Objectives: Surgical margin status is a significant determinant of treatment outcome in oral cancer. Negative surgical margins can decrease the loco-regional recurrence by five-fold. The current standard of care of intraoperative clinical examination supplemented by histological frozen section, can result in a risk of positive margins from 5to 17 percent. In this study, we attempted to assess the utility of intraoperative optical coherence tomography (OCT) imaging with automated diagnostic algorithm to improve on the current method of clinical evaluation of surgical margin in oral cancer. Materials and methods: We have used a modified handheld OCT device with automated algorithm based diagnostic platform for imaging. Intraoperatively, images of 125 sites were captured from multiple zones around the tumor of oral cancer patients (n = 14) and compared with the clinical and pathologic diagnosis. Results: OCT showed sensitivity and specificity of 100%, equivalent to histological diagnosis (kappa, κ = 0.922), in detection of malignancy within tumor and tumor margin areas. In comparison, for dysplastic lesions, OCT-based detection showed a sensitivity of 92.5% and specificity of 68.8% and a moderate concordance with histopathology diagnosis (κ = 0.59). Additionally, the OCT scores could significantly differentiate squamous cell carcinoma (SCC) from dysplastic lesions (mild/moderate/severe; p ≤ 0.005) as well as the latter from the nondysplastic lesions (p ≤ 0.05). Conclusion: The current challenges associated with clinical examination-based margin assessment could be improved with intra-operative OCT imaging. OCT is capable of identifying *

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Catheterization of central veins is a routine technique which is widely used in emergency department and medical intensive care units. Seldinger's technique is widely used to place central venous and arterial catheters and is generally considered safe. The technique does have multiple potential risks. Guide wire-related complications are rare but potentially serious. We describe a case of a lost guide wire during central venous catheter (CVC) insertion followed by a review of the literature of this topic. Measures which can be taken to prevent such complications are explained in detail as well as recommended steps to remedy errors should they occur.

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The incorporation of telemedicine and artificial intelligence for early screening and assessment of severity of life-style disorders has a great potential for better assessment in a busy outpatient clinic and thereby curtail down the related morbidities. A computer based algorithm based upon standardized questionnaire (from established assessment tools) is designed to assess the risk of obstructive sleep apnoea syndrome (OSAS). In addition the incorporation of basic screening questions of anamnesis help in suggesting a probable diagnosis of sleep related disorder as well. The overall data at our center has been analyzed to establish the existing pattern of sleep related disorders. Of 850 healthy subjects screened, prevalence of snoring was 20.47% while OSAS was seen in 4.20% (N = 25) in males and 2.64% (N = 8) in females. The parasomnia was most prevalent (14.71%), followed by insomnia (10.24%), periodic leg movement (6.59%), bruxism (1.65%) and narcolepsy (0.59%). Hypertension, laryngopharyngeal reflux and obesity were the common comorbidities in OSAS while family history of hypertension and diabetes were common in snorers. A significant association with OSA was seen with diabetes mellitus, neck circumference and nasal obstruction, while, obesity and apnoeic episodes were more significantly associated with OSA than snorers. Increased waist to hip ratio was appreciated in both the OSAS and snorers. The algorithm based online assessment is likely to diagnose the occult clinical cases as well as assess the risk of OSAS. In routine outpatient clinic, a clinician may better assess the patient morbidity with a comprehensive availability of symptoms and moreover enhance the post-treatment compliance. In addition a smartphone based computerized assessment for general population may be designed for other lifestyle disorders as well.

Background: Febrile thrombocytopenia is the thrombocytopenia associated with fever. Diseases which commonly present with fever and thrombocytopenia are malaria, leptospirosis, septicemia, typhoid, arbovirus diseases such as dengue.Aims and Objectives: The study was intended to know the underlying etiology of febrile thrombocytopenia in Malwa region and its various presentations.Materials and Methods: This study was conducted at Department of General Medicine of a tertiary care centre for two years. Five-hundred adult patients (age >18 years) of febrile thrombocytopenia were evaluated for possible inclusion in this study. Routine investigations including complete blood counts, peripheral smear examination, kidney function tests, liver function tests, ultrasound of abdomen were done in all subjects. The specific investigations were done as and when indicated.Results: Out of 500 patients of febrile thrombocytopenia, 298 were male, while 202 were female. Commonest symptom after fever was malaise (83%) followed by nausea-vomiting (76%), headache (63.4%), jaundice (26.8%), easy fatigability (22.4%), bleeding manifestations (7.8%), cough (6.8%), dyspnea (5.8%), rash (2.4%) and delirium (1.4%). Dengue was found in 178 patients. Malaria was found in 122 patients. Other causes of febrile thrombocytopenia were septicemia (22 cases), leptospirosis (12 cases), chikungunya fever (10 cases), viral hepatitis (9 cases), enteric fever (9 cases), acute lymphoblastic leukemia (2 cases), non-hodgkin lymphoma (one case), disseminated tuberculosis (one case).Conclusion: Febrile thrombocytopenia is an important clinical condition commonly caused by infections, particularly viruses and malaria. Such studies will help in finding changing trends of locally prevalent infectious diseases and finding some new emerging diseases not prevalent in the particular region.Asian Journal of Medical Sciences Vol.8(5) 2017 83-86