Targeted therapies are the drugs which are designed in order to interfere with the specific molecules necessary for the tumor growth and progression. The traditional cytotoxic chemotherapies mostly kill the rapidly dividing cells in the body by interfering with the cell division while causing the toxicity in normal cells also. This review article aims to highlight the most recent FDA-approved anticancer drugs eligible for targeted therapies. In addition, an early outline evaluation of the costs of the therapies was also taken in consideration. Moreover, further studies have been going on in order to plan treatment regimen for these drugs. On the basis of these fields, the oncologists will have new means to make treatment decisions for their patients in order to maximize benefit and minimize toxicity

Black stain (BS) is a specific type of extrinsic dyschromia caused by the presence of chromogenic bacteria in the oral cavity, which occurs more frequently in children, but may also occur in adults. This article shows a case of black stain in an adult woman and treatment to remove it.

The objective of this study was to evaluate the effects of two different mean arterial blood pressure (MAP) targets in septic shock. Sepsis is a syndrome is caused by a dysregulated inflammatory response to bacterial infections. We carried out a prospective observational study enrolling patients admitted to the ICU with sepsis from 01/01/2017to 01/03/2018. Both the medical and surgical units of the ICU were included. This study was conducted at Apollo Health City, Critical Care Medicine, Hyderabad, India after obtaining permission from the hospital ethics committee. A total of 100 members were included in this study, had septic shock. These were divided in to two groups aiming at increasing mean arterial pressure from 65mmHg to 80mmHg in older patients. MAP at the end of resuscitation was 57.32 ± 13.69 mmHg (mean ± SD) and 78.45 ± 17.23 mmHg respectively, for low-MAP and high-MAP groups. The high-MAP group had a more positive fluid balance. MAP below 65 mm Hg was shown to be associated with highest mortality during the first 48 hours of septic shock. The longer the time spent below MAP 65 mmHg, the higher the risk of mortality, acute kidney and myocardial injury. The MAP target of around 75–85 mmHg may reduce the incidence of acute kidney injury (AKI) in patients with chronic hypertension. The perfusion pressure is highly heterogenous not only between different patient but also in the same patient between different organs and different periods of septic shock. Hence the MAP target needs to be individualized according to patient requirements

Background: Streptococcus mutans (S. mutans) is one of the main agents of caries formation, mainly because of the ability to form biofilms on the tooth surface. Bacteriophage of S. mutans are viruses that can attack and limit the pathogenic activity of S. mutans, hence limiting their cariogenic effect and preventing dental caries. There is a deficiency in the literature on the successful isolation of phage against S. mutans. Aims: The purpose of this study is to isolate S. mutans strains from clinical plaque samples, screen those samples for phage and test them against laboratory type cultures for phage. Methods: Thirty-eight clinical plaque samples were collected from participants using ESwab (Copan Italia, Brescia, Italy) and cultured on Brain Heart Infusion (BHI) and Tryptone-yeast-cysteine-sucrose-bacitracin (TYCSB) agars to isolate S. mutans strains. Following isolation and identification by Gram stain and PCR, phage screening by spot assay against laboratory type cultures was carried out. Six NCTC S. mutans strains (10832, 10919, 10920, 10923, 11060, 11061) and twelve type strains provided by Newcastle University (S. mutans UA159, 10449, UA140, Ingbritt, GS5, sobrinus 12279, gordonii DL1, sanguinis SK36, oralis 34, tigurinus JP1BV1, oligofermentans LR11BV4 and Actinomyces oris MG1) were all used for spotting. Results: The isolation of S. mutans strains from the clinical samples was successful. TYCSB agar showed to be selective for S. mutans while BHI media showed rich growth of different colonies. Gram stain was performed on the suspected colonies and confirmed later by PCR for S. mutans. On spot assay, no evidence of phage lysis was found within pooled filtrate samples against NCTC type strains and Newcastle type strains. Conclusion: The isolation of S. mutans from clinical samples was achieved using TYCSB media. Phage isolation was unsuccessful from the 38 clinical plaque samples probably due to low frequency of their natural occurrence. Isolation of Streptococcus mutans and bacteriophage from human plaque samples

Tumors of the round ligament are rare and exceptional; leomyomas are the most common tumor. We report in our case the case of an inguinal woman with a left inguinal mass previously explored by todensitometry and magnetic resonance imaging which was found to be related to a leiomyoma of the round ligament. The patient had an excision of the tumor mass with simple follow-ups. The anatomo-pathological data confirmed the diagnosis.

Osteomyelitis is an inflammatory disease which is heterogeneous in pathophysiology, clinical presentation and management. It occurs more commonly in the mandible than in the maxilla as the maxilla has a significant collateral blood flow, thin cortical bones which make it less prone to infection. Factors that predispose an individual to osteomyelitis of jaw is virulence of the microorganism, compromised vascular perfusion in the host bone at the local, regional or systemic level, and environment distressing host resistance or defense. Early diagnosis and management is of utmost importance so as to avoid the potentially serious consequences of the disease. We report an unusual case of maxillary osteomyelitis in a 33 year old female patient with poorly controlled diabetes and recurrent maxillary sinusitis

Technological advances in three-dimensional (3D) imaging, computer-assisted surgical planning and simulation in the field of medicine are now regularly being used for analysis of craniofacial structures. It also gained ingress in prediction of surgical outcomes in orthognathic surgery. A variety of patient-specific surgical guides and devices have been designed and manufactured using 3D printing technology, which rapidly gained widespread popularity to improve the outcomes. The article presents an overview of 3D printing technology and its applications in orthognathic surgery with emphasis on treatment feasibility and patient outcome.

Objective: To evaluate medication adherence and analyse the prescribing pattern of cardiovascular disease patients in tertiary care hospital using a newly developed medication adherence scale. Methods: It is a multi centered retro prospective observational study, conducted for a period of 6 months involving around 300 cardiac patients. The level of adherence is measured using newly developed medication adherence scale and prescribing patterns in cardiovascular patients is assessed through case reports. Analysis of data was done. Results: Among 300 cardiovascular patients, 58% were male and 42% were female. Most commonly diagnosed diseases are ST segment elevated myocardial infraction (28.3%) and left ventricular dysfunction (14%). Drugs used for the treatments are aspirin (95%) and clopidogrel (85.6%). Major risk factor is alcohol (11.6%) consumption, Hypertension and Diabetes Mellitus (9.6%). Major indication of cardiac patients is chest pain (42%), nausea (41%).The diagnosis was performed using Echocardiogram (89%), 2D-Echo (52%). The maximum adherence is seen in the age group of 31-40 female and male. Age group of 51-60 are more non adherent compared to other groups in males, whereas in females age group of 61-70 are more non adherent. Overall study show that Females (62%) are more non adherent compared to males (58.6%). The major reason for reduction of medication adherence is long duration regimens, lack of clinical communication between patients and health care professionals, forgetfulness etc. Conclusion: According to the study there is a suboptimal adherence is seen in cardiac patients and requires clinical interventions, which include affordable medications, easy-to-use medication regimens with fewer daily doses, communication between patients and healthcare providers

Background: This study was undertaken in a tertiary care teaching hospital in Kolkata to comparatively analyse the non-pharmacological supportive care interventions for reducing stress and pain in preterm and term newborns. Methodology: A prospective observational study conducted on 100 newborns of gestational age 34 weeks and above who weighed more than 1.5kg admitted in NICU at the Department of Paediatrics, of Dr B C Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India from January 2018- December 2018. All the patients experienced moderately painful heel lance procedure and comparative analysis of four non-pharmacological supportive care interventions namely swaddling, facilitative tucking, kangaroo mother care (KMC) and non-nutritional sucking (NNS) for reducing stress and pain were studied using Premature Infant Pain Profile (PIPP)scales. Results: Present study had 52% female newborns. 69% were term babies with a mean weight of 2.59kg. Non-pharmacological supportive care interventions significantly (p-value < 0.001) reduce stress and pain in preterm and term newborns. Mean PIPP score was statistically significantly lower with each intervention; swaddling (4.27), facilitative tucking (3.43), KMC (1.84) and NNS (0.78) as compared with control (7.21). Non-nutritional sucking followed by Kangaroo mother care, facilitative tucking and swaddling were effective in reducing pain and stress in that order. Conclusion: Non-nutritive sucking, a non-pharmacological supportive care intervention is significantly effective and the best intervention in reducing stress and pain in preterm and term newborns

One of the most notable congenital malformations in the head and neck include cleft lip, palate & alveolus. It may manifest as unilateral or bilateral and complete or incomplete. Reconstruction of the alveolar cleft is challenging and has ever remained controversial with regard to timing, graft materials, surgical techniques, and methods of evaluation. The primary goal of alveolar cleft reconstruction in is to provide a bony bridge at the cleft site that allows maxillary arch continuity, oronasal fistula repair, eruption of the permanent dentition into the newly formed bone, enhances nasal symmetry through providing alar base support, orthodontic movement and placement of osseointegrated implants when indicated. In addition to these it also enhances speech, periodontal conditions, establishes better oral hygiene, and limits growth disturbances. In order to rehabilitate oral function in patients with cleft lip and or palate, alveolar bone grafting is necessary. Secondary bone grafting is the most widely accepted method for treating alveolar clefts. Literature shows that autogenous bone graft is the primary source for reconstructing alveolar cleft defects and is currently the preferred grafting material. However, it is believed that the use of a membrane in conjunction with an autogenous bone graft for alveolar ridge augmentation provides superior results. Hence, this paper reviews the role of collagen membrane in alveolar bone grafting.

Sapropel being a unique natural organic product, which due to multicomponent composition, has a wide range of pharmacological activity. The resources of sapropel in Ukraine comprise approximately 74.5 million tonnes. Taking into consideration significant natural resources of sapropel in Ukraine as a promising raw material for preparing effective medicines products, sapropel was used as an active ingredient for the development of the cream composition. The anti-inflammatory activity of creams with sapropel extracts on the model of acute photodynamic skin inflammation in animals (UV erythema) was investigated. It is established that the creams with sapropel extracts have expressed anti-inflammatory properties, reduce the intensity of acute photodynamic inflammation and cut down the treatment duration. The anti-inflammatory activity of the studied medicinal products largely depends on the concentration of the active substance

Diabetes is a metabolic disorder and long standing diabetic patients are prone to get neuropathy. The pain I the neuropathy is unbearable and cannot be treated by cox inhibitors. Pregabalin is a structural similar drug of the inhibitory neurotransmitter γ-amino butyric acid but it is not functionally the same. It binds to the α-2-δ subunit of voltage-gated calcium channels reducing the release of several excitatory neurotransmitters and blocking the development of hyprealgesia and central sensitization. This study puts in a effort to find the efficacy of this drug in controlling the diabetic neuropathy pain

In the field of maxillofacial surgery, digital photographic documentation plays a crucial role in clinical practice. The main advantage of digital photography is the possibility of immediate reappraisal of the photographs for alignment, brightness, positioning, and other photographic settings, which aids in avoiding errors in addition to permitting the instant repetition of photographs if and when required. This paper gives an overview of the evolution from analog to digital in photography and highlights the significance of digital photography in orthognathic surgery

Congenital diaphragmatic hernia is exceptional in children. It is defined by the presence of an abnormal diaphragmatic defect causing the abdominal cavity and the thoracic cavity to communicate. It usually manifests itself at birth through respiratory distress, or sometimes through sepsis requiring urgent treatment. We report the rare case a girl with cholestatic jaundice secondary to a left antero diaphragmatic hernia with visceral content (hail and colon).

Environmental Management (UKL) and Environmental Monitoring (UPL) efforts are specific to each type of business or activity associated with its impact. Therefore, the technical guidelines of UKL and UPL are set by agencies responsible for sectoral activities that are directly related to the technical activities of the business concerned. The sugar Mill in Kwala Madu is one of the factories of PT Perkebunan Nusantara II, where is located in the village of Kwala Begumit, Stabat Sub-District, Langkat Regency. Mill production produces white and hatched crystalline sugar. In July 2018, it was a period of repair and service of Mill machines which will be re-operated in the 2019 milling year. After the overhauled, Mill's operations are expected to produce much production than before. The research method used is the normative jurisprudence by analyzing legal materials through literature study. The present study is expected to obtain a detailed and systematic overview of the problem. The sugar Mill at Kwala Madu is a sugar Mill located in North Sumatra. Kwala Madu sugar Mill is operated once a year after the cane harvest. In drafting the Environmental Impact Analysis study, the initiator can ask the consultant to compile the Environmental Impact Analysis document.