Charge-ordering breakdown dynamics and ferromagnetic resonance studies ofB-site Cu diluted Pr1‒xSrxMnO3

Here, we report the influence of Jahn-Teller active Cu substitution on the charge-ordering (CO) characteristics of one of the well-known manganite Pr0.45Sr0.55MnO3(S55) with a distorted tetragonal structure. Magnetization studies unveil a complex magnetic phase diagram for S55, showing distinct temperature ranges corresponding to various magnetic phases: a ferromagnetic phase dominated by the Double Exchange interaction withTC∼ 220.5 K, an antiferromagnetic phase belowTN∼ 207.6 K induced by CO with a transition temperature ofTCO∼ 210 K consistent with the specific heatCP(T) data, and a mixed phase in the rangeTNTN(T Collapse

Key Words

• Jahn-Teller effect
• antiferromagnetism
• charge-ordering
• ferromagnetic resonance
• manganites
• perovskites

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Affiliation(s)

A Bordoloi Department of Physics, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
S K Jena Department of Physics, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
P Tiwari Department of Physics, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
A Datta Department of Physics, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
B Weise Leibniz-IFW Dresden, Institute for Complex Materials, D-01069 Dresden, Germany
R Medwal Department of Physics, Indian Institute of Technology Kanpur, Kanpur 208016, Uttar Pradesh, India
R S Rawat Natural Sciences and Science Education, National Institute of Education, Nanyang Technological University, Singapore 637616, Singapore
S Thota Department of Physics, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India

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Determinants of malaria prevention and control at household level in Assam: An analysis of data using composite index

Background

Malaria prevention and control is a major public health problem of tropical countries including India. Usage of insecticide-treated bed nets, and early treatment especially in high-risk areas are the crucial factors for the malaria prevention at household levels. This study aimed to determine the crucial factors associated with malaria prevention at households' level such as household's characteristics, education, knowledge and awareness, insecticide treated bed nets usage, early treatment etc.

Methods

Data of 1989 households was used from the cross-sectional survey of malaria-endemic areas of Assam. Principal component analysis and multinomial logistic regression model were used to compute the composite scores of malaria awareness and prevention practices, and to estimate the associated factors with malaria prevention practices, respectively.

Results

The average age of household respondents were 41.1 ± 12.0 years and among them 71% were males. Almost 47% respondents were illiterate, and 38.6% of the respondents were farmers and 35% were employed. Multinomial logistic regression analysis indicates that malaria prevention practices are associated with age, education, religion, type of house and occupation of household heads and their level of malaria awareness among them. The prevention practices were significantly five times associated [Adjusted Rates Ratio (ARR): 5.0, 95% CI: 2.7-9.4] with the high level of malaria awareness compared with the low level of awareness. Overall, the level of prevention awareness, education, occupation, and house type related to the standard of living was significantly associated with the malaria prevention practices.

Conclusion

Malaria awareness and education are the key factors of malaria prevention practices that need to be accelerated for effective control of malaria. Malaria education and increasing awareness of people have a high impact on malaria prevention practices and their control.

Color Doppler Ultrasound Indices as Predictors of Propranolol Response in Infantile Hemangioma: A Prospective Study

OBJECTIVE

To evaluate the utility of color Doppler ultrasonography in assessing infantile hemangioma response to treatment with oral propranolol.

METHODS

A prospective study was conducted between January, 2016 and December, 2022, wherein children with symptomatic (ulceration, bleeding, pain and scarring) infantile hemangioma were given oral propranol (2 mg/kg per day in three divided doses) as outpatient therapy. The clinical response was assessed three months post-initiation of treatment (intermediate clinical response) and three months post-completion of treatment (final clinical response, FCR). The primary outcome measurement was a clinical and radiological response (resistivity index (RI), pulsatility index (PI) and peak systolic velocity) to treatment. The secondary outcomes assessed were the complications related to treatment.

RESULTS

Out of 601 patients who were started on propranolol, 99 developed severe adverse effects and were excluded from analysis. At FCR assessment, out of 502 participants, 64.3% (n = 323) showed excellent response, 17.7% (n = 89) showed partial, and 17.9% (n = 90) were non-responders. A significant increase in RI and PI values was noted in all children following propranolol treatment for six months. An increase > 7.5% in RI could identify responders with 92% sensitivity, 91% specificity and area under the curve (AUC) of 0.963. An increase of > 11.5% in PI could identify responders with 86% sensitivity, 91% specificity and AUC of 0.896. Patients initially showing no response but later becoming excellent responders had significantly higher RI and PI values.

CONCLUSIONS

Color Doppler ultrasonography is a valuable tool in predicting the treatment outcome of infantile hemangioma using propranolol.

Current Evidence for the Management of Edentulous Atrophic Mandible Fractures: A PRISMA-SWiM Guided Review

Study Design

PRISMA-SWiM guided systematic review.

Objective

1. Provide consistent evidence regarding the management of atrophic mandible fractures; 2. To search, evaluate and validate existing guidelines if any for the management; 3. Provide evidence regarding specific management of condylar fractures in the atrophic mandible; 4. To address the clinical applicability of bone grafts.

Methods

A systematic review was conducted using the PRISMA-SWiM protocol. PROSPERO ID: CRD42021235111. Studies with adequate data on outcome, treatment methods were selected. Isolated case reports, case series, and non-human studies were excluded. Quality assessment was done using Newcastle -Ottawa scale. The level of evidence was assessed using Oxford Level of Evidence.

Results

Mandibular body was the most common type of fracture. Self falls and RTA were the most common etiologies. Condylar fracture was most commonly managed conservatively with ORIF employed in few studies. For the mandible compression and non-compression osteosynthesis were used. Bone grafts were used in cases with segmental defects or cases requiring augmentation.

Conclusions

There is lack of proper evidence to definitely conclude any single treatment modality. However, the consensus is towards ORIF. Reconstruction plates are preferred by many authors. However, unilateral fractures may be managed by miniplates. Bilateral fractures require more rigid fixations. Open reduction and internal fixation of condylar fracture is indicated in cases with displacement or low-level fractures.

Kite String (Manjha) Injuries Among Children: Single Center Experience Over Four Years

We reviewed hospital records for kite-string injuries among children over four years (2017-2022). Of 42 affected children, mortality was 9.5%. The mean (SD) Pediatric Trauma Score (PTS) was 8.02 (2.66), with passively involved children facing greater severity [mean (SD) PTS, 5.58 (2.23)]. Kite-string injuries, alarmingly, endanger even bystanders, urging stricter preventive strategies.

Reentrant canonical spin-glass dynamics and tunable field-induced transitions in (GeMn)Co2O4Kagomé lattice

We report on the reentrant canonical semi spin-glass characteristics and controllable field-induced transitions in distorted Kagomé symmetry of (GeMn)Co2O4. ThisB-site spinel exhibits complicated, yet interesting magnetic behaviour in which the longitudinal ferrimagnetic (FiM) order sets in below the Néel temperatureTFN∼ 77 K due to uneven moments of divalent Co (↑ 5.33μB) and tetravalent Mn (↓ 3.87μB) which coexists with transverse spin-glass state below 72.85 K. Such complicated magnetic behaviour is suggested to result from the competing anisotropic superexchange interactions (JAB/kB∼ 4.3 K,JAA/kB∼ -6.2 K andJBB/kB∼ -3.3 K) between the cations, which is extracted following the Néel's expression for the two-sublattice model of FiM. Dynamical susceptibility (χac(f, T)) and relaxation of thermoremanent magnetization,MTRM(t) data have been analysed by means of the empirical scaling-laws such as Vogel-Fulcher law and Power law of critical slowing down. Both of which reveal the reentrant spin-glass like character which evolves through a number of intermediate metastable states. The magnitude of Mydosh parameter (Ω ∼ 0.002), critical exponentzυ= (6.7 ± 0.07), spin relaxation timeτ0= (2.33 ± 0.1) × 10-18s, activation energyEa/kB= (69.8 ± 0.95) K and interparticle interaction strength (T0= 71.6 K) provide the experimental evidences for canonical spin-glass state below the spin freezing temperatureTF= 72.85 K. The field dependence ofTFobtained fromχac(T) follows the irreversibility in terms of de Almeida-Thouless mean-field instability in which the magnitude of crossover scaling exponent Φ turns out to be ∼2.9 for the (Ge0.8Mn0.2)Co2O4. Isothermal magnetization plots reveal two field-induced transitions across 9.52 kOe (HSF1) and 45.6 kOe (HSF2) associated with the FiM domains and spin-flip transition, respectively. Analysis of the inverse paramagnetic susceptibilityχp-1χp=χ-χ0after subtracting the temperature independent diamagnetic termχ0(=-3 × 10-3emu mol-1Oe-1) results in the effective magnetic momentμeff= 7.654μB/f.u. This agrees well with the theoretically obtainedμeff= 7.58μB/f.u. resulting the cation distributionMn0.24+↓A[Co22+↑]BO4in support of the Hund's ground state spin configurationS=3/2andS= 1/2of Mn4+and Co2+, respectively. TheH-Tphase diagram has been established by analysing all the parameters (TF(H),TFN(H),HSF1(T) andHSF2(T)) extracted from various magnetization measurements. This diagram enables clear differentiation among the different phases of the (GeMn)Co2O4and also illustrates the demarcation between short-range and long-range ordered regions.

Leveraging Quantitative Imaging and Machine Learning to Differentiate Radionecrosis from Disease Recurrence in Patients with Brain Metastases

PURPOSE/OBJECTIVE(S)

Radiation necrosis can be difficult to non-invasively discern from tumor progression after stereotactic radiosurgery (SRS). In this work, we investigate the utility of radiomics (computerized features) and machine learning to capture per-voxel lesion heterogeneity on routine MRI scans, to differentiate radionecrosis from tumor recurrence in patients with brain metastases treated with SRS.

MATERIALS/METHODS

A retrospective analysis was conducted of patients with brain metastases treated with SRS. Eighty-three lesions (n = 56 intact; n = 27 surgical cavity) from 69 patients were identified with median age 68.8 years (range 40.2 - 91.0), of whom 53.6% were male and 33.3% received prior whole-brain radiotherapy (WBRT). Lesion histology included lung (60.2%), renal cell (15.7%), melanoma (10.8%), breast (9.6%), and other (3.6%). Pathologic confirmation was available in 73.5% of lesions. Both intact and resection cavity lesions were included and individually segmented. Image preprocessing and radiomic feature extraction were done using ANTsPy and open-source software. A total of 210 features were extracted from post-contrast T1-weighted (T1w) and T2/FLAIR MRIs. Highly correlated features were removed. Univariate logistic regression was conducted on the remaining T1w and T2/FLAIR features as well as on clinical variables. Multivariate analysis was implemented with various classifiers (Random Forest, Ridge, Lasso, Support Vector Machine [SVM]) on the top-performing features found on univariate logistic regression. Models were assessed using cross-validation to select the best model by area under ROC curve (AUC). Specificity and sensitivity were calculated.

RESULTS

On univariate analysis, the top 10 radiomics features consisted of 6 T1w features and 4 T2/FLAIR features (4 GLCM, 3 first order, 1 GLSZM, 1 GLRLM, and 1 shape feature). Age, gender, disease site, prior WBRT, prior fractionated SRS, planning tumor volume, brain-GTV V12 Gy, and immunotherapy before or after SRS were not predictive (AUC less than 62.0%) on univariate analysis compared to radiomic features. Multivariate analysis of top performing radiomic features on both intact and surgical cavities yielded an AUC of 72.0% (standard deviation [SD] ±8.8%). Multivariate analysis of top features on intact lesions alone improved the AUC to 80.5% (SD ±10.8%), with sensitivity of 77.8%, specificity of 72.4%, and positive likelihood ratio of 2.82 in differentiating radionecrosis from recurrence.

CONCLUSION

Radiomics and machine learning tools may improve diagnostic ability of distinguishing radiation necrosis from tumor recurrence after SRS. Further work is needed to deploy this in a larger multi-institutional cohort and prospectively evaluate its efficacy as a decision-support tool to personalize care in patients with brain metastases.

Polyester nanomedicines for visceral leishmaniasis treatment

Tweetable abstract Unveiling the power of polyester nanomedicines in revolutionizing visceral leishmaniasis treatment with enhanced drug loading and precise targeting.

Wide-awake local anesthesia and no tourniquet (WALANT) in upper limb fractures

Wide-awake local anesthesia and no tourniquet (WALANT), first used for hand surgery, has been sparingly described for use in fracture fixation of the upper limb. We present our experience using this technique. 26 patients with upper limb fractures (3 distal radius, 6 radial shaft, 11 ulnar shaft, and 6 olecranon fractures) were operated on using WALANT by three orthopedic surgeons. We used 35-40ml of 2% Lignocaine with 1:80000 Adrenaline(7mg/kg) diluted with normal saline. Numeric Pain Rating (NPR) scoring was done during injection and per-operatively, and the Likert scale was used for the surgeon's satisfaction. The average NPR score was reported as 0.65 (1-3) during injection and 0.15 (0-2) preoperatively. All three surgeons reported excellent satisfaction in all the cases operated on. No complication occurred due to anesthesia. WALANT is a much simpler option and can be safely used in place of general anesthesia or regional blocks for fixation of fractures of the upper limb, with added advantages of no need for a tourniquet and better intraoperative assessment of fracture fixation.

An update on lipid-based nanodrug delivery systems for leishmaniasis treatment

Lipid-based nanodrug delivery systems hold considerable promise in therapeutic intervention for leishmaniasis by enhancing drug solubility and targeted delivery.

Outcome of Mandibular Reconstruction with Fibula free Flaps: Retrospective Analysis of Complications

Rationale: Fibula free flap has become the workhorse for head and neck reconstruction. In this retrospective study we aimed at determining the outcomes of mandibular reconstruction with fibula free flaps. Methods: Any patient who underwent a mandibulectomy and reconstructed with vascularised fibula flap was included in the study. The predictor variables were age, sex, type of lesion, tobacco and alcohol use, tracheostomy, neck dissection, post operative radio and chemotherapy. Flap failure, fistulas, dehiscence, bone exposure and hardware complications were the outcomes. A P value of < 0.05 was considered statistically significant. Results: 242 patient records were selected for evaluation. PORT, CRT, neck dissection, no. of segments were the factors significantly associated with every complication. Malignant lesion was significantly associated with every complication except for plate fracture. Plate fracture although occurred more frequently with malignant diseases, the association was insignificant. Tobacco consumption was significantly associated with increased incidence of post -operative complications. Alcohol consumption was significantly associated with plate fracture, screw loosening, fistulas, bone exposure and flap failure. Conclusion: Overall the fibula free flap has a success rate of 90.0% with fistulas being the most significant complication.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03344-2.

Development of chemically synthesized hydroxyapatite composite with reduced graphene oxide for enhanced mechanical properties

A successful attempt has been made to improve the mechanical properties of Hydroxyapatite (HAp) and reduced graphene oxide (rGO) composite nanoparticles (NPs). Various proportions of HAp and rGO were synthesized to improve the mechanical properties. HAp NPs were prepared using the wet precipitation method and further calcined to form crystalline particles. The physicochemical characterization of the HAp NPs revealed that the crystalline size and percentage of crystallinity were calculated to be 42.49 ± 1.2 nm and 44% post calcination. Furthermore, the rGO-HA composites were prepared using ball milling and obtained in the shape of pellets with different ratios of rGO (10, 20, 30, 40, 50% wt.). The mechanical properties have been evaluated through a Universal testing machine. Compared to calcined HAp (cHAp), the strength of variants significantly enhanced with the increased concentration of rGO. The compressive strength of HA-rGO with the ratio of the concentration of 60:40% by weight is a maximum of about 10.39 ± 0.43 MPa. However, the porosity has also been bolstered by increasing the concentration of rGO, which has been evaluated through the liquid displacement method. The mean surface roughness of the composites has also been evaluated from the images through Image J (an image analysis program).

Bleomycin-triamcinolone sclerotherapy in the management of propranolol resistant infantile hemangioma of the maxillofacial region: A single arm prospective evaluation of clinical outcome and Doppler ultrasound parameters

INTRODUCTION

Propranolol has emerged as a first line agent in the management of hemangiomas. With increased use of propranolol, studies have also focused on relapses following propranolol therapy. Our current study evaluates the role of bleomycin triamcinolone sclerotherapy for the management of propranolol resistant Infantile Hemangioma (IH). We also evaluated the role color Doppler USG for response assessment of sclerotherapy.

METHODS

Patients with Propranolol resistant (Non- responders/ Partial responders) IHs were included in the study. Patients received intralesional bleomycin at a dose of 0.5 IU/kg followed by intralesional injection of triamcinolone at a dose of 2mg/kg body weight. Clinically patients were grouped into excellent, partial and non responders. Doppler parameters; Resistivity index (RI), Pulsatility index(PI) and Peak systolic velocity (PSV) were used to evaluate the response to sclerotherapy. These parameters were evaluated prior to sclerotherapy and 3 months following completion of therapy. The clinical responses of the patients were compared with the change in Doppler parameters before and after treatment.

RESULTS

A total of 115 participants were considered for analysis; 60.86% had excellent response, 32.17% had partial response and 6.95% had poor response. There was a significant change in terms of RI, PI and PSV in patients who were either excellent or partial responders. Poor responders did not have a significant change in Doppler parameters.

CONCLUSION

Combined bleomycin- triamcinolone sclerotherapy is an effective therapy for the management of propranolol resistant IHs. Doppler parameters RI, PI and PSV are reliable indicators of response in the management of IH.

Efficacy of Radial Endobronchial Ultrasound (R-EBUS) guided transbronchial cryobiopsy for peripheral pulmonary lesions (PPL...s): A systematic review and meta-analysis

BACKGROUND

Transbronchial lung cryobiopsy (TBLC) is frequently described for the diagnosis of diffuse parenchymal lung diseases (DPLD). A few studies have reported transbronchial cryobiopsy for the diagnosis of peripheral pulmonary lesions (PPL...s). We aimed to study the utility and safety of transbronchial cryobiopsy for the diagnosis of PPL...s.

METHODS

We performed a systematic search of the PubMed and Embase databases to extract the relevant studies. We then performed a meta-analysis to calculate the diagnostic yields of transbronchial cryobiopsy and bronchoscopic forceps biopsy.

RESULTS

Following a systematic search, we identified nine relevant studies (300 patients undergoing cryobiopsy). All used Radial Endobronchial Ultrasound (R-EBUS) for PPL localization. The pooled diagnostic yield of transbronchial cryobiopsy was 77% (95% CI, 71%...84%) (I^2=38.72%, p=0.11). The diagnostic yield of forceps biopsy was 72% (95% CI, 60%...83%) (I^2=78.56%, p<0.01). The diagnostic yield of cryobiopsy and forceps biopsy was similar (RR 1.05, 95% CI 0.96...1.15), with a 5% risk difference for diagnostic yield (95% CI, ...6% to 15%). There was significant heterogeneity (I^2=57.2%, p=0.017), and no significant publication bias. One severe bleeding and three pneumothoraxes requiring intercostal drain (ICD) placement (major complication rate 4/122, 1.8%) were reported with transbronchial cryobiopsy.

CONCLUSIONS

R-EBUS guided transbronchial cryobiopsy is a safe and efficacious modality. The diagnostic yields of TBLC and forceps biopsy are similar. More extensive multicentre randomized trials are required for the further evaluation and standardization of transbronchial cryobiopsy for PPL...s.

Sandwich therapy in the management of propranolol resistant infantile hemangioma of the lip

RATIONALE

Propranolol has evolved as a first line management of infantile haemangiomas. Nevertheless, the resistance to propranolol has warranted alternative treatment modalities. We hypothesize that combination of medical and surgical therapy (sandwich therapy) to be beneficial in the management.

METHODS

Patients were divided into three groups (total=31), Group A (bleomycin sclerotherapy), Group B (surgical group), Group C (sandwich therapy). A p value &lt;0.05 was taken as significant.

RESULTS

In Group A 54.5% of patients had excellent response, 27.3% partial response and 18.2% had no response. Comparing cosmetic outcome, 25% of patients in Group B and 16.7% of patients in Group C had excellent upshot. On the contrary 18.2% of patients in bleomycin had unsatisfactory and 18.2% had poor cosmetic outcome. Sandwich therapy was cosmetically more acceptable than Bleomycin sclerotherapy (p- value = 0.049). In terms of recurrence, sandwich therapy differed significantly from surgical therapy with fewer recurrences (p-value= 0.049).

CONCLUSION

Sandwich therapy is superior to bleomycin sclerotherapy in terms of cosmetic outcome and has fewer recurrences compared to surgical group and requires single stage resection. However, further studies with the help of Doppler ultrasound are required in this regard.

Management of Maxillary Sagittal Fracture by using Pre-activated Rapid Maxillary Expansion (RME)

Introduction

Different techniques of the management of sagittal maxillary fractures have been described with different advantages and disadvantages. We herein present our experience and results of managing these cases by reversing pre-activated maxillary expanders and evaluation of its efficacy.

Patient and Methods

A prospective study was conducted from April 2016 to February 2020 including all the patients managed for sagittal palatal fractures using the modified technique. The patients were evaluated for healing, occlusion and complications.

Results

A total of five patients with sagittal palatal fracture were managed. The mean Glasgow Coma (GCS) score and injury severity score (ISS) of patients were 11.6 ± 2.4 and 15.2 ± 4.3, respectively. Both had a significant strong negative correlation with a correlation coefficient of - 0.889 (p = 0.44). The median duration for initiating the treatment for facial fractures was 2 days (range 2-12 days). All patients achieved satisfactory outcomes and tolerated this technique well. No obvious complications were found.

Conclusion

This method could produce enough transversal force to reduce fractured fragments and then serve as an external fixator to maintain stability for bony healing.

Stable and Discriminatory Radiomic Features from the Tumor and Its Habitat Associated with Progression-Free Survival in Glioblastoma: A Multi-Institutional Study

BACKGROUND AND PURPOSE

Glioblastoma is an aggressive brain tumor, with no validated prognostic biomarkers for survival before surgical resection. Although recent approaches have demonstrated the prognostic ability of tumor habitat (constituting necrotic core, enhancing lesion, T2/FLAIR hyperintensity subcompartments) derived radiomic features for glioblastoma survival on treatment-naive MR imaging scans, radiomic features are known to be sensitive to MR imaging acquisitions across sites and scanners. In this study, we sought to identify the radiomic features that are both stable across sites and discriminatory of poor and improved progression-free survival in glioblastoma tumors.

MATERIALS AND METHODS

We used 150 treatment-naive glioblastoma MR imaging scans (Gadolinium-T1w, T2w, FLAIR) obtained from 5 sites. For every tumor subcompartment (enhancing tumor, peritumoral FLAIR-hyperintensities, necrosis), a total of 316 three-dimensional radiomic features were extracted. The training cohort constituted studies from 4 sites (n = 93) to select the most stable and discriminatory radiomic features for every tumor subcompartment. These features were used on a hold-out cohort (n = 57) to evaluate their ability to discriminate patients with poor survival from those with improved survival.

RESULTS

Incorporating the most stable and discriminatory features within a linear discriminant analysis classifier yielded areas under the curve of 0.71, 0.73, and 0.76 on the test set for distinguishing poor and improved survival compared with discriminatory features alone (areas under the curve of 0.65, 0.54, 0.62) from the necrotic core, enhancing tumor, and peritumoral T2/FLAIR hyperintensity, respectively.

CONCLUSIONS

Incorporating stable and discriminatory radiomic features extracted from tumors and associated habitats across multisite MR imaging sequences may yield robust prognostic classifiers of patient survival in glioblastoma tumors.

Assessing the optimal imaging modality in the diagnosis of jaw osteomyelitis. A meta-analysis

Osteomyelitis is an inflammatory infectious disease that affects bone and bone marrow. Histopathology remains the gold standard method for diagnosis, but imaging modalities also play an important role. We systematically reviewed five articles with comparative studies on plain films, computed tomography (CT) scan, magnetic resonance imaging (MRI), cone beam computed tomography (CBCT), positron emission tomography (PET), single photon-emission computed tomography (SPECT), scintigraphy, and SPECT/CT. Scintigraphy and SPECT/CT has the highest sensitivity of 100%. PET is only to be used in cases of follow up. Orthopantomography (OPG) is the most common initial diagnostic tool despite its low sensitivity. CT provides the necessary specificity needed for radionuclide imaging, which has the highest negative predictive value of 100% and a positive predictive value >95%. SPECT/CT with 100% sensitivity and 85% specificity can be considered as the imaging modality of choice for initial diagnosis and follow up.

Temporomandibular joint ankylosis: A tertiary center-based epidemiological study

Introduction:

Limitation of mouth opening can be caused by bony or fibrous ankylosis of the temporomandibular joint (TMJ) as a sequel to trauma, infection, or autoimmune diseases. The incidence of TMJ ankylosis differs significantly in different parts of the world. The purpose of this study was to analyze the etiological incidence of TMJ ankylosis at our tertiary-level center, which covers a huge population from parts of Bihar and eastern Uttar Pradesh.

Materials and Methods:

This study was conducted from July 2016 to April 2019, and a total of 1607 children were screened in the duration of 33 months. Participants were included in this study as per the inclusion and exclusion criteria.

Results:

After screening of the 1607 children, 128 TMJ ankylosis cases were identified. Out of the 128 cases of TMJ ankylosis, 33 cases were bilateral and 95 cases were unilateral (48 left sided and 47 right sided). Most of the patients (83.5%) were in the 10–15-year-old age group (mean age was 12.1 ± 2.83 years). There was a female preponderance, and the male-to-female ratio was 7:10. Overall, the most common cause of ankylosis was found to be childhood trauma.

Conclusion:

The major etiologic factor of TMJ ankylosis was found to be birth/childhood trauma. TMJ ankylosis cases were detected in significant numbers in this study. This increased prevalence may be due to the lack of knowledge about this pathological entity among the general population and health-care professionals at primary level, which leads to poor initial management.

Adverse Drug Reactions Following Propranolol in Infantile Hemangioma

OBJECTIVES

To assess the adverse effects of propranolol therapy in infantile hemangioma.

METHODS

An ambispective study was conducted from August 2011 to December 2019. In retrospective arm all children managed for infantile hemangioma with propranolol were included and case records were assessed for adverse reactions. In prospective arm the adverse reactions were identified on the basis of predefined criteria.

RESULTS

A total of 514 patients (358 retrospective records) were included. A majority, 378 (73.5%) patients had an excellent response, 75 (14.5%) had partial response and 61 (11.8 %) had no response. A total of 82 (15.9%) patients experienced at least one adverse effect. Diarrhea with weight loss (27, 32.9%) and irritability with decreased sleep (21, 25.6%) were the most common adverse effects. The adverse effects in 22 (4.2%) cases lead to the discontinuation of propranolol. Younger age, low body weight and early onset were risk factors for development of severe adverse reactions.

CONCLUSIONS

Young children with low body weight were at higher risk for adverse effects of propranolol.

Adverse Drug Reactions Following Propranolol in Infantile Hemangioma

OBJECTIVES

To assess the adverse effects of propranolol therapy in infantile hemangioma.

METHODS

An ambispective study was conducted from August 2011 to December 2019. In retrospective arm all children managed for infantile hemangioma with propranolol were included and case records were assessed for adverse reactions. In prospective arm the adverse reactions were identified on the basis of predefined criteria.

RESULTS

A total of 514 patients (358 retrospective records) were included. A majority, 378 (73.5%) patients had an excellent response, 75 (14.5%) had partial response and 61 (11.8 %) had no response. A total of 82 (15.9%) patients experienced at least one adverse effect. Diarrhea with weight loss (27, 32.9%) and irritability with decreased sleep (21, 25.6%) were the most common adverse effects. The adverse effects in 22 (4.2%) cases lead to the discontinuation of propranolol. Younger age, low body weight and early onset were risk factors for development of severe adverse reactions.

CONCLUSIONS

Young children with low body weight were at higher risk for adverse effects of propranolol.

Do medial sural artery perforator flaps have better clinical outcomes compared to the rectus abdominis perforator (DIEAP) flap in reconstruction of glossectomy defects? A Prisma guided meta-analysis

BACKGROUND

There is an increasing evidence for the use of thin flaps based on vascular perforators for reconstructive surgeries. The medial sural and deep inferior epigastric artery flaps offer versatility for the reconstruction of major defects of the head and neck.

OBJECTIVES

"Whether medial sural artery perforator (MSAP) flap or rectus abdominis perforator flap is better for the reconstruction of glossectomy defects in terms of functional outcome?"

DATA SOURCES

PubMed, Cochrane Library, clinicaltrials.gov and hand searches.

PARTICIPANTS AND INTERVENTIONS

Patients who underwent tongue reconstruction with either MSAP flap or deep inferior epigastric artery perforator (DIEAP) flap.

STUDY APPRAISAL AND SYNTHESIS METHODS

Based on defined study criteria 6 studies were selected according to Prisma Guidelines. The overall estimated effect was categorized as significant where P < 0.05.

RESULTS

There was no significant difference between both flaps in terms of receptor site complications (P = 0.223). Overall odds ratio (OR) for complications was 1.35 (95% confidence interval [CI]: 0.412-0.736) and the test for overall effect t value was 2.836, P < 0.05. Overall OR was 6.01 (95% CI 0.5-7.45) and the test for overall effect t value was 1.41, P < 0.05 indicating there was a statistical difference in the intelligibility of speech.

LIMITATIONS

Anatomical variations, under-reporting of studies and lack of universal tool for speech intelligibility.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Both the flaps are comparable in terms of functional outcome. Medium-sized defects can be reconstructed with MSAP and composite larger defects would benefit from DIEAP. In females, anterolateral thigh flap still remains the choice for composite reconstructions.

Effectiveness of life skills health education program: A quasi-experimental study among school students of South India

BACKGROUND

Adolescence is a vital stage of growth and development; however, many adolescents do die prematurely due to accidents, suicide, violence, poor mental stability, depression, and other illnesses that are either preventable or treatable. Life skills are important for the promotion of well-being of adolescents and to develop positive attitude and values to lead a healthy life.

OBJECTIVES

The study was conducted to assess the change in life skills postintervention and study the association between different variables and the postintervention life skills score.

MATERIALS AND METHODS

A quasi-experimental study was conducted among 137 adolescents each in urban and rural schools. Life skills training module based on ten domains of life skills given by the World Health Organization was implemented using interactive teaching-learning methods. After 6 months of implementation of life skills training sessions, a postintervention assessment was done using the life skills assessment scale, and the differences in the scores were measured.

RESULTS

Higher life skills score was observed postintervention, and this difference was statistically significant (P < 0.001). Higher postintervention mean score (above 15) was seen in critical thinking (19.58), self-awareness (18.03), creative thinking (15.78), and interpersonal thinking (15.15).

CONCLUSION

Increase in the postintervention scores using an educational intervention module and interactive teaching-learning methods suggests effectiveness of the life skills education program. Implementing this health promotion module on life skills in the school curriculum will address the overall development of the personality of the school students.

Complex Coacervation and Overcharging during Interaction between Hydrophobic Zein and Hydrophilic Laponite in Aqueous Ethanol Solution

In this paper, for the first time, we have reported the formation of complex coacervate during interaction between hydrophobic protein, zein, and hydrophilic nanoclay, Laponite, in a 60% v/v ethanol solution at pH 4. Dynamic light scattering and viscosity measurements revealed the formation of zein-Laponite complexes during the interaction between zein at fixed concentration, C Z = 1 mg/mL, and varying concentrations of Laponite, C L (7.8 × 10-4 - 0.25% w/v). Further investigation of the zein-Laponite complexes using turbidity and zeta potential data showed that these complexes could be demarcated in three different regions: Region I, below the charge neutralization region (C Z = 1 mg/mL, C L ≤ 0.00625% w/v) where soluble complexes was formed during interaction between oppositely charged zein and Laponite; Region II, the charge neutralization region (C Z = 1 mg/mL, 0.00625 < C L ≤ 0.05% w/v) where zein-Laponite complexes form neutral coacervates; and Region III, the interesting overcharged coacervates region (C Z = 1 mg/mL, C L > 0.05% w/v). Investigation of coacervates using a fluorescence imaging technique showed that the size of neutral coacervates in region II was large (mean size = 1223.7 nm) owing to aggregation as compared to the small size of coacervates (mean size = 464.7 nm) in region III owing to repulsion between overcharged coacervates. Differential scanning calorimeter, DSC, revealed the presence of an ample amount of bound water in region III. The presence of bound water was evident from the presence of an additional peak at 107 °C in region III apart from normal enthalpy of evaporation of water from coacervates.

Exophytic gingival growth of the maxillary canine region in a young individual: Extremely rare case report of peripheral dentinogenic ghost cell tumor

The present case report is a case of peripheral dentinogenic ghost cell tumor (PDGCT), an extremely rare solid benign neoplastic variant of calcifying cystic odontogenic tumor of the gingiva mimicking clinically as pyogenic granuloma, fibroma, peripheral ossifying fibroma, and peripheral giant-cell granuloma. A 24-year-old male reported with painless, firm, solitary, sessile, smooth-surfaced, nonulcerative, nonpulsatile, well-defined swelling measuring ≈12 mm × 9 mm in the interdental gingiva of the teeth #13 and #14 extending to the mucogingival junction. Intraoral periapical radiographic showed a normal trabecular pattern with mild radiolucency without bony expansion, periapical lesion, and resorption of the adjacent teeth. The diagnosis was established by histopathologic examination. Very few cases of this entity have been documented in the literature. The present case report aims to document this rare entity and emphasizes on the fact that histopathological examination of every localized gingival growth should be included in the treatment planning to differentiate with other commonly found lesions.

Comparative evaluation of buccal pad of fat with and without bovine collagen membrane in the management of oral submucous fibrosis: A prospective clinical study

Background

Oral submucous fibrosis (OSMF) is a chronic, debilitating disease characterized by juxtaepithelial fibrosis. The present study evaluates the efficacy of buccal fat pad (BFP) and bovine collagen membrane as reconstruction options.

Materials and Methods

The sample size includes 22 patients between 20 and 60 years, randomly distributed in two groups: Group I in which BFP was used and Group II where BFP with bovine collagen membrane was used after surgical resection of fibrotic bands. The clinical evaluation on postoperative 1^st, 3^rd, and 5^th days and 1^st, 2^nd, 3^rd, 4^th, 12^th, and 24^th weeks subsequently.

Results

The mean age in Group I was 27.17 ± 3.157 years and Group II was 37.90 ± 6.657 years. The mean preoperative mouth opening was 9.75 ± 6.717 and 8.90 ± 3.784 mm in Groups I and II, respectively. The mean duration of presenting illness in Group I was 9.75 ± 2.598 years and in Group II was 8.80 ± 1.989 years. There was no significant difference observed between Groups I and II in relation to reduced mouth opening and duration of symptoms (P > 0.05) except for age. No significant difference was observed between both the groups in relation to preoperative pain, burning sensation, cheek stiffness, mucosal suppleness, postoperative infection, and postoperative pain at days 1 and 5 and 1^st week. There was a significant difference observed in postoperative pain among both the groups on the 3^rd day and 2^nd week.

Conclusion

In the present study, both the groups have proved to give better results, as BFP in the form of interposition material showed rapid epithelization and minimum wound contracture.

Utility of Real-Time Online Teaching During COVID Era Among Surgery Postgraduates

A cross-sectional study was conducted to assess the utility of online teaching for general surgery postgraduate residents at the end of 1 month of online teaching during the COVID-19 lockdown. A questionnaire related to different aspects of online teaching was developed on a 5-point Likert scale from “strongly agree” to “strongly disagree”. Following a pilot study, the questionnaire was shared among surgery residents, and response collection was done. The residents who did not attend at least 90% of scheduled classes were excluded. A total of 55 resident doctors without prior experience of online teaching program were enrolled in the study. All the participants responded to all questions and submitted their responses within stipulated time. On the basis of validity testing, questions 1 and 2 were found invalid and hence deleted. The median value for the total cohort was 4 indicating that majority of residents gave affirmative response. On segregating the result with the year of residency program, similar results were found in the 1st year and 2nd year group; however, the 3rd year group showed a median of 3, thus eliciting that only 50% of 3rd year residents liked online teaching. From the present study, it can be concluded that the online teaching is a feasible alternative to the physical class among surgical postgraduates. The questionnaire utilized in the present study can be used for assessing similar online teaching protocols.

Magnitude of Gonial Angle Influence on the Commonness of Mandibular Angle Fractures

Background:

The aim of the study was to review the literature on the influence of gonial angle on mandibular angle fracture. The present systematic review addresses the following focus question: Does the magnitude of gonial angle influence the incidence of mandibular angle fractures?

Materials and Methods:

Electronic and manual literature searches were conducted on databases: PubMed/MEDLINE, Embase, Science direct, the Cochrane Library, and clinicaltrials.gov for studies published up to August 2019 to collect information about the effect of gonial angle, a skeletal morphological parameter with an incidence of fracture of the angle of the mandibular arch. Systematic literature review was performed to identify studies evaluating the effect of gonial angle in patients suffering from mandible fractures. Large retrospective studies were included and case reports were excluded.

Results:

Fifteen hundred articles published before August 2019 were identified. One hundred and sixteen articles met the inclusion criteria. Two articles remained when exclusion criteria were applied. As measured in the two included studies containing 280 panoramic radiographs of mandibular fractures, the mean gonial angle of patients in the angle fracture group ranged from 126.8° ± 7.9° to 128.5° ± 5.4°. The mean gonial angle of patients in the nonangle fracture group ranged from 118.5° ± 4.4° to 122.3° ± 4.9°. The mean gonial angle of patients in the angle fracture group displayed a range from 118.9° to 134.7° (confidence interval [CI] 95% 5.89–8.05), whereas the mean gonial angle of patients in nonangle fracture group displayed a range from 114.1° to 127.2° (CI 95% 3.89–4.95).

Conclusion:

A high gonial angle is an important factor influencing the occurrence of mandibular angle fractures owing to the poorer quality of bone and reduced height at the ramus angle region, all of which necessitate a modification of osteosynthesis techniques.

Determination of cut-off and correlates of delay in treatment-seeking of febrile illness: a retrospective analysis

Background

Early diagnosis and treatment of malaria symptoms reduces the risk of severe complication and malaria transmission. However, delay in malaria diagnosis and treatment is a major public health problem in India. The primary aim of the study was to determine cut-off for the delay in seeking treatment of fever, and the secondary aim was to identify the factors associated with delay in malaria-endemic areas of Assam, Northeast India.

Methods

The present study analysed data from two prior cross-sectional surveys (community- and hospital-based) that was conducted to study the health-seeking behaviour of people residing in high malaria-endemic areas of Assam, Northeast India. The hospital-based survey data were used to determine optimal cut-off for the delay in reporting, and further, used to identify the factors associated with delay using community-based data.

Results

Mean age of fever cases was similar in both community- and hospital-based surveys (23.1 years vs 24.2 years, p = 0.229). Delay in reporting fever was significantly higher among hospital inpatients compared to community-based fever cases (3.6 ± 2.1 vs 4.0 ± 2.6 days; p = 0.006). Delay of > 2 days showed higher predictive ability (sensitivity: 96.4%, and ROC area: 67.5%) compared to other cut-off values (> 3, > 4, and > 5 days). Multivariable logistic regression analysis revealed that the adjusted odds ratio (aOR) of delay was significantly higher for people living in rural areas (1.52, 95%CI: 1.11–2.09), distance (> 5 km) to health facility (1.93, 95%CI: 1.44–2.61), engaged in agriculture work (2.58, 95%CI: 1.97–3.37), and interaction effect of adult male aged 20–40 years (1.71, 95%CI: 1.06–2.75).

Conclusion

The delay (> 2 days) in seeking treatment was likely to be twice among those who live in rural areas and travel > 5 km to assess health care facility. The findings of the study are useful in designing effective intervention programmes for early treatment of febrile illness to control malaria.

Conveyor Belt Entrapment Trauma in Children: An Unreported Menace

A retrospective study was conducted including all the children who sustained motorized machine belt entrapment injuries. Six children included in study had mean (SD) Glosgow coma scale and pediatric trauma score of 5.7 (3.54) and 3.2 (1.21), respectively. Overall mortality and paraplegia rate were 33.3% each. Awareness and legislation both are important to curb this menace.

A Clinico-Radiological Study: Veria Technique of Cochlear Implant-A Study of 50 Cases

Main limitation of classical technique is limited access to cochlea in terms of cochlear rotations and related structures, thus causing difficulty in electrode insertion. Veria technique allows full access to cochlea after raising tympanomeatal flap. To our best knowledge this is first clinic-radiological study for Veria technique studying distance between tympanic segment of facial nerve and posterior wall of external auditory canal (EAC) demonstrating facial nerve safety. Prospective study was done on 50 patients having bilateral sensori-neural hearing loss. Patients underwent cochlear implant surgery irrespective of age and gender. Preoperative high-resolution computed tomography temporal bone and magnetic resonance imaging head was done, distance between tympanic segment of facial nerve and posterior wall of EAC and basal turn angle were measured. Intraoperative NRT followed by orbito-meatal X-ray was done in post operative period. 25 (50%) were male, 25 (50%) female. 35 patients (70%) showed that the distance between tympanic segment of facial nerve and posterior wall of EAC was more than 3 mm with mean 4.41 mm (± 0.63 SD). Distance calculated was greater in older age group than younger group. Patient having inner ear malformation, mean was 3.96 mm (± .44 SD). Whereas patients having acquired disease, mean distance was 4.30 mm (± .47 SD). On gender comparison of basal turn angle score, no significant difference was observed male (54.34° ± 4.48°) versus female (55.66° ± 4.15°) (p = 0.282). Mean of basal turn angle (BTA) in ≤ 5 years age group was 54.89° ± 3.65°, in 6-10 years age group was 55.21° ± 5.23° and in age group ≥ 11 years was 54.93° ± 4° with no significant difference in mean value between the groups (p = 0.282). High jugular bulb was seen in 4 patients (2 in right side, 2 in left side), hypoplastic jugular bulb was seen in 10 patients (9 in left, 1 in right), otosclerosis in 2 patients. Veria technique is safe for facial nerve, as preoperatively distance between tympanic segment of facial nerve and posterior canal wall can be identified. It is suitable method for rotated cochlea (identified preoperatively through BTA) and deformed cochlea as it offers a wide visibility and accessibility as compared to posterior tympanotomy approach. BTA and distance between posterior canal wall of EAC and tympanic segment of facial nerve should be done in all cases to see any cochlear rotation and feasibility of surgery.

Development of a biomarker of efficacy in second-line treatment for lymphangioma of the tongue: a pilot study

Lymphangioma of the tongue is a rare lymphatic malformation, and various authors have reported the successful use of sirolimus for its treatment. However, the safety of sirolimus in children needs further evaluation so that those who do not respond are not necessarily exposed to its potential adverse effects. We hypothesised that assessment of lymphangiogenesis can be used to predict whether the patient will respond to sirolimus, so we organised a prospective study after ethics committee approval had been given. After clinical and histological diagnoses of lymphangioma of the tongue had been confirmed, 16 patients were given sirolimus 0.8mg/day in three divided doses. Clinical response was assessed and compared with lymphatic microvessel density (LMVD), which was calculated immunohistochemically using the monoclonal antibody D2-40 as the lymphatic endothelial marker. Nine patients responded well, five partially, and two failed to respond. Mean (SD) LVD among the good responders was 21.00 (3.74), whereas among non-responders it was 8.00 (4.24). There was a significant difference in mean LVD between good responders, partial responders, and non-responders (p=0.04). Sirolimus is effective in treating children with lymphangioma of the tongue, and lymphangiogenesis is a useful therapeutic predictive marker.

Disorder in Pixel-Level Edge Directions on T1WI Is Associated with the Degree of Radiation Necrosis in Primary and Metastatic Brain Tumors: Preliminary Findings

BACKGROUND AND PURPOSE

Co-occurrence of local anisotropic gradient orientations (COLLAGE) is a recently developed radiomic (computer extracted) feature that captures entropy (measures the degree of disorder) in pixel-level edge directions and was previously shown to distinguish predominant cerebral radiation necrosis from recurrent tumor on gadolinium-contrast T1WI. In this work, we sought to investigate whether COLLAGE measurements from posttreatment gadolinium-contrast T1WI could distinguish varying extents of cerebral radiation necrosis and recurrent tumor classes in a lesion across primary and metastatic brain tumors.

MATERIALS AND METHODS

On a total of 75 gadolinium-contrast T1WI studies obtained from patients with primary and metastatic brain tumors and nasopharyngeal carcinoma, the extent of cerebral radiation necrosis and recurrent tumor in every brain lesion was histopathologically defined by an expert neuropathologist as the following: 1) "pure" cerebral radiation necrosis; 2) "mixed" pathology with coexistence of cerebral radiation necrosis and recurrent tumors; 3) "predominant" (>80%) cerebral radiation necrosis; 4) predominant (>80%) recurrent tumor; and 5) pure tumor. COLLAGE features were extracted from the expert-annotated ROIs on MR imaging. Statistical comparisons of COLLAGE measurements using first-order statistics were performed across pure, mixed, and predominant pathologies of cerebral radiation necrosis and recurrent tumor using the Wilcoxon rank sum test.

RESULTS

COLLAGE features exhibited decreased skewness for patients with pure (0.15 ± 0.12) and predominant cerebral radiation necrosis (0.25 ± 0.09) and were statistically significantly different (P < .05) from those in patients with predominant recurrent tumors, which had highly skewed (0.42 ± 0.21) COLLAGE values. COLLAGE values for the mixed pathology studies were found to lie between predominant cerebral radiation necrosis and recurrent tumor categories.

CONCLUSIONS

With additional independent multisite validation, COLLAGE measurements might enable noninvasive characterization of the degree of recurrent tumor or cerebral radiation necrosis in gadolinium-contrast T1WI of posttreatment lesions.

Coexisting Congenital Subglosso-palatal Membrane and Tongue Dermoid in a Neonate

BACKGROUND

Neonatal respiratory distress due to coexisting subglosso-palatal membrane and tongue dermoid has not been reported yet.

CASE CHARACTERISTICS

A newborn with respiratory distress having a membrane in the oral cavity. Excision of membrane revealed a tongue mass with cleft palate, obstructing the nasopharynx completely. Elective ventilation was followed by excision of mass.

OUTCOME

The child was cured with uneventful course at follow-up of six months.

MESSAGE

Co-existing congenital anomalies causing airway obstruction may be missed in presence of subglosso-palatal membrane.

Shape Features of the Lesion Habitat to Differentiate Brain Tumor Progression from Pseudoprogression on Routine Multiparametric MRI: A Multisite Study

BACKGROUND AND PURPOSE

Differentiating pseudoprogression, a radiation-induced treatment effect, from tumor progression on imaging is a substantial challenge in glioblastoma management. Unfortunately, guidelines set by the Response Assessment in Neuro-Oncology criteria are based solely on bidirectional diametric measurements of enhancement observed on T1WI and T2WI/FLAIR scans. We hypothesized that quantitative 3D shape features of the enhancing lesion on T1WI, and T2WI/FLAIR hyperintensities (together called the lesion habitat) can more comprehensively capture pathophysiologic differences across pseudoprogression and tumor recurrence, not appreciable on diametric measurements alone.

MATERIALS AND METHODS

A total of 105 glioblastoma studies from 2 institutions were analyzed, consisting of a training (n = 59) and an independent test (n = 46) cohort. For every study, expert delineation of the lesion habitat (T1WI enhancing lesion and T2WI/FLAIR hyperintense perilesional region) was obtained, followed by extraction of 30 shape features capturing 14 "global" contour characteristics and 16 "local" curvature measures for every habitat region. Feature selection was used to identify most discriminative features on the training cohort, which were evaluated on the test cohort using a support vector machine classifier.

RESULTS

The top 2 most discriminative features were identified as local features capturing total curvature of the enhancing lesion and curvedness of the T2WI/FLAIR hyperintense perilesional region. Using top features from the training cohort (training accuracy = 91.5%), we obtained an accuracy of 90.2% on the test set in distinguishing pseudoprogression from tumor progression.

CONCLUSIONS

Our preliminary results suggest that 3D shape attributes from the lesion habitat can differentially express across pseudoprogression and tumor progression and could be used to distinguish these radiographically similar pathologies.

Role of intralesional bleomycin and intralesional triamcinolone therapy in residual haemangioma following propranolol

With the emergence of propranolol as the first choice of treatment for problematic infantile haemangioma at many centres, the number of patients with a partial or non-response to propranolol has also been growing. This study investigated the role of intralesional bleomycin and triamcinolone in patients with residual disease following propranolol therapy for infantile haemangioma. Sixty-seven patients with residual haemangioma were assigned randomly to receive either intralesional bleomycin (group A, n=36) or intralesional triamcinolone (group B, n=31). The response to treatment and adverse effects were assessed in both groups. All patients received at least four doses and a maximum of six doses of the assigned drug. In group A (mean follow-up 9.38months), 47.2% had an excellent response and 44.4% a good response. In group B (mean follow-up 7.42months), 25.8% had an excellent response and 48.4% a good response. There was no difference in overall response between the groups (P=0.074). Among patients who were initially non-responders to propranolol, bleomycin showed a better response than triamcinolone (P=0.037). This may be due to an overlap in the mechanism of action of propranolol and triamcinolone. Thus, intralesional bleomycin should be preferred in patients with no initial response to propranolol therapy, while bleomycin or triamcinolone can be used in patients with a partial response to propranolol therapy, as they have equal efficacy.

126 A Comparison of Two Different Follicular Coasting Periods for In Vitro Embryo Production in Indian Nelore Cattle

Ongole, also known as Nelore (Bos indicus) cattle, are indigenous to the Andhra region in the Prakasam District in the State of Andhra Pradesh in India. A better understanding and utilisation of follicular wave dynamics within this breed would ultimately enhance oocyte and potential embryo production. Therefore, the aim of this study was to evaluate the differences between coasting periods of 24 h (S1) and 36 h (S2) on oocyte recovery, the rate of viable oocytes, cleavage, and Day 7 blastocyst rates of Nelore cattle in India. A total of 58 ovum pick-up (OPU) sessions (29 per treatment) were performed on 32 healthy donor cows that were randomly assigned to 1 of 2 coasting treatments (S1 or S2). Donors were stimulated as follows: 2.5 mL of gonadotropin-releasing hormone (GnRH; Receptal, MSD Animal Health, New Zealand) given IM on Day 1 followed by once-daily descending dose of Folltropin® (FSH, Vetoquinol, Canada) on Days 3 to 5 for a total of 180 mg. Cumulus-oocyte complexes were collected following OPU on Day 6 either at 24 (S1) or 36 h (S2) following the last FSH injection (coasting period). Donors were subject to OPU 1 to 3 times with a minimum interval of 15 days between procedures from March to April 2017. All 32 donor cows were non-lactating at the time of aspiration and divided equally between treatment groups. A total of 1492 follicles produced 850 total oocytes with oocyte recovery numbers for treatments S1 and S2 (785, 707; 441, 409; respectively). All data were analysed by ANOVA (P < 0.05). The mean number of follicles aspirated from S1 (27 ± 20.2) was not significantly different from that of S2 (24.4 ± 14.4). For S1, 393/441 (89%) quality oocytes were utilised for culture compared with 323/409 (78.9%) for S2, with no differences between rates. Additionally, there were no differences between mean number of oocytes, cleaved embryos, and blastocysts for S1 (15.2 ± 12.7; 9.9 ± 9.2; 4.3 ± 5.4) and S2 (14.1 ± 10; 7.4 ± 6.0; 3.6 ± 3.3; respectively). In conclusion, there were no differences found between 24- or 36-h coasting periods of Nelore cattle undergoing OPU for follicle counts, oocyte recovery, viable oocyte rates, cleavage, and blastocyst rates. Further research is needed to determine whether different stimulation protocols, the use of lactating cows, or coasting periods could alter outcomes.