Background Metformin, by reducing intracellular Mycobacterium tuberculosis growth, can be considered as an adjunctive therapy to anti-tuberculosis treatment (ATT). We evaluated whether metformin with standard ATT reduces time to sputum culture conversion and tissue inflammation in adults with pulmonary tuberculosis (PTB). Methods In a randomized 8-weeks clinical trial, newly diagnosed, culture positive PTB patients were randomized to standard ATT (HREZ = Control arm) or standard ATT plus daily 1000mg metformin (MET-HREZ = METRIF arm) for 8-weeks, during 2018-2020 at five sites in India. The primary endpoint was time to sputum culture conversion by liquid culture during 8 weeks of ATT. Plasma inflammatory markers were estimated in a subset. Cox proportional hazard model were used to estimate time and predictors of culture conversion. Results Of the 322 patients randomized, 239 (74%) were male, 212 (66%) had bilateral disease on chest radiograph with 54 (18%) showing cavitation. The median time to sputum culture conversion by liquid culture was 42 days in the METRIF arm and 41 days in the Control arm [HR 0.8, 95% CI (0.624 – 1.019)]. After 8-weeks of ATT, cavitary lesions on x-ray [7 (5.3%) vs 18 (12.9%), RR 0.42 (0.18, 0.96), p=0.041] and inflammatory markers were significantly lower in METRIF arm. Higher BMI and lower sputum smear grading were associated with faster sputum culture conversion. Conclusion The addition of metformin to standard ATT did not hasten sputum culture conversion, but diminished excess inflammation thus reducing lung tissue damage as seen by faster clearance on x-ray and reduced inflammatory markers.

Mandible is the lower facial bone that plays an important role in complex function of chewing, deglutition, speech, supports Tongue and forms contour of lower third of Face. Rapid urbanization has resulted in increase in the number of road traffic accidents with fractures of the Facial bones. Mandible is the second most common facial bone to get fractured. Fractures of the Mandible need intervention at the earliest. AIMTo retrospectively analyse the cause, age and sex incidence, sites of fracture of mandible, combination of fractures, various diagnostic and treatment modalities that were used. METHOD AND MATERIALSThe study includes 1087 patients with isolated fractures of the mandible treated in the Department of Plastic Surgery at Gandhi Hospital between the years 2005 to 2014. The patterns of the history, clinical examination, diagnostic tests done were assessed. Age, sex, aetiology, method of management were the variables analysed. The statistical analysis was done using SPSS (Statistical Package for Social Sciences 0 Version 15.0 Statistical analysis software). The values are represented in frequencies and percentages. RESULTS1087 patients with isolated fractures of the mandible were studied. Steep rise in the incidence from 8.98% in 2005 to 18% in 2014 was noted. Males were more frequently involved (92.64%) in comparison to females. The commonly involved age group was between 21-30 years (54.55%). Most of the patients sustained injury due to road traffic accidents (75.9%) of which majority were two wheeler accidents (45.81%). Parasymphysis was fractured in 41.39%. X-rays were used as the diagnostic modality between the years 2004 to 2010. Later digital X-rays and 3D Computerized Tomography have replaced it. Closed reduction was done in 57.22%. Complications (1.1%) in the form of infection and mal-occlusions were noted. DISCUSSION AND CONCLUSIONSThe commonest aetiology was road traffic accidents and sense of public awareness is to be created about traffic rules and regulations. Males, age group between 21-30 and parasymphysis were commonly involved. Class I occlusion was achieved with closed method of Maxillomandibular fixation in 57.22% and open reduction was done in cases where closed reduction was not possible and they amounted to 42.77%. KEYWORDSMandible Fracture, RTA, Parasymphysis, Closed Reduction, Open Reduction, MMF, Class I Occlusion. HOW TO CITE THIS ARTICLE:Rangaswamy G, Kumar AS, Manjula G, et al. A retrospective study of epidemiology fractures of mandible in tertiary care teaching hospital over a period of a decade.

There is growing evidence that enteral feeding tubes are associated with increased mortality and complication rates in patients with advanced dementia. Buried Bumper Syndrome is an uncommon, but well documented late complication of PEG placement. Our case report reinforces this recognised risk of PEG feeding in an elderly, cognitively impaired patient.

BACKGROUND Zygoma is a very crucial component, which maintains facial contour. Fracture and dislocation of this bone not only causes cosmetic defects, but also disrupts ocular and mandibular functions. Fractures can involve any of the four articulations of zygoma, which include zygomaticomaxillary complex, zygomatic complex and orbitozygomatic complex. Management depends on a thorough preoperative physical examination with special attention to the ophthalmologic assessment. Fractures involving zygoma should be repaired at the earliest, because it can cause both functional and cosmetic defects. These fractures are common in our institution and a study is being undertaken to study the causes, pattern of fractures, the diagnostic and treatment modalities adopted. The aim of this study is to analyse the cause, age and gender, incidence, sites of fracture of zygoma, various combinations of fractures, diagnostic and treatment modalities that were used. MATERIALS AND METHODS This retrospective descriptive study includes 366 patients with fractures of zygoma treated in the Department of Plastic Surgery at Gandhi Medical College between the years 2008-2017. The history obtained, clinical examination and diagnostic tests done were analysed. Incidence, age, gender, site of fracture, side of fracture, aetiology and method of management and the outcome after surgery were the different variables analysed. RESULTS 366 patients with fractures of zygoma were analysed. There is a rise of incidence ranging from as low as 12.96% to as high as 62.50% of total fracture of faciomaxillary cases during the decade. Males were more frequently involved (88.79%) in comparison to females. The commonly involved age group was between 21-30 years (36.88%). Most of the patients sustained injuries due to road traffic accidents (78.14%). Body of the zygoma was involved in 33.33% of total cases of fracture zygoma cases. X-rays, digital x-rays and 3D computerised tomography were used as the diagnostic modalities. Open reduction and internal fixation with plate and screws was done in 50.27% of cases. Complications like wound infection, plate exposure were noted in 8.46% (31 out of 366 patients). CONCLUSION Road traffic accidents were found to be the common cause of fractures of the zygoma. Awareness regarding traffic rules and regulations and counselling youth regarding hazards of drunken driving, bike and car races on public roads should to be done. In young males, body of the zygoma was more commonly involved. Early intervention enabled good functional and aesthetic outcomes. Patients with restricted mouth opening can be attended to by either redo-ORIF or dilatations with Heister's dilator or by insertion of the ice cream sticks by increasing them progressively.

Background: Forced expiratory volume in 1 second (FEV1) to forced vital capacity ratio (FVC) is being used to diagnose the obstructive lung diseases. Forced manoeuvre (FVC) or relaxed/slow manoeuvre (SVC) can be used to determine vital capacity (VC). In healthy individuals the difference between SVC and FVC (SVC-FVC) is minimal whereas in the presence of airway obstruction this difference will become significant. The present study was done with the objective to detect and compare the airway obstruction by determining the FEV1/FVC and FEV1/ SVC ratios.Methods: This was a prospective cross-sectional study done at OPD, Government Thiruvoteeswarar hospital of thoracic medicine/Kilpauk medical college during the period from September 2016 to February 2017among the patients presenting with symptoms of obstructive airway disease. The sample comprised of 353 patients who underwent spirometry according to standard of ATS/ERS guidelines. As per the criteria, the patients are classified into four groups, by spirometry.Results: The analysis of FEV1/FVC revealed the presence of airway obstruction in 131 (37%) individuals compared to 165 (46%) individuals by the analysis of Fev1/SVC ratio. In the obstruction and mixed groups, the difference in vital capacity SVC – FVC is statistically superior (p<0.05) when compared to normal and restriction groups.Conclusions: The FEV1/SVC ratio detected the presence of airway obstruction in more individuals than did FEV1/FVC ratio and hence FEV1/SVC considered as more reliable factor in the detection of obstructive airway diseases.