Complexity of the Diagnosis of COVID-19 in the Context of Pandemicity: Need for Excellence in Diagnostic Acumen / 가정의학회지

Coronavirus disease 2019 (COVID-19) is a highly infectious disease that has caused a pandemic devastating many countries worldwide. It is a complex and multifaceted disease with a unique coronavirus etiology, pathogenesis, zoonotic, and human-to-human transmission, causing acute respiratory distress syndrome with high mortality. Accurate and timely diagnosis is of utmost importance. In this study, we discussed the complexities of COVID-19 diagnostic elements in the context of pandemicity, drawing from our awareness, observations, and lessons learned from two previous coronavirus pandemics, namely SARS-CoV (severe acute respiratory syndrome coronavirus) in 2002 and MERS-CoV (Middle East respiratory syndrome-related coronavirus) in 2012, and how they applied to the diagnosis of COVID-19 today. Diagnosis of COVID-19 takes place without physician-patient personal contact due to isolation or quarantine or in the hospital setting, emergency units, and critical care units with the cumbersome barriers of personal protective equipment. Technical diagnosis is important, but we also emphasized the human impact of diagnosing COVID-19. Conveying the diagnosis of a critical disease to patients and families requires aspects of excellence in professionalism: ethics, empathy, and humility. Diagnostic skills in COVID-19 should extend to prognostication for patients suffering at the end of life, so that they will not be deprived of high-quality palliative care and comfort.

Reassessment of Relative Value in Shoulder and Elbow Surgery: Do Payment and Relative Value Units Reflect Reality?

Background@#Many U.S. health care institutions have adopted compensation models based on work relative value units (wRVUs) to standardize payments and incentivize providers. A major determinant of payment and wRVU assignments is operative time. We sought to determine whether differences in estimated operative times between the Centers for Medicare & Medicaid Services (CMS) and the National Surgical Quality Improvement Program (NSQIP) contribute to payment and wRVU misvaluation for the most common shoulder/elbow procedures. @*Methods@#We collected data on wRVUs, payments, and operative times from CMS for 29 types of isolated arthroscopic and open shoulder/elbow procedures. Using regression analysis, we compared relationships between these variables, in addition to median operative times reported by NSQIP (2013–2016). We then determined the relative valuation of each procedure based on operative time. @*Results@#Seventy-nine percent of CMS operative time were longer than NSQIP time (R2 = 0.58), including, but not limited to, shoulder arthroplasty and arthroscopic shoulder surgery. The correlation between payments and operative times was stronger between CMS data (R2 = 0.61) than NSQIP data (R2 = 0.43). Similarly, the correlation between wRVUs and operative times was stronger when using CMS data (R2 = 0.87) than NSQIP data (R2 = 0.69). Nearly all arthroscopic shoulder procedures (aside from synovectomy, debridement, and decompression) were highly valued according to both datasets. Per NSQIP, compensation for revision total shoulder arthroplasty ($10.14/min; 0.26 wRVU/min) was higher than that for primary cases ($9.85, 0.23 wRVU/min) and nearly twice the CMS rate for revision cases ($5.84/min; 0.13 wRVU/min). @*Conclusions@#CMS may overestimate operative times compared to actual operative times as recorded by NSQIP. Shorter operative times may render certain procedures more highly valued than others. Case examples show that this can potentially affect patient care and incentivize higher compensating procedures per operative time when less-involved, shorter operations have similar patient-reported outcomes.

Effect of Seminal Zinc, Calcium, Oxidative Stress and Protein Profile on Semen Quality of Crossbred Bulls

The objective of present study was to investigate the effect of endogenous minerals (Zn and Ca), seminal proteins and oxidative stress on semen quality of crossbred bulls. Two crossbred bulls with history of good initial quality, high sperm motility percentage, and freezable ejaculates and poor initial quality, low sperm motility percentage, and donating mostly non-freezable ejaculates (Bull B), respectively were utilized. Six ejaculates from each bull were used and categorized into high progressive motile as good quality and low progressive motile as poor quality ejaculates groups. Total 24 ejaculates were taken during entire period of study. The level of Zn, Ca in seminal plasma and Ca in sperm pellets was found significantly (P<0.05) higher in good quality ejaculates of Bull A compared to poor quality ejaculates of Bull B; however, the level of reactive oxygen species and malondialdehyde was significantly higher (P<0.05) in poor quality ejaculates of Bull B compare to good quality ejaculate of Bull A. The 25 kDa protein band was prominent only in good quality ejaculate of Bull A. It was concluded that several proteinaceous antioxidant enzymes which may be present in 25 kDa band and minerals like Zn and Ca as a cofactors of these enzymes could be responsible for good quality semen ejaculates of Bull A

Racial Disparity in Time to Surgery and Complications for Hip Fracture Patients

Background@#Racial and ethnic disparities in orthopedic surgery may be associated with worse perioperative complications. For patients with hip fractures, studies have shown that early surgery, typically within 24 to 48 hours of admission, may decrease postoperative morbidity and mortality. Our objective was to determine whether race is associated with longer time to surgery from hospital presentation and increased postoperative complications. @*Methods@#We queried the National Surgical Quality Improvement Program database from 2011 to 2017 for patients (> 65 years) with hip fractures who underwent surgical fixation. Patients were identified using Current Procedural Terminology codes (27235, 27236, 27244, and 27245). Delayed surgery was defined as time to surgery from hospital admission that was greater than 48 hours. Time to surgery was compared between races using analysis of variance. A multivariate logistic regression analysis adjusting for comorbidities, age, sex, and surgery was performed to determine the likelihood of delayed surgery and rate of postoperative complications. @*Results@#A total of 58,456 patients who underwent surgery for a hip fracture were included in this study. Seventy-two percent were female patients and the median age was 87 years. The median time to surgery across all patients was 24 hours. African Americans had the longest time to surgery (30.4 ± 27.6 hours) compared to Asians (26.5 ± 24.6 hours), whites (25.8 ± 23.4 hours), and other races (22.7 ± 22.0 hours) (p < 0.001). After adjusting for comorbidities, age, sex, and surgery, there was a 43% increase in the odds of delayed surgery among American Africans compared to whites (odds ratio, 1.43; 95% confidence interval, 1.29–1.58; p < 0.001). Despite higher odds of reintubation, pulmonary embolism, renal insufficiency or failure, and cardiac arrest in African Americans, mortality was significantly lower compared to white patients (4.41% vs. 6.02%, p < 0.001). Asian Americans had the lowest mortality rate (3.84%). @*Conclusions@#A significant disparity in time to surgery and perioperative complications was seen amongst different races with only African Americans having a longer time to surgery than whites. Further study is needed to determine the etiology of this disparity and highlights the need for targeted strategies to help at-risk patient populations.

Evaluation of bactericidal and virucidal activity of novel disinfectant Aaride AGT-1 compared to other commercially available disinfectants against hospital-acquired infections (HAIs)

@# Hand hygiene is the topmost crucial procedure to prevent hospital-acquired infections. Choosing an effective hand disinfectant is necessary in enforcing good hand hygiene practice especially in hospital settings. The aim of the study was to investigate the efficacy of Aaride AGT-1 as a hand disinfectant for the inhibition of pathogenic microorganisms’ transmission among both patients and personnel in the health care system compared to other commercially available disinfectants. In the present study, a new hand disinfectant Aaride AGT-1 was tested against several bacterial and viral pathogens to evaluate its antimicrobial activity profile. The results revealed that Aaride AGT-1 displayed the highest antibacterial activity against five pathogenic bacteria including MRSA when compared to other commercially available hand sanitizers. Aaride AGT-1 showed the lowest percentage needed to inhibit the growth of bacterial pathogens. In addition, results obtained from time killing assay revealed that Aaride AGT-1 demonstrated the best killing kinetics, by eradicating the bacterial cells rapidly within 0.5 min with 6 log reduction (>99.99% killing). Also, Aaride AGT1 was able to reduce 100% plaque formed by three viruses namely HSV-1, HSV-2 and EV-71. In conclusion, Aaride AGT-1 is capable of killing wide-spectrum of pathogens including bacteria and viruses compared to other common disinfectants used in hospital settings. Aaride AGT-1’s ability to kill both bacteria and viruses contributes as valuable addition to the hand disinfection portfolio.

Epitope variances demonstrated by Blastocystis sp. ST3 symptomatic and asymptomatic isolates

@#Blastocystis sp. is an enteric protozoan parasite of humans and many animals. Blastocystis sp. subtype 3 (ST3) proves to be the highest frequency case in most populations around the world and it is further distinguished into symptomatic and asymptomatic isolates based on the clinical symptoms exhibited by infected individuals. Phenotypic and genotypic studies implicate the distinctiveness of this parasite which may describe its pathogenesis. However, the antigenic distinctiveness which describes the antibody mediated cell lysis of this parasite has not been explored. This study was aimed to identify the cross-reactivity and cytotoxicity effect between three isolates of symptomatic and asymptomatic Blastocystis sp. ST3 respectively. Antigen specificity and diversity of this parasite was performed by coculturing sera (10-fold dilution) obtained from mice immunised with Blastocystis sp. symptomatic and asymptomatic antigens and the respective Blastocystis sp. ST3 live cells through complement dependant cell cytotoxicity (CDC) assay. The results obtained has shown that, the sera (at 10-fold diluted concentration) from symptomatic and asymptomatic solubilised antigen immunised mice were able to specifically lyse the respective live parasites with an average percentage of 82% and 86% respectively. There were almost 50% crossreactivity observed between the three isolates of Blastocystis sp. ST3 from symptomatic and asymptomatic group proving high antigen diversity or rather low antigen specificity within the same group. However, there was only 17% cross-reactivity observed between the mice sera and parasitic cells of different groups (symptomatic vs asymptomatic isolates) suggesting high specificity between these two groups. We, for the first time have proven that through CDC analysis there were epitopes dissimilarities between Blastocystis sp. ST3 symptomatic and asymptomatic isolates which may allow the parasite to set up diverse immune modulations such as imbalanced Th1/Th2 responses in an infected host.

A comparison of three different gauge Quincke’s spinal needles in patients undergoing elective surgery under spinal anaesthesia: a prospective randomized study

Background: The present study was conducted to compare three different Quincke’s spinal needles i.e. 23, 25 and 26 gauge in patients undergoing elective surgery under spinal anaesthesia (SA).Methods: The prospective randomized double-blind study was conducted on 150 male patients in the age group of 18-50 yrs., having physical status class I to II, scheduled for elective surgery under SA. Patients were randomly divided into three groups comprising 50 patients each. SA was administered using Quincke’s spinal needles of 23, 25 and 26 gauge in group 1, 2 and 3 respectively. Ease of insertion, number of attempts and time of appearance of CSF and incidence of PDPH was recorded in all the patients.Results: Ease of insertion was graded easy in 98%, 84% and 82% in group 1, 2 and 3 respectively. First attempt success rate was highest in group 1, (98%). Meantime for appearance of CSF beyond hub was maximum in group 3 i.e. 14.60±2.56 sec. Mild PDPH was reported in 6% and 2% patients after 24 hrs in group 1 and group 2 respectively.Conclusions: Finer spinal needle proved to be more dependable in generating less traumatic effect on the dura and preventing PDPH but are technically more difficult thus decreasing first attempt success rate.

Antibiotics sensitivity and resistant pattern in tribal region of Chhattisgarh, India: a retrospective observational study

Background: Antimicrobial resistance (AMR) is the biggest health care problem globally, it is responsible for the high rate of mortality worldwide which was commonly observed in developing countries. We tried to find the incidence of antimicrobial resistance in the tribal region of Chhattisgarh, India.Methods: It was an institutional based retrospective observational study. Out of 3389 samples from inpatient and outpatient department, a total number of 1676 cultured proven micro-organism were isolated from Jan 2017 to Dec 2018. SPSS v23 was used for descriptive analysis.Results: More than 75% of the samples collected from the inpatient department in which surgical IPD were significantly higher. The commonest isolated were Staphylococcus aureus followed by Escherichia coli, then Klebsiella species. Amoxycillin-clavulanic acid was resistant to the majority of microorganism followed by 3rd generation cephalosporins then Co-trimoxazole.Conclusions: Antimicrobial resistance was higher even in the tribal region. The incidence of AMR is increasing at an alarming rate. Microorganism targeted antimicrobial therapy with the use of narrow-spectrum antibiotics and avoidance of broad-spectrum antibiotics will possibly overcome the antimicrobial resistance. There is also a need to strengthen laboratory or microbiology department to produce an accurate report to combat antimicrobial resistance.

Knowledge, attitude and practices about rabies prophylaxis among medical officers

Background: One of the important requirements to achieve “Zero Human rabies deaths by 2030” is to build awareness of the PEP and care for exposed victims. So, this study was undertaken with the aim and objective to study knowledge, attitude and practices related to animal bite transmitting rabies, amongst medical officer.Methods: A cross sectional study was done among 95 medical officer. Pretested and structured questionnaire was prepared related to training sessions conducted and their knowledge, attitude and practices (KAP) related to rabies prophylaxis. Data was entered and analysed using Microsoft Excel 16 version. Percentages were calculated and appropriate statistical test were applied.Results: None of them had received training on rabies prophylaxis. Regarding WHO categorization of animal bite, 69.5% participants had sufficient knowledge about category III, 47.4% about category II and 42.10% about Category I. Only 4.21% participants were aware of the preexposure prophylaxis and 29.47% participants had sufficient knowledge about intradermal (ID). schedule. Attitude was poor (47.40%) regarding willingness of administrating equine antirabies serum at their setup. 81% practiced immediate wound toileting and 45.30% of participants administered ARV by intradermal route. All patients were referred to tertiary care centre for administration of ARS and 82.10% of participants referred the patients immediately.Conclusions: There was an apparent lack of awareness seen in rabies prophalaxis and management. Effort should be taken to emphasize the importance PEP management through regular reorientation programs.

A cross-sectional study among defaulters of DOTS under RNTCP in tuberculosis units of Solapur city

Background: Tuberculosis (TB) is a specific infectious disease caused by mycobacterium tuberculosis affecting pulmonary and extra-pulmonary organs. Default is one of the unfavorable outcomes for patients on DOTS and represents an important challenge for the control programme. Inadequate treatment adherence is considered as a potential cause of drug resistance. This study was conducted ascertain causes of defaults & to study socio-demographic corelates of defaulters.Methods: A cross-sectional study was conducted from 1st January 2014 to 31st December 2014. All default patients registered from 1st January 2014 to 31st December 2014 under RNTCP in both Tuberculosis Units of Municipal Corporation are considered for this study.Results: Total 104 cases of defaulters were registered under RNTCP in both TB units; 83 (79.8%) defaulters were males and remaining 21 (21.2%) were females and difference was statistically significant. Side effects of DOTS drugs were the most common reason of defaulting the treatment. Default of DOTS was significantly associated with socioeconomic status, educational status, addiction, religion and marital status of the patients.Conclusions: Poverty has effect on illness and completion of treatment.

Novel mutation in Cul7 gene in a family diagnosed with 3M syndrome

This study evaluates a family with two siblings having severe growth retardation and facial dysmorphism, born to consanguineous normal healthy parents. Affymetrix CytoScan 750K microarray showed a 34-Mb pericentric homozygous region on chromosome 6 for both siblings. CUL7 was one of the 141 genes present in this region. Sanger sequencing of CUL7 gene detected a 2-bp novel deletion in the 15th exon (c.2943_2944delCT of the cDNA). This deletion leads to a frameshift and a premature termination signal much upstream of the wild-type termination signal, leading to a nonsense mediated decay of the mRNA. CUL7 protein plays an important role in formation of 3M complex, ubiquitination, microtubule dynamics and cell cycle regulation. Mutations in CUL7 gene is known to cause a rare 3M syndrome. Information about the novel mutation has been accepted in the ClinVar database with rs1064792895.

Collagenase Clostridium Histolyticum Injection for Dupuytren Contracture: 2-Year Follow-up

BACKGROUND: Dupuytren disease is characterized by the development of palmar fibrous tissue that can lead to fixed flexion contracture (FFC) and contribute to functional loss of the involved digits. Our goal was to investigate rates of contracture resolution and recurrence in patients who underwent enzymatic fasciotomy for Dupuytren contracture consisting of collagenase clostridium histolyticum (CCH) injection followed by passive manipulation combined with splinting and home-based therapy. METHODS: We prospectively enrolled 34 patients (44 metacarpophalangeal [MCP] and 33 proximal interphalangeal [PIP] joints) treated by one orthopaedic hand surgeon between November 2010 and November 2014. On day 1, CCH was injected into a palpable fibrous cord of the involved fingers. The next day, the finger was passively extended to its maximal corrective position. FFC was measured for each joint before injection and immediately after manipulation. Patients were instructed to wear an extension splint at night and perform stretching exercises at home and were re-evaluated at 6 weeks, 4 months, 1 year, and 2 years. Resolution was defined as improvement of contracture to ≤ 5° of neutral. Recurrence was defined as an increase in FCC of ≥ 20° after treatment. RESULTS: Immediate contracture resolution occurred in 42 of 44 MCP joints (p < 0.001), improving from 50° to 1.5°, and in 14 of 33 PIP joints (p = 0.182), improving from 44° to 16°. Four joints had recurrence within 6 weeks. Of the 48 joints with minimum 4-month follow-up (mean, 26 months), 12 had recurrence at 2-year follow-up (MCP, 6; PIP, 6). At 2-year follow-up, MCP and PIP contractures measured 17° and 35.5°, respectively. Older age and multiple digit involvement were associated with higher recurrence rates. CONCLUSIONS: CCH offers a safe, nonoperative option to correct FCC in Dupuytren disease with greater success for MCP joints compared to PIP joints. There is a tendency of reoccurrence within 2 years of treatment. Further investigation is needed to determine optimal timing of repeat CCH injection to improve upon or extend the period of contracture resolution.

Immunogenic and antigenic heterogeneity of Blastocystis sp. subtype 3 from symptomatic and asymptomatic individuals

@#Blastocystis sp. subtype 3 (ST3) has been implicated previously to be phenotypically heterogeneous between isolates from symptomatic and asymptomatic persons in previous studies. The aim of this study is to identify the immunogenic and antigenic heterogeneity among three different isolates of Blastocystis sp. ST3 isolated from asymptomatic and symptomatic individuals. Immunogenic and antigenic profile of ST3 isolates was assessed through splenocyte proliferation, cytokine assessment and antibody measurements. The total IgG antibody responses in mice immunised with symptomatic (0.736±0.033) and asymptomatic (0.426±0.025) of ST3 Blastocystis sp. were significantly higher compared to the controls respectively. High secretions of IgG antibody mixture of IgG1/IgG2a antibodies were detected in sera of mice immunised with symptomatic and asymptomatic solubilised Blastocystis sp. Antigen (Blastocystis-Ag). Predominant IgG1 production was detected higher in mice injected with Blastocystis sp. ST 3 from asymptomatic individuals (0.148±0.016) (P<0.05) whereas predominant IgG2a production was detected higher in mice injected with the same subtype but from the symptomatic individuals (0.355±0.021). This data was supported by the production of significantly higher Th1 (IFNγ and IL-2) response (393.56±49.21) and (628.89±31.06) respectively in symptomatic isolates compared to Th2 (IL-4 and IL-10) response (93±7.85) and (103.22±11.33) in asymptomatic isolates after in-vitro stimulations. Splenocyte stimulation index (SI) was detected higher in symptomatic Blastocystis-Ag group. This study is the first to demonstrate antigenic and immunogenic heterogeneity among ST3 symptomatic and asymptomatic Blastocystis-Ag with symptomatic isolates being highly immunogenic and antigenic. No significant variations among the three isolates of asymptomatic and symptomatic groups. The study supports the suggestion from previous study that surface variations between symptomatic and asymptomatic isolates as well their distinct phenotypic variation despite being the same subtype may have caused the differences in the distinct immune responses.

Epónimos en la anatomía y radiología de cabeza y cuello / Eponyms in Head and Neck Anatomy and Radiology

En el lenguaje médico, el uso de epónimos es frecuente. Si bien comúnmente se piensa que los epónimos están en vías de extinción, eso no es totalmente cierto. Existe disenso entre quienes creen que su uso debería abandonarse y quienes abogan que los epónimos convierten términos inmemorables en memorizables, transmiten conceptos complejos y promueven el interés en la historia de la Medicina. Nos sentimos parte de ese segundo grupo y nuestra intención es hacer una revisión de ocho epónimos vinculados a la Anatomía y Radiología de cabeza y cuello. Creemos que ese abordaje puede ser útil para la educación de estudiantes de Medicina, residentes y especialistas en diagnóstico por imágenes.

The use of eponyms in medical language is frequent. While it is commonly thought that eponyms are on their way to extinction, this is not entirely true. There is dissent between those who believe that their use should be abandoned and those who advocate that eponyms make unmemorable terms memorable, convey complex concepts and promote interest in the history of medicine. We feel part of this second group, and our intention is to make a review of eight eponyms linked to head and neck anatomy and radiology. We believe that this approach can be useful for the education of medical students, residents and diagnostic imaging specialists.

Peripheral Cemento-Ossifying Fibroma withUncommon Clinical Presentation: A Case Report / Fibroma periférico cemento-ossificante con una presentación clínica poco común: Reporte de caso

Abstract Peripheral cemento-ossifying fibroma (PCOF) is a reactive gingival over growth, occurring frequently in the maxillary anterior region of teenage and young females. Peripheral cemento-ossifying fibroma (PCOF) is supposed to be originating from periosteum and/or periodontal ligament. A large number of factors have been implicated in the pathogenesis of PCOF, which includes trauma, local irritation, calculus and hormonal disturbances. The definitive diagnosis of PCOF is based upon its clinical, radiological and histological features. Because of the high recurrence rate (8-20%) of PCOF, a close post-operative follow-up is required. Herewith, we are presenting a case of PCOF in 24-year old female patient at an uncommon location.

Resumen El fibroma cemento-osificante periférico (PCOF, por sus siglas en inglés) es un crecimiento gingival reactivo, que se produce con frecuencia en la región anterior del maxilar en adolescentes y mujeres jóvenes. Se supone que el fibroma cemento-osificante periférico (PCOF) se origina en el periostio y/o el ligamento periodontal. Una gran cantidad de factores han sido implicados en la patogénesis de PCOF, dentro de las que se incluye trauma, irritación local, cálculo y alteraciones hormonales. El diagnóstico definitivo de PCOF se basa en sus características clínicas, radiológicas e histológicas. Debido a la alta tasa de recurrencia (8-20%) , se requiere un seguimiento post-operatorio estricto. Mediante este artículo presentamos un caso de PCOF en una paciente de 24 años de edad y el manejo teraupético.

Efficacy Of Dhathu Bushti Chooranam In The Management Of Male Infertility With Special Reference To Oligospermia - An Open Pilot Study

Infertility is a common problem of new age couples. It is affecting them psychologically and also affecting the harmony of the family. Among infertility couples, 40% was caused by male partner particularly by oligospermia. Literally oligospermia means insufficient number of spermatozoa in semen, but significantly, it means that oligospermia is a medical condition characterized by the total sperm count less than 20 million/ml of ejaculate. Extensive clinical researches are going on worldwide to treat oligospermia by utilizing various natural sources like plants, mineral and animal origin. Siddha medicine is having many formulations to treat oligospermia, one among them is Dhathu bushti chooranam described in Noigalukku Siddha Parigaram –a Sasthiric siddha literature. 10 male partners of infertility couples attending Sool mahalir maruthuvam OPD of the Ayothidoss Pandithar Hospital, National Institute of Siddha, Tambaram sanatorium, Chennai-47 were recruited for this pilot study. All patients were treated with 10 gm of Dhathu bushti chooranam twice a day with milk for 90 days. All patients were subjected to complete semenogram on 0th and 90th day of treatment. Results were observed by analyzing the semenogram parameters. The ingredients of Dhathu bushti chooranam are Salamisiri, Nilapanai kizhangu,Thaneervittan kizhangu, Poonaikaali vidhai, Boomisarkkarai kizhangu and most of them are having good spermatogenesis and aphrodiasic activities, hence the author selected this drug for this study. The efficacy of the trial drug Dhathu bushti chooranam was appreciable and the drug may be taken for clinical trial in large number of population.

Carbon Dioxide versus Air Insufflation in Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) with air insufflation is commonly used for the staging and treatment of early gastric carcinoma. However, carbon dioxide (CO2) use has been shown to cause less post-procedural pain and fewer adverse events. The objective of this study was to compare the post-procedural pain and adverse events associated with CO₂ and air insufflation in ESD. METHODS: A systematic search was conducted for randomized control trials (RCTs) comparing the two approaches in ESD. The Mantel-Haenszel method was used to analyze the data. The mean difference (MD) and odds ratio (OR) were used for continuous and categorical variables, respectively. RESULTS: Four RCTs with a total of 391 patients who underwent ESD were included in our meta-analysis. The difference in maximal post-procedural pain between the two groups was statistically significant (MD, -7.41; 95% confidence interval [CI], -13.6 – -1.21; p=0.020). However, no significant differences were found in the length of procedure, end-tidal CO2, rate of perforation, and postprocedural hemorrhage between the two groups. The incidence of overall adverse events was significantly lower in the CO2 group (OR, 0.51; CI, 0.32–0.84; p=0.007). CONCLUSIONS:: CO2 insufflation in gastric ESD is associated with less post-operative pain and discomfort, and a lower risk of overall adverse events compared with air insufflation.

Bovine adenovirus type 3 virions cannot be rescued in vivo after full-length viral genome transfection in the absence of detectable polypeptide IX

Bovine adenovirus type 3 (BAdV3) is being used in the development of potential vehicles for gene therapy and vectored vaccine. To that end, a more comprehensive description of BAdV3 biology is essential. In this study, we focused on the role of pIX in BAdV3 virion rescue after full-length BAdV3 genome transfection. Initially, pIX deletion or initiation codon mutation abolished the production of progeny virions, which suggested that pIX was essential for the rescue of BAdV3 containing a full-length genome. Moreover, through transfection of a panel of pIX mutant BAdV3 genomes, we observed that the conserved N-terminus and the putative leucine zipper element (PLZP) were essential for virion rescue, whereas the C-terminus following the coiled-coil domain was non-essential. In addition, swap of the PLZP element and its following region of BAdV3 pIX to corresponding domains of human adenovirus type 5 (HAdV5) did not affect virion production, whereas swap of the entire pIX abolished production of progeny virions. We suggest that failure of the full-length BAdV3 pIX swap might be due to species specificity of its N-terminus region before the PLZP element.

Value addition of corn husks through enzymatic production of xylooligosaccharides

ABSTRACT Corn husks are the major wastes of corn industries with meagre economic significance. The present study was planned for value addition of corn husk through extraction of xylan, followed by its enzymatic hydrolysis into xylooligosaccharides, a pentose based prebiotic. Compositional analysis of corn husks revealed neutral detergent fibre 68.87%, acid detergent fibre 31.48%, hemicelluloses 37.39%, cellulose 29.07% and crude protein 2.68%. Irrespective of the extraction conditions, sodium hydroxide was found to be more effective in maximizing the yield of xylan from corn husks than potassium hydroxide (84% vs. 66%). Application of xylanase over the xylan of corn husks resulted into production of xylooligosaccharides with different degree of polymerization namely, xylobiose and xylotriose in addition to xylose monomer. On the basis of response surface model analysis, the maximum yield of xylobiose (1.9 mg/ml) was achieved with the enzymatic hydrolysis conditions of pH 5.8, temperature 44°C, enzyme dose 5.7U/ml and hydrolysis time of 17.5h. Therefore, the corn husks could be used as raw material for xylan extraction vis a vis its translation into prebiotic xylooligosaccharides.

Inverted and impacted maxillary and mandibular third molar: unusual case reports with review of the literature

Inversion has been defined as the malposition of a tooth in which the tooth is reversed and positioned upside down. Very few cases of inverted and impacted third molars have been reported in the literature. The most common location of such a third molar in the mandible is in the ascending ramus. In the maxilla, the teeth may be displaced as far as the floor of the orbit. Two cases of inverted and impacted third molars are described. They were conservatively managed without surgery. The two cases are reported because impaction with inversion of a molar tooth is not common