV, and BI. In addition, patients treated with cerebellar iTBS had a significant increase in MEP amplitude, and patients treated with sham stimulation had a significant decrease in Hmax/Mmax ratio. Compared with the sham stimulation group, the MAS, MTS, and SWV decreased more in the cerebellar iTBS group.Conclusion: Cerebellar iTBS is a promising adjuvant tool to reinforce the therapeutic effect of conventional physical therapy in upper limb spasticity management after subacute stroke (Chinese Clinical Trial Registry: ChiCTR1900026516).

Clinico sonological evaluation of right iliac fossa mass

Back ground and Objectives: Mass in the abdomen, by reason of their wide spread implications, has since long exercised the minds of many workers. Mass in the right iliac fossa is not an uncommon entity. The temple of surprises, pandoras box- hackeyened phraseology is apt in case of mass In the right iliac fossa. This challenging task of recognising certain well defined clinicopathological aspects of mass in the right iliac fossa has stimulated in undertaking this study. Ultrasound is quick, non invasive and has bridged the gap between palpation and direct visualization. In this common clinical condition often disparity between clinical, ultrasound, and final diagnosis. The role of ultrasound in evaluation is necessary as some require emergency surgical intervention and some improve with conservative management. Materials and Methods: Retrospective study of 42 patients presented with clinical diagnosis of right iliac fossa mass were selected. Pediatric age group, gynaecological conditions, and parietal wall swellings were excluded. In these cases ultrasound examination by 5 and 7.5 Mh ransducers were used and clinical, ultrasound and final diagnosis ware compared. Results: Appendicular mass constituted 14 cases (33%), appendicular abscess 11cases (26%) leocaecal tuberculosis 8 cases (19%) carcinoma cecum 5 cases (12%) and crohn's disease 1 case (3%). Appendicular mass common in the age group 30-39 years, appendicular abscess in 60- 70 years, Ileocecal tuberculosis in 30-39 years, carcinoma caecum in > 40years, and 1 case of crohns disease between 40-49 years. Ultrasound was able to diagnose appendicular abscess which were clinically diagnosed as appendicular mass. ultrasound was able to find out the bowel thickening with target sign and pseudo kidney sign in Ileocecal tuberculosis. and Carcinoma cecum with moderate specificity. Conclusion: Appendicular pathology constituted 59% cases. it was able to detect appendicular abscess with high sensitivity and specificity. It helped in early assessment and early intervention of the required, reduces the cost and morbidity, It is an adjuvant diagnostic tool in cases of Ileocecal tuberculosis and carcinoma cecum. In the elderly who cannot withstand and in cases of misleading presentation it has a ole and it is really cost effective, non invasive procedure done in OPD set up without preparation with good result, is a first good line of investigation modality in right iliac ossa mass.