The diagnosis and therapy of Helicobacter pylori infection have undergone major changes based on the use the principles of antimicrobial stewardship and increased availability of susceptibility profiling. H. pylori gastritis now recognized as an infectious disease, as such there is no placebo response allowing outcome to be assessed in relation to the theoretically obtainable cure rate of 100%. The recent recognition of H. pylori as an infectious disease has changed the focus to therapies optimized to reliably achieve high cure rates. Increasing antimicrobial resistance has also led to restriction of clarithromycin, levofloxacin, or metronidazole to susceptibility-based therapies. Covid-19 resulted in the almost universal availability of polymerase chain reaction testing in hospitals which can be repurposed to utilize readily available kits to provide rapid and inexpensive detection of clarithromycin resistance. In the United States, major diagnostic laboratories now offer H. pylori culture and susceptibility testing and American Molecular Laboratories offers next-generation sequencing susceptibility profiling of gastric biopsies or stools for the six commonly used antibiotics without need for endoscopy. Current treatment recommendations include (a) only use therapies that are reliably highly effective locally, (b) always perform a test-of-cure, and (c) use that data to confirm local effectiveness and share the results to inform the community regarding which therapies are effective and which are not. Empiric therapy should be restricted to those proven highly effective locally. The most common choices are 14-day bismuth quadruple therapy and rifabutin triple therapy. Prior guidelines and treatment recommendations should only be used if proven locally highly effective.

Background: Knowledge about the morphological shapes of the coronoid process is useful for the maxillofacial surgeon. The Coronoid process can be easily harvested as a donor bone. It is also helpful in determining buccal vestibule during denture fabrication.Aim of the study: To find out the variation in shape of coronoid process and the intercoronoid distance in dry mandible of Maharashtra region. Material and Methods:One hundred and fifty seven (male 84 and female 73) dry mandible of Maharashtra region were studied for variations of shape in coronoid process of both sides and the intercoronoid distance .Results: Triangular shape coronoid process was found in 204 (64.97%), Hook shape in 66 (21.02%) sides. and rounded in 44 (14.01%) sides of mandible. Mean intercoronoid distance among males was found to be 9.2000 and 9.100 in females. Conclusions:It was found that most common shape of coronoid process found in our study was triangular. Mandible with hook shape coronoid process was almost equal in male and female mandible while triangular shape was slightly more in the male .

Background: Coronary artery bypass grafting (CABG) is a proven approach in the treatment of coronary heart disease, but the surgery has several complications, including stroke and death. Though it has been established that perioperative stroke is associated with higher rates of long-term mortality, the relationship between stroke and mortality in the perioperative period has not yet been systematically examined. Methods: Online databases of peer-reviewed literature were searched to retrieve articles concerning mortality and stroke after CABG in patients with carotid stenosis. Six studies (n=3786) were included for analysis. This study was conducted at a single University hospital system, University of Pittsburgh Medical Center, on patients who underwent CABG. The data obtained from peer-reviewed literature originated from several sources, primarily single institution hospitals. Results: Consistent with current literature, the incidence of stroke in CABG patients with significant carotid stenosis was 2.1%. Data were further analyzed to generate a summary odds ratio of stroke-related mortality after CABG, which showed that patients who died within 30 days of CABG were 7.3 times more likely to have had a perioperative stroke (95% confidence interval, 4.1-13.2). The 30-day mortality rate among perioperative stroke victims was 14.4% versus 2.3% for nonstroke patients. Conclusions: Together, these data suggest an association between stroke and mortality in the perioperative period in patients undergoing CABG, demonstrating a need for improved monitoring, screening, and treatment of stroke before, during, and shortly after surgery.

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Background and aims : Supra-scapular notch is roofed by superior transverse scapular ligament and converted into a foramen which provides passage for suprascapular nerve. When it is completely ossified that time it manifest as supra-scapular foramen in dry scapulae. Variations of superior transverse scapular ligament include calcification, partial or complete ossification and multiple bands. Presence of this foramen in dry scapulae is considered to be rare. Aim of the study was to verify the prevalence of supra-scapular foramen in Indian dry scapulae. Materials and methods : A total of three fifty dry scapulae were analyzed (Right- 176, Left-174) to see the presence of supra-scapular foramen. Results : In the present study, suprascapular foramen was present in 25 right and in 12 left sided scapulae i.e., 10.57% incidence which is alarming. Conclusion : Present study demonstrates that suprascapular foramen which is the result of complete ossification of superior transverse scapular ligament, is common in Indian population. The anatomical knowledge of this foramen is of extreme importance for clinicians; it can be a risk factor during surgical explorations involving a suprascapular nerve decompression.