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Context: Preparation of the root canal system is recognized as being one of the most important stages in root canal treatment which removes organic debris and microorganisms from the root canal system by means of chemico- mechanical preparation and irrigation of the canals. The use of nickel-titanium instruments has drastically reduced the time and the difficulties that were encountered with traditional hand instruments made up of stainless steel. Utilizing properties of super-elasticity, shape memory and different tapers of these instruments reduces not only the possibility of canal transportation but also affects both the geometry and volume of root canals. This subjects the root dentin to stress and consequently dentinal defects which increases the risk of root fracture during or after root canal treatment. Clinicians now have the opportunity to choose from differently tapered instruments having unique characteristics in their geometry and metallurgy. These are progressively tapered instruments, fixed tapered instruments, and variable tapered instruments, which come with the benefit of conforming to the root canal anatomy as well as removing dentin as little as possible while cleaning and shaping. The aim of this study was to examine the influence of instrument taperAim: on the fracture resistance of endodontically treated roots under in vitro experimental conditions.Conclusion: Under the limitations of this study in in-vitro conditions there were no significant differences between the fracture loads between the different file systems used, however samples prepared with Hyflex EDM recorded the highest fracture resistance, followed by ProTaper NEXT, ProTaper Gold and NeoEndo Flex respectively.
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Objective: Minor constriction which is the narrowest diameter is considered to be the appropriate apical limit of endodontic treatment. Apex locators provide greater precision, fewer procedural errors, less discomfort to the patient during measurement of working length. The aim of this article is to compare the accuracy of four electronic apex locators in detecting the apical constriction using histological sections as the gold standard. 80Materials and Methods: extracted single-rooted permanent teeth were selected and coronally flattened for stable reference point. Access cavity was prepared and canal patency was checked. Samples were embedded in alginate upto cemento-enamel junction. Working length was determined with the apex locators. A 15 K file adjusted to that reading was placed in the root canal and stabilized with flowable composite. Apical 4 mm of root was longitudinally sectioned and the position of the file in relation to the minor constriction was recorded for each tooth under stereomicroscope at 40X magnification. Chi-square test was carried out to test the difference in accuracy at various levels from the minor foramen. Kruskal Wallis Test was carried out to compare the differences between the study groups for the distance from the tip of the file relative to the minor foramen (P<0.05). Measurements of mean working lengths within ±0.5 mm of minor diameter were 85%Results: acceptable for CanalPro followed by Root ZX Mini (80%) and Propex Pixi (80%) and the least by DPEX V (65%). Conclusion: Accuracy of these instruments for detecting the minor diameter is acceptable for clinical practice
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Changeri ghrita is a medicated ghee formulation, mentioned in Grahani rog chikitsa. Sneha murchana is a procedure prior to Snehapaka. Snehapaka and Murchana bring changes in Sneha. Materials and Methods: Two batches of Changeri ghrita prepared using Murchita and Amurchit ghrita. Prepared Ghrita subjected to physico-chemical analysis. Result and Discussion: Specific gravity increased in Murchita ghrita. Refractive index, viscosity, saponification value, iodine values were increased. While acid value is decreased. Peroxide value is slightly increased. Unsaponifiable matter remains unchanged. There was change in organoleptic properties after Murchana. Physico-chemical changes have been occurring except in unsaponifiable matter and congealing point. Peroxide was present in both samples of Amurchit and Murchit Changeri ghrita. Saponification value was increased in Murchit Changeri Ghrita Conclusion: It can be concluded that antioxidants were added during Murchana. Murchana maintains stability of lipid preparation and offer good health impact, increases palatability.
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Edwardsiella septicemia disease in the cultured Indian major carps is caused by the fish pathogen Edwardsiella tarda and it is preventable by DNA vaccination. Here, we tried to develop a bicistronic DNA vaccine pGPD/IFN expressing the Glyceraldehyde 3-phosphate dehydrogenase (GAPDH) gene of Edwardsiella tarda and Interferon-gamma (IFN-?) gene of Labeo rohita. The vaccine showed high protective efficiency in our previous studies; however as a limitation of bicistronic construct the expression of gene cloned in second frame (B) is poor. To overcome this limitation we re-engineered the construct and designed a fusion gene co-expressing the GAPDH and IFN-? genes as one frame with an aim to get the optimum expression of both the genes. For this purpose, a fusion insert comprising GAPDH and IFN-? coding sequences was cloned in to pcDNA3.1(+) plasmid vector. The fusion genes' in vitro expression was confirmed in the striped snakehead fish cell line (SSN-1). Successful expression of the re-engineered fusion gene DNA vaccine in the cell line was achieved at 48h post-transfection, which was confirmed by amplifying the expression transcripts of GAPDH and IFN-? genes. Thus, the study concludes that the re-engineered fusion vaccine pcGPD/IFN (pcDNA3.1(+) plasmid having fusion GPD/IFN) is functional and can be effectively utilized to vaccinate rohu (Labeo rohita) as it contains the species-specific immune gene (IFN-?) as an adjuvant
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BACKGROUND: Congenital heart disease is an abnormality of anatomical structure of the heart that is of paramount importance. The incidence is approximately 8 per 1000 live births. CHD not only contributes to signi?cant mortality and morbidity but also causes tremendous psychological stress and economical burden to whole family. OBJECTIVE: To study the pattern and clinical pro?le of congenital heart diseases in a tertiary care hospital and to aid for early stdetection and quick referral of children with congenital heart disease In this study, done between January 1 2020 to RESULTS: june 31st 2021, 54 children with con?rmed congenital heart disease were observed. ACHD was the most common type of CHD and of them, VSD was the most common type, followed by ASD. Based on sex distribution, 31 were male (55.5%) and 23 were female (44.5%), with a male: female ratio of 1.25:1. Most children belonged in the age group 6m – 1year (46.2%) followed by (42.5%) in 30days – 6months age. The common clinical presentation observed in this study was breathlessness. The common complication observed in the current study was heart failure followed by malnourishment and recurrent LRTI.
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Coronavirus disease 2019 (COVID-19) is a viral infection produced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus epidemic, which was declared a global pandemic in March 2020. The World Health Organization has recorded around 43.3 billion cases and 59.4 million casualties to date, posing a severe threat to global health. Severe COVID-19 indicates viral pneumonia caused by the SARS-CoV-2 infections, which can induce fatal consequences, including acute respiratory distress syndrome (ARDS). The purpose of this research is to better understand the COVID-19 and ARDS pathways, as well as to find targeted single nucleotide polymorphism. To accomplish this, we retrieved over 100 patients’ samples from the Sequence Read Archive, National Center for Biotechnology Information. These sequences were processed through the Galaxy server next generation sequencing pipeline for variant analysis and then visualized in the Integrative Genomics Viewer, and performed statistical analysis using t-tests and Bonferroni correction, where six major genes were identified as DNAH7, CLUAP1, PPA2, PAPSS1, TLR4, and IFITM3. Furthermore, a complete understanding of the genomes of COVID-19-related ARDS will aid in the early identification and treatment of target proteins. Finally, the discovery of novel therapeutics based on discovered proteins can assist to slow the progression of ARDS and lower fatality rates.
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Methods@#We analyzed 124 operated CSM cases from March 2019 to April 2021 for preoperative clinical features, cervical sagittal radiographic parameters, and magnetic resonance imaging (MRI) signal intensities (SI). The risk factors associated with missing the MCID (poor outcome) on mJOA at the final follow-up were identified using binary logistic regression. Multivariate analysis was used to find significant risk factors, and odds ratios (OR) were computed. @*Results@#A total of 110 men (89.2%) and 14 women (10.8%) with an average age of 53.5±13.2 years were included in the analysis. During the last follow-up, 89 cases (72.1%) achieved MCID (meaningful gains following surgery) while 35 (27.9%) could not. The final model identified the following parameters as significant risk factors for poor outcome: increased duration of symptoms (OR, 6.77; p=0.001), lower preoperative mJOA scale (OR, 0.75; p=0.029), the presence of multilevel T2-weighted (T2W) MRI SI (OR, 4.79; p=0.004), and larger change in cervical sagittal vertical axis (ΔcSVA) (OR, 1.06; p=0.013). Also, an increase in cSVA postoperatively correlated with a reduced functional recovery rate (r=−0.4, p<0.001). @*Conclusions@#Surgery for CSM leads to significant functional benefits. However, poorer outcomes are observed in cases of greater duration of symptoms, higher preoperative severity with multilevel T2W MRI SI, and a larger increase in the postoperative cSVA (sagittal imbalance).
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Purpose@#This study was performed to develop a linear regression model using the pulp-to-tooth volume ratio (PTVR) ratio of the maxillary canine, assessed through cone-beam computed tomography (CBCT) images, to predict chronological age (CA) in Indonesian adults. @*Materials and Methods@#A sample of 99 maxillary canines was collected from patients between 20 and 49.99 years old. These samples were obtained from CBCT scans taken at the Universitas Padjadjaran Dental Hospital in Indonesia between 2018 and 2022. Pulp volume (PV) and tooth volume (TV) were measured using ITK-SNAP, while PTVR was calculated from the PV/TV ratio. Using RStudio, a linear regression was performed to predict CA using PTVR.Additionally, correlation and observer agreement were assessed. @*Results@#The PTVR method demonstrated excellent reproducibility, and a significant correlation was found between the PTVR of the maxillary canine and CA (r = - 0.74, P<0.01). The linear regression analysis showed an R 2 of 0.58, a root mean square error of 5.85, and a mean absolute error of 4.31. @*Conclusion@#Linear regression using the PTVR can be effectively applied to predict CA in Indonesian adults between 20 and 49.99 years of age. As models of this type can be population-specific, recalibration for each population is encouraged. Additionally, future research should explore the use of other teeth, such as molars.
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Objectives@#Pre-pregnancy diet has an important role in preparing for healthy generation. However, evidence on this issue has been scarce. A scoping review synthesising current evidence will support the demand to map ‘what has been researched’ on pre-pregnancy diet and maternal and child health. @*Methods@#Systematic search was performed using PICOS (Population, Intervention, Comparison, Outcomes, and Study design) framework in electronic databases. Articles were screened for eligibility, summarized, and the quality was assessed using the National Institute of Health assessment tool. The review structure complies with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guide. @*Results@#Forty-two articles were included after full-text screening. Twenty-five studies were in high-income countries (HICs), six in each upper-middle income, five in lower-middle income countries (LMICs), and one in low-income countries (LIC). Based on the regions: North America (n=16), Europe (n=5), South America (n=4), Australia (n=4), Asia (n=5), Middle East (n=2), and sub-Saharan Africa (n=1). The two-most observed diet-related exposures were dietary pattern (n=17) and dietary quality (n=12). The most assessed outcome was gestational diabetes mellitus (n=28) and fetal and newborn anthropometry (n=7). The average quality score±standard deviation was 70±18%. @*Conclusions@#Research related to pre-pregnancy diet is still concentrated in HICs. The context of diet may vary; therefore, future research is encouraged in LMICs and LICs context, and Mediterranean, South-East Asia, Pacific, and African regions. Some maternal and child nutrition-related morbidity, such as anemia and micronutrient deficiencies, have not been discussed. Research on these aspects will benefit to fill in the gaps related to pre-pregnancy diet and maternal and child health.
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Objectives@#Prospective studies on vaccination status and mortality related to coronavirus disease 2019 (COVID-19) in low-resource settings are still limited. We assessed the association between vaccination status (full, partial, or none) and in-hospital mortality among COVID-19 patients at most hospitals in Jakarta, Indonesia during the Delta predomination wave. @*Methods@#We conducted a retrospective cohort study among hospitalized COVID-19 patients who met the study criteria (>18 years old and admitted for inpatient treatment because of laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection). We linked individual-level data in the hospital admission database with vaccination records. Several socio-demographic and clinical characteristics were also analyzed. A Cox proportional hazards regression model was used to explore the association between vaccination status and in-hospital mortality in this patient group. @*Results@#In total, 40 827 patients were included in this study. Of these, 70% were unvaccinated (n=28 543) and 19.3% (n=7882) died during hospitalization. The mean age of the patients was 49 years (range, 35-59), 53.2% were female, 22.0% had hypertension, and 14.2% were treated in the intensive care unit, and the median hospital length of stay across the group was 9 days. Our study showed that the risk of in-hospital mortality among fully and partially vaccinated patients was lower than among unvaccinated adults (adjusted hazard ratio [aHR], 0.43; 95% confidence interval [CI], 0.40 to 0.47 and aHR, 0.70; 95% CI, 0.64 to 0.77, respectively). @*Conclusions@#Vaccinated patients had fewer severe outcomes among hospitalized adults during the Delta wave in Jakarta. These features should be carefully considered by healthcare professionals in treating adults within this patient group.
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Background and Objectives@#There is limited data on the impact of type 2 myocardial infarction (T2MI) during the coronavirus disease 2019 (COVID-19) pandemic. @*Methods@#The National Inpatient Sample (NIS) database from January 2019 to December 2020 was queried to identify T2MI hospitalizations based on the appropriate International Classification of Disease, Tenth Revision-Clinical Modification codes. Monthly trends of COVID-19 and T2MI hospitalizations were evaluated using Joinpoint regression analysis. In addition, the multivariate logistic and linear regression analysis was used to compare inhospital mortality, coronary angiography use, and resource utilization between 2019 and 2020. @*Results@#A total of 743,535 patients hospitalized with a diagnosis of T2MI were identified in the years 2019 (n=331,180) and 2020 (n=412,355). There was an increasing trend in T2MI hospitalizations throughout the study period corresponding to the increase in COVID-19 hospitalizations in 2020. The adjusted odds of in-hospital mortality associated with T2MI hospitalizations were significantly higher in 2020 compared with 2019 (11.1% vs. 8.1%:adjusted odds ratio, 1.19 [1.13–1.26]; p<0.01). In addition, T2MI hospitalizations were associated with lower odds of coronary angiography and higher total hospitalization charges,with no difference in the length of stay in 2020 compared with 2019. @*Conclusions@#We found a significant increase in T2MI hospitalizations with higher inhospital mortality, total hospitalization costs, and lower coronary angiography use during the early COVID-19 pandemic corresponding to the trends in the rise of COVID-19 hospitalizations. Further research into the factors associated with increased mortality can increase our preparedness for future pandemics.
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Abstract The purpose of the present study was to develop stable lyophilized formulation of peginterferon alfa-2b which is acquiescent to the short lyophilization process. The present study evaluates the effect of buffering components and cryoprotectant(s) on depegylation of the peginterferon alfa-2b in combination with lyophilization process. Finally, a short lyophilization process was identified which can produce a stable pharmaceutical form of peginterferon alfa-2b without any depegylation during long-term storage. Formulations were analyzed mainly for depegylation by HP-size exclusion chromatography and in-vitro antiviral activity. Residual moisture content in the lyophilized product was also used as a key indicating parameter to check its role with respect to depegylation upon storage under various temperature conditions. It was observed that the peginterferon alfa-2b when formulated in presence of cryoprotectant like sucrose requires longer lyophilization process of about 5 days, irrespective of the buffering components used, to reduce the level of residual moisture content and thereby to produce the stable formulation without depegylation. A stable formulation in presence of high concentration of lactose as a cryoprotectant was developed which can withstand stresses exerted to protein-polymer conjugate during lyophilization phases without any significant depegylation. A short lyophilization process of about 48 hours can be utilized for peginterferon alfa-2b when formulated in presence of lactose as a cryoprotectant through which a stable lyophilized formulation can be produced as against longer process required when sucrose is used a cryoprotectant, which is essential from commercial point of view as lyophilization is a costly process.
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Freeze Drying/methods , Interferon alpha-2/pharmacology , Antiviral Agents/adverse effects , Pharmaceutical Preparations/analysis , Chromatography, Gel/methodsABSTRACT
This study aimed to develop and modify the surgical technique of simple limbal epithelial transplantation in patients with limbal stem cell deficiency to provide support to epithelial explants during the post-operative period. This is a case series of five eyes of five patients who underwent modified supportive simple limbal epithelial transplantation (M-SLET) surgery. The health and stability of the ocular surface were assessed based on clinical slit lamp examination; they were the main outcome measures. All patients had a stable ocular surface and healed epithelium during all the follow-up visits. The M-SLET technique provides additional support to limbal epithelial explants, adhering to the cornea, thus creating a stable epithelial surface. This is particularly important when there is a risk of explants being dislodged by eye rubbing.
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The new Corona virus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). It is a highly communicable infectious disease [1]. Clinical manifestations of COVID-19 vary from asymptomatic to ARDS leading to death, it is important to differentiate between severe and non-severe cases. Early warning signs can be identified by several laboratory tests which are often expensive, time taking. Neutrophil-lymphocyte ratio (NLR), C- reactive protein (CRP) are two simple tests that can be used as markers for clinical outcome in COVID-19 patients. The aim and objectives of the study were to correlate patients clinical severity and CRP, NLR levels and to assess direct correlation between CRP levels and NLR. 101 patients who fulfilled the inclusion criteria were taken into the study. Patients are divided into mild, moderate severity based on WHO criteria and CBP, CRP were sent on the 6th/ 7th day of illness. Among the 101 patients, 93 were in mild group, 8 were in moderate group. The study group included subjects who aged between 18 years to 80 years of age. Plasma CRP levels were higher in moderate cases than in mild cases, and this difference was significant (p < 0.001). The mean NLR of moderate severity were significantly higher than those of mild cases (p-0.00003). Results showed that NLR was positively correlated with CRP levels.NLR and CRP are potential, reliable and easy-to-use predictors for deteriorating covid-19 infection. The integration of NLR and CRP may lead to improved predictions and help to triage patients at the time of hospital admission.
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Vitamin D has an immunomodulatory effect that increases antimicrobial responses in macrophages by inducing antibacterial proteins, stimulating autophagy, and increasing autophagosome activity through various signaling pathway. This review emphasizes the several signalling pathway of vitamin D and vitamin D receptor(VDR)to induce autophagy in infection and its role in infectious disease. This study was performed based on PRISMA guidelines. Literature search conducted from Cochrane, PubMed, Science Direct and ProQuest using the terms "vitamin D" and 揤DR� and "autophagy in infection". The inclusion criteria were original article, publication in English, published in 2012-2022, investigating vit D, VDRpathway and autophagy mechanism in infection. Twelves studies met our criteria. Despite numerous autophagy signalling in vitamin D and VDR, there are 2main mechanisms vit D induces autophagy; increase expression LL-37/cathelicidin, CAMP, DEFB4 and upregulated autophagy genes (LC3B, ATG5, BECN1, MMPI, ATG16L1, PR39). While, vit D induced autophagy via expression CYP27B1 and VDR in co-infection HIV and tuberculosis. In sepsis, artesunate relates with VDR to enhance autophagy via NF-?B. Similarly, vitamin D could enhance cell resistance to Aspergillus fumigatusafter modulating NF-?B. Vitamin D3 through PDIA3-STAT3-MCOLN3-Ca2+ axis and CAMP/LL-37 (cathelicidin antimicrobial peptide) are mediator for autophagy induction in H.pylori. Upregulated autophagy gene activity through vit D/VDR appears as new target therapy for infection in future.
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Thrombotic thrombocytopenic purpura (TTP) is a syndrome characterized by microangiopathic hemolytic anemia, thrombocytopenia, neurological abnormalities, fever and renal dysfunction. Early clinical suspicion and presumptive diagnosis of TTP helps in timely initiation of treatment modalities speci?c for TTP which may prove to be lifesaving and thus augment in reducing the mortality rate of TTP which is estimated to be 80 – 90 % if left untreated. We report a case of a known case of multiple myeloma who developed TTP which proved fatal despite plasmapheresis. Signi?cant autopsy ?ndings of presence of microthrombi in the microvasculature of multiple organs is also highlighted.
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Introduction: Mesenchymal stem cells (MSCs) are the adult stem cells with potential to differentiate into various tissues. Like in other tissues, MSCs also reside in dental pulp after toot development and help in repair and regeneration by differentiating into odontoblasts. Dental Pulp Stem Cells (DPSCs) and Stem cells from Apical Papilla (SCAP) are the type of MSCs from dental papilla and apical papilla respectively. Aim: The aim of this paper is to highlight the characteristics of DPSCs and SCAP. Method: Information was obtained and compiled from published literature and electronic database search engine from PubMed and Google Scholar. Results: In spite of both DPSCs and SCAP having similar cell population origin they possess some different characteristics. Conclusion: The Dental stem cells with different characteristics of similar origin can be utilized in the stem cell based tissue engineering.
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Superior Mesenteric Artery (SMA) syndrome (known as Wilkie’s syndrome) is a rare cause of upper gastrointestinal obstruction. It is an acquired disorder, causes compression of the third part of the duodenum between the SMA and the aorta, due to loss of fatty tissue as a result of a variety of debilitating conditions. We report a case of 18 year old female presented with history of intermittent abdominal pain, vomiting of 6 months duration followed by significant weight loss for which she is hospitalized. Patient underwent extensive invasive and non-invasive tests, thereafter revealed her diagnosis. This case emphasizes the challenges in the diagnosis of SMA syndrome and the need for increased awareness of this entity.
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Multiple sclerosis and neuromyelitis optica spectrum disorder may be seen in the acute setting of coronavirus disease 2019 (COVID-19) infection or even post-recovery. Such patients may present with optic neuropathy along with weakness in the back and lower limbs. Ascending paralysis can present with respiratory distress in acute COVID-19 infection and may even prove to be fatal. We report a unique case of a 16-year-old female with past history of COVID-19 infection having optic neuropathy, and radioimaging showing demyelinating plaques in the central nervous system with spinal cord edema. Serology showed positivity for rheumatoid arthritis, and the patient was managed with steroids and rituximab.
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Objectives: To present the result of newborn sickle cell disease (SCD) screening and clinical profile of SCD newborns in a tribal area of Gujarat. Methods: We screened all newborns of sickle cell trait (SCT) and SCD mothers for SCD using high-performance liquid chromatography (HPLC) within two days of birth at a secondary care hospital in a tribal area in Gujarat from 2014 to 2019. Newborns with SCD were registered under an information technology based platform for hospital-based comprehensive care. Neonates were followed prospectively every 3 months. If they missed the clinic visit, a medical counsellor visited them at home to collect the required information. Results: Out of 2492 newborns screened, 87 (3.5%) were diagnosed with SCD. Among the 67 newborns screened for alpha-thalassemia deletion, 64 (95.4%) of babies had alpha-thalassemia deletion. We recorded total 554 clinic visits over the period of 221.5 person-years. The rates of acute febrile illness, painful crisis, hospitalization and severe anemia were 42.9, 14.9, 14.9 and 4.5 per 100 person-year, respectively. Two deaths were recorded, and 5 babies (5.7%) had severe SCD. Conclusion: We found a high prevalence of alpha thalassemia deletion among newborn SCD cohort in tribal area of Gujarat, and 70% babies had atleast one clinical complication on follow-up.