Modulating the production of xylanase by Bacillus pumilus BS131 through optimization using waste fiber sludge / Modulando a produção de xilanase por Bacillus pumilus BS131 por meio da otimização usando lodo de fibra residual

Abstract In recent days, cheapest alternative carbon source for fermentation purpose is desirable to minimize production cost. Xylanases have become attractive enzymes as their potential in bio-bleaching of pulp and paper industry. The objective of the present study was to identify the potential ability on the xylanase production by locally isolated Bacillus pumilus BS131 by using waste fiber sludge and wheat bran media under submerged fermentation. Culture growth conditions were optimized to obtain significant amount of xylanase. Maximum xylanase production was recorded after 72 hours of incubation at 30 °C and 7 pH with 4.0% substrate concentration. In the nutshell, the production of xylanase using inexpensive waste fiber sludge and wheat-bran as an alternative in place of expensive xylan substrate was more cost effective and environment friendly.

Resumo Nos últimos dias, a fonte alternativa de carbono mais barata para fins de fermentação é desejável para minimizar o custo de produção. As xilanases têm se tornado enzimas atraentes como seu potencial no biobranqueamento da indústria de papel e celulose. O objetivo do presente estudo foi identificar a capacidade potencial na produção de xilanase por Bacillus pumilus BS131 isolado localmente usando lodo de fibra residual e farelo de trigo em meio de fermentação submersa. As condições de crescimento da cultura foram otimizadas para obter uma quantidade significativa de xilanase. A produção máxima de xilanase foi registrada após 72 horas de incubação a 30 °C e pH 7 com concentração de substrato de 4,0%. Resumindo, a produção de xilanase usando lodo de fibra residual de baixo custo e farelo de trigo como uma alternativa no lugar do substrato de xilano caro foi mais econômica e ecológica.

Glycogen synthase kinase-3 (GSK-3) a magic enzyme: it's role in diabetes mellitus and glucose homeostasis, interactions with fluroquionlones. A mini-review / Glicogênio sintase quinase-3 (GSK-3), uma enzima mágica: seu papel no diabetes mellitus e na homeostase da glicose: interações com fluoroquinolonas. Uma mini-revisão

Abstract Diabetes mellitus (DM) is a non-communicable disease throughout the world in which there is persistently high blood glucose level from the normal range. The diabetes and insulin resistance are mainly responsible for the morbidities and mortalities of humans in the world. This disease is mainly regulated by various enzymes and hormones among which Glycogen synthase kinase-3 (GSK-3) is a principle enzyme and insulin is the key hormone regulating it. The GSK-3, that is the key enzyme is normally showing its actions by various mechanisms that include its phosphorylation, formation of protein complexes, and other cellular distribution and thus it control and directly affects cellular morphology, its growth, mobility and apoptosis of the cell. Disturbances in the action of GSK-3 enzyme may leads to various disease conditions that include insulin resistance leading to diabetes, neurological disease like Alzheimer's disease and cancer. Fluoroquinolones are the most common class of drugs that shows dysglycemic effects via interacting with GSK-3 enzyme. Therefore, it is the need of the day to properly understand functions and mechanisms of GSK-3, especially its role in glucose homeostasis via effects on glycogen synthase.

Resumo O diabetes mellitus (DM) é uma doença não transmissível em todo o mundo, na qual existe nível glicêmico persistentemente alto em relação à normalidade. O diabetes e a resistência à insulina são os principais responsáveis ​​pelas morbidades e mortalidades de humanos no mundo. Essa doença é regulada principalmente por várias enzimas e hormônios, entre os quais a glicogênio sintase quinase-3 (GSK-3) é uma enzima principal e a insulina é o principal hormônio que a regula. A GSK-3, que é a enzima-chave, normalmente mostra suas ações por vários mecanismos que incluem sua fosforilação, formação de complexos de proteínas e outras distribuições celulares e, portanto, controla e afeta diretamente a morfologia celular, seu crescimento, mobilidade e apoptose do célula. Perturbações na ação da enzima GSK-3 podem levar a várias condições de doença que incluem resistência à insulina que leva ao diabetes, doenças neurológicas como a doença de Alzheimer e câncer. As fluoroquinolonas são a classe mais comum de drogas que apresentam efeitos disglicêmicos por meio da interação com a enzima GSK-3. Portanto, é necessário hoje em dia compreender adequadamente as funções e mecanismos da GSK-3, principalmente seu papel na homeostase da glicose via efeitos na glicogênio sintase.

A Variação Anormal da Pressão Arterial Circadiana está Associada aos Escores SYNTAX em Pacientes Hospitalizados com Síndrome Coronariana Aguda / Abnormal Circadian Blood Pressure Variation is Associated with SYNTAX Scores in Hospitalized Patients with Acute Coronary Syndrome

Resumo Fundamento Menor redução da pressão arterial (PA) noturna, conhecida como hipertensão não-dipper, é um forte preditor de morbimortalidade cardiovascular. Objetivos Este estudo visou investigar a relação entre a hipertensão não-dipper e a gravidade e complexidade da doença arterial coronariana usando o escore SYNTAX em pacientes hospitalizados com síndrome coronariana aguda. Métodos Foram selecionados 306 pacientes consecutivos com síndrome coronariana aguda. Pacientes clinicamente estáveis internados na unidade de terapia intensiva intermediária pelo menos 24 horas após a angiografia e/ou revascularização bem sucedida. Após os critérios de exclusão, foram incluídos 141 pacientes (34 mulheres e 107 homens; idade média 61 ± 11 anos). A hipertensão não-dipper foi definida como uma queda de 0% a 10% na PA sistólica média durante a noite em comparação com o dia, medida em intervalos de 1 hora, usando o mesmo dispositivo automático de medição de PA em monitores de beira de leito (Vismo PVM-2701; Nihon Kohden Corp., Tóquio, Japão). O escore SYNTAX foi calculado com uma calculadora online. Os preditores independentes do escore SYNTAX foram avaliados por meio de análise de regressão logística multivariada. P < 0,05 foi considerado estatisticamente significativo. Resultados Os pacientes com hipertensão não-dipper apresentaram escore SYNTAX maior do que os pacientes com hipertensão dipper (11,12 ± 6,41 versus 6,74 ± 6,45, p < 0,0001). Em um modelo de regressão logística multivariável, o status de hipertensão não dipper (odds ratio: 5,159; intervalo de confiança de 95%: 2,246 a 11,852, p < 0,001), sexo (p = 0,012) e colesterol de lipoproteína de baixa densidade (p = 0,008) emergiram como preditores independentes de alto escore SYNTAX. Conclusões Os resultados do nosso estudo fornecem um possível mecanismo adicional ligando o perfil anormal da PA circadiana à gravidade e à complexidade da doença arterial coronariana em pacientes com síndrome coronariana aguda.

Abstract Background Blunted nocturnal blood pressure (BP) reduction, referred to as non-dipper hypertension, is a strong predictor of cardiovascular morbidity and mortality. Objectives This study aimed to investigate the relationship between non-dipper hypertension and the severity and complexity of coronary artery disease using SYNTAX score in hospitalized patients with acute coronary syndrome. Methods A total of 306 consecutive patients with acute coronary syndrome were screened. Patients who were clinically stable and admitted to the intermediate intensive care unit at least 24 hours after angiography and/or successful revascularization. After the exclusion criteria, 141 patients (34 female and 107 male; mean age 61 ± 11 years) were included. Non-dipper hypertension has been defined as a 0% to 10% decrease in average systolic BP at nighttime compared to daytime, measured at hourly intervals using the same automatic BP measuring device on bedside monitors (Vismo PVM-2701; Nihon Kohden Corp., Tokyo, Japan). SYNTAX score was calculated with an online calculator. The independent predictors of SYNTAX score were assessed using multivariable logistic regression analysis. P < 0.05 was considered statistically significant. Results The patients with non-dipper hypertension had higher SYNTAX score than the patients with dipper hypertension (11.12 ± 6.41 versus 6.74 ± 6.45, p < 0.0001). In a multivariable logistic regression model, non-dipper hypertension status (odds ratio: 5.159; 95% confidence interval: 2.246 to 11.852, p < 0.001), sex (p = 0.012) and low-density lipoprotein cholesterol (p = 0.008) emerged as independent predictors of high SYNTAX score. Conclusions The results of our study provide a possible additional mechanism linking abnormal circadian BP profile with coronary artery disease severity and complexity in patients with acute coronary syndrome.

Episode of Hepatitis C viral infection in the people of Swat, Pakistan / Episódio de infecção viral por Hepatite C no povo de Swat, Paquistão

ABSTRACT Infectious agents cause serious diseases in humans worldwide and are responsible for the high rate of morbidity and mortality. The prevalence and epidemiology of infectious disease (HCV) in the hospital visited patients referred by the physicians through the initial findings and their associated risk factors were studied in Swat. The data of 174 infected patients were collected during the period of 2015 to 2017 from two clinical laboratories of Tehsil Matta Swat. Inform consent form was taken before blood collection. After taking informed consent blood samples were collected and ICT test was performed and then ICT positive cases were conform through PCR. A total of 174 ICT positive samples [106 male and 68 females] were included in this study. Age was considered from 10 to 72 years. Of the 174 ICT strip positive, 99 [63 males, 36 females] were confirmed through PCR. The prevalence rate was recorded 56.89%. I.V/I.M injection was recorded in 100% of the individuals. Visits to the barber shop was reported in (58%) of the individuals, married individuals were (81.0), surgical operation was reported in (44.8%), sharing toothbrush was observed in (29.9%), piercing was reported in (39.7%), family history was reported in (26.4%), dental treatment was observed in (21.8%), jaundice were (13.2%) and tattooing was (1.7%). Blood transfusion, surgical operations, Jaundice, family history and dental treatment were found significant risk factors for acquiring HCV infection. It was concluded that proper implementation of precautionary measures should be needed to control the spread of HCV in far near future.

RESUMO Agentes infecciosos causam doenças graves em humanos em todo o mundo, e são responsáveis pelo alto índice de morbimortalidade. A prevalência e a epidemiologia das doenças infecciosas no hospital que atendeu pacientes encaminhados pelos médicos por meio dos achados iniciais e seus fatores de risco associados foram estudadas em Peshawar. Os dados de 174 pacientes infectados foram coletados durante o período de 2015 a 2017 oriundos de dois laboratórios clínicos de Tehsil Matta Swat. O formulário de consentimento informado foi obtido antes da coleta de sangue. Após a obtenção do consentimento informado, foram coletadas amostras de sangue e foi realizado o teste ICT e, em seguida, os casos ICT positivos foram confirmados por PCR. Um total de 174 amostras ICT positivas [106 homens e 68 mulheres] foi incluído neste estudo. A idade considerada foi de 10 a 72 anos. Das 174 tiras de ICT positivas, 99 casos [63 homens, 36 mulheres] foram confirmados por PCR. A taxa de prevalência foi de 56,89%. A injeção IV / IM foi registrada em 100% dos indivíduos. A visita à barbearia foi relatada em (58%) dos indivíduos, os números de casados foram (81,0%), e a operação cirúrgica foi relatada em (44,8%), o compartilhamento de escova de dente foi observado em (29,9%), o piercing foi relatado em (39,7%), antecedentes familiares foram relatados em (26,4%), tratamento odontológico em (21,8%), icterícia (13,2%) e tatuagem em (1,7%). Transfusão de sangue, operações cirúrgicas, icterícia, histórico familiar e tratamento odontológico foram fatores de risco significativos para adquirir infecção por Vírus da Hepatite C (VHC). Concluiu-se que a implementação adequada de medidas de precaução deve ser necessária para controlar a propagação do VHC em um futuro próximo.

Population structure and phylogenetic relationships in Brassica rapa L. subspecies by using isozyme markers / Estrutura populacional e relações filogenéticas em subespécies de Brassica rapa L. utilizando marcadores isoenzimáticos

Abstract The present study aimed to assess population structure and phylogenetic relationships of nine subspecies of Brassica rapa L. represented with thirty-five accessions cover a wide range of species distribution area using isozyme analysis in order to select more diverse accessions as supplementary resources that can be utilized for improvement of B. napus. Enzyme analysis resulted in detecting 14 putative polymorphic loci with 27 alleles. Mean allele frequency 0.04 (rare alleles) was observed in Cat4A and Cat4B in sub species Oleifera accession CR 2204/79 and in subspecies trilocularis accessions CR 2215/88 and CR 2244/88. The highest genetic diversity measures were observed in subspecies dichotoma, accession CR 1585/96 (the highest average of observed (H0) and expected heterozygosity (He), and number of alleles per locus (Ae)). These observations make this accession valuable genetic resource to be included in breeding programs for the improvement of oilseed B. napus. The average fixation index (F) is significantly higher than zero for the analysis accessions indicating a significant deficiency of heteozygosity. The divergence among subspecies indicated very great genetic differentiation (FST = 0.8972) which means that about 90% of genetic diversity is distributed among subspecies, while 10% of the diversity is distributed within subspecies. This coincides with low value of gene flow (Nm = 0.0287). B. rapa ssp. oleifera (turnip rape) and B. rapa ssp. trilocularis (sarson) were grouped under one cluster which coincides with the morphological classification.

Resumo O presente estudo teve como objetivo avaliar a estrutura populacional e as relações filogenéticas de nove subespécies de Brassica rapa L. representadas com 35 acessos, cobrindo uma ampla gama de áreas de distribuição de espécies usando análise isoenzimática, a fim de selecionar acessos mais diversos como recursos suplementares que podem ser utilizados para melhoria de B. napus. A análise enzimática resultou na detecção de 14 loci polimórficos putativos com 27 alelos. A frequência média de 0,04 alelo (alelos raros) foi observada em Cat4A e Cat4B, nas subespécies Oleifera CR 2204/79 e nas subespécies trilocularis CR 2215/88 e CR 2244/88. As maiores medidas de diversidade genética foram observadas na subespécie dicotômica CR 1585/96 (a média mais alta observada (H0) e heterozigosidade esperada (He) e número de alelos por locus (Ae). Essas observações tornam esse acesso um valioso recurso genético a ser incluído em programas de melhoramento de oleaginosas B. napus. O índice médio de fixação (F) é significativamente maior que 0 para os acessos à análise, indicando uma deficiência significativa de heterozigose. A divergência entre as subespécies indicou uma grande diferenciação genética (FST = 0,8972), o que significa que cerca de 90% da diversidade genética é distribuída entre as subespécies, enquanto 10% da diversidade é distribuída nas subespécies. Isso coincide com o baixo valor do fluxo gênico (Nm = 0,0287). B. rapa ssp. oleifera (nabo) e B. rapa ssp. trilocularis (sarson) foram agrupados conforme a classificação morfológica.

Prevalence and causes of avoidable blindness and visual impairment, including the prevalence of diabetic retinopathy in Siwan district of Bihar, India: A population-based survey

Purpose: The aim of this study was to estimate the prevalence and causes of visual impairment (VI) and blindness and diabetic retinopathy (DR) in Siwan district, Bihar. Methods: A population-based cross-sectional study was done from January to March 2016 using the Rapid Assessment of Avoidable Blindness 6 (RAAB 6, incorporating DR module) methodology. All individuals aged ?50 years were examined in 57 randomly selected clusters within the district. Results: A total of 3476 individuals were enumerated and 3189 (92%) completed examination. The overall prevalence of blindness and severe VI was 2.2% (95% confidence interval (CI): 1.6–2.8) and 3.4% (95% CI: 2.6–4.3), respectively. Untreated cataract was the leading cause of blindness (73%) and severe VI (93%). The cataract surgical coverage (CSC) at <3/60 was 71.5% for eyes and 89.3% for persons in this sample and the CSC was similar between the genders. Refractive error (71%) was the primary cause of early VI. The overall prevalence of known and newly diagnosed diabetes was 6.3% (95% CI, 5.4–7.2%). Prevalence of any DR, maculopathy, and sight-threatening DR was 15, 12.4, and 6%, respectively. Conclusion: To conclude, as compared to previous reports, the prevalence of blindness and DR in Siwan district of Bihar was found to be lower and the CSC was higher. However, the problem of avoidable blindness remains a major problem in this region.

Bioengineering Approaches for Corneal Regenerative Medicine

BACKGROUND@#Since the cornea is responsible for transmitting and focusing light into the eye, injury or pathology affecting any layer of the cornea can cause a detrimental effect on visual acuity. Aging is also a reason for corneal degeneration. Depending on the level of the injury, conservative therapies and donor tissue transplantation are the most common treatments for corneal diseases. Not only is there a lack of donor tissue and risk of infection/rejection, but the inherent ability of corneal cells and layers to regenerate has led to research in regenerative approaches and treatments. @*METHODS@#In this review, we first discussed the anatomy of the cornea and the required properties for reconstructing layers of the cornea. Regenerative approaches are divided into two main categories; using direct cell/growth factor delivery or using scaffold-based cell delivery. It is expected delivered cells migrate and integrate into the host tissue and restore its structure and function to restore vision. Growth factor delivery also has shown promising results for corneal surface regeneration. Scaffold-based approaches are categorized based on the type of scaffold, since it has a significant impact on the efficiency of regeneration, into the hydrogel and non-hydrogel based scaffolds. Various types of cells, biomaterials, and techniques are well covered. @*RESULTS@#The most important characteristics to be considered for biomaterials in corneal regeneration are suitable mechanical properties, biocompatibility, biodegradability, and transparency. Moreover, a curved shape structure and spatial arrangement of the fibrils have been shown to mimic the corneal extracellular matrix for cells and enhance cell differentiation. @*CONCLUSION@#Tissue engineering and regenerative medicine approaches showed to have promising outcomes for corneal regeneration. However, besides proper mechanical and optical properties, other factors such as appropriate sterilization method, storage, shelf life and etc. should be taken into account in order to develop an engineered cornea for clinical trials.

Bioengineering Approaches for Corneal Regenerative Medicine

BACKGROUND@#Since the cornea is responsible for transmitting and focusing light into the eye, injury or pathology affecting any layer of the cornea can cause a detrimental effect on visual acuity. Aging is also a reason for corneal degeneration. Depending on the level of the injury, conservative therapies and donor tissue transplantation are the most common treatments for corneal diseases. Not only is there a lack of donor tissue and risk of infection/rejection, but the inherent ability of corneal cells and layers to regenerate has led to research in regenerative approaches and treatments. @*METHODS@#In this review, we first discussed the anatomy of the cornea and the required properties for reconstructing layers of the cornea. Regenerative approaches are divided into two main categories; using direct cell/growth factor delivery or using scaffold-based cell delivery. It is expected delivered cells migrate and integrate into the host tissue and restore its structure and function to restore vision. Growth factor delivery also has shown promising results for corneal surface regeneration. Scaffold-based approaches are categorized based on the type of scaffold, since it has a significant impact on the efficiency of regeneration, into the hydrogel and non-hydrogel based scaffolds. Various types of cells, biomaterials, and techniques are well covered. @*RESULTS@#The most important characteristics to be considered for biomaterials in corneal regeneration are suitable mechanical properties, biocompatibility, biodegradability, and transparency. Moreover, a curved shape structure and spatial arrangement of the fibrils have been shown to mimic the corneal extracellular matrix for cells and enhance cell differentiation. @*CONCLUSION@#Tissue engineering and regenerative medicine approaches showed to have promising outcomes for corneal regeneration. However, besides proper mechanical and optical properties, other factors such as appropriate sterilization method, storage, shelf life and etc. should be taken into account in order to develop an engineered cornea for clinical trials.

The effect of different mouth washes and text messages reminder in the oral health of orthodontic patients

Aim: The aim of this study was to investigate the effect of different mouth washes and to study the effect of text message reminder on the oral health status of orthodontic patients treated with fixed appliances. Methods: This study was a clinical trial with pre-test and post-test control group design, conducted on 24 patients undergoing fixed orthodontic treatment aged 15-30 years. The patients randomly divided into two groups; one received a weekly telephone text massage reminder for the instructions of brushing and rinsing while the second group did not receive any messages. Ortho-plaque index and gingival index were used to evaluate the patient's oral hygiene status. The reading indices after brushing only were regarded as a control, then the patients were instructed to use two mouth washes, one containing sodium fluoride with cetylpyridinium chloride, the second containing chlorhexidine digluconate with cetylpyridinium chloride and Aloe Vera. Each one was used routinely for 4 weeks with the same amount and method. The washout period between the two types mouth washes was 4 weeks with a standardized toothbrush and paste. Results: Ortho-plaque index values decreased over the time between first, second and third visits. However, this index raised up at the fourth visit and again dropdown at the fifth visit. Similar results were detected for gingival index. Also, significant interaction between messages and the assessments was recorded for gingival index with a significant difference between the group of text messages and without text messages group (p<0.05). Conclusions: The results of this study showed that the combination of sodium fluoride with cetylpyridinium chloride was more potent for plaque control, while chlorhexidine digluconate with cetylpyridinium chloride and Aloe Vera combination showed a better gingival improvement. Moreover, the text messages reminder could enhance, but not replace direct oral hygiene instruction in orthodontic patients

Presystolic Wave is Associated with Subclinical Left Ventricular Dysfunction Assessed by Myocardial Performance Index in Type 2 Diabetes Mellitus / Onda Pressistólica Associada à Disfunção Ventricular Esquerda Subclínica e Avaliada com Base no Índice de Performance Miocárdica em Pacientes com Diabetes Mellitus Tipo 2

Abstract Background: Myocardial performance index (MPI), demonstrates both systolic and diastolic functions of the left ventricle. Presystolic wave (PSW) is frequently detected on Doppler examination of the left ventricular outflow tract and possible mechanism of PSW is impaired LV compliance and left ventricular stiffness. Objective: To investigate the relationship between PSW and MPI in type 2 diabetic patients. Method: A total of 129 type 2 diabetic patients were included in this study. Patients were divided into two groups according to the presence of PSW on Doppler echocardiography. There were 90 patients (38 male, mean age 57.77 ± 10.91 years) in the PSW-positive group and 39 patients (13 male; mean age: 55.31 ± 11.29 years) in the PSW-negative group. The p values of < 0.05 were considered statistically significant. Results: MPI was higher in PSW- positive group (0.63 ± 0.17vs 0.52 ± 0.13, p < 0.001). In addition, subclinical left ventricle dysfunction (LVD) was higher in the PSW- positive group (p = 0.029). Univariate analysis showed that the presence of PSW associated with abnormal MPI (p = 0.031). Pearson correlation analysis showed that PSW velocity correlated with MPI (r: 0.286, p = 0.006). Conclusion: Presence of the PSW on Doppler examination was associated with subclinical LV dysfunction in patients with DM type 2. This easy-to-perform echocardiographic parameter may be related to subclinical LVD among patients with type 2 DM.

Resumo Fundamento: O índice de performance miocárdica (IPM) avalia as funções sistólica e diastólica do ventrículo esquerdo. A onda pressistólica (OPS) é geralmente detectada no exame Doppler da via de saída do ventrículo esquerdo e seus possíveis mecanismos são complacência prejudicada e rigidez do ventrículo esquerdo. Objetivo: Investigar a relação entre OPS e IPM em pacientes com diabetes tipo 2. Método: 129 pacientes com diabetes tipo 2 foram incluídos no estudo. Os sujeitos foram alocados em dois grupos, com base na presença de OPS no exame ecocardiográfico com Doppler. Foram incluídos 90 pacientes (38 homens, idade média 57,77 ± 10,91 anos) no grupo OPS-positiva e 39 pacientes (13 homens; idade média 55,31 ± 11,29 anos) no grupo OPS-negativa. Valor de p < 0,05 foi considerado para significância estatística. Resultados: O IPM foi mais alto no grupo OPS-positiva (0,63 ± 0,17 vs 0,52 ± 0,13, p < 0,001). Além disso, a disfunção ventricular esquerda subclínica (DVE) foi maior no grupo OPS-positiva (p = 0,029). Análise univariada mostrou associação de OPS com IPM anormal (p = 0,031), assim como o coeficiente de correlação de Pearson mostrou correlação entre velocidade de OPS e IPM (r: 0,286, p = 0,006). Conclusão: Presença de OPS na ecocardiografia com Doppler foi associada à DVE subclínica em pacientes com diabetes tipo 2. Esse exame ecocardiográfico de fácil execução pode ser relacionado à DVE subclínica entre pacientes com diabetes tipo 2.

Prevalence of refractive errors, uncorrected refractive error, and presbyopia in adults in India: A systematic review

Purpose: The objective of this review is to estimate the prevalence of refractive errors, uncorrected refractive error (URE), and uncorrected presbyopia in adults aged ?30 years in India. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. A detailed literature search was performed to include all studies published from India from the year 1990 using the Cochrane Library, Medline, and Embase. Refractive error was defined by >0.50 D ametropia. URE was defined by presenting visual acuity (PVA) worse than 6/18 improving with pinhole or spectacle correction, and uncorrected presbyopia by near vision Results: Fifteen studies were included from South India, one each from Western and Central India, and one study covered 15 states across India. The prevalence of RE of at least 0.50 D of spherical equivalent ametropia was 53.1% [(95% confidence interval (CI): 37.2–68.5), of which myopia and hyperopia was 27.7% and 22.9%, respectively. The prevalence of URE was 10.2% (95% CI: 6.9–14.8), but heterogeneity in these estimates was very high. The prevalence of uncorrected presbyopia was 33% (95% CI: 19.1–51.0). Conclusion: This review highlights the magnitude of refractive errors among adults in India. More studies are needed using standard methods in regions where there is a lack of information on UREs. Programs delivering spectacles for adults in India will need to primarily focus on reading glasses to correct presbyopia along with spectacles for hyperopia and myopia.

Comparison of Shear Bond Strength of Occlusal Pad Debonding Pliers Before and After Er-YAG Laser Application: An In vitro Study

Background: Er-YAG laser showed to be effective in debonding ceramic bracket from the enamel surface. Until lately, no previous study was conducted to assess the outcome of the laser in debonding ceramic brackets from tooth surface comparing it with conventional occlusal pad debonding pliers. Materials and methods: Total 60 ceramic brackets were bonded on the tooth surface which was divided randomly into 2 groups. One was assigned as a control non-lased group and the other was experimental lased groups. Er-YAG laser irradiated the experimental groups at the power of 5 W for 10 seconds with swiping motion and 50% air-water cooling. In the lased experimental group, the laser was applied at energy of 250 mJ, 20 Hz frequency, and pulse duration of 100 μs. Results: Shear bond strengths and adhesive remnant index scores were statistically calculated. A highly significant difference of SBS between the non-lased control group and the lased experimental group was observed (p<0.000). A non-significant difference in ARI scores was observed when the non-lased control group was compared with the lased experimental group. Conclusion: It could be concluded that Er-YAG laser is effective in ceramic bracket debonding. This protocol promotes debonding without bracket fracture or enamel surface cracks or damage.

Knowledge of final-year medical students at the University of KwaZulu-Natal about family medicine, and long-term career choices

Background: While international experience suggests that well-trained primary care physicians improve the quality and cost effectiveness of health care, family medicine (FM) as the discipline of the specialist primary care physician appears to not be an attractive career for medical graduates in South Africa (SA). The aim of this study was to establish final-year medical students' knowledge about FM and its relevance to the healthcare system, explore their perceptions of the discipline's relevance, and identify their specialty preference.Methods: This was a descriptive study conducted amongst final-year medical students at the University of KwaZulu-Natal (UKZN) in 2017 attheconclusion of their seven-week FM module. Data were collected using a self-administered questionnaire and results were analysed descriptively.Results: The response rate of completed questionnaires was 80.2% (157/196). Students reported limited exposure to FM in their early undergraduate years and low levels of awareness about essential public health programmes. Students showed good awareness of the six roles of family physicians (FPs), but FM was only the sixth most popular choice for specialisation. Conclusions: In general, students had favourable views concerning FM and its role in the future of healthcare delivery in SA,although their knowledge of essential health programmes was poor. The majority of students had limited interest in pursuing a career in FM. A key recommendation to address these issues is to introduce FM into the curriculum earlier, to cover the key roles of the FP, and provide teaching that highlights the relevance of FM to health system programmes

Serum CA 125, progesterone, and betaHCG levels in the differential diagnosis of abortion and ectopic pregnancy

This study aimed to investigate the role of serum cancer antigen [CA] 125, progesterone, and beta-human chorionic gonadotropin [betaHCG] levels in the differential diagnosis of intrauterine pregnancy, complete or incomplete abortion, and extrauterine pregnancy. This study was carried out in a teaching and research hospital between 2007 and 2009. A total of 175 patients with abortion, tubal ectopic pregnancy, and healthy pregnancy were recruited into the study. Pre- and post-treatment blood levels were compared among the groups. Serum betaHCG levels were higher in cases of normal healthy pregnancy than in cases of abortion and ectopic pregnancy. No difference was observed between serum betaHCG levels of abortion and ectopic pregnancy cases. The levels of serum CA 125 in abortions were found to be higher compared with the other two groups. The levels of serum progesterone in cases of ectopic pregnancy were found to be lower compared with the other two groups. The utilization of the serum betaHCG level in the differential diagnosis of normal/abnormal pregnancies and serum CA 125 and progesterone levels in the differential diagnosis of abortion and ectopic pregnancies are alternative parameters

Cataract surgery in patients with ocular surface disease: An update in clinical diagnosis and treatment

In this article we review essentials of diagnosis and management of ocular surface disease in patients who undergo cataract surgery. It is clearly shown that dry eye disease worsens following the cataract surgery in patients with prior history of ocular surface disease, Also new cases of dry eye might appear. Current strategies for the timely diagnosis and proper management of dry eye syndrome in the face of cataract surgery patients are mainly emphasized. To achieve the best outcome in cataract surgery, a healthy ocular surface is crucial. While ocular surface preparation is indispensable in patients with established ocular surface disease, it is also helpful in those with minimal signs or symptoms of surface disease. The current approach begins with early diagnosis and drastic management of ocular surface disease before cataract surgery using a stepwise regimen customized to each patient and disease severity. These measures are continued throughout and after the surgery

Multicentric myxoid liposarcoma; a case report and literature review

Llposarcoma is a common malignant soft tissue tumor, accounting for 10% to 16% of all sarcomas. Multicentric myxoid liposarcoma is an uncommon condition. Differentiation between several primary tumors and metastasis of a single liposarcoma represents the main difficulty in diagnosis. A 47-years old woman presented with right thigh myxoid liposarcoma and underwent wide margin tumor resection. Other investigations like CXR, abdominal and pelvic CT-scans were negative. After 18 months another myxoid liposarma was found in her ipsi-lateral breast without any evidence of other organs metastasis. Second lesion location, time between two presentation and cytogenetic differences are accepted criteria to site a sarcoma in multicentric category, but in myxoid liposarcoma these can be explained by the special features inherent to this tumor

Chlorpromazine induced ocular myasthenia gravis.

Drug induced bilateral ptosis is a very rare adverse drug reaction. Here we report a case of ten year old male child with chlorpromazine induced bilateral ptosis due to ocular myasthenia.

Intern’s knowledge of clinical pharmacology and therapeutics at Puducherry: a cross-sectional study.

Background: Internship is the intermediate period between under-graduation and general practice. The dexterity of health professional relies upon prescribing practices. Clinical pharmacology and therapeutics (CPT) is a crucial discipline for interns to acquire safe and rational prescription of drugs. Cultivating sound knowledge about CPT during under graduation is, henceforth, mandatory. Aims and objectives: 1. To assess whether the undergraduate CPT teaching and internship training had prepared interns adequately for safe and rational prescription. 2. To assess the awareness and reporting of adverse drug reaction (ADR). Methods: 110 interns were enrolled after obtaining informed written consent. A structured questionnaire was given to them including basic demographic information, undergraduate CPT teaching, experience of ADR and any deficiency in the under-graduate CPT teaching. Results: Response rate was 91 % in which 53 were males and 47 females. 81 considered themselves aware of CPT. 56% & 57% interns were able to prescribe drug safely and rationally respectively. Without supervision, they were confident to prescribe antacids (93%), vitamins and minerals (90%), NSAIDS (85%), antihistamines (82%), antibiotics (75%), antiemetics (62%) and antiasthmatics (52%). Only 22% had reported ADR and opined that it could lead to hospitalization (51%), prolonged hospital stay (33%), morbidity (16%) and death (21%). According to interns, the topics where more emphasis needed were ADR, dosage calculation, pediatric and emergency medicine and therapeutic drug monitoring during undergraduate CPT teaching. Conclusion: CPT teaching should be improved at undergraduate level for safe and rational prescribing including ADR monitoring, ADR reporting and dosage calculation.

Diagnostic value of CD56 and nm23 markers in papillary thyroid carcinoma.

Context: Thyroid cancer is the most common malignant endocrine tumor. Nowadays tissue biopsy and pathological assessment are the best diagnostic modalities for thyroid lesions. Differential diagnosis between adenomas and follicular variant of papillary thyroid carcinoma (PTC) is an important issue in pathology. Aims: This study is designed to show any association between expressions of CD56 and nm23 and types of thyroid lesions (benign vs. malignant). Settings and Design: In this cross-sectional study, 78 paraffin-embedded tissue blocks of thyroid tissue from a tertiary care center were selected, and assessed by using immunohistochemistry for expressions of CD56 and nm23 genes. Materials and Methods: we studied 39 benign and 39 malignant thyroid lesions, CD56 and nm23 expressions were determined by immunohistochemical staining, and the results were used for differentiation of benign and malignant lesions of thyroid. Statistical Analysis: The obtained results were analyzed and evaluated using SPSS (Version 18). Results: CD56 was expressed in 93% of benign specimens and in only 5% of malignant types. The sensitivity and specificity of this test were 94.8% and 92.3, respectively (P = 0.001). All malignant specimens and 95% of benign specimens were positive for nm23. The sensitivity and specificity of nm23 were 100% and 5%, respectively. Conclusion: Considering high sensitivity and specificity of CD56, it is possible to apply immunohistochemistry for definite diagnosis and differentiation of benign lesions from PTC. We conclude that by using this marker, the diagnostic mistakes in pathologic diagnosis of thyroid cancer versus benign lesions like thyroid adenoma will decrease.

Third-degree heart block in thalassemia major: a case report

First and second-degree heart blocks are partly common rhythm disorders in thalassemic patients but complete heart block is a very rare complication of iron overload cardiomyopathy. This 15-year-old boy, a known case of major beta-thalassemia was admitted to our emergency unit with dyspnea and cough because of decompensated heart failure. The electrocardiogram showed complete heart block with junctional escape rhythm. Interestingly, his previous electrocardiogram taken 2 months earlier, had some PVC and second degree, Mobitz type 1 [Wenckebach] heart block. After improvement of dyspnea and control of blood pressure in normal range, the patient was referred to ER. A dual-chamber permanent pacemaker was implanted and his symptoms improved, but he died 24 days after discharge from hospital. we present a rare case of complete heart block after a second-degree [Mobitz 1] heart block that was due to severe iron overload cardiomyopathy