Comparative Evaluation of Efficacy of Three Single File Retreatment Systems for Removal of Gutta Percha and Assessment of Root Canal Transportation - An In Vitro Study

Background: In comparison to multiple file systems, recent advancements in single file retreatment systems had reduced the working time and ease of operation for clinicians. Aim: To compare the efficacy of retreatment systems compared with hand instrumentation, by evaluating their removal efficacy, time required for retreatment and assessment of canal transportation. Methods and Material: Forty premolars were instrumented using ProTaper Gold gold files. Post instrumentation, scan was taken, obturated using warm vertical compaction technique, and stored in artificial saliva for three months and randomly divided into four groups for retreatment. Hand instrumentation (Hi), Neoniti (Nn), Mtwo R (Mt), WaveOne Gold (Wg). Post retreatment, scan was taken. Teeth were sectioned longitudinally and photographed under the stereomicroscope. Retreatment time was recorded, and canal transportation was calculated. Statistical Analysis: The results were analyzed using one?way analysis of variance (ANOVA) followed by Tukey’s post hoc test at 95% confidence level. Results: The retreatment time was significantly longer in the Hi group. Within the test groups, a significantly longer time has been taken by Wg (p < 0.05) compared to Mt and Nn. There was no difference in the canal transportation between the single file systems at 3 mm, 6 mm and 9 mm from the apex, there was statistically significant higher transportation for the Hi group at 9 mm from the apex (p < 0.05). Conclusions: All techniques were effective in removal of filling material with minimal canal transportation. Wg system was shown to increased time compared to Nn and Mt systems. Hi group was slowest with maximum canal transportation at 9 mm from the apex.

Practical to Demonstrate Electromyographic Changes Associated With Phenomena of Fatigue Due to Isometric Exercise

Purpose of the study: Teaching the physiology of motor unit recruitment as a strategy for force generationand changes in the recruitment patterns as a consequence of fatigue.Methodology: A protocol was designed to study fatigue developed as a consequence of graded isometricexercise and the surface electromyographic (sEMG) features associated with development of fatigue.Main findings: Fatigue can be quantified by reduction in grip force in isometric hand grip. During maximalexercise, sEMG amplitude declined with time as a consequence of fatigue. The sEMG amplitude wasobserved to increase in the case of submaximal exercise representing recruitment of additional motor unitsto compensate for declining force production in fatigued motor units.Conclusion: The proposed practical exercise fulfils the teaching goal of acquainting the students with themotor unit recruitment patterns as reflected in sEMG associated with fatigue development.

An Innovative Method to Demonstrate Nerve – Muscle Physiology Experiments Using Finger Muscle Twitch Recording in a Human Subject

Purpose of the study: Demonstration of nerve-muscle experiments play a vital role for teaching Physiologyto undergraduate medical students. In recent days, procuring frogs for the conduction of these experimentshave become a major concern. Therefore, we have designed an innovative method to carry out nerve-musclePhysiology experiments in human subjects.Methodology: We designed a simple and feasible method to demonstrate the effect of increasing strengthof stimuli, two successive stimuli and tetanic stimuli on human finger muscle twitch response.Main findings: Results of four nerve-muscle experiments performed in a human subject using an innovativemethod has been presented in this article. First, recording of finger muscle twitch by ulnar nerve stimulation.Second, effect of subthreshold, threshold, maximal and supramaximal stimulus with increase in the strengthof stimulus. Third, effect of two successive stimuli on finger twitch response. Four, effect of tetanizingstimuli on finger twitch response.Conclusion: Here we propose a simple innovative practical for effective demonstration of nerve-musclePhysiology experiments using human subject for under-graduate teaching.

A comparative study of laparoscopic (LC) vs. open cholecystectomy (OC) in a medical school of Bihar, India

Background: Gallstone disease is a significant health problem world over (in both developing and developed nations). The incidence of gallstone disease increases after age of 40years and it becomes 4-10 times more common in old age. As many as 16% and 29% of women above the age of 40-49 years and 50-59 years, respectively, had gall stones. Laparoscopic cholecystectomy introduced in 1985 has become the procedure of choice for surgical removal of the gallbladder. The aim is to compare laparoscopic cholecystectomy and open cholecystectomy in patients of cholelithiasis by measuring parameters such as use of post-operative analgesia, operative time, post-operative hospital stays, morbidity, mortality and patient satisfaction.Methods: It is a prospective randomized study of 120 patients of cholelithiasis aged between 20years to 80years operated during 2015-2018 at of Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. They were divided into open and laparoscopic Cholecystectomy groups by drawing a lottery.Results: The median (range) operation time for laparoscopic cholecystectomy was 55-155 min (mean=102 min) and 40-105 min (mean=72 min) for open cholecystectomy (p <0.001). Form LC group 5 cases had to be converted to OC. Rate of conversion was 5/60=8.3% which is within limits of worldwide laparoscopic cholecystectomy conversion rate of 5% to 10%. LC was found to be superior to OC.Conclusions: Laparoscopic cholecystectomy is better than open cholecystectomy However, open cholecystectomy is preferable in cases of complicated cholecystectomy.

High direct costs of medical care in patients with Type 1 diabetes attending a referral clinic in a government-funded hospital in Northern India.

Background. There is little information regarding costs of managing type 1 diabetes mellitus (T1DM) from low- and middle-income countries. We estimated direct costs of T1DM in patients attending a referral diabetes clinic in a governmentfunded hospital in northern India. Methods. We prospectively enrolled 88 consecutive T1DM patients (mean [SD] age 15.3 [8] years) with age at onset <18 years presenting to the endocrine clinic of our institution. Data on direct costs were collected for 12 months—6 months retrospectively followed by 6 months prospectively. Results. Patients belonged predominantly (77%) to the middle socioeconomic strata (SES); 81% had no access to government subsidy or health insurance. The mean direct cost per patient-year of T1DM was `27 915 (inter-quartile range [IQR] `19 852–32 856), which was 18.6% (7.1%–30.1%) of the total family income. A greater proportion of income was spent by families of lower compared to middle SES (32.6% v. 6.6%, p<0.001). The mean out-of-pocket payment for diabetes care ranged from 2% to 100% (mean 87%) of the total costs. The largest expenditure was on home blood glucose monitoring (40%) and insulin (39.5%). On multivariate analysis, total direct cost was associated with annual family income (β=0.223, p=0.033), frequency of home blood glucose monitoring (β=0.249, p=0.016) and use of analogue insulin (β=0.225, p=0.016). Conclusions. Direct costs of T1DM were high; in proportion to their income the costs were greater in the lower SES. The largest expenditure was on home blood glucose monitoring and insulin. Support for insulin and glucose testing strips for T1DM care is urgently required. Natl Med J India 2016;29:64–7

Plant-derived Tetranortriterpenoid, Methyl Angolensate Activates Apoptosis and Prevents Ehrlich Ascites Carcinoma Induced Tumorigenesis in Mice.

Background: Cancer is a leading health problem throughout the world. For decades, natural plant products have been playing promising roles as anticancer agents. Objective: The present study aims to investigate the chemotherapeutic potential of methyl angolensate (MA), purified from Soymida febrifuga in mice bearing carcinoma and examines the molecular basis for its anticancer actions. Study Design: The inhibitory effects of MA treatment on the survival of mice bearing Carcinoma and adverse side effects of MA treatment in mice were analyzed. Methods: Tumor volume, life span, histopathology, immunohistochemical (IHC) analysis, estimation of liver enzyme, alkaline phosphatase and metabolites, creatinine and urea. Results: Oral administration of MA in mice with Ehrlich Ascites Carcinoma showed significant inhibition of tumor growth compared to untreated mice. We observed a significant increase in the life span (~4-fold) of tumor bearing animals following treatment with MA. MA affected tumor cell proliferation by activating intrinsic pathway of apoptosis without imparting any side effect on normal cells. MA treatment in mice showed no major side effects. Conclusion: MA treatment showed significant inhibition of tumor growth by inducing apoptosis as well increased life span of mice, with no adverse side effects to normal cells. Altogether, the present in vivo study provides new insights of MA serving as a cancer chemotherapeutic agent.

Socio-economic and demographic determinants of childhood anemia / Fatores socioeconômicos e demográficos determinantes de anemia infantil

ABSTRACT OBJECTIVE: To evaluate socio-economic and demographic determinants of anemia among Indian children aged 6-59 months. METHODS: Statistical analysis was performed on the cross-sectional weighted sample of 40,885 children from 2005 to 2006 National Family Health Survey by using multinomial logistic regression to assess the significance of some risk factors in different degrees of child anemia. Anemia was diagnosed by World Health Organization (WHO) cut-off points on hemoglobin level. Pearson's chi-squared test was applied to justify the associations of anemia with different categories of the study population. RESULTS: The prevalence of anemia was 69.5%; 26.2% mild, 40.4% moderate, and 2.9% severe anemia. Overall prevalence rate, along with mild and moderate cases, showed an increasing trend up to 2 years of age and then decreased. Rural children had a higher prevalence rate. Of 28 Indian states in the study, 10 states showed very high prevalence, the highest being Bihar (77.9%). Higher birth order, high index of poverty, low level of maternal education, mother's anemia, non-intake of iron supplements during pregnancy, and vegetarian mother increased the risks of all types of anemia among children (p < 0.05). Christian population was at lower risk; and Scheduled Caste, Scheduled Tribe, and Other Backward Class categories were at higher risk of anemia. CONCLUSION: The results suggest a need for proper planning and implementation of preventive measures to combat child anemia. Economically under-privileged groups, maternal nutrition and education, and birth control measures should be priorities in the programs.

RESUMO OBJETIVO: Avaliar os fatores socioeconômicos e demográficos determinantes de anemia em crianças indianas de seis a 59 meses. MÉTODOS: A análise estatística foi feita na amostra transversal ponderada de 40.885 crianças da Pesquisa Nacional de Saúde da Família de 2005-2006, Governo da Índia, com a técnica de regressão logística multimodal para avaliar a relevância de alguns fatores de risco em diferentes graus de anemia infantil. A anemia foi diagnosticada pelos pontos de corte de nível de hemoglobinas da OMS. O teste qui-quadrado de Pearson foi usado para justificar as associações da anemia com diferentes categorias de população estudada. RESULTADOS: A prevalência de anemia foi de 69,5%, 26,2% de anemia leve, 40,4% de anemia moderada e 2,9% de anemia grave. A taxa de prevalência geral, juntamente com a de anemia leve e moderada, mostrou uma tendência de aumento até os dois anos e depois disso de queda. As crianças da zona rural têm maior taxa de prevalência. Dos 28 estados indianos do estudo, 10 apresentaram prevalência muito alta. Bihar foi o maior deles (77,9%). A ordem de nascimento elevada, o alto índice de pobreza, o baixo nível de escolaridade materna, a anemia materna, a não ingestão de suplementos de ferro durante a gravidez e o vegetarianismo materno aumentaram os riscos de todos os tipos de anemia entre crianças (p < 0,05). A população cristã tinha o menor risco; e as categorias casta reconhecida, tribo reconhecida e outras classes atrasadas tinham o maior risco de anemia. CONCLUSÃO: Os resultados sugerem a necessidade de planejamento e implantação adequados de medidas preventivas contra a anemia infantil. Grupos economicamente carentes, a nutrição e a escolaridade maternas e o controle da natalidade devem ser prioridades nos programas.

Psychometrics of Multiple Choice Questions with Non-Functioning Distracters : Implications to Medical Education.

Objectives: The functionality of distracters in a multiple choice question plays a very important role. We examined the frequency and impact of functioning and non-functioning distracters on psychometric properties of 5-option items in clinical disciplines. Methods: We analyzed item statistics of 1115 multiple choice questions from 15 summative assessments of undergraduate medical students and classified the items into five groups by their number of non-functioning distracters. We analyzed the effect of varying degree of non-functionality ranging from 0 to 4, on test reliability, difficulty index, discrimination index and point biserial correlation. Results: The non-functionality of distracters inversely affected the test reliability and quality of items in a predictable manner. The non-functioning distracters made the items easier and lowered the discrimination index significantly. Three non-functional distracters in a 5-option MCQ significantly affected all psychometric properties (p<0.5). The corrected point biserial correlation revealed that the items with 3 functional options were psychometrically as effective as 5-option items. Indian J Physiol Pharmacol 2015; 59(4) : 428–435 *Corresponding author : (Received on April 12, 2014) Introduction There has been a growing trend of wider usage of multiple choice questions (MCQs), both in high stake entrance examinations and in in-house assessments in medicine. The items used in the examination must 2College of Medicine, University of Dammam Conclusions: Our study reveals that a multiple choice question with 3 functional options provides lower most limit of item format that has adequate psychometric property. The test containing items with less number of functioning options have significantly lower reliability. The distracter function analysis and revision of nonfunctioning distracters can serve as important methods to improve the psychometrics and reliability of assessment.

Phytochemicals and antimicrobial potentials of mahogany family

Drug resistance to human infectious diseases caused by pathogens lead to premature deaths through out the world. Plants are sources for wide variety of drugs used for treating various diseases. Systematic screening of medicinal plants for the search of new antimicrobial drug candidates that can inhibit the growth of pathogens or kill with no toxicity to host is being continued by many laboratories. Here we review the phytochemical investigations and biological activities of Meliaceae. The mahogany (Meliaceae) is family of timber trees with rich source for limonoids. So far, amongst the different members of Meliaceae, Azadirachta indica and Melia dubia have been identified as the potential plant systems possessing a vast array of biologically active compounds which are chemically diverse and structurally complex. Despite biological activities on different taxa of Meliaceae have been carried out, the information of antibacterial and antifungal activity is a meager with exception to Azadirachta indica. Together we provide new insights of Meliaceae members demonstrating as a potential source as antimicrobial agents using in vitro studies.

Potential antibacterial activity of berberine against multi drug resistant enterovirulent Escherichia coli isolated from yaks (Poephagus grunniens) with haemorrhagic diarrhoea

OBJECTIVE@#To evaluate the antimicrobial efficacy of berberine, a plant alkaloid.@*METHODS@#Five multi-drug resistant (MDR) STEC/EPEC and five MDR ETEC isolates from yaks with haemorrhagic diarrhoea were selected for the study. Antibacterial activity of berberine was evaluated by broth dilution and disc diffusion methods. The binding kinetics of berberine to DNA and protein was also enumerated.@*RESULTS@#For both categories of enterovirulent Escherichia coli (E. coli) isolates, berberine displayed the antibacterial effect in a dose dependent manner. The MIC(50) of berberine chloride for STEC/EPEC isolates varied from 2.07 μM to 3.6 μM with a mean of (2.95 ± 0.33) μM where as for ETEC strains it varied from 1.75 to 1.96 μM with a mean of (1.87 ± 0.03) μM. Berberine bind more tightly with double helix DNA with Bmax and Kd of (24.68±2.62) and (357.8±57.8), respectively. Berberine reacted with protein in comparatively loose manner with Bmax and Kd of (18.9±3.83) and (286.2±113.6), respectively.@*CONCLUSIONS@#The results indicate clearly that berberine may serve as a good antibacterial against multi drug resistant E. coli.

Diuretic effect of chloroform extract of benincasa hispida rind (Pericarp) in sprague-dawley rats.

The diuretic activity of Benincasa hispida fruit rind extract (outer thick pericarp) was investigated and its activity was compared to control (normal saline) and standard diuretic hydrochlorothiazide in albino rats. Total of 54 adult male Sprague-Dawley rats were taken whose weights ranged from 175-225 gm. The rats were divided into three groups of 18 rats each (control, standard and test). Control group received 0.9% normal saline 25ml/kg orally. Standard group received hydrochlorothiazide 2.5mg/kg body weight orally along with normal saline keeping the volume of the fluid administered constant. Test group received aqueous extract of rind of Benincasa hispida at the dose of 100mg/kg orally along with normal saline 25ml/kg. Urine was collected for a period of 5 hours by placing the animals in metabolic cages. The urinary volume, pH, and urinary excretion of sodium, potassium and chloride were measured and compared. The extract produced significant increase (p<0.001) in urine volume, sodium and chloride levels, and significant decrease (p<0.001) in potassium excretion. Benincasa hispida rind extract possesses significant diuretic activity.

Isolation and characterization of microsomal omega-6-desaturase gene (fad2-1) from soybean.

A genomic DNA sequence (fad2-1) encoding seed specific microsomal 0-6 desaturase was isolated from soybean (Glycine max. L cv. Pusa-9702). A positive genomic clone of 1852 nucleotides containing a single uninterrupted 3' end exonic region with an ORF of 1140 bp encoding a peptide of 379 amino acids, a complete 3' UTR of 206 bp and 86 bp of 5' UTR interrupted by a single intron of 420 bp was obtained on screening the sub-genomic library of soybean. Southern blots revealed at least two copies of the gene per haploid genome. Analysis of the translated product showed the presence of three histidine boxes, with the general sequence HXXXH and five probable transmembrane segments reported to be involved in substrate specificity.

Antimicrobial efficacy of secondary metabolites from Glomerella cingulata

Fungi are known to produce a vast array of secondary metabolites that are gaining importance for their biotechnological applications. Early reports suggest that G. cingulata has the capability to transform many compounds by various enzymatic actions. Therefore, the focus of this study was to determine the antibacterial and antifungal activity of crude ethyl acetate extract of G. cingulata using agar cup bioassay method. Crude extract of G. cingulata exhibited remarkable antifungal activity against Rhizopus oryzae, Chrysoporium tropicum and Beauveria bassiana but no antifungal activity was found against Alternaria tenuissima and Aspergillus niger at any concentrations. The crude extract presented no antibacterial activity against Gram positive and Gram negative bacteria at any concentration.

Fungos são conhecidos produtores de uma vasta coleção de metabólitos secundários que vem mostrando importância crescente na sua aplicação biotecnológica. Publicações anteriores sugerem que G. cingulata tem a capacidade de transformar vários componentes por diferentes ações enzimáticas. Logo, o foco deste estudo foi determinar a atividade antibacteriana e antifúngica do extrato bruto de G. cingulata obtido por acetato de etila utilizando-se um método envolvendo bloco de agar. O extrato bruto de G. cingulata demonstrou marcante atividade antifungica contra Rhizopus oryzae, Chrysoporium tropicum e Beauveria bassiana entretanto, não foi possível detectar, em nenhuma concentração, atividade antifungica contra Alternaria tenuissima e Aspergillus niger. O mesmo extrato não apresentou atividade antibacteriana, em nenhuma concentração, contra bactérias Gram negativa e positiva.

New method of electrode placement for determination of cardiac output using impedance cardiography.

In thirty eight young healthy adult subjects, cardiac output was determined non-invasively by using two methods of electrode placement viz. vertical (uses silver braided wires in a band shape) and horizontal (conventional stick-on type surface ECG electrodes), using the technique of Impedance Cardiography. The recordings were taken in supine position on the same day in two separate sets with 30.0 min interval between two sets. In each set of recording, five successive recordings, each at an interval of five minutes were taken. The mean values of cardiac out put by two methods were compared. For the set I, the respective values (Mean +/- SD) of cardiac output by horizontal and vertical methods for the each of the five recordings were 4.87 +/- 0.77 and 5.03 +/- 0.64 for the first, 4.87 +/- 0.71 and 4.91 +/- 0.66 for the second, 4.99 +/- 0.67 and 5.00 +/- 0.70 for the third, 4.78 +/- 0.69 and 4.98 +/- 0.61 for the fourth, 4.84 +/- 0.69 and 4.98 +/- 0.62 for the fifth recording in supine position. The respective P values for these pairs for between the group comparisons were 0.33, 0.50, 0.96, 0.17, and 0.36. In addition, to see the repeatability for each method, within the group comparison was done, the P values were 0.71 and 0.91 for the horizontal and vertical methods, respectively. The mean value of cardiac output did not differ significantly between two methods for recordings of set II in supine position. The cardiac output measurement by placing four spot electrodes horizontally, gave consistent result on repeated measurements and their values showed concordance with the cardiac output values obtained by conventional four band electrodes tied around the chest.

Vector control in leishmaniasis.

Indoor residual spraying is a simple and cost effective method of controlling endophilic vectors and DDT remains the insecticide of choice for the control of leishmaniasis. However resistance to insecticide is likely to become more widespread in the population especially in those areas in which insecticide has been used for years. In this context use of slow release emulsified suspension (SRES) may be the best substitute. In this review spraying frequencies of DDT and new schedule of spray have been discussed. Role of biological control and environment management in the control of leishmaniasis has been emphasized. Allethrin (coil) 0.1 and 1.6 per cent prallethrin (liquid) have been found to be effective repellents against Phlebotomus argentipes, the vector of Indian kalaazar. Insecticide impregnated bednets is another area which requires further research on priority basis for the control of leishmaniasis. Role of satellite remote sensing for early prediction of disease by identifying the sandflygenic conditions cannot be undermined. In future synthetic pheromons can be exploited in the control of leishmaniasis.

Preservation of Leishmania donovani promastigotes in blood agar slants.

Long-term cultivation of Leishmania promastigotes by weekly passage to fresh medium was reported to be disadvantageous because needs labor, risk of contamination, lowering in infectivity and virulence pattern. Cryopreservation and Lyophilization require expensive facilities which could be a burden and unaffordable to most laboratories of developing countries where the disease is endemic. These problems could be minimized by simple preservation of Leishmania donovani promastigotes in blood agar slants at 7-8 degrees C for 6-7 months. The preserved promastigotes were examined for viability up to one year at a regular interval of one month. Viable promastigotes were found and revived successfully from all the slants stored up to 7 months after that, the viability of promastigotes was found to be decreased in the slants of 8-9 month storage. No viable promastigotes were recovered from the slants stored up to 11-12 months. By this method, the promastigotes can easily be stored up to 7 months without loss of biological activity. The number of passage of promastigotes to fresh medium has been greatly reduced by this method from 30 times to 01 when compared with weekly passage in liquid medium. This simple and economical method can be recommended for short storage of Leishmania culture without loss of any activity.

Morphological variations in Phlebotomus argentipes (Diptera: Psychodidae) Annandale and Brunetti.

Morphological variations were observed in Phlebotomus argentipes, the vector for visceral leishmaniasis reported from the endemic states of Bihar, West Bengal and Uttar Pradesh. The taxonomic features distinguishing vector and nonvector species of P. argentipes were relative length of ascoid and antennal segment IV. Three morphotypes were characterized as <0.4, = 0.4 and >0.4 respectively. Other characteristics of wing width, wing length, eye, style, antennal segment III, IV, V was found statistically significant (p<0.05) and eleven other morphological measurements were not significant. This study suggests three different morphotypes of P. argentipes in these three endemic states. The genetic and reproductive isolation among such morphotypes will establish the variability in further studies.

Susceptibility of Phlebotomus argentipes against DDT in endemic Districts of North Bihar, India.

Susceptibility status of Indian kala-azar vector Phlebotomus argentipes after DDT spray from endemic areas of Muzaffarpur and Vaishali district and unsprayed non-endemic area of Patna district, Bihar, India were compared. Higher Lc50 viz. 2.6% and 3.2% and LT50, values 51.0 and 69.0 minutes to 4% DDT were observed for P. argentipes of Muzaffarpur and Vaishali district, whereas P. argentipes of Patna district was 100% susceptible to same concentration, indicating increased tolerance in P. argentipes. It is concluded DDT resistant P. argentipes, particularly in endemic zone growing. The possible explanation could be long-term insecticidal pressure.

Evaluation of cholinesterase level in an endemic population exposed to malathion suspension formulation as a vector control measure

The manuscript describes a study on the blood cholinesterase (ChE) level in an exposed population at different interval of time after spraying with malathion suspension (SRES) use for kala-azar vector control in an endemic area of Bihar, India. The toxicity of a 5 percent malathion formulation in the form of a slow release emulsified suspension (SRES) was assessed by measuring serum ChE levels in spraymen and in the exposed population.The study showed a significant decrease in ChE levels in the spraymen (p < 0.01) after one week of spraying and in exposed population one week and one month after of spraying (p < 0.01), but was still within the normal range of ChE concentration, one year after spraying, the ChE concentration in the exposed population was the same as prior to spraying (p > 0.01). On no occasion was the decrease in ChE level alarming. A parallel examination of the clinical status also showed the absence of any over toxicity or any behavioural changes in the exposed population. Hence, it may be concluded that 5 percent malathion slow release formulation, SRES, is a safe insecticide for use as a vector control measure in endemic areas of kala-azar in Bihar, India so long as good personal protection for spraymen is provided to minimize absorption and it can substitute the presently used traditional DDT spray.