bluuebunny/crossref_metadata_2025 huggingface dataset:
Adenosine-induced Profound Hypotension in Facilitating Intracranial Aneurysm Clipping – Our Institutional Experience
Authors: Bose Manikandan , Pravallika A. , Manoharan Ganesh Kumar , Prasad R. J. V. V.
Published: September 2024

ABSTRACT

Introduction:

Adenosine-induced transient hypotension and temporary cardiac asystole are one of the novel techniques for facilitating aneurysm clipping. Till now, extensive studies have been done and no major complications are notified. However, there is no standardised safe dose mentioned in the literature. Here, we share our experience with adenosine in intracranial aneurysm clipping in our institution.

Methodology:

A total of 15 cases have been studied where adenosine is used in variable dosage to attain required transient hypotension and cardiac asystole. The bolus dosage, duration of hypotension and asystole and post-operative complications are noted.

Results:

Adenosine dosage of 0.5 mg/kg was used to achieve necessary hypotension and thus facilitating aneurysm clipping. No significant complications are observed at this dose of adenosine.

Conclusion:

A bolus of adenosine can allow a transient asystole with temporary hypotension that decompresses the aneurysm sac and improves visualisation without the negative effects of prolonged hypotension and thus facilitating aneurysm clipping. We could achieve the required duration of asystole and hypotension with 0.5 mg/kg of adenosine without any notable complications.
Cavernoma of the Septum Pellucidum: Case Report and Review of Literature
Authors: Kulkarni Akshay V , Rathod Sanjeev T , Menon R Girish
Published: September 2024

ABSTRACT

Intraventricular cavernomas are rare and septum pellucidum cavernomas are still rarer with only nine reported cases in the literature. We present our experience with the successful surgical management of a patient with septum pellucidum cavernoma and discuss the management concerns. A 30-year-old male presented with raised intracranial pressure features of 1-month duration. Magnetic resonance imaging revealed obstructive hydrocephalus secondary to a lesion around the foramen of Monro mimicking a colloid cyst but with certain atypical imaging findings. First, a surgical attempt to excise the lesion was aborted due to vascularity and bleeding from the lesion. During the second surgery, a vascular mulberry-like lesion was seen attached to the septum pellucidum and complete excision was done in toto. Histopathological examination confirmed the diagnosis of cavernoma. The patient had an uneventful recovery and at 6-month follow-up is doing well except for minimal memory impairment related to forniceal injury. Septum pellucidum cavernomas can mimic a colloid cyst of the third ventricle on radiology and a differential diagnosis of cavernoma should be considered while attempting the excision of septal lesions. Complete excision is the treatment of choice and gives good results.
Role of Continuous Cisternal Drainage in Addition to Cisternostomy in the Surgical Management of Ruptured Aneurysms - A Retrospective Analysis of Clinical Outcomes
Authors: Manoharan Ganesh Kumar , Prasad R. J. V. V.
Published: September 2024

ABSTRACT

Introduction:

Subarachnoid haemorrhage is the major factor in morbidity and mortality following aneurysm ruptures. Thick subarachnoid haemorrhage in cisternal spaces increases risk of vasospasm, delayed cerebral ischaemia and incidence of hydrocephalus following surgery. Continuous cisternal drainage in addition to opening of basal cisterns during clipping of aneurysm helps in continuous drainage of cisternal blood thus improving the clinical outcome.

Materials and Methods:

We conducted a retrospective review of 50 consecutive cases of ruptured aneurysms treated by microsurgical clipping between January 2020 and February 2023. Patients were stratified into two groups: Group 1 included patients with only cisternostomy (opening all the cisterns around major vessels) and Group 2 included patients with additional continuous cisternal drainage (CCD). We compared their baseline characteristics and clinical outcomes.

Results:

There were no statistically significant differences between the two groups in terms of epidemiological characteristics, WFNS score, Fisher’s scale and presence of intraventricular haemorrhage. Patients in group two (cisternostomy with continuous cisternal drainage) showed less incidence of vasospasm and hydrocephalus.

Conclusion:

Cisternostomy with continuous cisternal drainage (CCD) allows the effective removal of subarachnoid blood, thereby reducing vasospasm, arachnoid inflammation and fibrosis.
Differentiating Postmortem Claw Marks by the Asian Water Monitor (Kabaragoya) from Antemortem Sharp Weapon Trauma Based on the Injury Pattern
Authors: Dileka Piumi , Gunathilaka Chiranthika Madhupoorni A. , Ranchamali Thilinika , Gunawardena Sameera A.
Published: September 2024

The Asian water monitor (Varanus salvator) or kabaragoya is the predominant large animal scavenger of human remains in Sri Lanka; however, its significance is rarely discussed in the forensic literature. This is the case of a 54-year-old male with a history of dementia, depression, and wandering behavior whose body was found, partially submerged in a river, 2 days after he was reported missing. There were several linear wounds with regular margins over his arms and face which raised the suspicion of homicidal sharp weapon trauma. The injuries were seen in clusters and did not involve harder structures such as tendons, ligaments, or bones. There were no signs of inflammation or bleeding. They were attributed to kabaragoya claw marks, which are postmortem artifacts that mimic incised wounds. However, there were no areas of tissue loss to indicate that the animal had begun feeding on the corpse. This case discusses the problems faced by medicolegal investigators when encountering this phenomenon which is relatively underreported in the forensic literature.
Age Estimation Using Single-Rooted Teeth of Indian Residents by Modified Kvaal’s Method: A Pilot Study
Authors: Jose Deepa , Mane Deepa R , Varghese Soma Susan , Mathews Pramod Philip , Sebastian Joseph
Published: September 2024

Background:

This study aimed to create an age estimation formula with high sensitivity and specificity using the modified Kvaal’s dental radiographic method. The parameters for age estimation were assessed by measuring the length and width of tooth, root, and pulp with the help of a stereomicroscope and digital image analysis.

Materials and Methods:

Only single-rooted noncarious teeth were included. A total of 203 samples of teeth, with an age ranging from 15 to 85 years, were collected, of which only 123 samples were included in the study. Images of vertically sectioned teeth specimens were captured under a stereomicroscope (version SZ-790, ×10 mm eyepiece), and parameters were measured using Adobe Photoshop.

Results:

Karl Pearson’s correlation coefficient was used to correlate age with the dental parameters, and step-wise regression analysis was used to derive the age estimation formula. A significant correlation of age with pulp length and root and pulp width having P < 0.001 was observed, and an age estimation formula with a standard estimation error of 14 could be derived.

Conclusion:

Kvaal’s parameter in extracted single-rooted tooth showed a better reliability and reproducibility in age estimation. Further studies with a larger sample size and tooth-specific formula using principal component analysis should be considered to validate the accuracy of the present result.
A Retrospective Study to Evaluate the Morphometry of the Foramen Magnum and its Role In Forensic Science in a Nigerian Population of Delta State
Authors: Ominde Beryl Shitandi , Igbigbi Patrick Sunday
Published: September 2024

Background:

Sexual dimorphism of the foramen magnum has increased its interest in forensic science. Gender determination is an important preliminary step in the identification of unknown skeletal remains. This study aimed at determining the dimensions of the foramen magnum in Delta State Nigeria and their role in gender discrimination.

Materials and Methods:

We retrospectively analyzed computed tomographic images of 336 patients (199 males and 137 females) aged ≥18 years, archived in the Radiology Department of a Teaching Hospital in Nigeria. Ethical approval was granted by the hospital's ethical board. The length, width, and area of the foramen magnum were measured and analyzed using the Statistical Package for the Social Sciences software version 23. We used an independentt-test and analysis of variance to evaluate the association of these dimensions with sex and age, respectively. The percentage accuracy of sex discrimination and the association between variables were assessed using discriminant functional analysis and Pearson's correlation test correspondingly. The results were considered significant atP< 0.05.

Results:

The foramen magnum length, width, and area showed a statistically significant gender difference (P< 0.05). The width was the best sex discriminating variable (64.3%) and the overall accuracy of correct sex allocation using all the variables was 75%. All the parameters measured showed a significant strong positive correlation with each other (0.5 ≤ r < 1,P< 0.05).

Conclusion:

The foramen magnum length width and area were sexually dimorphic. Their high overall accuracy (75%) in gender discrimination implies that they may collectively be utilized in the sex estimation of unknown skulls in Delta State Nigeria.
The Trend of Homicides in South Kerala from 2002-2016
Authors: Dileeph Nikhil , Sharija S. , Stanley Antony , Valsala K. , Sujisha S. S. , Prabhakaran Nikita
Published: September 2024

Aims:

The aim was to analyze the homicide pattern in South Kerala from autopsies conducted between 2002 and 2016.

Objectives:

Exploring the age and gender distribution of death due to homicide, the type and distribution of injuries according to the region of the body, and trends of homicide. We also tried to study the pattern of defense wounds in homicidal cases and characteristics in dyadic deaths (homicide-suicide).

Materials and Methods:

It was a retrospective descriptive study. The setting was the Department of Forensic Medicine, State Medico-Legal Institute, Government Medical College (GMC), Thiruvananthapuram. All cases of autopsies with an alleged history of homicide, between 2002 and 2016, done at Mortuary of GMC, Thiruvananthapuram, were included in the study. Records of all cases of an alleged history of homicide from January 1, 2002 to December 31, 2016 were perused.

Results:

957 cases were analyzed. The annual incidence of homicide is declining after 2012. Young adult males (31–40 years) are the most common group involved (24.97%). Head injury was the most common cause of death (43.68%). The head was the most common area to be affected in fatal blunt force injuries (49%) while the chest was involved commonly in fatal sharp force injuries (36%). Females were more often the homicide victims in murder-suicides. Husband–wife and father–child combination was the most common pairs in dyadic deaths.

Conclusion:

The characteristics which were associated with the homicides were generally in agreement with the existing forensic literature. The findings encourage examining the motives of homicide and potential sociocultural factors affecting the victims and possibly the assailants. We also found that the murder-suicide cases differed from the homicides requiring a separate domain of understanding and subsequent investigations.
Forensic Identification of Four Indian Snake Species Using Single Multiplex Polymerase Chain Reaction
Authors: Mitra Ishani , Roy Soma , Haque Ikramul
Published: September 2024

Among different endangered animal species, snakes are the most neglected creature looked at with apathy and therefore, are ruthlessly killed, illegally trafficked, and poached for their venom, lucrative skin, meat, and bones for manufacturing of medicines, accessories, and food items. Establishing the identity of the endangered snake species is important for punishing the offenders under Wildlife Protection Act (WPA) (1972) but morphological characters fail to establish identity as they are often altered. The technique of identification of snake species at molecular level holds very effective conclusion in punishing offender. Here, we have constructed and demonstrated a novel multiplexing polymerase chain reaction technique, using 16S rRNA and C-mos gene for identification of four Indian snake species, namely Ptyas mucosa, Daboia russellii, Naja naja, and Xenochrophis piscator. They are listed in Appendix-II and III of convention on international trade in endangered species of wild fauna and flora and Schedule II; Part II of Indian WPA, 1972. Therefore, it may be considered a functional tool for establishing species-specific identity of four Indian snake species and promising to be useful for their conservation.
Study on Transfer and Persistence of Fibers
Authors: Mane Manashree , Devika G
Published: September 2024

Fiber evidence has played a crucial role in ascertaining various characteristics and has aided in providing evidential value to the fiber evidence as well as reconstructing events during crime scene investigation. Although fibers are transferred easily at the crime scene and various methods of interpretation exist, it is challenging to get a fiber match. The present study aims to provide a systematic review of the role of fiber as trace evidence. It explores the fiber population, transfer and persistence of fibers, fiber shedability and recovery, effect of laundry on fibers, stabbing events, the resistance of fabric against weapon's penetration, the behavior of fabric upon ballistic impact, and various analytical techniques of fiber examination. The study approaches to evaluate the significances and uncertainties of the recovered fiber evidence.
Hyphenated Techniques in Liquid Chromatography and their Applications in Forensic Toxicology
Authors: Kumar Sachil , Bogusz Maciej J.
Published: September 2024

Conventional analytical methods, such as gas chromatography, high performance liquid chromatography (LC), ultra-violet, and others, are ineffective in addressing the increasing number of problems in forensic toxicology. Hyphenated analytical methods, wherein the separation method are coupled or combined with spectral methods, with the help of a proper interface, are the available alternative options. The key benefits of these methods are the requisites of low limits for detection, shorter analytical time, the possibility of automation, better reproducibility, and high precision and repeatability. This review discusses on some of the hyphenated analytical methods that involve LC as the separation tool, for their most recent applications in the area of forensic toxicology focusing on the screening of drugs of abuse, the usage of alternative matrices for monitoring drug abuse, analysis of chemical warfare agents, determination of doping agents and related substances, natural toxins, environmental poisons, and examination of food produce adulteration. The incorporation of the more user-friendly LC-interfaces, such as atmospheric pressure chemical ionization, and electrospray ionization in the LC- mass spectrometry has increased the popularity of this technique tremendously among scientists of different disciplines. Hyphenated approaches have extremely low constraints regarding the identification and quantification, and offer high reproducibility, with unparalleled potential.
Y-STR Kits and Y-STR Diversity in the South African Population
Authors: Shabalala Sthabile , Ghai Meenu , Okpeku Moses
Published: September 2024

The South African population consists of four ethnic groups, i.e., Blacks, Coloreds, Indians, and Whites, and is considered the most diverse conglomeration of humans. In addition to autosomal short tandem repeat (STR) variation, an important tool to study population diversity is Y-chromosome (Y)-STR analysis. Y-STRs aid in forensic investigations and provide essential data about paternal lineage origins. Y-STR kits consisting of an array of stable and rapidly mutating markers offer crucial information on a given population's genetic and haplotype diversity. This review discusses the development of Y-STR kits over the years and highlights some prominent Y-STR studies conducted on the South African population. The earliest Y-STR kit developed was the Y-PLEX™6, with the most recent being the UniQTyper™ Y-10 Multiplex. The South African population studies show varying data, with the “minimal haplotype” having low discrimination capacity among the ethnic groups and the UniQTyper™ Y-10 showing high genetic diversity among the ethnic groups of the country. There is a dearth of Y-STR studies on the South African population. With the advent of new Y-STR kits with increased discriminatory markers, additional studies are required to represent the South African population in the Y-STR databases. Considering the diversity of the South African population, establishment of a local/regional population database would be beneficial. In addition, data on the origins and prevalence of mutations and silent alleles should be obtained from STR datasets generated during kinship investigations (specifically, parentage tests) so that detailed information about the frequencies of mutations, silent alleles, and uniparental disomy in the South African population at Y STR loci can be estimated.
European Court of Human Rights as a Guarantee of Observation the Medical Secrecy
Authors: Prudnykova Olena V , Pyvovarov Vasil M , Fedosova Olena V , Stasevska Oksana A , Umanets Olga V
Published: September 2024

The European Convention on Human Rights proclaims the right of everyone to privacy of information about their state of health, which is a particularly important issue during the COVID-19 pandemic. The aim of the study is to determine the essence of the ECtHR's activity as a guarantee of information culture, highlight the main elements of its activities in this aspect, and analyze the right to medical secrecy in the practice of the European Court of Human Rights. The formal-logical method was used to analyze the norms of the European Convention on Human Rights, determine the content of basic concepts, and systematize the material in order to obtain generalizing conclusions within the framework of the stated problem. The predictive method was used to determine the prospects for the development of legislation aimed at creating a system of effective legal provision for the confidentiality of patient information. The European Court of Human Rights has more than once drew attention to the enormous importance of protecting personal, in particular medical data, so that a person can enjoy his or her right to private and family life with satisfaction. That is why public authorities must ensure the confidentiality of information about the health of individuals. It should not be disclosed or processed without the prior informed consent of the person concerned. There are a lot of cases of unlawful disclosure of information about the patient's health and liability for unlawful disclosure.
Morphometric and Volumetric Evaluation of Maxillary Sinus as an Aid in Sex Identification in Forensic Odontology – A Cone-Beam Computed Tomography Study
Authors: Ceena Denny E. , Bhoraskar Mohana , Natarajan Srikant , Binnal Almas , Bastian T. S.
Published: September 2024

Background:

Various methods are used in forensic odontology for the purpose of sex and personal identification. Some of them include cheiloscopy, rugoscopy, mandibular measurements, and study of paranasal sinuses. In our study, we have used maxillary sinus as an aid in sex identification. For this purpose, we have evaluated the morphometric and volumetric measurements of the maxillary sinus using a 3-Dimensional imaging modality, Cone Beam Computed Tomography.

Aims and Objectives:

Sex and age identification are important in the process of identification of both the living and the dead. Hence, this transverse retrospective study was done to appraise the precision of the dimensions and volume of the maxillary sinus to aid in sex and age identification.

Material and Methods:

Eighty full Field of View (FOV) Cone-Beam Computed Tomography (CBCT) images were retrieved from the archives which were matched with age and sex. The maxillary sinuses on either side were measured mediolaterally in the axial section and supero-inferiorly in the coronal section. The volumetric analysis of the sinus was done in the sagittal section. The sex was classified using discriminant function analysis and the differences were compared using independent t-test. The differences with age were analyzed using one-way ANOVA.

Results:

Independent t-test was done for comparison of the sinuses between both sexes. Maxillary sinuses measurements were larger among the males both superior-inferiorly on either side (P <0.001) and mediolaterally on the right (P <0.049) showed statistically significant values. A significant correlation existed while comparing the maxillary sinus volume among both the sexes on either side (P <0.001 and <0.002 in the case of right and left respectively). On comparing the supero-inferior and mediolateral measurements and the maxillary sinus volume on either side among the various age groups, the values were statistically insignificant. Present study shows that the maxillary sinus measurements using Cone-beam computed tomography were diagnostic in the identification of sex but not in age estimation and can be used in forensic dentistry.
Stature and Body Weight Estimations from Footprint Dimensions among Asante and Fante Females in Ghana
Authors: Dwomoh Samuel Kwaku , Appiah Atta Kusi , Appiah Nancy Darkoa Kusi , Abaidoo Chrissie Stansie
Published: September 2024

Background:

Footprints recovered from crime scenes can assist in establishing the identity (stature, body weight, and sex) of a person. Due to variations (genetic and environmental factors) in the morphology of the foot, several authors have derived populationspecific regression equations for stature and weight estimations.

Aims and Objectives:

Tribal differences in the footprint dimensions of Ghanaians have not been established. Hence, this study was done to determine if they were tribal differences in footprint dimensions.

Materials and Methods:

The footprints of Ghanaian females, aged 19–35 years, and belonging to two tribal groups (72 Asante and 73 Fante) were recovered using an ink pad method. Height, body weight, and footprint measurements were obtained following standard procedures.

Results:

Although Fante females had longer foot lengths and shorter foot breadths than Asante females, the difference was significant (P < 0.001) only in the left big toe-pad length (eta squared = 0.496). Height correlated better with footprint dimensions of Fante (r = 0.246 – 0.809) than Asante (r = 0.214 – 0.660) females. Body weight correlated weakly with footprint dimensions. Unlike in Asante females, foot length measurements did not correlate significantly with body weight among Fante females.

Conclusion:

The use of mixed population in deriving stature, weight and sex equations is cautioned especially when there is increased genetic diversity. The findings of this study have important applications in forensic anthropometric investigations.
Forensic Science and its Limitations in Rape and Murder Cases in India
Authors: Charan J Lakshmi , Manikyam K Sita
Published: September 2024

Forensic science plays a significant role in crime scene analysis and other evidence collection (such as clothes, cigarette butts, blood, semen, hair, etc.,) to scientifically establish the accused’s guilt. In rape and murder cases, DNA tests confirm the victim’s identity. It provides certain evidence that is helpful in the speedy investigation and conclusion of a trial. However, it is not a foolproof science and it has certain limitations. Hence, the first responders, such as the Crime Laboratory Ultimate Evidence System team and the forensic experts, must keep these limitations in mind during sample collection and examination, otherwise, it may lead to incorrect results. Such incorrect results may be obtained due to insufficient sample quantity, improper collection methods, or delay in an examination. It is highly recommended to implement standard operating procedure guidelines, failing which the admissibility of such forensic evidence to prove beyond all reasonable doubts is at stake. Accordingly, the court shall acquit the accused giving him the benefit of doubt. This article focuses on the applicability and limitations of forensic science in the Indian Criminal Justice System and the need to adopt due protocols to yield viable results.
Delirium in elderly
Authors: Grover Sandeep
Published: September 2024

Delirium is considered a manifestation of acute brain failure that usually has an acute onset, fluctuating course, and is often associated with multitude of negative outcomes. It is usually seen in medical-surgical patients, with very high prevalence rates among those on mechanical ventilation. It is often undiagnosed and undertreated. In developed countries, delirium is usually managed by multidisciplinary teams and the focus is on both prevention and management of delirium. In contrast to the developed countries, in India, physicians–surgeons have a negative attitude toward delirium and due to which not only it is underdiagnosed and undertreated but also mismanaged, and mental health professionals are not consulted. The research on delirium in India is also limited. The psychiatrists when involved in the care of patients with delirium also mainly focus on using pharmacological agents, with relatively lesser emphasis on the use of nonpharmacological measures. Further, in their encounter with specialists from other specialties, psychiatrists pay little attention to discussing the diagnosis of delirium and its management. There is a need to have an attitudinal change both at the level of the physicians–surgeons and psychiatrists in terms of clinical practice and research on delirium in the Indian context.
Undiagnosed depression and cognitive impairment with possible dementia among elderly population in urban areas of Hyderabad
Authors: Syed Saba , Kilaru Pranati
Published: September 2024

Background:

Elderly population in India is steadily increasing and depression and dementia are the most common neuropsychiatric disorders in the older adult population. Epidemiological studies have reported disparity in the prevalence of mental health morbidity in older Indian adults. The aim of the present study was to assess community-based prevalence of undiagnosed depression and cognitive impairment with possible dementia and its associated factors in elderly persons residing in urban areas.

Materials and Methods:

The present study was a cross-sectional community-based study conducted in persons above 60 years residing in urban localities of selected four different zones of Greater Hyderabad through multistage sampling. The questionnaire consisted of sociodemographic details, the validated “Mini-Mental State Examination (MMSE)” Questionnaire and Geriatric Depression Scale short-form.

Results:

The study was completed with a total of 230 individuals. The mean age of participants was 68.02 (±5.71) years. The study group comprised 50.87% males and 49.13% females and 56.08% of participants were self-employed/employed. Of total participants, 37.39% were residing alone of whom 70% were male. More than half (57.83%) of study participants had studied less than 8th grade. Cognitive impairment with possible dementia was present in 51.74% of participants, the prevalence of depression was 22.71% and in 16.09% of participants, both conditions coexisted. Factors found to be significantly associated with depression and cognitive impairment with possible dementia or both conditions were current unemployment [Odds ratio [OR] 5.0 (95% CI (2.44–10.81)], residing alone (OR 2.78 [1.48–5.23]) and education less than high school (OR 24.85 [2.53–9.32]).

Conclusions:

Depression and cognitive impairment with possible dementia were considerably prevalent in the elderly population of Hyderabad, India. Factors significantly associated with the prevalence of either or both conditions were, residing alone and education less than high school.
Approach to Sinonasal Masses
Authors: Reghunath Anjuna , Mittal Mahesh Kumar , Thukral Brij Bhushan , Sinha Mukul
Published: September 2024

The complex anatomy and exposure to various potential carcinogens lead to the development of tumors and tumor-like pathologies of the nose and paranasal sinuses. Delays in the diagnosis of sinonasal masses are common, leading to significant morbidity and mortality. Often the radiologist is the first person to recognize a neoplasm in a suspected inflammatory condition. Computed tomography and magnetic resonance imaging play a synergistic role in the assessment of pathologies in the sinonasal region, and their importance has become increasingly prevalent in the current scenario of coronavirus disease 2019 associated mucormycosis. Besides, imaging is essential for mapping the exact extent of the pathology and delineating vascular supply of hypervascular masses, thus facilitating the operating surgeon and interventional radiologist in management. The cases presented in this article have been accrued over the past three decades and analyzed as a retrospective observational study, with clinical, radiological, and pathological data having been extracted from the existing database in the institution. We present the imaging spectrum of sinonasal masses in the pediatric and adult population, highlight the key radiological features of the common pathologies and discuss an imaging template for reporting these masses, with special focus on the surgically relevant points to be included in the report. The educational goal of this review is to explore a meticulous and systematic imaging approach toward soft tissue lesions in the sinonasal region, which would enable the radiologist to reach a diagnosis or point toward the possible etiology and nature of the lesions.
Clinicopathological and Demographic Profile of Salivary Gland Cancer Patients from a Tertiary Care Hospital
Authors: Aashita  , Sharma Rajiv , Manikandan Muthu , Yadav Vikas , Malik Abhidha , Thakur Pragyat
Published: September 2024

Background:

Salivary gland cancer is a rare disease of the head-and-neck region. It can arise from either the three major salivary glands or minor salivary glands located throughout the aerodigestive tract.

Materials and Methods:

This retrospective analysis was performed in the Department of Radiation Oncology in a tertiary care hospital in north India. The records of 49 salivary gland cancer cases over the last 7 years were analyzed for demography and tumor characteristics.

Results:

In our department, the incidence of salivary gland cancer in the last 7 years was 0.51%. The mean age of presentation of patients with salivary gland cancer was 49.6 years. The male:Female ratio was 2.06:1. Patients presented after a mean symptom duration of 13.6 months in the locally advanced stage. The parotid gland was the most common site of involvement, followed by the submandibular gland. The most common histopathology observed was mucoepidermoid carcinoma and adenoid cystic carcinoma. Other histologies that were found were adenocarcinoma, acinic cell carcinoma, carcinoma ex pleomorphic adenoma, squamous cell carcinoma, mesenchymal tumor, muco-epidermoid carcinoma, salivary duct carcinoma, Hurthle cell carcinoma, malignant melanoma, atypical epitheliodermoid, undifferentiated neoplasm.

Conclusion:

Due to the heterogeneity of salivary gland tumors, diagnosis and management remains elusive. Multi-centric prospective studies are needed to better understand the disease.
Reliability and Reproducibility of Measurements in Cephalometric Radiography Acquired by a Charge-Coupled Device Imaging System
Authors: Abdelrahim Ala Mohamed , Abuaffan Amal Hussein
Published: September 2024

Objective:

To evaluate and compare the reliability, reproducibility, and speed of two cephalometric tracing methods computer-aided cephalometric tracing and manual tracing.

Materials and Methods:

This was an analytical, cross-sectional study. One hundred and three pretreatment cephalometric radiographs were randomly selected from the orthodontics department of a public university. Twelve cephalometric landmarks were identified, and fifteen measurements were calculated both manually and digitally using Vistadent OC software. The reliability of measurements was assessed for each method by applying the intraclass correlation coefficient (ICC). Paired t-test was used to compare the measurements' reproducibility and time difference between the two methods.

Results:

All angular and linear measurements for both the methods showed a range of moderate correlation (0.8 ≥ ICC ≥0.5) to strong correlation (ICC ≥0.8) except for L1-MAD, which displayed a poor correlation for both manual and digital tracing, (ICC = 0.36 and 0.33, respectively), as well as digital tracing of interincisal angle (ICC = 0.36). No statistically significant differences between the two methods were observed for all angular and linear measurements except upper anterior facial height (UAFH) and lower anterior facial height (P = 0.000). There was a statistically significant time difference between the two techniques (P = 0.000). The mean tracing time of the operator for single tracing was 18.02 min for manual tracing and 8.85 min when using the Vistadent program.

Conclusion:

Cephalometric measurements in conventional manual and digital cephalometric analysis are highly reliable. Although the reproducibility of some measurements between two methods showed statistically significant differences, most differences were considered minimal and clinically acceptable. Computer-assisted cephalometric analysis proved to be more time-efficient.
Oncological Outcome Following 3-Drug Neo-Adjuvant Chemotherapy Initiated “Triple Regimen” for Selected Subset of cT4b Bucco-Alveolar Carcinoma with Supra-Notch Infratemporal Fossa Extension
Authors: Patel Parin , Mandlik Dushyant , Gupta Karan , Patel Purvi , Sharma Nitin , Joshipura Aditya , Kaushal Ashish , Jani Kinjal , Kanhere Subhadha , Shah Diva , Shah Digish , Vishwakarma Gayatri , Newpane Bijay , Patel Kaustubh D.
Published: September 2024

Background:

Locally advanced bucco-alveolar complex carcinoma (T4b) with supra-notch (supra-sigmoid notch) infratemporal fossa (ITF) extension is an oncological challenge with poor outcome. We analyzed oncological outcome in patients managed with 3-drug neo-adjuvant chemotherapy (NACT) followed with surgical compartmental resection and adjuvant radiotherapy/Chemotherapy-RT (RT/CTRT), i.e., “Triple regimen.”

Materials and Methods:

Thirty-three cases of T4b bucco-alveolar complex carcinoma with supra-notch ITF extension were included from June 2009 to January 2017. Patients received 3-Drug NACT for 2–3 cycles every 21 days. Response to NACT was assessed with clinical examination, improvement in symptoms (like improved mouth opening etc.,), and Response Evaluation Criteria in Solid Tumors (RECIST) criterion. Patients showing stable disease and responders on NACT underwent compartmental surgical resection with complete ITF clearance followed by adjuvant RT/CTRT. Data were analyzed using STATA 13 and Kaplan − Meir graphs for survival rates.

Results:

Thirty-one patients (93.9%) showed response on NACT and subsequently went ahead with surgery. Clinical response according to RECIST criterion and subjective clinical improvement of more than 50% was noted in 18 cases while it was <50% in 13 cases. Seventeen of the 31 patients were disease free at last follow-up. There were no recurrences in ITF. The 3-year disease-free survival and disease-specific survival were 69% and 73%, respectively.

Conclusion:

Three-drug NACT followed by surgical resection in selected cases who show response to NACT with adjuvant chemoradiation provides a realm of hope for these borderline resectable T4b supra-notch cases.
Accelerating Endoscopic Diagnosis by Videomics
Authors: Piazza Cesare , Paderno Alberto , Montenegro Claudia , Sordi Alessandra , Gennarini Francesca
Published: September 2024

Videomics, an emerging interdisciplinary field, harnesses the power of artificial intelligence (AI) and machine learning (ML) for the analysis of videoendoscopic frames to improve diagnostic accuracy, therapeutic management, and patient follow-up in medical practice. This article reviews recent advancements and challenges in the application of AI and ML techniques, such as supervised learning, self-supervised learning, and few-shot learning, in videomics for otolaryngology-head-and-neck surgery. We discuss key concepts and tasks in videomics, including quality assessment of endoscopic images, classification of pathologic and nonpathologic frames, detection of lesions within frames, segmentation of pathologic lesions, and in-depth characterization of neoplastic lesions. Furthermore, the potential applications of videomics in surgical training, intraoperative decision-making, and workflow efficiency are highlighted. Challenges faced by researchers in this field, primarily the scarcity of annotated datasets and the need for standardized evaluation methods and datasets, are examined. The article concludes by emphasizing the importance of collaboration among the research community and sustained efforts in refining technology to ensure the successful integration of videomics into clinical practice. The ongoing advancements in videomics hold significant potential in revolutionizing medical diagnostics and treatment, ultimately leading to improved patient outcomes.
Facial Nerve Anatomy Revisited – A Surgeon's Perspective
Authors: Ramachandran Riju , Pillai Anoop Vasudevan
Published: September 2024

Facial nerve (FN) anatomy is an enigma and its knowledge helps in safe and adequate parotidectomy without compromising the nerve. A review of the literature was done by searching the databases in PubMed, Embase, Scopus, and Google Scholar using the keywords “Parotid,” “FNT,” “Anatomy,” “Surgery,” and “Parotidectomy” and retrieving about 433 manuscripts fulfilling our requirements. FNT anatomy has been described in detail dividing the extracranial FNT under “Exit,” “Trunk,” “Pes Anserinus,” “Divisions,” “Branches,” “Communications,” “Relationships,” and “Termination.” Normal anatomy and variations including classification of the variation have been done. Knowledge of FNT anatomy helps in performing a safe parotidectomy. It is possible to preempt the course of the nerve and dissect the gland in a precise and rapid fashion, especially in surgery for a recurrence.
The Comparative Effect of Lidocaine-Remifentanil Intravenous Infusion and Gargle on Hemodynamic Responses and Sore Throat and Cough after Endotracheal Extubation
Authors: Shabani Mohammad , Modir Hesameddin , Barsari Farzad Zamani
Published: September 2024

Purpose:

The present evidence-based clinical study addressed the therapeutic effectiveness of lidocaine-remifentanil intravenous infusion versus gargle on attenuation of hemodynamic responses and prevention of sore throat and cough after endotracheal extubation.

Materials and Methods:

In a double-blind clinical trial whereby 76 cases receiving endotracheal intubation under general anesthesia were classified into two intervention groups being treated with lidocaine-remifentanil mixture administered by either intravenous infusion or gargle using balanced block randomization. Hemodynamic parameters including heart rate and blood pressure during surgery and in recovery every 15 min and respiratory symptoms such as cough, hoarseness, and sore throat during recovery and at certain postoperative time points of 2, 4, 8, 12, and 24 h were gathered. Pain score was measured by a Visual Analog Scale. Statistical analysis was conducted using the software SPSS v22 by Chi-square and independent t-test.

Results:

No statistically significant observed intergroup in terms of oxygen saturation, heart rate, mean blood pressure, need for analgesic medication, duration of surgery, and the incidence of cough and hoarseness (P > 0.05), but not in pain score in recovery and eight postoperative hours. While the intergroup difference was found at other times, the intravenous infusion group was associated with less pain score, compared to the gargling group (P > 0.05).

Conclusion:

A reduction in sore throat observed in subjects receiving an intravenous infusion compared to those receiving the gargling intervention during recovery and 8 h after surgery. We have convincing evidence to support the superiority of intravenous therapy comprising of lidocaine and remifentanil; however, larger sample size is needed to establish whether or not the interventions are effective.
Sutureless Technique for Thyroidectomy
Authors: Khunteta Nitin , Badwal Jaspreet Singh
Published: September 2024

The purpose of the present systematic review is to compare the outcomes and complications of two techniques of thyroidectomy: the surgical technique for thyroidectomy performed by a sealing device (LigaSure small jaw) versus conventional clamp-and-tie technique (CAT). Clinical studies were retrieved from the electronic databases of PubMed, EMBASE, and Scopus. One-hundred and five articles provided information in relation to outcomes of thyroidectomy performed with the use of sealing device versus that performed using traditional CAT technique. Of these, 27 articles were selected for final inclusion. A thorough review of available literature shows that sealing device provides better results in terms of intraoperative and postoperative blood loss, postoperative drain volume, incidence of transient or permanent palsy of recurrent laryngeal nerve and external branch of superior laryngeal nerve, postoperative transient or permanent hypocalcemia, and length of hospital stay.
Comparative Evaluation of Sclerostin Levels in Gingival Crevicular Fluid of Periodontal Health and Disease before and after Nonsurgical Periodontal Therapy
Authors: Mathur Ankita , Gopalakrishnan D. , Shetty Sharath , Mehta Vini , Bagwe Shreya
Published: September 2024

Aim:

The purpose of this study was to measure the concentration of sclerostin in the gingival crevicular fluid (GCF) before and after 1, 3, and 6 weeks of nonsurgical periodontal therapy (NSPT) in subjects with and without chronic periodontitis.

Materials and Methods:

An interventional study was conducted among 35 subjects of age groups 30–50 years. Subjects were divided into three groups: Group I (10 healthy individuals), Group II (10 gingivitis), and Group III (15 chronic periodontitis only). Clinical parameters assessed were gingival index (GI), plaque index (PI), probing pocket depth (PPD), and clinical attachment level (CAL). The GCF samples were collected from all the groups at baseline and in Group III at baseline and 1, 3, and 6 weeks after NSPT using micropipettes.

Results:

Table 1 shows age and gender details. Although the mean sclerostin concentration in GCF (ng/ml) was highest in Group III at baseline (5.41 ± 0.68) and lowest in Group 1 (4.98 ± 0.46), there was no statistically significant difference (P < 0.05) when intergroup comparison was done [Tables 2 and 3]. PPD and CAL measured for Group III were 6.93 + 1.2 and 7.67 + 1.2, respectively. PI (2.52 + 0.25) and GI (2.52 + 0.17) were measured highest in Group III [Table 4].

Conclusion:

There was a substantial decrease in the concentration of sclerostin in the GCF of chronic periodontitis patients after 1, 3, and 6 weeks after NSPT. This proves sclerostin to be a responsive measure of inflammation in periodontal destruction.
Minor Salivary Gland Neoplasm of the Larynx
Authors: Nayak Dipak Ranjan , Balakrishnan R , Ahmed C Jalwa
Published: September 2024

Introduction:

Minor salivary gland neoplasm of larynx is a rare tumor of head and neck and account to around 1% of laryngeal cancers. This is a disease of middle age and affects subglottis mostly than other parts of the larynx. Preferred treatment is total laryngectomy (TL) due to high propensity for submucosal spread. In this case series, we discuss our experience in the management of salivary gland tumors of larynx.

Methods:

Retrospective analysis of five patients of salivary tumors of larynx treated at our institute for over 30 years.

Results:

Among the five patients, four had Adenoid cystic carcinoma (ACC) and one had clear cell carcinoma (CCC). Four ACC patients had the lesion in the subglottis and 3 underwent TL with chemoradiation and had no recurrence till latest review after 32 months of surgery. However, one patient who underwent chemoradiation alone had a persistent disease and is receiving palliative care. CCC patient had lesion in the glottis and underwent hemilaryngectomy and had no recurrence till 15 years following surgery. No locoregional metastasis identified, though one patient had lung metastasis.

Discussion:

ACC is the most common salivary tumor seen in the larynx. Literature had shown male predominance, however, our study had shown no sex predilection. In our study, patients who underwent TL with adjuvant chemoradiation showed no recurrence as compared to one patient who underwent chemoradiation alone and had disease progression.

Conclusion:

ACC is the most common salivary gland neoplasm of larynx and surgical treatment with chemoradiation seem to provide better outcome than chemoradiation alone.
Risk for Obstructive Sleep Apnea in Patients with Bipolar Disorder, Prevalence from Kashmir
Authors: Wani Rayees Ahmad , Dar Shabir Ahmad , Shah Naveed Nazir , Haq Inaamul , Gani Suraya
Published: September 2024

Background:

An association exists between obstructive sleep apnea (OSA) and bipolar disorder (BD). The prevalence of OSA in BD has significantly increased during the past two decades. We aimed to assess the prevalence of risk for OSA in BD.

Materials and Methods:

This was a hospital-based, cross-sectional, case–control study. Out of 218 participants enrolled in the study, 109 had BD and 109 were recruited for comparison in the control group. All the participants were asked to complete the Berlin Questionnaire, a self-assessment tool to establish the risk for OSA.

Results:

About two-thirds of the patients with BD were found to be at risk for OSA as compared to the 19.27% of prevalence in the control group. Patients of BD at high risk for OSA were males, had significantly higher body mass index (BMI), with comorbid physical illnesses, and in those who were on a combination of valproate and lithium in comparison to valproate alone.

Conclusion:

Patients with BD had significantly higher BMI in comparison to controls. In comparison to controls, significant higher percentage of patients with BD had higher risk for OSA in comparison to healthy controls. Our finding of over half of patients being in the high-risk range should be sufficient to sensitize clinicians and raise awareness concerning OSA in BD.
Epithelial Dysplasia as a Predictor of Malignant Transformation in Oral Potentially Malignant Disorders
Authors: Janardhanan Mahija , Suresh Rakesh , Savithri Vindhya , Aravind Thara , Mohan Mridula , Biniraj K. R.
Published: September 2024

Oral potentially malignant disorders (OMPDs) are a group of precursor lesions with varied clinical manifestations which exhibit an increased risk of malignant transformation. Early diagnosis and prevention of oral cancer now focuses more on the early recognition of OPMDs and assessment of their risk of malignant transformation. Although epithelial dysplasia is being widely used as a yardstick to assess the malignant potential of OMPDs, the interobserver variability and lack of reproducibility observed in the interpretations had made their efficacy as a predictor of malignant transformation highly questionable. The aim of this paper is to discuss the concept, controversies, and challenges involved in the utility of epithelial dysplasia as a predictor of malignant transformation.