Concept of field cancerization was first introduced over six decades ago in the setting of oral cancer. Later, field cancerization involving histologic and molecular changes of neoplasms and adjacent tissue was explained. Field cancerization involves the lateral spread of pre-malignant or malignant disease and contributes to the recurrence of head and neck tumors. The overall hypothesis underlying this work is that endothelial cells actively participate in tumor cell invasion by secreting chemokines and creating a chemotactic gradient for tumor cells. The article tries to explain the conflicting aspects of field cancerization in the setting of oral cancer.

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Infectious rates and peripheral intravenous cannulae-associated complications are very common in patients with intravenous therapy. This study was aimed to assess the incidence of intravenous cannulae complications among patients after 72 hours in situ and to examine the impact of structured teaching program on knowledge and practices of staff nurses. In this study, researcher used descriptive and quasi-experimental approach; a non-probability convenient sampling technique was adopted to select 80 staff nurses, each 40 in experimental and 40 in control group. 67.79% of patients developed peripheral intravenous cannulae-related complications with grade 1 (33.05%) and grade 2 (34.74%) complications. Result revealed that it was highly significant at 0.05 level (t = 9.978; P < 0.05) for knowledge and not significant (t = 0.974; P > 0.05) for practice. The post-test knowledge found to be highly significant at 0.05 level (t = 3.909; P < 0.05), whereas practice score was not significant (t = 0.426; P > 0.05). It could be inferred that there is no significant difference between the pre-test and post-test practice score of staff nurses who attended the structured teaching program regarding prevention of intravenous cannulae complications.

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Objective: To evaluate the hepatoprotective activity of Clearliv a polyherbal formulation in Wistar rats. Materials and Methods: The hepatoprotective potential of Clearliv was evaluated in thioacetamide-induced liver necrosis, DL-galactosamine [GalN]-induced liver injury, and carbon tetrachloride [CCl ₄ ]-induced hepatitis models in Wistar rats. In all the models, Clearliv (at the dose levels of 800, and 1000 mg/kg) was administered for 3 days orally followed by single intraperitoneal administration of the hepatotoxicant on the last day after one hour of Clearliv administration. After 24 h of toxicant administration blood sample was collected by sino-orbital puncture in sodium EDTA tubes. The efficacy of Clearliv was evaluated by plasma biochemical parameters (AST, ALT, and ALP), and antioxidant enzyme (lipid peroxidation, catalase, superoxide dismutase, glutathione peroxidase, and hydroxyproline) levels. Results: In thioacetamide-induced necrosis, and GalN-induced liver injury models, Clearliv at 1000 mg/kg showed significant reduction in the elevated plasma liver markers, and elevated antioxidants levels. In CCl ₄ -induced hepatitis, the Clearliv had favorable hepatoprotective effect, but the results were not significant. Conclusion: Clearliv 800, and 1000 mg/kg showed significant hepatoprotective effect against thioacetamide- and GalN-induced liver necrosis and injury, respectively.

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Background and Purpose: The modified functional reach test (MFRT) is the objective measure for dynamic sitting balance. It quantifies sitting balance in two directions: Forward and lateral reach. So, the purpose of the study was to 1) provide clinical reference value and 2) examine the factors that may influence the anthropometrics measures. Materials and Methods: A total of 200 apparently healthy subjects participated in this descriptive study. All subjects were divided in two groups: Younger (20-39 yr) and middle-aged (40-59 yr). After anthropometric measurement, all subjects performed test by reaching forward and lateral with a closed fist while sitting. MFRT was taken with 3 trials with 15 sec break in between. Results: The mean score of the forward and lateral reach of right and left in group 1 was higher compared to group 2. The normative value of forward reach in group 1 was 34.05 ± 9.03 cm; for lateral reach right and left, it was 18.2 ± 5.26 cm and 17.32 ± 5.21 cm, respectively. For group 2, normative values for forward reach, lateral right and left were 25.18 ± 5.71 cm, 14.02 ± 3.98 cm and 13.53 ± 4.25 cm, respectively. There was no significant correlation of forward and lateral reach measures with the anthropometric characteristics in both the groups, except trunk length and BMI in group 1, which was significantly correlated ( P < 0.001). Conclusion: This study provides clinical reference value for younger and middle age group subjects while anthropometrics do not affect performance except trunk length and BMI in younger age group.

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Hearing loss is becoming more common in the society living in cities with lot of background noise around, and frequent use of gadgets like mobile phones, MP3s, and IPods are adding to the problem. The loss may involve the conductive or perceptive pathway. Majority of the patients with conductive hearing loss will revert back to normal hearing levels with medical and/or surgical treatment. However, in sensorineural hearing loss, many factors are involved in the management. Though traditionally hearing aids in various forms are the most commonly used modality in managing these patients, there are some drawbacks associated with them. Implantable middle ear amplifiers represent the most recent breakthrough in the management of hearing loss. Middle ear implants are surgically implanted electronic devices that aim to correct hearing loss by stimulating the ossicular chain or middle ear. Of late, they are also being used in the management of congenital conductive hearing loss and certain cases of chronic otitis media with residual hearing loss. The article aims to provide general information about the technology, indications and contraindications, selection of candidates, available systems, and advantages of middle ear implants. (MEI)

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A frontocutaneous fistula secondary to chronic frontal sinusitis can present with a fistulous opening in the forehead or in the eyelid. It may or may not be associated with Pott's puffy tumor. In this article, we present 2 cases. A case of frontocutaenous fistula with opening in the upper eyelid at the lateral portion of floor of frontal sinus and another case of chronic frontal sinusitis with sub-periosteal abscess in the forehead on the right side near the eyebrow. Relevant literature has also been reviewed.

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Background: Heart is a vital organ of circulatory system. Valves maintain the unidirectional flow of blood. Mitral valve (MV) prevents the backflow of blood into the left atrium. For the proper functioning of the heart, all valves should be intact. MV prolapse and regurgitation is the main cause of MV replacement. Mean circumference of MV varies from person to person. Aim of the present study is to measure the average size of the valve in the cadavers of North Karnataka region by using cardiac sizer, which would help in the selection of prosthetic valve in the cardiac surgery. Materials and Methods: This study was carried out on 50 cadaveric adult human hearts. Left atrium was opened along the left border of heart so as to expose the mitral orifice. Then, the diameter of the valve was measured by using cardiac sizer, whereas circumference was calculated manually. Number of mitral valve cusps and papillary muscles were observed. Results: The mean annular circumference and diameter of the mitral valve was found to be 8.03 ± 0.82 cm and 2.56 ± 0.32 cm, respectively. Majority (72%) of the mitral valves had the circumference ranging from 7.53 to 8.47 cm and the diameter ranging from 2.4 to 2.7 cm. Conclusion: The size of mitral valve in the North Karnataka region was found to be less as compared to the other studies. This study might help cardio-thoracic surgeon as well the prosthetic valve manufacturing companies for the rough estimation of the mitral valve size.

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Background and Objectives: The husk fibers of coconut (Cocos nucifera) are reported to be used by people of rural areas of South India for daily cleaning their teeth. As the beneficial effects of this plant material, with respect to antimicrobial properties against common cariogenic bacteria, are not scientifically proven, the present study was conducted. Materials and Methods: The husk of coconut was collected and aqueous extract was prepared and antimicrobial properties against common oral pathogens like Streptococcus mutans, Streptococcus salivarius, Streptococcus mitis, and Lactobacillus acidophilus were performed by agar well diffusion method. The values obtained were then subjected to statistical analysis using one way ANOVA and Tukey HSD. Results: Aqueous extract of coconut husk showed a concentration-dependent antimicrobial activity against different tested organisms with zone of inhibition ranging from 4.44 to 15.33 mms. However, the efficacy was less in comparison to chlorhexidine. Conclusion: Inhibitory action against cariogenic bacteria exhibited by aqueous extract of coconut husk indicate presence of highly effective active compounds in these extracts, which can be identified and incorporated into modern oral care systems for controlling dental caries.

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Background: Cervical cancer is an important public health problem among adult women in many developing countries. Cervical cytology became the standard screening test for cervical cancer and premalignant cervical lesions with the introduction of the Papanicolau (Pap) smear. The most widely used system for describing PAP smear result is the Bethesda System 2001. Material and Methods: This study was aimed at evaluating the entire spectrum of types and frequencies of cervical cytological abnormalities i.e. infective, pre-cancerous and cancerous, in women who underwent routine cytological cervical screening at our hospital which caters largely to women of low socio-economic status. Results: A total of 610 cases of cervical pap smears were received in our cytology laboratory during this two year period, 348(57%) abnormal Pap smears, and 238(39%) cases which were normal. Out of the 348 cases, 306(50.2%) cases were reported to have inflammatory/reactive/reparative changes whereas epithelial cell abnormality was reported in 42 cases. Discussion: Cervical smear cytology also plays an important role in the diagnosis of cervical infections which are common in women of the reproductive age group. Conclusion: Hence, the need of the hour is an effective screening programme that is based on available resources and is readily available to the low socio-economic and disadvantaged sections of our society.

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Osteosarcoma is the most common primary malignancy of bone if we exclude the marrow-based malignancies such as myeloma, lymphoma, and leukemia. Osteosarcoma is the eighth most common form of childhood cancer, comprising 2.4% of all malignancies in pediatric patients, and approximately 20% of all primary bone cancers. The proximal fibula is a very rare site for osteosarcoma, and in Mayo series, reported incidence was only 2%. The purpose of this article is to report a very rare presentation of osteosarcoma in proximal fibula and to discuss the challenges in its surgical management. Proximal fibula osteosarcoma carries a good prognosis if sound oncological margins are achieved during the initial surgery. In addition, lateral soft tissue structures should be meticulously reconstructed to prevent post-operative knee instability and to ensure a good functional outcome.

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Extramedullary hematopoiesis (EMH) is the development of hematopoietic tissue outside the bone marrow and it most often occurs in the liver and spleen. Renal EMH is quite rare, and there are very few case reports concerning the kidney. We describe a case diagnosed with congenital dyserythropoetic anemia presenting with a solitary renal mass with splenomegaly. CECT showed a heterogeneously enhancing mass lesion suggestive of renal neoplasm. Microscopic examination revealed features of extramedullary hematopoiesis. We intend to present this case because of the rarity of EMH in kidney and to emphasize that its possibility should be kept in mind in any case of solitary renal mass, especially in those patients suffering from chronic hematological disorders.

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Probiotic bacteria have been added to various foods because of their beneficial effects for human health, especially gut. Numerous studies have proved definite reliability of these viable bacteria in the treatment of gastrointestinal infections and diseases. The effect of probiotic in prevention and treatment of various oral disorders is also being studied. Although only a few clinical studies have been conducted so far, the results to date suggest that probiotics could be useful in preventing and treating oral infections, including dental caries, periodontal disease, and halitosis. This article summarizes the currently available data on the potential benefits of probiotics for oral health.

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Papillary thyroid microcarcinomas (PTMC) have excellent prognosis, although a few may present with metastasis to cervical lymphnodes. We present one such case of PTMC presenting as a left neck cyst without evidence of palpable primary thyroid nodule either clinically or on imaging. On histopathological examination of the excised cyst and subsequent total thyroidectomy, a final diagnosis of PTMC with cervical lymphnode metastasis undergoing cystic degeneration was given. We conclude that PTMC may also present as lateral neck cyst with an occult primary in thyroid gland.

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Objective: To describe the speech and swallowing characteristics following segmental mandibulectomy and coronoidectomy to release trismus. Materials and Methods: A detailed speech and swallowing function assessment was carried out using various formal and informal tests following the surgeries. Result: After the initial assessment, the patient had severe impairment with the movement of articulators, and distortion was observed for labio dentals, lingual sounds, and vowels. Speech intelligibility, diadokokinetic rate, maximum phonation duration were reduced, and also patient had severe voice problem and swallowing problems. Following the assessment post-coronoidectomy, patient had articulatory errors such as distortion, omission, and substitution for majority of sounds secondary to reduced articulatory movements. Swallowing and voice characteristics have improved slightly, and the voice parameters were near normal. Conclusion: Segmental mandibulectomy can have several effects on an individual's daily living as it affects speech, which becomes a major hindrance for communication. Also, due to the swallowing difficulties, there may be health issues. Hence, the affected individuals should be evaluated by a speech language pathologist to define the exact nature of changes in communication (including speech and voice), and swallowing that also helps to plan a comprehensive management strategy that includes speech therapy and surgical recommendation, which will have good prognosis in speech and swallow characteristics to give a good quality of life.

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Giant pigmented nevi are congenital melanocytic nevi that are of great cosmetic distress for the patient and cause an equal psychological stress to the parents. Here we report a case of a 4 year old female child who presented to us with a large black patch over her back extending upto upper half of her buttocks with multiple satellite lesions all over the body, since her birth. Their management is a challenge for the treating dermatologist owing to their large size and a propensity to recur. There have been reports of malignant change in upto 2% to 15% of the cases. However, there have been recent advances in the field with many new therapeutic modalities available.

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Background: Objective structured clinical examination (OSCE), an important tool for assessment of clinical skills, introduced more than 4 decades ago. KIST Medical College, a new medical school of Nepal, affiliated to Tribhuvan University Institute of Medicine, has made learning of physical examination skills structured and integrated with greater involvement of different clinical science departments. Students learn physical examination skills in second year MBBS as a part of early clinical exposure. Objective: To share the experiences regarding implementation of integrated OSCE. Materials and Methods: At the end of clinical posting of learning of physical examination skills, assessment was done with OSCE. Fifteen OSCE stations including each of 5 minutes were developed and arranged. Standardized patients and validated checklist were used. OSCE was conducted in novel way. Prior to the OSCE session: Suitable venue was selected, assessors were identified, standardized patients were selected, running order of the stations in circuit was developed, list of equipments/instruments required was prepared, and tasks, checklists, feedback questionnaires were printed. The day before the OSCE session: OSCE stations were inspected and clearly labeled, condition of required equipments/instruments was checked, a pack of the documents for each OSCE station were made available, and signs were displayed at proper places. On the day of the OSCE session: Reliable stop watch and loud manual bell were used, support staffs were placed to direct the candidates, examiners, and standardized patients (SPs), assessors explained SPs, students were briefed, supervisors observed the session, and feedback were taken from students, assessors, and SPs. At the end of the OSCE session: Checklists and feedback questionnaires were collected, token money was paid to SPs, and a contribution of everyone was appreciated. After the OSCE session: Score was compiled and result declared, and feedback questionnaires data compiled and shared with academic team. Results: Ninety eight percent of the students attended the OSCE session. All agreed that standardized patient were co-operative, 93% found the faculty's presentation as non-threatening where as 99% found the overall OSCE environment conducive. Most (92%) of the faculties found the selection of simulated patients appropriate, and all were satisfied with student's approach towards SP. All expressed satisfaction with the overall management. Only 250 US dollars expended for conducting session. Conclusion: Integrated OSCE session was organized in novel way and cost effectively. Both students and faculty members were satisfied with OSCE process and management.

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Objectives: To investigate the quality assurance system in Indian physiotherapy education. Design: A cross-sectional survey with mixed method was employed in this research. Participants: Forty two participants were involved in the study and responded to a questionnaire. Seven participants out of the 42 were selected for video interview. Materials and Methods: A questionnaire and an audio or video interview technique were used for the data collection. Descriptive statistics was used to analyze the questionnaire. A qualitative method was analyzed with content analysis. Results: The questionnaire result showed that hardly one-third of participants were aware about quality in general in the physiotherapy education. In the analysis of the interviews, four categories emerged: They indicated that awareness, skills, rating, and requirements related to quality seem to be important in developing quality assurance in physiotherapy. Conclusion: As a small scale study of quality assurance system, this study can contribute to develop an overall awareness of quality system in the Indian physiotherapy education. It can also contribute to the educational and professional life ahead by developing experience and updating the upcoming new physiotherapy researches. However, affirmative effects can also extend physiotherapists in advance.

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The strength of small is huge, that is what one ought to say about the revolution called nanotechnology. And why not! Nanotechnology, a science which deals with atoms a few nano meters large, has the potential to make scientific strides across industries. The speed at which advances are being made in science has catapulted nanotechnology from its theoretical foundations straight into the real world. Dentistry also is facing a major revolution in the wake of this technology having already been targeted with novels 'nano-materials.' Molecular technology is destined to become the core technology underlying all 21 ^st century medicine and dentistry.

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