Clinical significance of frusemide stress test in predicting the severity of acute kidney injury / Significância clínica do teste de estresse com furosemida na predição da gravidade da lesão renal aguda

Abstract Introduction: The outcomes of Acute Kidney Injury (AKI) remain dismal even today, owing in part due to the lack of an ideal biomarker for detecting renal damage early enough. We conducted this pilot study to determine the clinical significance of Frusemide Stress Test (FST) to predict the severity of AKI. Methods: A total of 80 patients with AKI-KDIGO (Kidney Disease: Improving Global Outcomes) stage 1 or stage 2 underwent FST by administering a bolus dose of frusemide (1mg/kg for frusemide naïve and 1.5mg/kg for prior frusemide exposure in the past week), and urine output was then measured for the next two hours with volume replacement as desirable. The progression to AKI-KDIGO stage 3 within 14 days of FST was studied as the primary outcome. The composite end point of achieving AKI-KDIGO stage 3 or death within 14 days of FST was studied as the secondary outcome. Results: Out of 80 patients, 28(35%) patients met the primary outcome, and 34(42.5%) patients met the secondary composite outcome. Except for baseline Chronic Kidney Disease (CKD) status (p=0.018), other demographic characteristics were comparable between progressors and non-progressors group. Using receiver operating characteristics (ROC) curve analysis, a cumulative 2-hour post-FST urine output of ≤300 mL predicted progression to stage 3 AKI with 82.14% sensitivity, 82.69% specificity, and AUC of 0.89±0.03 (p<0.0001). Conclusion: The FST showed promising results as a novel tubular biomarker to identify progression to severe AKI with good predictive ability.

Resumo Introdução: Os desfechos da Lesão Renal Aguda (LRA) permanecem desanimadores ainda hoje, em parte pela falta de um biomarcador ideal para detectar danos renais com a devida antecedência. Realizamos este estudo piloto para determinar a importância clínica do Teste de Estresse com Furosemida (TEF) em prever a gravidade da LRA. Métodos: Um total de 80 pacientes com LRA-KDIGO estágio 1 ou 2 foram submetidos ao TEF pela administração de uma dose em bolus de furosemida (1mg/kg para pacientes virgens de furosemida e 1,5mg/kg para exposição prévia à furosemida na semana anterior). O débito urinário foi então medido durante as duas horas seguintes com reposição de volume conforme desejável. A progressão para LRA-KDIGO estágio 3 dentro de 14 dias de TEF foi estudada como principal desfecho. O desfecho composto de atingir a LRA-KDIGO estágio 3 ou óbito em 14 dias após TEF foi estudado como desfecho secundário. Resultados: Dos 80 pacientes, 28 (35%) atingiram desfecho primário, e 34 (42,5%) pacientes atingiram o desfecho composto secundário. Exceto pelo estado basal da Doença Renal Crônica (DRC) (p=0,018), outras características demográficas foram comparáveis entre o grupo progressores e não progressores. Usando a análise da Curva Característica de Operação do Receptor (ROC), um débito urinário cumulativo de 2 horas pós-TEF de ≤300 mL previu a progressão para estágio 3 da LRA com 82,14% de sensibilidade, 82,69% de especificidade, e AUC de 0,89±0,03 (p<0,0001). Conclusão: O TEF mostrou resultados promissores como novo biomarcador tubular para identificar progressão para LRA grave com boa capacidade preditiva.

Remineralization efficacy of nonfluoride versus herbal-based pediatric dentifrice in demineralized primary teeth

Background: Dental caries is one of the most prevalent posteruptive bacterial infections worldwide, characterized by a progressive demineralization process that affects the mineralized dental tissues. Although the decline of dental caries prevalence can be attributed to the widespread use of dentifrices that contain fluoride, yet there is a need for an advanced alternative nonfluoride remineralizing dentifrice. Yet, there is a need for an advanced alternative nonfluoride remineralizing dentifrice. Aim: The aim of this study was to evaluate and compare the remineralizing effect of nonfluoride-based and herbal-based pediatric dentifrice in demineralized primary teeth with an ideal in vitro method of pH cycling and evaluating the values under Polarized Light Microscope (Olympus BX43) using image analysis software (ProgRes, Speed XT core3). Materials and Methods: A total of 30 tooth samples were collected and placed in the demineralizing solution for 96 h to produce a demineralized lesion of approximately 100 ?m, and then cut longitudinally into 60 sections that were randomly assigned to two groups with 27 samples each, Group A – nonfluoride-based dentifrice (Mee Mee®), Group B – herbal-based dentifrice (Mamaearth™), after which they were subjected to pH cycling for 7 days along with dentifrice slurry preparation. The sections were evaluated under the polarizing light microscopy for remineralizing efficacy. The lesion depth was measured and tabulated to be sent for statistical analysis. Results: The mean demineralization value for nonfluoride and herbal-based dentifrice groups were 7.8730 ?m and 28.3174 ?m, respectively. Hence, it can be inferred that since lesion depth measured was lesser in nonfluoride than herbal-based dentifrice, remineralization has occurred in the nonfluoride-based dentifrice group. Conclusion: Nonfluoride-based dentifrice showed significant results in remineralizing the demineralized lesion, while herbal-based dentifrice showed poor efficiency in remineralizing the demineralized lesion.

Repeated mild traumatic brain injury affects microbial diversity in rat jejunum

Traumatic brain injuries (TBI) manifest into post-traumatic stress disorders such as anxiety comorbid with gut ailments. Theperturbations in gut microbial communities are often linked to intestinal and neuropsychological disorders. We havepreviously reported anxiety and abnormalities in gut function in mild TBI (MTBI)-exposed rats. The current studydemonstrates the changes in gut microbiome of MTBI-exposed animals and discusses its implications in intestinal healthand behaviours. The rats were subjected to repeated MTBI (rMTBI) and microbial composition in jejunum was examinedafter 6 h, 48 h and 30 days of rMTBI. Significant reduction in bacterial diversity was observed in the rMTBI-exposedanimals at all the time points. Principal coordinate analysis based on weighted UniFrac distances indicated substantialdifferences in gut microbial diversity and abundances in rMTBI-exposed animals as compared to that in healthy controls.The abundance of Proteobacteria increased dramatically with reciprocal decrease in Firmicutes after rMTBI. At the genuslevel, Helicobacter, Lactobacillus, Campylobacter, and Streptococcus were found to be differentially abundant in thejejunum of rMTBI-exposed rats as compared to sham controls indicating profound dysbiosis from the healthy state.Furthermore, substantial depletion in butyrate-producing bacterial communities was observed in rMTBI-exposed animals.These results suggest that the traumatic stress alters the gut microbiome with possible implications in gut health andneuropsychopathology.

A comparative study of medical termination of pregnancy between 8-12 weeks with misoprostol versus mifepristone along with misoprostol at tertiary care hospital

Introduction: Medical method of abortion has advantages over surgical methods as it is noninvasive. Hence, no complications of anesthesia and administration of drugs is easy in medical methods. There is a need for evolving a safe and effective method for safe and effective method for terminating pregnancy in the first trimester. Aim: We have taken up the present study to know the efficacy of combination of mifepristone and misoprostol versus single drug misoprostol alone for 1st trimester abortion. Materials and methods: It was a Cross-Sectional Study carried on pregnant women coming for MTP under family planning op at CKM hospital for 2 years. The study included two groups Group-A and Group-B. Group-A consisted of 50 randomly selected cases received Vaginal Misoprostol 600 micrograms stat dose followed every 4th hourly by 400 micrograms for 24 hours, for a maximum of 4 doses. Group-B has 50 cases received Oral Mifepristone 200 mg and simultaneously 600 micrograms of vaginal Misoprostol stat dose followed every 4th hourly with 400 micrograms vaginal Misoprostol for a period of 24 hours maximum 4 doses. Depending on response USG was done within 24-48 hours in both studies and rescan after 2 weeks. V. Aruna Devi, M. Nagalakshmi, P. Rajitha. A comparative study of medical termination of pregnancy between 8-12 weeks with misoprostol versus mifepristone along with misoprostol at tertiary care hospital. IAIM, 2018; 5(10): 63-72. Page 64 Results: Among Group B subjects 86% had expulsion within 5-10 hrs and remaining 14% had expulsion within 10-15 hours. Among Group A subjects 76% required >24 hrs for expulsion, 10% required 20-24 hrs, 6% required 15-20 hrs and 8% needed 10-15 hrs for expulsion. The difference between grouping and induction to abortion interval was found to be statistically significant. In Group A, 15 subjects (30%) had complete expulsion of products. 35 subjects (70%) required D&C. In Group B, 43 subjects (86%) had complete expulsion, 7 subjects (14%) required D&C. The difference between grouping and final outcome was found to be statistically significant. Majority of study subjects who require D&C were present in Group A compared to Group B. The difference between grouping and D&C was found to be statistically significant. Conclusion: Thus combination of Mifepristone and vaginal Misoprostol is more efficacious than vaginal Misoprostol alone.

Effect of substituting increasing levels of organic Zn for inorganic Zn on performance, hematological and serum biochemical constituents, antioxidant status and immune response in rat

The effect of replacing dietary Zn supplemented from inorganic [ZnCO3] source with organic Zn [Zn methionine; Zn-met] was investigated in 72 rats [98.42 +/- 1.483 g] by randomly allotting to 4 diets [6 replicates/diet, 3 rats/replicate]. Basal diet was prepared with purified ingredients without Zn. The control diet [AIN-76A] contained 12 ppm of Zn from ZnCO3 [100-I]. In the other diets ZnCO3 was replaced with Zn-met at the rates of 50 [50I:50O], 75 [25I:75O] or 100% [100-O]. Weekly body weight and daily feed intake were recorded for 14 weeks. Blood was collected by retro-orbital puncture on the 70th and 80th day to determine haematological and various serum biochemical constituents, and antioxidant enzyme activities in haemolysate, respectively. Rats were antigenically challenged with sheep RBC on day 73 to assess humoral immune response [HIR], and on day 95 for cell mediated immune response [CMIR] and rats were sacrificed at the end of rearing period to collect liver, muscle, pancreas and kidneys for Zn estimation and oxidative stress markers in liver. The data were analysed using completely randomized design. Weight gain and feed intake, hematological and serum biochemical constituents, Zn content in organs [except liver] were not influenced by replacing ZnCO3 with Zn-met. Zinc concentrations in the serum and liver were higher [P<0.05] with 50% replacement of ZnCO3 with Zn-met compared to 0 or 100% replacement. Lower [P<0.05] lipid peroxidation and higher [P<0.05] glutathione peroxidase and glutathione reductase activities were observed with 50 and 75% replacement of ZnCO3 with Zn-met compared to 0 or 100% replacement. Protein carbonyls and reduced glutathione in liver were not affected, while TBARS decreased [P<0.05] with substituting Zn-met [50-100%] for ZnCO3. The HIR and CMIR increased with increasing Zn-met supplementation and the highest response was observed with 75-100% replacement of ZnCO3 with Zn-met. It is concluded that replacement of 50 or 75% of ZnCO3 with Zn-met increased antioxidant and immune response in rats with no effect on growth

A Study of Correlation Between Hemoglobin Level and Cognitive Function in Children from Rural Area Staying in Residential School.

Objectives: Poor performance in the academic activities is common in children of low socioeconomic background. The following study was conducted to see the effect of nutrition by measuring their hemoglobin on cognitive function. Methods: 60 children between 9 to 12 years of age residing in the residential school were included in study. Their hemoglobin measured by Sahli’s method. The cognitive functions were assessed by A. Reaction time - Visual reaction time -simple and choice (choice-simple), Whole body reaction time - simple and choice (C1). B. MMSE Score Results: The study showed a highly significant negative correlation between hemoglobin and various reaction times (SWBRT r = –0.617, p = 0.000**), (CWBRT r = –0.530, p = 0.000**). Conclusion: Our study showed positive correlation between hemoglobin % and cognitive function in children. This study confirms the hypothesis that nutrition has a positive effect on cognitive function.

Effectiveness of pranayama on the levels of serum protein thiols and glutathione in breast cancer patients undergoing radiation therapy: A randomized controlled trial.

The effect of Pranayama on the levels of protein thiols and glutathione was studied among breast cancer patients receiving radiation therapy. 160 patients were randomised into experimental and control group using block randomisation. The experimental group received fractionated radiation for five days a week and performed Pranayama (Nadishodhana, Brahmari and Sheethali) for 30 minutes twice daily for five days a week. The control group received only radiation. Blood samples were collected from both the groups at the end of six weeks of radiation therapy and analysed for the levels of serum protein thiols and glutathione. An independent sample ‘t’ test showed a significant difference in the level of serum protein thiols between the two groups (t = 4.43 p 0.001). A Mann- Whitney U test showed a significant difference (z = –3.07 p 0.002) in the level of glutathione as well. These Pranayama techniques improve the antioxidant status of breast cancer patients receiving radiation therapy.

The Effect of Flowable Composite Lining Thickness With Various Curing Techniques On Internal Voids In Class ii Composite Restorations - An Invitro Study.

Aim of this study was to compare class II composite restoration using flowable composites as lining with various thickness and curing techniques by evaluating internal voids. Fifty intact molars, each prepared with two box-only class II cavities, were randomly divided into five groups: Group I, P 60 filling alone; Group II, ultra thin flowable composite lining (0.5-1mm) co-cured with overlying composite; Group III, thin lining (1-1.5) co-cured with overlying composite; Group IV, ultra thin lining (0.5-1mm) precured and Group V, thin lining (1-1.5) precured. Internal voids were recorded in the gingival interface, cervical and occlusal halves of restorations. Precured techniques for flowable composite lining showed the least number of interface and cervical voids where as the co-cured technique of flowable and packable composites showed the least number of occlusal voids

Esthetic Rehabilitation of Discouloured Anteriors By Ceramic Veneers- A Case Report.

Porcelain laminate veneers were first introduced by Charles Pinacus in 1930 s. Since then gained popularity in the field of esthetic dentistry because of the optimal esthetics, minimal preparation and durability. The advancement in dental adhesives also contributed the successes of ceramic laminates. This article highlights the improved esthetics of a patient who came with a complaint of discolored teeth, restoring them with ceramic veneers

Need of implant dentistry at undergraduate dental curriculum in Indian dental colleges.

Edentulism is the major problem in the developing countries, and is widely spread in the current population, although the prevalence is declining and incidence of tooth loss is decreasing in the developed nations. The prevalence of edentulism in India varies from 60% to 69% of 25 years and above age group. It is obvious that the number of lost teeth increases with age leading to an increase in prevalence of partially edentulous patients. From a biological point of view, the replacement of a single missing tooth with an implant rather than a three-unit fixed partial denture, and the implant-supported complete denture has been proved more efficient in improving the mastication and maintaining the bone for a longer time and also more cost-effective treatment. Many dental schools throughout Europe and America have to a various extent introduced implant dentistry as part of the compulsory undergraduate curriculum. Thus, it becomes more essential to introduce implant dentistry at undergraduate level in Indian dental schools to manage the higher percentage of edentulism.

A Comparison of Bond Strengths of Amalgam, Composite And Glass Cermet Cores When Restored With A Prefabricated Parallel Post - An Invitro Study.

Dentists have come to realize that with proper endodontic therapy and adequate restoration, pulpless teeth can continue indefinitely as an integral part of the dental apparatus. And yet endodontic therapy should not be done on teeth that can not be restored. In this study 45 freshly extracted maxillary premolars were restored with prefabricated parallel post and subsequently restored with Amalgam, composite and Glass cermet. The teeth in each of the restoration groups were allocated to three different loading conditions, load at an angle of 100, 450 and 900 to long axis of the specimen. It is observed that glass cermet core showed a mean failure load that was lower for all three loading conditions than those of Amalgam and composite cores. The aim of the study was to compare the bond strengths of Amalgam, composite and glass cermet cores restored with a pre-fabricated parallel post when subjected to simulated occlusal forces from varying angles.

Renoprotective effects of combining ACE inhibitors and statins in experimental diabetic rats

The combination of angiotensin II receptor antagonists and HMG CoA reductase inhibitors have shown to confer renoprotection.The purpose of this study was to find out the renoprotective effects of telmisartan and atorvastatin in combination and in monotherapy of Streptozotocin [STZ] induced diabetic nephropathy in rats. Diabetes was induced by i.p injection of STZ to rats, after 18 hrs of fasting. Diabetic rats were randomly grouped and treated with telmisartan and atorvastatin in combination as well as monotherapy for 30 days. The serum and urine glucose, creatinine and serum triglyceride, cholesterol, albumin and micro-albumin and blood urea nitrogen, total protein and histological analyses of the left kidney were performed at the end of the study. By the end of the study, the combination showed significant [P < 0.05] improvement in urine glucose, serum cholesterol, serum and urine creatinine, blood urea nitrogen, total protein, serum albumin, micro-albuminuria levels in comparison to monotherapy. However, this combination didn't show significant changes on serum glucose and triglyceride levels. Kidney pathological injury was attenuated by the combination as compared to the diabetic group. The present study document that, telmisartan and atorvastatin combination have better renoprotective effects but not with individual drug when compared to the diabetic group. The combination also attenuated the progression of diabetic nephropathy by slowing the proteinuria and microalbuminuria and these effects were confirmed by histopathological analysis

Mitogenic response of rat lung and tracheal epithelial cells in monolayer primary cultures—Modulation of TNF-α expression.

Epithelial cells isolated from rat lung and trachea were grown on monolayers and their response to a number of hormones and growth factors were studied. Maximum proliferative response in serum containing media was observed when insulin, cholera toxin and cortisol were present together. However, these additives when present independently showed a marginal response. The synergism, due to these factors in promoting growth was seen very early in culture (day 4) as shown by thymidine labelling studies, On examining the indices of early mitogenesis, such as the expression of c-myc, our data suggests that these factors stimulate the expression of c-myc within 4 h. With respect to expression of TNF-α mRNA, this study suggests a possible modulation of TNF-α expression in response to these mitogens that stimulate proliferation maximally. Whether this expression of TNF-α by these epithelial cells is due to a maximal proliferative stimulus and/or is an early step in the cascade of intracellular signalling events is to be investigated in detail.