Lung cancer is still the main cause of cancer-related deaths worldwide, with most patients present with advanced disease and poor long-term prognosis. The aim of lung cancer treatment is to slow down the progression of the disease, to relieve the patients from the lung cancer symptoms and whenever possible, to increase the overall survival. The discovery of small molecule targeting tyrosine kinase of epidermal growth factor receptor opens a new way in the management of advanced nonsmall cell lung cancer (NSCLC). This review will discuss several Phase II and III trials evaluated the clinical efficacy of gefitinib as monotherapy in pretreated patients with advanced NSCLC, as well as both monotherapy and combined with chemotherapy in chemotherapy-naive patients.

Aim: The PreFRP web server extracts sequence and basic information of a protein structure and groups amino acid residues in a protein into three important types such as high, moderate, and weak fluctuating residues. Materials and Methods: The server takes a protein data bank file or an amino acid sequence as input and prints the probability of amino acid residues to fluctuate. The server also provides a link to Jmol, a molecular visualization program to visualize the high, moderate, and weak fluctuating residues in three different colors. Results: Prediction and visualization of fluctuating amino acid residues in proteins may help to understand the complex three-dimensional structure of proteins and may further help in docking and mutation experiments. Availability: The web server is freely accessible through the web page of the author's institution http://www.mpi.edu.in/prefrp/link.html.

Background and Objective : In the contemporary scenario of both parents employed, there seems to be limited focus on the dietary habits and dental health of their children. Hence, we attempted to correlate the socioeconomic and working status of the parents to the incidence of their children's dental caries. Materials and Methods: One thousand school children aged between 3 and 12 years were enrolled in the study. Socioeconomic and working status of their parents was obtained by a pretested questionnaire following which these children were examined for their dental caries status. The data collected were statistically analyzed using logistic regression analysis and calculation of odds ratio. Results: A significant correlation was observed between working status of the parents and dental caries status of their children. Though, the socioeconomic status and dental caries had a weak correlation, the odds ratio was high, indicating that the children of lower socioeconomic status or family with both parents employed were at a higher risk for dental caries. Conclusion: Efforts are needed to implement programs at the school level to enhance the oral and dental health among children, as parental responsibilities toward this maybe inadequate due to economic or time constraints.

Purpose: The purpose of this in vitro study was to compare four methods of root canal obturation in primary teeth using conventional radiography. Materials and Methods: A total of 96 root canals of primary molars were prepared and obturated with zinc oxide eugenol. Obturation methods compared were endodontic pressure syringe, insulin syringe, jiffy tube, and local anesthetic syringe. The root canal obturations were evaluated by conventional radiography for the length of obturation and presence of voids. The obtained data were analyzed using Chi-square test. Results: The results showed significant differences between the four groups for the length of obturation (P < 0.05). The endodontic pressure syringe showed the best results (98.5% optimal fillings) and jiffy tube showed the poor results (37.5% optimal fillings) for the length of obturation. The insulin syringe (79.2% optimal fillings) and local anesthetic syringe (66.7% optimal fillings) showed acceptable results for the length of root canal obturation. However, minor voids were present in all the four techniques used. Conclusions: Endodontic pressure syringe produced the best results in terms of length of obturation and controlling paste extrusion from the apical foramen. However, insulin syringe and local anesthetic syringe can be used as effective alternative methods.

Background: Performing successful total hip replacement (THR) in dysplastic, subluxed, and dislocated hip is a challenging task. Here, we assessed midterm clinical and radiological outcomes of uncemented total hip arthroplasty in osteoarthritis (OA) of hip secondary to Hartofilakidis low and high-dislocated hips with a mean follow-up of 8.8 years. Materials and Methods: A retrospective study of prospectively collected data was designed involving all consecutive patients who underwent uncemented THR for OA of hip secondary to developmental dysplasia of the hip and Grade II or Grade III Hartofilakidis classification. Results: Thirty-two patients underwent 45 THR, with 23 Grade II (low dislocation) and 22 Grade III (high-dislocation) of Hartofilakidis classification. Thirteen patients had bilateral hip replacements, 19 patients had unilateral THR. There was highly statistically significant difference between preoperative and postoperative HHS and SF-36v2 ^TM at each follow-up. Survivorship of original implant was 98.88% at a mean follow-up of 8.8 years. The mean improvement in leg length in this series was 3.6 cm (1.8-4.5, 95% confidence interval). No sciatic nerve or femoral nerve palsies were observed. Conclusions: Uncemented THR provides better function and quality of life. However, longer follow-up studies are needed to assess survivorship of uncemented THR in Hartofilakidis low and high-dislocations.

Aim: Self-medication is widely practiced with varying dimensions in India. This practice has many implications, especially among medical and paramedical students having some knowledge and good exposure to drugs. We conducted a two-period observational study to evaluate the change in knowledge and practice of self-medication, over 5 years of time period, among medical and paramedical students from different parts of India. Materials and Methods: A structured questionnaire was administered to medical (MBBS), dental (BDS), and paramedical students, who come to attend pan India annual cultural, literary, and sports event at New Delhi. The study was conducted in two phases (2007 and 2012) in different respondents of same categories (medical and paramedical) of students. Three-hundred and thirty students from 39 colleges in 2007 and 356 students from 38 colleges in 2012 participated in the study. Results: The prevalence of self-medication remained high in both 2007 and 2012 (74.6% and 69.4%), although no significant difference was observed between the two phases (P = 0.14%). Oral antibacterial agents, oral anti-inflammatory agents, and antipyretics were the most common group of drugs used in both phases of study. A significant increase was observed in number of students who took complete course of oral antibiotics (28.3-38.3%, P = 0.01). Conclusion: The prevalence of self-medication among undergraduate students remains unaltered over the span of 5 years. Nevertheless, there was a better sensitization toward appropriate antibiotic usage and the practice of responsible self-medication needs to be promoted among future healthcare providers.

Background: Currently, the most common therapy for periodontal diseases consists of professional scaling and root planing (SRP). However, it was found to be of limited efficacy especially in areas which are inaccessible to periodontal instrumentation. Therefore, treatment strategies using antimicrobials in conjunction with conventional therapy have evolved. Thus, the study was undertaken with an. Aim: To evaluate the efficacy of application of chlorhexidine gel and curcumin gel as an adjunct to SRP. Materials and Methods: The study was conducted on thirty chronic periodontitis patients who were divided into two groups as control and experimental groups using a split-mouth design. After SRP chlorhexidine gel was applied in control and curcumin gel in experimental groups. The plaque index, gingival index, sulcus bleeding index, probing pocket depth were recorded at baseline and subsequently after 1 month and 45 days. Results: The results revealed that both chlorhexidine gel and curcumin gel have an effect on mild to moderate periodontal pockets in chronic periodontitis patients, but greater reduction was observed in the experimental group than the control group. Conclusion: It can be concluded that both control and experimental gel can be used as an adjunct to SRP, but the curcumin gel was more effective than the chlorhexidine gel in the treatment of mild to moderate periodontal pockets with a significant reduction in the indice scores when compared to the baseline values.

Introduction: Over a period, tribal population has migrated to cities in search of livelihood. Data on various health problems of the tribes are sparse. Sugalis constitute the third largest tribe in Andhra Pradesh and have settlements in urban areas. Objective: To estimate the prevalence of malnutrition, diarrhea, and acute respiratory infections (ARI) among under-five children of Sugali tribe living in Chittoor district of Andhra Pradesh state in South India. Materials and Methods: A community-based cross-sectional study was conducted in four community blocks/mandals in 2012. A total of 500 Sugali households with under-five were identified. Demographic details, episodes of diarrhea, and ARI among under-five children and treatment/care seeking behavior were collected from mothers/care givers by interview. Nutritional status was assessed using new WHO standards. Results: Of the total 669 children in these 500 households, 343 (51.3%) were girls and 326 (48.7%) were boys. In the last 1 month, 21.4% (18.4-24.6) reported diarrhea and 51.6% (47.7-55.3) reported ARI. The prevalence of underweight, wasting, and stunting among under-five children was 32.7% (29.1-36.4), 18.3% (15.3-21.4), and 38.3% (34.2-41.9), respectively. Majority (70%) sought treatment for illness in modern system of medicine and only few continued with the practice of herbs and traditional medicine. Discussion: Despite living in urban area, the tribal children had high prevalence of malnutrition, diarrhea, and ARI, though lower compared to other tribes in India possibly due to improved access to health care services. Efforts need to be strengthened for social inclusion of tribes into mainstream.

Aim: We aimed to identify the predictors of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (type 2 DM). Methods: About fifty Asian Indian patients with type 2 DM patients aged >40 years and fifty sex- and age-matched nondiabetic controls were enrolled for this study. Following complete medical history and baseline clinical data, laboratory investigations were performed to assess fasting and postprandial plasma glucose levels, lipid profile, blood urea, serum creatinine, and serum uric acid levels. Results: Body mass index (BMI), waist-to-hip ratio, serum uric acid, serum total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, very LDL cholesterol were significantly higher among diabetic patients compared to controls. On univariate analysis, serum LDL cholesterol (odds ratio [OR]: 29.67, P < 0.001), serum uric acid (OR: 25.65, P < 0.001), low high-density lipoprotein (HDL) cholesterol (OR: 21.12, P < 0.001), hypertension (OR: 17.06, P < 0.001), family history of cardiovascular disease (CVD) (OR: 9.43, P = 0.002), and duration of diabetes (OR: 4.65, P = 0.03) were identified as predictors of CVD among diabetic patients. On multivariate regression, only LDL cholesterol (OR: 1.51, P = 0.002) and serum uric acid (OR: 1.21, P = 0.01) were the independent predictors of CAD among diabetic patients. Significant positive correlation of serum uric acid with duration of diabetes (r = 0.38, P = 0.006), BMI (r = 0.35, P = 0.01), triglycerides (r = 0.356, P = 0.01), LDL cholesterol (r = 0.38, P = 0.007), HDL cholesterol (r = −0.514, P < 0.001), and hypertension (r = 0.524, P < 0.001) was observed. Conclusion: Serum LDL cholesterol and hyperuricemia may serve as independent predictors of CAD among Asian Indian subjects with type 2 DM.

Introduction: Polycystic ovarian syndrome (PCOS) constitutes most cases of endocrine disorder among females. Objectives: This study was done to assess the proportion of university students with PCOS and to study its risk factors. Materials and Methods: Data were collected from students of a private medical, dental, and nursing college using a self-administered questionnaire. Height and weight of all participants were recorded by standard procedures. Results: The mean age of students was 20.4 ΁ 1.5 years. Of the 480 participants, 39 (8.1%) were already diagnosed with PCOS. Out of the remaining 441 participants, 40 (9.1%) were at high risk, and 401 (90.9%) were at low risk for PCOS. Greater proportion of PCOS cases was seen in the age group 23-25 years (P = 0.026), among those with family history of PCOS (P = 0.002), among those who were permanent residents of urban areas (P = 0.048), and among those who were overweight or obese (P = 0.004). About 90% of PCOS cases and those at high risk for PCOS, each had difficulty in controlling excess weight or were experiencing difficulty in maintaining ideal weight. About 36 (92.3%) of PCOS cases and all those at high risk had emotional problems such as feeling moody or experiencing fatigability over the previous 2 weeks. Conclusion: PCOS is a common disorder among young women in this settings and this warrants periodic screening activities. A multidisciplinary approach is required to bring about lifestyle modification and help those with emotional problems due to this endocrine disorder.

Appendiceal mucocele (AM) is a rare clinical entity comprising 8% of all appendiceal tumors, and it is seen in 0.2-0.3% of all appendectomy specimens. Apart from sporadic cases, there are no enough published data about the incidence of synchronous appendiceal tumors in patients with colorectal cancer. We describe a very rare case of synchronous occurrence of AM, colon adenocarcinoma, and tubulovillous adenoma of the rectum and review the relevant literature. We conclude that thorough preoperative and perioperative evaluations are mandatory in patients undergoing surgery for colorectal cancer to exclude a synchronous colon or an appendiceal primary tumor. Larger prospective studies are necessary to accurately determine the incidence of synchronous appendiceal tumors and colorectal cancer.

Acute massive pulmonary embolism is a life-threatening emergency that must be promptly diagnosed and managed. Over the last several years, the use of computed tomography scanning has improved the clinician's ability to diagnose acute pulmonary embolism. We report two cases of acute massive pulmonary embolism who presented with sudden onset of dyspnea and underwent successful open pulmonary embolectomy. The first case presented with acute onset of dyspnea of 2 days duration, in view of hemodynamic deterioration and two-dimensional echocardiography, it revealed clot in right ventricular (RV) apex and right pulmonary artery; the patient underwent cardiopulmonary bypass and open pulmonary embolectomy with RV clot extraction. The second case presented with a sudden onset of dyspnea on the 15 ^th postoperative day for traumatic rupture of urinary bladder, in view of recent surgery, the patient was subjected to surgical embolectomy. Following surgical intervention, both the patients made a prompt recovery.

Organ transplant recipients under immunosuppressive therapy have a highly increased risk of acquiring unusual opportunistic infections. Diagnosis of the etiology of infection may be difficult in clinical manifestations, which need further histological and biological investigations. Here in we report, for the 1 ^st time in the Iran, a Morganella morganii isolate harboring blaVIM, blaCTX-M, and blaSHV genes after kidney transplantation with persistent urinary infections.

Rheumatic heart disease is the most common cardiac disease complicating pregnancy in developing countries. Heart disease accounts for 15% pregnancy-related mortality. In the presence of maternal heart disease, the circulatory changes of pregnancy may result in exacerbation of the hemodynamic perturbations due to complex cardiac valvular lesions leading to decompensation or death of mother or fetus. Determining the ideal anesthetic technique for cesarean section in the presence of complex cardiac conditions remains a much debated topic. General anesthesia is associated with a further increase in pulmonary pressure in response to laryngoscopy and intubation along with myocardial depression by anesthetic agents. Neuraxial blockade may lead to decrease in systemic vascular resistance and cardiac output. We report the successful anesthetic management of a parturient suffering from rheumatic heart disease with multivalvular lesions resulting in severe pulmonary hypertension under epidural anesthesia with good maternal and neonatal outcome. Successful management requires vigilant perioperative monitoring and thorough knowledge of the hemodynamics of complex cardiac valvular disease.

Knowledge of various anatomic landmarks is pivotal for important success. Bifid canals pose a challenge and can lead to difficulties while performing implant surgery in the mandible. Bifid canals can be diagnosed with panoramic radiography and more accurately with cone beam computerized tomography (CBCT). This case report details the placement of the implant in a patient with bilateral bifid canal and compromised interocclusal space, which was successfully treated using CBCT.

A traumatic injury to primary maxillary anterior tooth is one of the common causes for problems with the succedaneous tooth leading to it noneruption. A missing anterior tooth can be psychologically and socially damaging to the patient. Despite a wide range of treatment options available, sometimes, it is inevitable to save the natural tooth. This paper describes the immediate replacement of a right central incisor using a fiber-composite resin splint with the natural tooth crown as a pontic following surgical extraction of the dilacerated impacted permanent maxillary central incisor. The abutment teeth can be conserved with minimal or no preparation, thus keeping the technique reversible and can be completed at chair side thereby avoiding laboratory costs. It can be used as an interim measure until a definitive prosthesis can be fabricated as the growth is still incomplete.

We report a very rare case of urinary bladder stone in a laboratory rat, which was associated with severe prostatitis and seminal vesiculitis. Importantly, the histopathological analysis revealed the rare variety of keratinizing desquamative squamous metaplasia of bladder, prostate, and seminal vesicle epithelium. Immunohistochemistry for alpha smooth muscle actin protein and aniline blue staining for collagen clearly showed interstitial prostate fibrosis. The detail information about these findings and subsequent discussion are provided here.