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Pradeep Jain, Anand Agarwal and Arvind Srivastava

Lateral Cephalometric Evaluation in Cleft Palate Patients

The aim of the study. The lateral cephalometric study in children with cleft palate was carried out to find out the cause of maxillary retrusion and to see if there were other changes induced by this entity in the maxillofacial morphology.

Material and methods. Lateral cephalometric evaluation of 28 patients with un-operated cleft palate (group A), 12 patients with operated cleft palate (group B) and 10 controls (group C) was done by tracing the lateral cephalographs, marking the various landmarks and taking the mean of each measurements made thrice.

Results. It showed significant decrease in maxillary length and S-N-ANS angle indicating maxillary hypoplasia in all group A patients, significantly so in 16-20 years age group. Group B patients having undergone palatal repair in their childhood revealed significant increase in lower anterior facial height, the other parameters being insignificantly altered when compared with control.

Conclusions. The findings suggest an intrinsic deficiency not only in maxilla but contrary to the past belief also in mandible. There was no significant difference in the cephalometric measurements between un-operated and operated cleft palate patients.

Open access

Pradeep Kumar, Shashi K. Jain, Virendra D. Sinha and Trilochan Srivastava

Abstract

Introduction: Aneurysmal Subarachnoid Hemorrhage (aSAH) remains a devastating and often fatal form of stroke. The aneurysm is targeted for obliteration to prevent re-bleeding and to manage the possible complications from the event. Endovascular coiling has emerged as a less invasive alternative to conventional surgical clipping to treat aneurysms.

Patients and methods: This study was done in 50 cases of anterior communicating (Acommm) aneurysm presented in the department of neurosurgery, SMS medical college, Jaipur from November 2015 to August 2016 to evaluate the outcome of both modalities used in the treatment of ruptured Acommm aneurysm. 50 patients with Hunt and Hess (H&H) grade I, II or III were classified into two groups of microsurgical clipping and endovascular coiling.

Results: Mortality rate was comparable in both groups that were 21. 21% in the clipping group and 23. 52% in the coiling group. Good Glasgow outcome score (GOS) were found in 60. 60% of clipping and 58. 58% of coiling group. All the complications found to be more in clipping group but that were not statistically significant except for hyponatremia which was significantly higher in clipping group(P=0. 007).

Conclusion: There was no statistically significant difference in GOS at 6 month of follow up between the two groups. We recommend further interventional studies with larger sample sizes and longer follow up for better evaluation of the modalities.

Open access

Ashish Kumar Dwivedi, Pradeep Kumar, Trilochan Shrivastava and Shashi Kant Jain

Abstract

Moyamoya disease is a progressive steno-occlusive disease of bilateral internal carotid artery with the development of fine collateral vessels and is an angiographic diagnosis. Concurrent Moyamoya disease with intracranial aneurysm had been reported in literature by various authors. Moyamoya disease is reported with aneurysm at various locations including basilar tip, anterior choroidal artery, posterior choroidal artery, anterior cerebral artery and middle cerebral artery. After reviewing literature thoroughly there is not a single case report on Moyamoya disease with isolated distal anterior cerebral artery aneurysm with the best of our knowledge. Here we are reporting a case of Moyamoya disease of left petrous and cavernous part of internal carotid artery with contralateral distal anterior cerebral artery aneurysm in a 36-year-old male.

Open access

Shiv Kumar Yadav, Chandra Kant Maurya, Pradeep Kumar Gupta, Ajai Kumar Jain, Kumaran Ganesan and Rahul Bhattacharya

ABSTRACT

Fentanyl [N-(1-phenethyl-4-piperidinyl)propionanilide] is a potent opioid analgesic agent, but a has narrow therapeutic index. We reported earlier on the synthesis and bioefficacy of fentanyl and its 1-substituted analogs (1-4) in mice. Here we report the synthesis and biological evaluation of four additional analogs, viz. N-isopropyl-3-(4-(N-phenylpropionamido)piperidin-1-yl)propanamide (5), N-tbutyl- 3-(4-(N-phenylpropionamido)piperidin-1-yl)propanamide (6), isopropyl 2-[4-(N-phenylpropionamido)piperidin-1-yl]propionate (7) and t-butyl 2-[4-(N-phenylpropionamido)piperidin-1-yl]propionate (8). The median lethal dose (LD50) determined by intravenous, intraperitoneal and oral routes suggests these analogs to be comparatively less toxic than fentanyl. On the basis of observational assessment on spontaneous activities of the central, peripheral, and autonomic nervous systems, all the analogs were found to be similar to fentanyl. Naloxone hydrochloride abolished the neurotoxic effects of these analogs, thereby ascertaining their opioid receptor-mediated effects. All the analogs displayed significant analgesic effects, measured by formalin-induced hind paw licking and tail immersion tests at their respective median effective dose (ED50). They also exhibited 8-12 fold increase in therapeutic index over fentanyl. However, 5 and 6 alone produced lower ED50 (20.5 and 21.0 μg/kg, respectively) and higher potency ratio (1.37 and 1.33, respectively) compared to fentanyl. They could thus be considered for further studies on pain management