Mandibular reconstruction is a complex procedure and is a challenge to the surgeon. Reconstruction is required following resection of mandible due to benign or malignant pathology, osteonecrotic mandible that could not be treated conservatively. Reconstruction modalities have changed significantly over the years with the introduction of newer techniques and technologies. This article reviews and summarizes the various reconstructive modalities for mandibular defects of past years, comparatively newer reconstructive options available and the recent advances in reconstruction done by Patient-Specific Implants produced by virtual planning.

Background & Objectives: Peritonitis due to hollow viscous perforation is one of the most common surgical emergencies attended by a surgeon on duty. Despite many advances in anti-microbial and supportive care, the mortality rate of diffuse peritonitis remains unacceptably high (10-20%). The treatment of peritonitis and the evaluation of different therapeutic approaches are hampered by lack of precise classification. A scoring system should be able to assess the need, type and quality of the care required for a particular patient. Realizing the need for a simple accurate scoring system in these conditions the present study was undertaken to evaluate the prognosis in patients with perforation peritonitis using Mannheim Peritonitis Index. Materials & Methods: Single centered, observational analytical study conducted in Jubilee Mission Medical College & Research Institute. In our study, we have included 64 patients after meeting the inclusion criteria. As per the study protocol, patient data was collected at the time of admission and intra operatively in the Surgery Department. Mannheim Peritonitis Index score was applied to assess the outcome and data analyzed. Results and Discussion: Out of 64 patients studied, statistically significant correlation was observed between incidence of mortality and the risk factors namely, age more than 50 yrs.(25.9%), presence of organ failure(36.4%), preoperative duration more than 24 hrs.(18.6%), diffuse peritonitis(18.2%) and feacal exudates (45.5%). No statistically significant correlation was observed between incidence of mortality and the risk factors namely female sex, non-colonic origin of sepsis, presence of malignancy. Conclusion: In our study population, all risk factors included in the Mannheim Peritonitis Index namely presence of organ failure; preoperative duration> 24hrs; age>50 years, generalized extension of peritonitis and type of exudate had significant association with adverse outcome while in patients with the non-colonic origin of sepsis, presence of malignancy and of the female sex there was no significant association of these risk factors with adverse outcome (mortality). The overall mortality in our study is 12.5%. Mortality in patients with MPI score < 21 was 0%, 21-29 was 4.3% and >29 was 53.84%. This reproducible scoring system allows a surgeon to determine the severity of intra-abdominal infections, to select a more aggressive management for high risk patients and to be able to inform patient's relatives with greater objectivity.

Background: Albumin is a family of globular proteins, the most common of which are the serum albumins. All the proteins of the albumin family are water-soluble, moderately soluble in concentrated salt solutions, and experience heat denaturation. Albumins are commonly found in blood plasma and differ from other blood proteins in that they are not glycosylated. Substances containing albumins, such as egg white, are called albuminoids. It contributes to the oncotic pressure of plasma and to maintaining the distribution of extracellular fluid between the vascular and extravascular compartments. Hypoalbuminemia is associated with poor tissue healing, decreased collagen synthesis in the surgical wounds or at anastomotic sites [1], and also plays a role in the impairment of immune responses, such as macrophage activation and granuloma formation. Although it is well established that hypoalbuminemia, as a marker of malnutrition and disease, is associated with greater risk of adverse surgical outcome, previous studies have been based on relatively small samples and selected types of operations and have failed to adequately separate the predictive ability of albumin level from other risk factors. Aim of study: To determine whether pre-operative serum albumin level can be used as an independent predictor of post-operative morbidity and mortality. Methods: This is a prospective comparison study conducted in general surgery department, Jubilee Mission Medical College. The source of the data will be all patients who undergo gastrointestinal surgery with resection and anastomosis in the Department of General Surgery, Jubilee Mission Medical College, Thrissur from December 2017 to May 2019. Patients are investigated preoperatively for liver function test, renal function test, thyroid function test and urine- protein creatinine ratio (obtained from urine microscopy) to rule out secondary causes of hypoalbuminemia and are classified into two groups:- normal albumin level and hypoalbuminemia. Patients with normal serum albumin level are compared with patients of low serum albumin for length of hospital stay, resumption of oral diet, surgical site infection and mortality. Results and Discussion: The preoperative albumin levels ranged from 2.1 to 3.4 g/dl with a mean value of 3.03 g/dl. In most other similar studies [1-4], a similar cut off normal range (3 or 3.5 g/dl) was assigned and patients were grouped into two based on this. To explore the possibility of using serum albumin as a simple and low-cost prognostic tool to predict the risk of adverse surgical outcomes, we used different statistical methods. Mann-Whitney U test has been performed to find out the significant role of albumin levels for length of hospital stay (Median 10.5 days and 8 days) and delay in resumption of diet (Median 5days and 3days) among two groups and it showed that there was statistically significant association with albumin levels between two groups in length of stay (p=0.021) if we classify the length of hospital stay as less than 10days and more than 10days. It is statistically significant in resumption of diet (p<0.001). There was a significant relationship found between the occurrence of surgical site infection and albumin levels. Where it was also found that those with low serum albumin had increased rates of complications (60%) against those with normal serum albumin levels 32.5%.15% mortality cases were reported; of which 22.5% falls in low serum albumin level group where as 7.5% in normal albumin level group. Conclusion: In view of these results, we conclude that preoperative albumin is a good prognostic indicator for predicting the outcome of surgery. It is a cheap and easily applicable test. By estimating albumin levels in surgical patients before surgery and adequately correcting lower levels where necessary, post-operative morbidity could be reduced in these patients.

Heterotopic pancreas is a rare condition with a probable incidence of 1 per 500 upper abdominal operations. Findings are incidental and are usually asymptomatic. Heterotopic pancreas is seen at different sites in the gastrointestinal tract. A 62 year old male presented with complaints of epigastric pain, nausea, vomiting and constipation since 3 months. The diagnosis of malignancy was based upon the findings of abdominal ultrasonography, CECTabdomen and Upper G.I. endoscopy.

Background: Wound healing is the process of repair that follows injury to the skin and other soft tissues. It is a natural restorative response to tissues injury. In the primitive years a lot of substances were considered to be medicinal and were used to enhance wound size contraction and closure. Similarly, the Iwere people of Delta State, Nigeria are known for using Achantina fulica species shell for wound healing although there is no known empirical study showing its ability to enhance wound contraction. Thus, this study was aimed at assessing the wound healing effect of powdered snail shell of Achantina fulica species on the wound sizes of rat. Materials and Methods: Eight wistar rats were used and grouped into experimental and control groups. Paravertebral round wound of 2cm were made on the skin of each rat under light chloroform anesthesia. The wounds were treated with powdered snail shell and 0.9% normal saline for the experimental and control group respectively. Wound sizes were measured everyday using a meter rule before redressing. Results and Discussions: Day 1, 2, 3, showed percentage reduction of 100%, 99% 92. 5% for those of the experimental group while 99%, 94% and 90% for those of the control group. On day 4, the percentage reduction was 72% for the experimental while 86% for the control group. This was the first outstanding wound size reduction observed in rats dressed with powdered snail shell. The wound size reduction continued from day 5- 12 with a percentage reduction of 61.5%, 50%, 40%, 34%, 26.5%, 24%, 15%, 9% for the experimental group while that of the control group was 86%, 76.5%, 65%, 63.7% 57.5%, 55%, 5 1.5%, 47.5%, 42.5%. Conclusion: The wounds treated with powered snail shell by day 13 was completely healed while those on 0.9% normal saline took 21 days to heal. It suggests that the powdered Achantina fulica shell promoted the wound size contraction which further led to a rapid healing and wound closure earlier than the control in the study. It could be inferred that this Achantina fulica shell powder could be refined and used as an alternative substance for wound healing.

Background: A positive behavior as well as attitude of the dental students can be improvised during their undergraduate studies and thereby it is considered as an essential factor as they can further promote the oral self-care habits of their patients and hence the society in general. Objectives: The primary objective of the present study is to relate the oral health knowledge, attitude, as well as practice with the periodontal status of the undergrad¬uate dental students. Materials and Methods: The data were collected through a combination of clinical examination and self-reported questionnaire. The estimated sample size was 234. The probing depths as well as the clinical attachment loss were measured in the interproximal sites, while the gingival index was calculated on the basis of Ramfjord index teeth. Classification by the CDC and the American Academy of Periodontology was used for periodontal diagnosis. The subjects were divided into three groups. Results: The dental students participated in study were 299. Moreover, significant differences were found among the three groups in their oral health knowledge, attitude, and practice scores. The gingival disease was detected in around 99.3-99.9% and periodontitis in about 60% of the dental students irrespective of its severity. Hence a positive correlation has been established between the oral health knowledge and attitude as well as oral hygiene prac¬tice. Conclusions: Present study highlighted need in order to improve the oral health knowledge, attitude, and practice of dental students. The gingival as well as the periodontal inflammation was highly prevalent among the participants.

Aim: The purpose of the study is to analyze how periodontal health is affected based on psychological understanding of people about various periodontal diseases and if they are aware of basic hygiene modalities to keep a healthy periodontium. Materials and methods: A cross- sectional interview-based survey was conducted among 300 people between age groups of 20-60 years. During interviews, participants provided information on their demographic characteristics, educational attainment and general gingival health. They were also assessed on their level of stress that they usually endure. Result: Our study showed general increase periodontal as well as gingival diseases with age. People also had relatively less knowledge, mostly in those people who were not well educated. Young people were enthusiastic to improve their periodontal health. Conclusion: The study shows that people who are under greater stress showed a steep decline in their periodontal health and people with poor socio-economic background also ended up with more frequent oral health problems.

Amyloidosis includes different forms of organic or systemic damage; it is characterized by deposits fibrillar in the connective tissue. At the ENT level, isolated involvement of the larynx is the most observed. However, isolated laryngeal involvement is rare. A search for forms multifocal or systemic by means of complementary examinations is therefore recommended. Preferential treatment of laryngeal form is endoscopic surgery with preservation functional.

Pre-eclampsia is an important clinical syndrome with an elevated blood pressure and marked proteinuria and may be associated with haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. Recently, oxidative stress is thought to play a role in the pathogenesis of pre-eclampsia. The current research consisted of 77 women with pre-eclampsia and 45 normotensive subjects attending Rasheed Shekoni specialist hospital and General hospital Dutse. Serum antioxidant vitamins A, C, E and some hematological indices were analyzed in both groups. Results revealed a statistical decrease (p<0.005) of vitamin A, C, E and platelet in pre-eclamptic compared to normotensive women. Antioxidant and platelet concentrate supplementation may supress the development of pre-eclampsia.