Cytological, Bacteriological and Antibiogram Studies for the Management of Uterine Infection in Repeat Breeder Bovines

Background: Repeat breeding syndrome (RBS) associated with sub-clinical uterine infection (UI) remains to be a major reproductive problem faced by Indian farmers. Present study documents its diagnosis, prevalent etiological agents, antibiogram pattern and efficacy of the treatment at field level. Methods: Seventy-eight RBS affected bovines were selected. The cervical mucous (CM) was collected for study of its characteristics, white-side test, endometrial cytology, microbial examination and antibiogram. The treatment protocol was developed and the animals’ response to the treatment was assessed. Result: The overall incidence of RBS was found to be 12.9% and the cases associated with uterine infection (RBS/UI+ve) and without uterine infection (RBS/UI-ve) were 44.87% and 55.13%, respectively. The mean scores of CM character, odour, pH and number of polymorphonuclear cells in RBS/UI +ve were 2.09±1.39, 1.14±0.12, 8.49±0.08 and 12.46±0.96, respectively, and differed significantly (P less than 0.05) from RBS/UI-ve cases. The microbial examination revealed the presence of gram negative bacilli, Trueperella spp., Pseudomonas spp., Staphylococcus spp., Escherichia coli and yeast infection. Antibiogram studies recorded the response of Tetracyclin as best (48.57%) followed by Cephalexin (22.86%), Chloramphenicol (20.0%) and Streptomycin (8.57%). The RBS/UI+ve cases were treated individually, on one-to-one basis, obeying antibiogram. The infection appeared to be considerably controlled and overall success rate was observed in the form of confirmed pregnancy in 71.43% cases. Thus, it was concluded that prompt diagnosis using endometrial cytology and antibiogram guided therapeutic approach may aid for effective management of RBS/UI +ve cases, under field conditions.

Management of Descending Necrotizing Mediastinitis, a Severe Complication of Deep Neck Infection, Based on Multidisciplinary Approaches and Departmental Co-Ordination

Objectives Descending necrotizing mediastinitis (DNM) developing after deep neck infection (DNI) is a potentially lethal disease of the mediastinum with a mortality rate as high as 40% prior to the 1990s. No standard treatment protocol is available. Here, we present the outcomes of our multidisciplinary approaches for treating DNM originating from a DNI. Methods Between June 2016 and July 2021, there were 390 patients with DNIs admitting to our tertiary hospital. A total 21 patients with DNIs complicated with DNM were enrolled. The multidisciplinary approaches included establishment of airway security, appropriate surgery and antibiotics, extracorporeal membrane oxygenation, and intensive care unit management. The clinical variables were analyzed. Results Two patients died and 19 survived (mortality 9.5%). The patients who died had a higher mean C-reactive protein (CRP) level than did those who survived (420.0 ± 110.3 vs 221.8 ± 100.6 mg/L) (P = .038). The most common pathogens were Streptococcus constellatus and Streptococcus anginosus. From 2001 to 2021, the average mortality rate of studies enrolling more than 10 patients was 16.1%. Conclusion Multidisciplinary approaches, early comprehensive medical treatment, and co-ordination among departments significantly reduce mortality. Patients with severe inflammation and high CRP levels require intensive and aggressive interventions.

A Pragmatic Approach to the Management of Severe Awake Bruxism in an Adolescent with Cerebral Palsy and Global Developmental Delay

Cerebral palsy is a neurological and motor condition characterised by muscle balance and posture impairments. Bruxism and malocclusion were frequently observed in patients with cerebral palsy, in contrast to other oral anomalies. The report outlines how severe awake bruxism is managed in a 16-year-old Korean boy who has nonverbal spastic cerebral palsy and global developmental delay. The treatment protocol involved the fabrication of soft occlusal splints of three and four millimetres in thickness, followed by the placement of stainless-steel crowns on all first permanent molars whilst video recording and a bruxism diary was kept. Fixed restorations demonstrate increased endurance in withstanding bruxism force in persons who are dependent on their caretaker.

Biophysical and Biomechanical Effect of Low Intensity US Treatments on Pancreatic Adenocarcinoma 3D Cultures

Current developments in medical technology have focused on therapeutic treatments that selectively and effectively address specific pathological areas, minimizing side effects on healthy tissues. In this regard, many procedures have been developed to provide non-invasive therapy, for example therapeutic ultrasound (US). In the medical field, in particular in cancer research, it has been observed how ultrasounds can cause cell death and inhibit cell proliferation of cancer cells, while preserving healthy ones with almost negligible side effects. Various studies have shown that low intensity pulse ultrasound (LIPUS) and low intensity continuous ultrasound (LICUS) regulate the proliferation, cell differentiation and cavitation phenomena. Nowadays, there are poorly known aspects of low intensity US treatment, in terms of biophysical and biomechanical effects on target cells. The aim of this study is to set up an innovative apparatus for US treatment of pancreatic ductal adenocarcinoma (PDAC) cells, monitoring parameters such as acoustic intensity, acoustic pressure, stimulation frequency and treatment protocol. To this purpose, we have developed a custom-made set up for the US stimulation at 1.2 and 3 MHz of tridimensional (3D) cultures of PDAC cells (PANC-1, Mia Paca-2 and BxPc3 cells). Images of the 3D cultures were acquired, and the Calcein/PI assay was applied to detect US-induced cell death. Overall, the setup we have presented paves the way to an innovative protocol for tumor treatment. The system can be used either alone or in combination with small molecules or recombinant antibodies in order to propose a novel combined therapeutic approach.

SMART Syndrome: A Case Report

Introduction: Stroke-like migraine attacks after radiation therapy (SMART) syndrome, is a late complication of brain radiotherapy. (1) Symptoms are commonly subacute in onset and involve migraine type of headache, seizures, focal neurologic deficits.(2) . MRI findings are usually unilateral and posterior predominant cortical-subcortical hyperintensity, swelling and prominent gyriform (cortical and leptomeningeal) gadolinum enhancement in the areas of brain that underwent irradiation with or without diffusion restriction.(1) There is no standard treatment protocol of SMART syndrome. Antiepileptics and corticosteroids are commonly used drugs.Case Report: A 65 years old woman diagnosed with breast cancer with brain metastases and treated with more than 50 Gy brain radiotherapy. A couple of months later patient presented with acute right sided weakness and numbness, episodic myoclonic jerking of the right arm and leg and gait instability. MRI and magnetic resonance angiography of the brain with gadolinium revealed left parietooccipital cortical diffusion restriction and accompanying dilatation of the left posterior cerebral artery as new findings. Computed tomography perfusion revealed increased perfussion in the affected area. The patient was diagnosed with SMART syndrome.Management & Outcome: The patient was treated with dexamethasone (16 mg/day) and anticonvulsant therapy. Myoclonic seizures had almost completely remitted. However, her cognitive impairment persisted, then the patient arrested because of aspiration a month later.Discussion: Besides confirming SMART syndrome, diagnostic investigations is also important to exclude other etiologies. Posterior reversible encephalopathy syndrome, post-ictal changes, meningoencephalitis and cerebrovascular diseases are radiological differential diagnosis which should be considered.(3) Proper and early diagnosis of SMART syndrome is significant to refrain unneccessary aggressive approaches and for appropriate treatment to prevent sequela lesions.

Intrusion of the maxillary posterior teeth with a single buccal mini-implant positioned bilaterally in young adults with a tendency towards hyperdivergence: A clinical study

Background: Skeletal anchorage systems have been used for intrusion of the posterior teeth with satisfactory results. To achieve this, mini-implants are placed at anatomically challenging sites such as the palate or require several mini-implants to produce the desired effect. Objective: To determine the magnitude of intrusion of the maxillary posterior teeth achieved on a continuous arch wire using a single buccal mini-implant placed bilaterally in young patients with a tendency towards hyperdivergence and to evaluate its influence on the skeletal, dental and soft-tissue structures. Methods: A total of 17 patients with proclination of the anterior teeth, tendency towards hyperdivergence and clockwise rotation of the mandible were selected. First premolars were extracted as part of treatment protocol. A 0.022-MBT bracket prescription was used. Mini-implants were placed bilaterally on the buccal aspect at the mucogingival junction or slightly gingival to it between the maxillary second premolar and first permanent molar. A total of 200 g of intrusive force was placed from a continuous 0.019 × 0.025 inch stainless-steel arch wire to the mini-implant by means of an elastomeric thread on both sides. Lateral cephalograms and study models were taken before the start of intrusion and six months later. Parametric and non-parametric tests were done to assess treatment results. Results: Significant intrusion was observed in the maxillary molar and premolar region with tendency towards intrusion in the anterior region. There was significant decrease in lower anterior facial height (LAFH) with anti-clockwise mandibular rotation, decrease in facial proportion index and total facial height. No changes were observed in the transverse plane. Conclusion: Intrusion of the permanent maxillary molar can be achieved on a continuous arch wire with a single buccal mini-implant placed bilaterally with improvement in facial aesthetics, especially in the vertical plane. This method may be beneficial in patients with borderline vertical discrepancy treated with conventional friction mechanics during space closure after first premolar extractions.

Clinical, Epidemiological and Microbiological Profile of A Potentially Pathogenic Environmental Saprophyte, Burkholderia pseudomallei; at A Tertiary Care Hospital in Coastal India

Melioidosis is a severe systemic infectious disease caused by Burkholderia pseudomallei, a gram-negative bacillus with bipolar staining. It is an environmental saprophyte endemic to Southeast Asia and Northern Australia. The disease can have varying manifestations. This is a retrospective study of the clinical and microbiological profile of culture-proven cases of melioidosis who presented to a tertiary care hospital in Coastal Karnataka between January 2018 and December 2020. The epidemiological, demographic, clinical and laboratory characteristics were studied and analyzed. A total of 27 cases were seen during the study period. All patients were from the western coastal areas of India. Fever was the most common presenting complaint. Analysis of the clinical manifestations showed 11 (40.74%) with bacteremia. Pneumonia was the most common primary clinical presentation with 11 cases (40.74%). 9 (33.3%) patients had an abscess in some part of the body on presentation. Secondary foci were seen in 5 (18.5%) patients. The prominent risk factors seen were history of type 2 diabetes mellitus, age >40 years, alcoholism and smoking. 13 (48.15%) were started with the treatment regimen for melioidosis. Only 8 (29.63%) were prescribed the eradication treatment regimen. One case which was inadequately treated came back with reactivation of melioidosis. Varied clinical presentation of melioidosis makes the specific clinical diagnosis difficult. Due to the high mortality and morbidity rate, early diagnosis and prompt management is warranted, this requires clinical vigilance and an intensive microbiological workup. Lack of adherence to the treatment protocol can lead to reactivation.

​Genital Changes, Haemato-biochemical Profile and Therapeutic Management of Endometritis in Crossbred Dairy Cows

Background: Reproductive performance is one of the major determinants for the economic improvement of a dairy farm. Endometritis and other uterine complications cause decrease the pregnancy rate. In this study, the genital changes and haemato-biochemical profile of crossbred dairy cows affected with endometritis was studied to evolve a suitable treatment protocol in order to improve reproductive efficiency. Methods: Crossbred cow affected with endometritis were selected based on mucopurulent vaginal discharge at estrus and tested positive for white side test. Animals were divided randomly into 8 groups with 24 animals in each group. Different therapeutic regimens fortified with supportive treatment were opted. The therapeutic regimens were supportive therapy having bypass fat, vitamins and minerals, Lugol’s iodine, Lugol’s iodine with supportive therapy, intrauterine (IU) antibiotic, IU antibiotic with supportive therapy, E. coli. LPS, E. coli. LPS with supportive therapy and control group respectively. Efficacy of each treatment regimen was based on first service conception rate (FSCR). Result: Of all the therapeutic regimens, fortification of Lugol’s iodine with supportive therapy resulted in higher FSCR (83.33%) indicating better applicability as a treatment tool for endometritis in crossbred cows.

Analysis of the Changes in Occlusal Plane Inclination in a Class II Deep Bite “Teen” Patient Treated with Clear Aligners: A Case Report

Background: Optimal management of hypodivergent growing patients demands a strict control of vertical dimension and to exploit the growth potential. If a deep bite malocclusion causes a traumatic contact between the upper and lower incisors and affects the facial appearance, an early interceptive treatment is recommended. The aim of this case report is to outline the clinical management of the occlusal plane of a growing Class II division 1 deep bite patient treated with aligners and Class II elastics. Methods: The treatment lasted 11 months and was divided into two phases. Treatment goals included improvement of the soft tissue profile and basal bone relationships through an increase in the mandibular third of the face and a sagittal advancement of the mandible. The correction of the curve of Spee involved intrusion of the mandibular incisors and extrusion of the mandibular premolars. Results: The cephalometric analysis at the end of the treatment displayed significant differences in the skeletal and occlusal pattern along with aesthetic improvements. Conclusion: The final cephalogram showed a consistency between the planned tooth movement and the clinical results. Although definitive recommendations must be withheld until longer follow-up is available, the patient presented here shows that the treatment protocol yielded positive mandibular growth.

Impact of the Ayurveda Treatment Protocol in the Management of COVID -19

Covid-19 is an infectious disease caused by SARS-COV-2, which can cause severe respiratory illness and complications in patients. Recognizing Ayurveda's endless possibilities for improving immunity and preventing disease progression, the Ministry of AYUSH developed and approved the Ayurvedic protocol for handling Covid-19. Even though Ayurveda practitioners have been prescribing medicines to the Covid-19 patients since approval, no studies have been reported from Kerala regarding the effectiveness of the Ayurveda Treatment approaches. Hence the School of Fundamental Research in Ayurveda designed an observational study to evaluate the impact of the Ayurveda Treatment approaches in the management of Covid -19. The study result affirms that the Ayurvedic treatment method is very effective against Covid-19 and the role of Ayurveda in addressing the Covid-19 challenge is invaluable. Key words: Covid-19, Ayurvedic protocol, School of Fundamental Research in Ayurveda.