Sodium glucose co-transporter (SGLT) inhibitors are a new class of drugs which are used in the pharmacotherapy of Type-II diabetes, which happens to be a major risk factor for developing both micro as well as macro-vascular complications. These drugs inhibit the glucose reabsorption by inhibiting SGLT, which exhibits a novel and promising mechanism of action by promoting the urinary glucose excretion hence providing a basis of therapeutic intervention. Results of SGLT-II inhibitors are very encouraging as there is a significant elevation of GLP-1 level, which forms the basis of relevance in treatment of diabetes. It targets the HbA1C and keeps a check on its levels. It also exerts other positive benefits such as weight loss, reduction in blood glucose levels, reduction in blood pressure and improvement in insulin resistance and β-cell dysfunction: All contributing to effective glycemic control. SGLT inhibition will develop as effective modality as it has the capability of inhibiting reabsorption of greater percentage of filtered glucose load.

Pain is defined as an "unpleasant sensory and emotional feeling which is associated with actual or potential injury of tissue or expressed in terms of such injury." Tooth pain usually refers to pain around the teeth or jaws mainly as a result of a dental condition. Mostly, toothaches are caused by a carious cavity, a broken tooth, an exposed tooth root or gum disease. The toothache may sometimes be the result of radiating pain from structures in the vicinity of tooth and jaws (cardiac pain, ear, nose, throat pain, and sinusitis). Therefore, evaluation by both dentists and physicians are sometimes necessary to diagnose medical illnesses causing "toothache." Cracked tooth syndrome is a major diagnostic challenge in clinical practice. Accurate diagnosis and appropriate treatment are complicated due to lack of awareness of this condition and its bizarre clinical features. Early diagnosis has been linked with successful restorative management and good prognosis. This article provides a detailed literature on the causes, classification, signs and symptoms, diagnosis, and treatment planning of cracked tooth syndrome.

Background: Perls' stain is routinely used to demonstrate iron in liver biopsies. We tested the hypothesis that it may be unnecessary in cases, where no iron or another similar pigment was seen on the routine hematoxylin and eosin (H and E) stained section. Aim: The aim of this study was to evaluate the efficiency of H and E stain in demonstrating iron in liver biopsies as well as to determine the possibility of replacing Perls' stain with H and E stain. Materials and Methods: Two hundred pairs of slides of liver biopsies were taken from the archival files of the Department of Pathology from 2006 to 2011. Perls' and H and E slides were independently reviewed for the presence of iron. Results: Hundred and one cases showed the presence of iron using H and E stain. 84 of 86 cases showed positive iron using both Perls' and H and E stains. Seventeen cases were positive using H and E stain but negative with Perls'. Only two cases did not show the presence of iron using H and E stain. Ninety-seven cases were negative using both Perls' and H and E stains. H and E stain showed a sensitivity, specificity, accuracy, positive predictive valve, and negative predictive value of 97.67%, 85.08%, 90.5%, 83.16%, and 97.98%, respectively. Conclusion: We demonstrate that the H and E stain is a sensitive method to detect iron pigment in liver biopsies, particularly when present in large quantities. A negative H and E stain might obviate the need for extra Perls' staining, thus saving costs and shortening report turn-around times.

Background: Cerebral venous thrombosis (CVT) is an uncommon condition characterized by severe clinical manifestations and high mortality rate. There is limited data on the role of methylenetetrahydrofolate reductase (MTHFR) A1298C mutation as a risk factor for CVT development in Iranians. Aim: The aim was to investigate a possible association between fasting plasma homocysteine (Hcy) levels, MTHFR A1298C mutation, and CVT in Iranian population. Materials and Methods: The study population consisted of 50 patients with a diagnosis of CVT (20–63 years old) and 75 healthy subjects (18–65 years old) as control. Genotyping of the MTHFR A1298C mutation and Hcy measurement was carried out by polymerase chain reaction-restriction fragment length polymorphism technique and enzyme immunoassay method, respectively. Results: Fasting plasma total Hcy levels were significantly higher in CVT patients than controls (P = 0.015). No significant differences were observed in the MTHFR A1298C genotypes frequency between CVT patients and controls (P > 0.05). The frequency of the 1298C allele was 36% and 37.5% in CVT patients and controls, respectively and did not differ significantly between the two groups (P = 0.16). Conclusions: Our study demonstrated that MTHFR A1298Cmutation is not a significant risk factor for CVT.

Background: In clinical neurophysiology, threshold tracking studies are used to evaluate the functionality of a muscle through studying the functionality of its motor units (MUs) that govern the muscle. The functionality of an MU can be quantified by estimation of its excitability properties via MU's stimulus-response curve. In this study, we aim to develop a model-based approach to estimate MU's threshold mean and its activation range as indications of MU's excitability. This is a different approach from routine strategies in neurophysiology, which are mostly subjective. Methods: To assess the excitability of a single MU, needle electromyography examination was used to obtain the axonal activity of that MU. To improve estimation, the examination was repeated several times on individuals. Replication of experiment introduces serial correlation between observations. We account for this correlation by using a mixed-effects model. We investigate the appropriateness of classical logistic mixed-effects model and its Bayesian formulation for estimation purpose. Results: Both classical and Bayesian models can obtain a reliable estimation of MU's threshold. However, we found Bayesian approach to provide a better estimate of MU's activation range. Moreover, if data contain outliers both classical and Bayesian methods are vulnerable to some extent. Conclusions: Compared to the classical approach, Bayesian method is more flexible in dealing with overdispersion and provides more robust estimation of MU's parameters.

Context: Mobile genetic elements such as plasmids, bacteriophages, insertion elements, and genomic islands play a critical role in virulence of bacterial pathogens. These elements transfer horizontally and could play an important role in the evolution and virulence of many pathogens. A broad spectrum of gram-negative bacterial species has been shown to produce a cytolethal distending toxin (CDT). On the other hand, Shiga toxin producing Escherichia coli are the one carry virulence genes such as stx 1 and stx 2 (Shiga toxin) and these genes can be acquired by horizontal gene transfer. Aim: The aim of this study was toinvestigate the presence of other virulence associated genes among CDT producing E. coli strains. Materials and Methods: Thirty CDT positive strains isolated from patients with diarrhea were characterized. Thereafter, the association with virulent genetic elements in known pathogenicity islands (PAIs) was assessed by polymerase chain reaction. Results: In this study, it was shown that the most CDT producing E. coli isolates express Shiga toxin. Moreover, the presence of prophages framing cdt genes (like P2 phage) was also identified in each cdt- type genomic group. Flanked regions of cdt-I, cdt-IV, and cdt-V- typewas similar to plasmid sequences while cdt-II and cdt-III- type regions similarity with hypothetical protein (orf3) was observed. Conclusion: The occurrence of each cdt- type groups with specific virulence genes and PAI genetic elements is indicative of horizontal gene transfer by these mobile genetic elements, which could lead to diversity among the isolates.

Aim: The aim was to evaluate the integrity and functional outcomes of skin grafts following external beam radiotherapy (EBRT). Materials and Methods: A prospective study of 15 patients, in whom EBRT was planned after their wound coverage with split-thickness skin graft (STSG). Parameters evaluated include defect size, time to postoperative radiotherapy, total radiotherapy dose, delays and interruptions in radiotherapy, wound complications, and the need for further surgical interventions. Results: In all the 15 (6 men, 9 women) patients of STSG, radical doses of EBRT, that is, 50–70 Gy in 25–35 fractions are delivered over around 6 weeks. All STSGs were placed on healthy vascular tissue beds. Median time to initial radiotherapy after grafting was 3 weeks (range 3–6 weeks). There were no interruptions in radiotherapy treatment. In one patient, there was partial skin graft loss after radiotherapy that was adequately managed with conservative treatment. No patient requires further surgical intervention. Conclusion: Adjuvant postoperative radiotherapy can be delivered to STSGs without significant complications. Postoperative radiotherapy can be started as early as 3–4 weeks after skin grafting. Skin grafts should be placed on well-vascularized healthy tissues. Minor skin graft loss resulting from postoperative radiotherapy can usually be treated conservatively.

Aim: This study evaluating N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and high-sensitivity C-reactive protein (hs-CRP) relationship with features of the metabolic syndrome (MS) in high risk subgroups for cardiovascular disease (CVD) in Trinidad. Materials and Methods: The sample population consisted of 160 subjects, 78 of whom were African and 82 East Indian attending medical outpatient clinics of regional health authority hospitals of Trinidad. Results: Systolic blood pressure, triglycerides, glucose and insulin as well as NT-pro-BNP were elevated among the East Indian sub-population, with only systolic blood pressure being significantly elevated among the African sub-population. NT-pro-BNP and hs-CRP demonstrated significant correlations with respect to the majority of independent risk factors inclusive of Adult Treatment Panel III and American Association of Clinical Endocrinologists defined criteria for MS. NT-pro-BNP demonstrated stronger association among the East Indian sub-population as compared to that of the African sub-population. Conclusions: Our study showed that the East Indian subgroup was more at risk for CVD as evidenced by the fulfillment of the criteria for diagnosis of MS and therefore NT-pro-BNP and hs-CRP can be deemed a suitable marker for MS.

Introduction: Hemorrhagic shock (HS) result in multiple organ injury and inflammatory response that lead to death. The exact mechanism is not clear. Apelin is an endogenous ligand of orphan G-protein coupled receptor APJ. Apelin has anti-inflammatory effects on the release of inflammatory mediators. Objectives: To examine the protective effects of apelin against multiple organ injury and the possible involvement of inflammatory pathways. Methodology: Male Sprague-Dawley rats (300–350 g) were subjected to hemorrhage over 60 min to reach a mean arterial blood pressure of 40 mmHg. Then, rats were treated or not with 1 mL of 10 nm/L apelin-13 intraarterially resuscitation was performed in vivo by the reinfusion of the shed blood for 30 min to restore normotension. Blood samples were collected for measurement of tumor necrosis factor (TNF) using ELISA (R and D systems). Biopsies were obtained from organs for light microscopic examination. Results: HS rats showed significant increase the levels of TNF. Apelin significantly lowered the production of TNF-α. Histological examination of hemorrhagic shocked untreated rats revealed structural damage. Less histological damage was observed in the organs of treated rats. Apelin-treatment decreased the number of inflammatory cells and mitochondrial swollen in cells. Conclusion: Treatment with apelin before resuscitation protects against multiple organ injury in HS by attenuation the inflammatory response and might be a therapeutic target for HS.

Hemovigilance plays an essential role in ensuring patient safety with regard to blood transfusions. The data generated through the hemovigilance system helps in framing important changes in the whole blood transfusion process which are useful for better patient safety. This article briefly describes the history of hemovigilance, why the need of hemovigilance was felt and also illustrates about the Hemovigilance Program of India.

Cornual pregnancy is uncommon among ectopic pregnancies. A diagnosis of cornual pregnancy remains challenging, and rupture of a cornual pregnancy causes catastrophic consequence due to massive bleeding. In very rare circumstances, cornual pregnancies can result in a viable fetus. We report a case of a 24-year-old primigravida who presented to us with complaints of decrease fetal movements at 37⁺⁵ weeks. Ultrasound revealed a single live intrauterine fetus with anterior low lying placenta with severe oligohydramnios (amniotic fluid index = 1.8). Emergency cesarean section was done and intraoperatively it was diagnosed as a case of placenta percreta with pregnancy in right noncommunicating horn of uterus. Right cornual resection with right salpingectomy done. Uterus, left fallopian tube and bilateral ovary were healthy. Postoperative period was uneventful.

Spider nevi are benign vascular lesions mostly seen in patients with decompensated liver cirrhosis. Mostly, these are seen in the superior vena cava distribution and are small with pinhead size central vessel. Giant spider nevus is rarely seen and hence this report.

Abdominal pregnancy is a rare form of ectopic pregnancy which occurs due to ruptured uterine or tubal pregnancy into the abdomen. Fetal loss is a common complication of these pregnancies and patient presents with acute abdominal pain which is a surgical emergency. Another rare but established complication of this ectopic pregnancy is fetal demise with the dead fetus being retained in the abdomen. It gets macerated and mummified over a period of time and is mostly detected incidentally during imaging. Radiological imaging has hallmark appearances of such a macerated fetus showing multiple fetal parts embedded in a calcified sac termed as lithopedion or stone baby. We report a unique case of retained abdominal pregnancy for 36 years in a 60-year-old postmenopausal female presented with abdominal pain and difficulty in micturition. Computed tomography showed multiple fetal bones in the abdomen surrounded by a membrane which was surprisingly not calcified.

Multiple literature addresses cleft alveolar bone, with little consensus on the preferred surgical technique. Hence, we described a transoral approach for repair of cleft alveolar bone with Z-plasty and using bioactive glass. Study design: Case presentation and surgical technique description. In conclusion, transoral mucosal repair cleft alveolar bone Z-plasty using bioactive glass demonstrated an alternative easy and simple approach for augmentation of unilateral alveolar cleft patients.

Extranodal natural killer/T-cell lymphoma, nasal type (ENKTCL) is a rare Epstein–Barr virus associated lymphoma seen predominantly in Asian population with a 5 years survival rate ranging from 10% to 75% depending on the stage of presentation. In this case report, we describe an unusual presentation of ENKTCL, which in its early stages was clinically misdiagnosed as buccal space infection and later on histologically as inflammatory myofibroblastic pseudotumor owing to manifold reasons. Postoperative biopsy specimen showed characteristic feature of ENKTCL both histologically and immunophenotypically. This case report underlines the importance of adequate sampling and the unusual presentation of ENKTCL nasal type with oral manifestations.

Plasmacytoid carcinoma of the urinary bladder or plasmacytoid urothelial carcinoma (PUC) is rare and only recently described a histological variant of transitional cell carcinoma. The morphological resemblance of PUC to other malignancies is a source of diagnostic dilemmas and often misdiagnosis. Immunohistochemistry plays a pivotal role in narrowing the differential diagnosis and reaching to a conclusive diagnosis. A diagnosis of PUC usually carries a dismal prognosis. Hence, correct diagnosis is important. We report here a 52-year-old male with a plasmacytoid variant of urothelial carcinoma.

Para-meatal urethral cyst or median raphe cyst of the glans penis is a benign cystic lesion uncommonly encountered in prepubertal age group. Approximately, about 50 cases have been reported till date in the world literature. Herein we report a case of para-meatal urethral cyst concurrent with urinary bladder calculi.

Segmental absence of intestinal musculature (SAIM) is a rare cause of intestinal obstruction and/or perforation seen in neonates, and rarely in adults. We present a case of SAIM in a 48-year-old male, who presented with acute abdominal symptoms and was repeatedly explored because of recurrence of abdominal symptoms.

Thrombocytosis is often an incidental finding seen in 35–50% of cases and the cause determination creates a diagnostic challenge. Extreme thrombocytosis is rare and seen in 2–5.8% patients only. Among the various causes of increased platelet count, surgical procedures have attracted much attention in both experimental and clinical domain. The appearance of thrombocytosis after surgery needs to be diagnosed to establish the type of thrombocytosis (clonal or reactive), as treatment and prognosis are quite different between them. This case report is vital because of two reasons:First, the increase in platelet count is difficult to rationalize than many of the other thrombocytoses, such as those related to primary augmentation of the function of the bone marrow; second, the association of platelets with the clotting process has led to the belief that their increase after a surgical procedure is connected with the occurrence of postoperative thrombosis. This case presents an interesting finding from a patient who has undergone major abdominal surgery and has shown an unexpected perpetual increase in platelet count.

Laryngocele is a rare, benign dilatation of the laryngeal saccule that may extend internally into the airway or externally through the thyrohyoid membrane. When it is secondarily infected, it is called laryngopyocele, which is even rarer. Many laryngoceles are asymptomatic; sometimes, they may cause a cough, hoarseness, stridor, sore throat and may present as a swelling on one or both sides of the neck. Laryngocele may be associated with supraglottic squamous cell carcinoma. Computed tomography scan is the most effective imaging method for diagnosis. Surgery is the treatment of choice. A case of large mixed laryngopyocele in a 75-year-old male is described together with surgical management and follow-up. A review of the literature is also presented.