Background: Ventilator-associated pneumonia (VAP) in critically ill patients are associated with high morbidity and mortality as they are at a high risk of acquiring respiratory infections, due to complex interplay between the endotracheal tube, host immunity and virulence of invading bacteria. Several studies reported multidrug-resistant bacteria like Acinetobacter spp., Pseudomonas spp., Gram-positive bacteria like S. aureus. For prompt initiation of empirical antimicrobial treatment, knowledge of local antimicrobial resistance patterns is essential. Aims: To study antimicrobial sensitivity among organisms isolated from endotracheal aspirates of patients with VAP and examine their various resistance pattern and look for biofilm production. Materials and Methods: ET aspirates were taken from 140 patients who were mechanically ventilated for various reasons in ICU of our hospital and were subjected to Gram stain and semiquantitative cultures. Organism identification and antimicrobial susceptibility testing were performed according to standard guidelines. Various resistance patterns and biofilm production on Congo Red Agar were observed. Results: Out of 140 ET aspirates processed, 120 samples (85.7%) were culture positive; most common isolate being Acinetobacter spp. (45.8%), followed by Pseudomonas spp. and Klebsiella spp. (16.6% each), and Gram-positive isolate Staphylococcus aureus (12.5%). All Staphylococcus aureus were sensitive to linezolid and resistant to cefoxitin (MRSA). Most of the Gram-negative isolates were sensitive to imipenem. ESBL resistance was seen in 25% of Klebsiella spp. and Amp C resistance was seen in 27% of Acinetobacter spp. Biofilm was produced in 62.5% of the isolates. Mortality was maximum in patients whose ET aspirates showed biofilm production. Conclusion: A local antibiogram pattern for each hospital, based on bacteriological profile and susceptibilities, is essential, to initiate empiric therapy and help in framing the appropriate institutional antibiotic policy.

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Background: There has been a paradigm shift in the way we understand, classify, diagnose, and treat breast cancer in the last two decades, mainly due to breakthrough in the knowledge and understanding the biology of the disease. The panel of St. Gallen meeting proposed to classify tumors based on intrinsic subtypes based on the immune-histochemical pattern for therapeutic purposes. Each subtype is unique in incidence, biological behavior, survival outcome, and response to therapy. Aim: To analyze the relevance of intrinsic molecular subtypes of breast cancer with clinico-pathological features with regard to patient characteristics, disease biology, management, and outcome at 2 years follow-up. Materials and Methods: St. Gallen International Expert Consensus Recommendation 2011 was used for this study. Clinico-pathological features (age, stage of disease, histological type and grade, tumor size, lymph node status, and lympho-vascular invasion) were analyzed among the subgroups. Results: In our study, we had 64 (34.4%) luminal A, 37 (19.9%) luminal B HER2 negative, 6 (3.2%) luminal B HER2 positive, 33 (17.7%) HER2 enriched, and 46 (24.7%) triple negative breast cancer (TNBC). The disease free survival and overall survival at 2 years of follow-up was 92.2% and 100% in luminal A, 89.2% and 100% in luminal B HER2 negative, 83.3% in luminal B HER2 positive, 78.8% and 90.9% in HER2 enriched, and 71.8% and 80.4% in TNBC subgroups, respectively. Conclusion: Intrinsic subtyping with immunohistochemistry corresponds well with clinico-pathological features and outcomes. This helps in prognosticating the outcome and administration of appropriate adjuvant therapy.

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Aim: To evaluate and compare the effect of Sodium hypochlorite, etidronic acid, and ethylenediamine tetraacetic acid (EDTA) on the contact angle of AH Plus and MTA Fillapex root canal sealers. Materials and Methods: 45 freshly extracted single rooted teeth were selected and decoronated. They were then split longitudinally to obtain two halves which were trimmed as flat dentin bars of 2 mm thickness. They were randomly assigned to 3 groups of 30 each. The samples were surface treated with 2.5% sodium hypochlorite in Group A, 2.5% sodium hypochlorite followed by 17% EDTA in Group B, and a combination of 2.5% sodium hypochlorite and 18% etidronic acid in Group C. Each group was subdivided into two subgroups based on the sealer used, i.e., Subgroup 1-AH Plus and Subgroup 2-MTA Fillapex. The contact angle was analyzed using Rame Harte Goniometer. Results: AH Plus has significantly lesser contact angles than MTA Fillapex. The contact angle values showed the order of C1 < B1 < A1 < C2 < B2 < A2. Conclusion: Irrigating solutions affect the wettability of rootcanal sealers. AH Plus showed better wettability compared to MTA Fillapex. Irrigation with a combination of sodium hypochlorite and etidronic acid significantly decreased the contact angle, thereby increasing the wettability of sealers.

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Background: Areca nut, a major component in areca quid possesses genotoxic and carcinogenic properties. Studies suggest that areca nut chewing is associated with a higher prevalence of oral submucous fibrosis (OSMF) which could be also due to the detrimental effects of areca nut extract on the host defense system. Objectives: To determine the effects of Areca nut extracts (ANE) of ripe (r-ANE) and tender (t-ANE) on the functions of neutrophils derived from peripheral blood and saliva samples in apparently healthy individuals with and without areca nut chewing habit. Materials and Methods: Sixty subjects with clinically normal-appearing oral mucosa without any systemic disorders were divided into two groups of 30 each consisting of subjects without any habits grouped under the control group while subjects with areca nut chewing habit were grouped under the study group. Blood and saliva samples were collected from both groups. Neutrophil functions in both blood and saliva were assessed by Nitroblue Tetrazolium assay (NBT) and Phagocytic assay (PHG) using various concentration of t-ANE and r-ANE extracts. Results: In both the groups, with increasing concentrations of t-ANE and r-ANE there was a drop in mean scores for both assays. A comparison between the groups revealed higher mean values in the control group than the study group which was statistically significant (P < 0.05). Conclusion: Areca nut affects the neutrophil function significantly in ripe form than tender form. Saliva can prove to be an effective alternative material for analyzing the neutrophil function and hence the immune status in individuals. This may alter the defensive role of the oral cavity, and this may be one possible mechanism by which areca nut compromises the oral health of users of areca nut products increasing the susceptibility for various pathologies including oral submucous fibrosis (OSMF).

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We report a case of 42-year-old male presented with acute onset breathlessness and blurring of vision in both eyes. Upon evaluation, the patient is found to have vitamin B12 and iron deficiency anemia; ophthalmoscopic examination revealed bilateral preretinal hemorrhages and Roth spots. This case documents the occurrence of retinopathy in nutritional dimorphic anemia causing blindness which is reversible after correction of anemia.

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Tuberculous peroneal tenosynovitis is a rare disease. The disease develops insidiously, and there will be a progressive inflammation of tendon sheath with limitation of excursion of inflamed tendons. We report a case of a 55-year-old man who was initially diagnosed as tendon sheath giant cell tumor clinically and radiologically, and after biopsy, it turned out to be tuberculous peroneal tenosynovitis.

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Impalement injuries are one of the severe types of injuries combining effects of both penetrating and blunt trauma leading to crushing injury, wound contamination, and multi-organ damage. These types of injuries are usually a result of falls from a height, vehicular accidents, and slip with strong external force. A 12-year-old boy was involved in a road traffic accident where an auto-rickshaw toppled. A loose rusted iron frame penetrated through his left knee and lower thigh. The impaled rod was removed under direct vision and the fractured lateral femoral condyle was fixed under general anesthesia. Impalement injuries require a multidisciplinary approach. The management of each case has to be individualized. Extensive wound exposure, extraction under direct vision, adequate debridement, and antibiotic coverage are pearls of management.

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Rasmussen's encephalitis (RE) is a chronic neurological disorder characterized by unilateral inflammation of the cerebral cortex leading to severe focal seizures, progressive loss of cognition, and neurological deficits in the affected hemisphere. We present a rare case of RE in a child with global developmental delay and cerebral atrophy. Neuroimaging helped in clinching the diagnosis of the disease. Immunomodulators may slow the progression of the disease; hence, it needs to be identified early and treated promptly. Functional cerebral hemispherectomy is the only treatment for drug-resistant seizures, but it has its functional compromise.

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Background : Saliva has been reported as an important diagnostic tool in many oral and general diseases and is also a main predisposing factor in the development of dental caries. The mean salivary pH is 6.8 that is liable to change with the intake of certain beverages and tea being one among them. Tea is the second most commonly consumed health drink in the world next to water and several studies have demonstrated the influence of green tea on salivary pH levels. This study has gone a step ahead and examined the role of different tea products on salivary pH levels. Aim: The study aimed to compare and evaluate the effect of three different commercially available tea infusions (Green tea, Lemon tea, Ginger tea) on salivary pH by adopting an in vitro methodology. Materials and Methods: A total of 30 healthy female subjects were randomly selected between 18 and 25 years of age. Commercially available tea products such as green tea, lemon tea, and ginger tea were used in the study. Portable digital pH meter was used for measuring the pH at baseline and at regular intervals after the consumption of tea (immediately, 5 min and 10 min). The results obtained were statistically analyzed. Results: In vitro pH readings of saliva after consumption of the three varieties of tea showed pH values of green tea as 7.033 ± 0.26, lemon tea as 7.0026 ± 0.26, and the ginger tea as 7.1818 ± 0.0.24. Thus, the clinical trial showed a statistically significant rise in salivary pH after green tea consumption followed by ginger tea, whereas lemon tea showed a drop in salivary pH after its consumption. Conclusion: The results revealed that there has been a rise in the salivary pH after the consumption of green tea and ginger tea and hence it adds value to the body of research that consumption of green and ginger tea respectively confers beneficial effects by providing a favorable environment in the oral cavity.

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Background: Stress actually means body's psychological perception of pressure and its response to that pressure, involving multiple factors. The factors may be either external or internal/physical or biological. Stress-management is one of the most prevalent and popular topic of the latest times. Stress is mostly associated and leading to depression in the present juncture. Aims: The main objective of this study is to evaluate and elicit the levels of stress and depression in association with various recent factors accounting and resulting in them. Prevalence of stress and depression in relation to factors such as body mass index (BMI), social feeling, gastric problems, appetite, hair fall can also be assessed by this study. Materials and Methods: 298 engineering students of an engineering college were requested to answer up the analysis sheet comprising of Beck's Depression Inventory (BDI), Perceived Stress Scale (PSS) and other criteria comprising some selected factors adding to stress and depression. Analysis sheets were assessed, results were obtained and statistically analysed by GraphPad InStat Software. Results: The results of the present study indicate that majority of the students are having moderate and higher levels of stress, and no depression. Most of the people felt the higher levels of stress during the period of examinations. Conclusions: The students studying first year felt more stressed, which could be due to their recent entry into the course. Female students are more prone to these stressors and depressors. Juniors were more stressed when compared to senior students.

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Introduction: Lichen planus (LP) was considered to be rare in childhood with global data showing 2-3% of total LP cases. There were very few studies reported. Aims and Objectives: To find out the prevalence of LP in children in a tertiary hospital and to evaluate the epidemiological and clinical features. Materials and Methods: Children aged <16 years were screened for lichen planus. Biopsy was done for confirmation in doubtful cases. Various clinical and epidemiological features were documented. Results: Of the total 54 children, 34 were males and 20 females. The mean age of children was 10.4 years, and the mean age at the onset of disease was 6.8 years. Preceding infection was noted in 16%, and there was no history of vaccination in any in preceding 6 months. Family history was noted in 4.5% of cases. Comorbidities were observed in 35 (65%) of our study subjects, of which obesity was noted in 15 (28%). Conclusion: Lichen planus is not uncommon in children. Classical papular form is common. Obesity is commonly associated comorbidity larger sample need to be studied for metabolic syndrome.

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