A study to evaluate perfusion index as a predictor of hypotension following spinal anesthesia for caesarean section.

Background and Aims: The perfusion index (PI) has been used as a marker of peripheral perfusion. A lower PI indicates greater peripheral vascular tone and increased risk of hypotension following spinal anesthesia. The present study was conducted to evaluate and correlate perfusion index (PI) with incidence of hypotension following spinal anesthesia for caesarean section. Material and Methods: The present prospective, double blind, observational study included sixty full term parturients in the age group 18-35 years belonging to American Society of Anesthesiologists (ASA) physical status I and II, having singleton pregnancy undergoing caesarean section under spinal anesthesia. On the basis of baseline PI, patients were allocated into one of the two groups: Group I (n = 30) Patients with baseline PI ≤.3.5 and Group II (n = 30) Patients with PI >3.5. Results: The incidence of hypotension in group I was 40% as compared to 73.3% in group II (p = 0.009). Thus, the incidence of hypotension in group II with baseline PI >.3.5 was more as compared to group I. Patients in group II with baseline PI >.3.5 had significantly more episodes of hypotension as compared to those in group I with baseline PI ≤3.5. Conclusion: PI can be used as a useful tool for predicting hypotension in parturients undergoing elective caesarean section under spinal anesthesia in everyday practice.

Global Burden of Dry Age-Related Macular Degeneration: A Targeted Literature Review.

PURPOSE: Age-related macular degeneration (AMD) is a leading cause of blindness, particularly in higher-income countries. Although dry AMD accounts for 85% to 90% of AMD cases, a comprehensive understanding of the global dry AMD burden is needed. METHODS: A targeted literature review was conducted in PubMed, MEDLINE, Embase, and the Cochrane Database of Systematic Reviews (1995-2019) to identify data on the epidemiology, management, and humanistic and economic burden of dry AMD in adults. A landscape analysis of patient-reported outcome (PRO) instruments in AMD was also conducted via searches in PubMed (1995-2019), ClinicalTrials.gov, PROQOLID, PROLABELS, and health technology assessment reports (2008-2018). FINDINGS: Thirty-seven of 4205 identified publications were included in the review. Dry AMD prevalence was 0.44% globally, varied across ethnic groups, and increased with age. Patients with dry AMD had higher risks of all-cause mortality (hazard ratio [HR] = 1.46; 95% CI, 0.99-2.16) and tobacco-related (HR = 2.86; 95% CI, 1.15-7.09) or cancer deaths (HR = 3.37; 95% CI, 1.56-7.29; P = 0.002) than those without dry AMD. Smoking, increasing age or cholesterol levels, and obesity are key risk factors for developing dry AMD. No treatment guidelines were identified for dry AMD specifically; management focuses on risk factor reduction and use of dietary supplements. In the United States and Italy, direct medical costs and health care resource utilization were lower in patients with dry versus wet AMD. Patients with dry AMD, particularly advanced disease, experienced significant visual function impairment. Dry AMD symptoms included reduced central vision, decreased ability to see at night, increased visual blurriness, distortion of straight lines and text, and faded color vision. Most PRO instruments used in AMD evaluations covered few, if any, of the identified symptoms reported by patients with dry AMD. Although the Quality of Life and Vision Function Questionnaire, 25-item National Eye Institute Vision Function Questionnaire, Low Vision Quality of Life, Impact of Vision Impairment-Very Low Vision, and Functional Reading Independence Index had strong content validity and psychometric properties in patients with dry AMD, they retained limited coverage of salient concepts. IMPLICATIONS: Despite dry AMD accounting for most AMD cases, there are substantial gaps in the published literature, particularly the humanistic and economic burden of disease and the lack of differentiation among dry, wet, or unspecified dry AMD. The significant burden of illness alludes to a high unmet need for tolerable and effective treatment options, as well as PRO instruments with more coverage of dry AMD symptoms and salient concepts.

Is Twice-weekly Maintenance Hemodialysis Justified?

BACKGROUND: The benefits of twice-weekly dialysis at initiation are significant with respect to access longevity, preservation of residual renal function, economic factors, and patient quality of life. It is widely practiced in developing countries due to resource and financial constraints. We present a 3-year follow-up of patients on twice-weekly dialysis and their outcomes. MATERIAL AND METHODS: This was a 3-year observational follow-up study of patients initiated on twice-weekly hemodialysis. Adequacy and basic cost-effective hematological and biochemical parameters were studied monthly. In case of complications, the patient was shifted to thrice-weekly hemodialysis. RESULTS: 88 incident hemodialysis patients were followed up. Total sessions of hemodialysis (HD) studied were 16,406. The mean hemoglobin level was 9.53 g/dl with hyperphosphatemia in 74.88% patients. The mean residual renal function (RRF) at initiation was 5.71 +/- 3.70 ml/min. The mean interdialytic weight gain was 1.91 +/- 1.26 kg with a mean ultrafiltration of 2600 ± 410 ml. The spKt/V and eKt/V were adequate in 68.54% and 48.34% patients; however, the standard Kt/V of 2 was achieved in only 10.51% patients. Emergency HD was done in 41 sessions (0.24%). There were 24 deaths (27.27%) during this period with the mean time to mortality being 503.12 +/- 296.62 days. CONCLUSION: Initiation at twice-weekly schedules for patients on maintenance hemodialysis is a viable option with increments in case of requirement, more so in patients with good urine output and residual renal function. The biochemical and hematological parameters were stable and within KDOQI guidelines and do not worsen with time.

A Critical Review on Recent Development of Techniques and Drug Targets in the Management of Breast Cancer.

BACKGROUND: The most documented illness affecting women overall is breast malignant growth. Since breast cancer disease is the most widely recognized threat in women, Since breast cancer disease is the most widely recognized threat in women, this review was done to provide data on the ongoing advancements in the medication focused on in the breast cancer regimen. Over the previous decades, it has been seen that different progressions have been made in the disclosure of new medications and treatments for treating breast malignancy and this is a direct result of the improved comprehension of the biologic heterogeneity of breast cancer, which has likewise permitted the advancement of increasingly compelling ways to deal with treating breast cancer. METHODS: We searched the scientific database using relevant keywords. Among the searched literature, only peer-reviewed papers were collected, which address our questions. The retrieved quality papers were screened and analyzed critically. The key findings of these studies are included along with the importance. RESULTS: The research in this review particularly includes the anti-breast cancer drugs, which accountfor the top largest market by sales in the pharmaceutical industry. Apart from these, natural and innovative therapies have emerged leading to better management of breast cancer. CONCLUSION: These recent developments have contributed to a more efficient and specific treatment protocol in breast cancer patients. Moreover, further investigation should be done in improving results for all the patients with breast cancer disease, particularly individuals who have advanced breast cancer and the issue of drug resistance, which also poses a threat to the successful development of targeted therapy in various subtypes of breast cancer, must also be considered.

Autorotation of the Mandible as Sequelae to Maxillary Intrusion: A Systematic Review.

BACKGROUND: Autorotation of the mandible is a normally anticipated phenomenon following a surgical superior repositioning of the maxilla in clinical situations where patients have an excessive gummy smile. Prediction of the surgical treatment outcome following a presurgical orthodontic treatment is a critical element in the surgical treatment planning. MATERIALS AND METHODS: The relevant articles were selected by hand search and electronic media (Google Scholar, PubMed, Science Direct, Medline, Embase, and Cochrane) from 1982 to 2020. All the relevant articles were properly screened, and findings were extracted from the articles. RESULTS: It was observed that, following maxillary intrusion, mandible would eventually autorotate to take a new occlusion. Mandibular autorotation as a result of maxillary intrusion would lead to minimal shortening of the lower lip in the vertical plane. It was observed that the amount of mandibular autorotation correlates with the extent of maxillary impaction. Studies have shown that there is a passive soft-tissue response which may be attributed to the fact that no muscular detachment had been affected in the lower lip and soft-tissue chin region during the maxillary surgery. CONCLUSION: It is observed that there is a definite influence on the mandibular and chin positions as a result of maxillary intrusion and autorotation of the mandible. Every 1 mm of maxillary superior impaction, the chin moved 0.6 mm vertically and 0.2 mm horizontally. There is an appreciable shortening of the lower lip length.

Cancer stem cells and field cancerization of head and neck cancer - An update.

Oral cancer results due to multiple genetic alterations that transform the normal cells in the oral cavity into neoplastic cells. These genetic changes in a particular tumor field lead to a rapid expansion of preneoplastic daughter cells producing malignant phenotype but the malignancy results due to such genetic changes occurr over several years. The morphological changes in these transformed cells help in the diagnosis of malignancy. Thus, the early changes at the gene level are present in the population of daughter cells in the organ, which explains the concept of field cancerization. Cancer stem cells (CSCs) represent a group of cells that have the capacity of self-renewal and have the potential to differentiate into other types of tumor cells. This review explains the cellular and genetic basis of field cancerization and the role of cancer stem cells in field cancerization.

Comparison of efficacy of ozonated water, normal saline, and povidone-iodine after surgical removal of impacted mandibular third molars: A cross-sectional study.

BACKGROUND: Surgical extraction of mandibular third molars is an important and one of the most frequently performed operative procedures in dentistry. There are a variety of postoperative complications that may follow this procedure. These include pain, trismus, infection, dry socket, or alveolar osteitis. Numerous techniques have been used for reducing these morbid conditions. These range from flap designs, suture placement, use of various irrigating solutions, etc. AIM: The present study aimed to compare the effectiveness of three irrigating solutions: Ozonated water, normal saline, and povidone-iodine in reducing postoperative complications following surgical removal of impacted mandibular third molars. MATERIALS AND METHODS: A total of 100 study participants formed the sample size of this study. Study subjects were categorized into three groups: Group I (third molar surgeries using ozonated water), Group II (third molar surgeries with normal saline irrigation), and Group III (third molar surgeries using povidone-iodine irrigation). Parameters studied postoperatively were alveolar osteitis (dry socket), pain, trismus, and infection after a week interval. All data obtained were entered in Microsoft Excel 2007 worksheets and Analysis of Variance (ANOVA) as a statistical tool was employed. A P value of < 0.01 was considered statistically significant. RESULTS: It was found that ozonated water provided the best statistically proven results with comparison to normal saline and povidone-iodine in reducing the incidence of alveolar osteitis or dry socket and pain. No statistically significant difference was observed in the incidence of trismus and infection rate among three studied groups. CONCLUSION: Ozonated water is the best irrigating solution when compared to normal saline and povidone-iodine in terms of reduction in pain and dry socket after a 1-week duration.

Evaluation of marginal bone loss around dental implants in cigarette smokers and nonsmokers. A comparative study.

BACKGROUND: The overall success of osteointegrated dental implants depends on various factors. The deleterious effects of smoking on wound healing after the tooth extraction and its association with poor quality of bone are well documented. Similar effects of tobacco use on the success of dental implants are expected. Cigarette smoke mainly contains nicotine that delays the bone healing and increases the rate of infections at the implant insertion site. AIM: The purpose of the present study was to evaluate and compare the marginal bone loss around dental implants in smokers and nonsmokers. MATERIALS AND METHODS: The study was conducted on 500 individuals who received dental implants in maxillary or mandibular edentulous regions from 2010 to 2017. The sample was divided into two groups: Group I (smokers, n = 280) and Group II (nonsmokers, n = 220). Marginal bone loss was measured on mesial, distal, buccal, and lingual side of each implant using periapical radiographs 3 months after loading, 6 months after loading, and 12 months after loading. RESULTS: The crestal bone loss around dental implants was significantly greater in smokers (Group I) as compared to nonsmokers (Group II) irrespective of the duration of loading (P < 0.001). Marginal bone loss did vary significantly by location in either groups. CONCLUSION: Smoking overall lowers the success rate of dental implants. Increased duration and frequency of smoking leads to a greater degree of marginal bone loss around dental implants.

Update on psoriasis: A review.

Psoriasis is a disease characterized by the presence of papules and plaques over the surface of skin with variable morphology, distribution and severity. The lesions of psoriasis are distinct from these other entities and are classically very well circumscribed, circular, red papules or plaques with a grey or silvery-white, dry scale. In addition, the lesions are typically distributed symmetrically on the scalp, elbows, knees, lumbosacral area, and in the body folds. The oral manifestations of psoriasis may involve the oral mucosa or the tongue. The dorsal surface of the tongue shows characteristic red patches surrounded with a yellow white border. The relationship between eye lesions and psoriasis are the current findings in the literature. The ocular complications along with the several extracutaneous manifestations are common complications seen in psoriasis. The pathogenesis of exact relationship between these two is still controversial. Immunological studies have shown a positive relationship between T helper cells and uveitis. Various signs and symptoms of ocular psoriasis may be overlooked. Thus, a complete understanding of ophthalmic involvement is important to the comprehensive care of patients with psoriasis. Almost any part of the body can be affected in psoriasis, but the ophthalmic complications of psoriasis usually remain clinically subtle. This review highlights the various manifestations of psoriasis with their clinical sign and symptoms.

Efficient One-Pot Synthesis and pH-Dependent Tuning of Photoluminescence and Stability of Au18(SC2H4CO2H)14 Cluster.

Developing efficient ways to control the nanocluster properties and synthesize atomically precise metal nanoclusters are the foremost goals in the field of metal nanocluster research. In this article, we demonstrate that the direct synthesis of atomically precise, hydrophilic metal nanoclusters as well as tuning of their properties can be achieved by an appropriate selection of reactants, binding ligand, and their proportions. Thus, a facile, single-step method has been developed for the direct synthesis of Au18(SC2H4CO2H)14 nanocluster in an aqueous medium under ambient conditions. The synthesis does not require any pH or temperature control and postsynthesis size-separation step. The use of a hydrophilic, bifunctional short carbon-chain capping ligand, HSC2H4CO2H, allows tuning of cluster properties such as the photoluminescence and stability in an aqueous medium via the variation of pH of the cluster solution. By using a phase transfer catalyst, the nanoclusters can also be transferred into toluene solvent, which further enhances the nanocluster photoluminescence. The formation, composition, and purity of the product clusters have been characterized by using a number of methods such as the polyacrylamide gel electrophoresis, UV-visible and FTIR spectroscopies, transmission electron microscopy, energy dispersive X-ray analysis, thermogravimetric analysis, X-ray photoelectron spectroscopy, and matrix-assisted laser desorption ionization-time-of-flight mass spectrometry. Gold nanoclusters with properties such as water solubility, water-to-organic phase-transfer ability, and tunable stability and photoluminescence are promising for various studies and applications. The work reveals a few principles that can be helpful in the development of a general toolbox for the rational design of size-selective synthesis and properties tuning of the metal nanoclusters.

Scrub typhus masquerading as acute pancreatitis.

The clinical spectrum of scrub typhus ranges from mild to fatal depending on the virulence of bacterial strain, susceptibility of the host and promptness with which treatment is started. We report a case of a 14-year-old child with scrub typhus who developed acute pancreatitis. On serological confirmation, doxycycline therapy was started. The patient responded well and had no complications on follow-up. This case report highlights the importance of recognising an uncommon presentation of this common tropical disease, and its prompt diagnosis and early treatment for prevention of serious complications of the condition.

Transcription facilitates sister chromatid cohesion on chromosomal arms.

Cohesin is a multi-subunit protein complex essential for sister chromatid cohesion, gene expression and DNA damage repair. Although structurally well studied, the underlying determinant of cohesion establishment on chromosomal arms remains enigmatic. Here, we show two populations of functionally distinct cohesin on chromosomal arms using a combination of genomics and single-locus specific DNA-FISH analysis. Chromatin bound cohesin at the loading sites co-localizes with Pds5 and Eso1 resulting in stable cohesion. In contrast, cohesin independent of its loader is unable to maintain cohesion and associates with chromatin in a dynamic manner. Cohesive sites coincide with highly expressed genes and transcription inhibition leads to destabilization of cohesin on chromatin. Furthermore, induction of transcription results in de novo recruitment of cohesive cohesin. Our data suggest that transcription facilitates cohesin loading onto chromosomal arms and is a key determinant of cohesive sites in fission yeast.

Triage hyperglycemia as a prognostic indicator of major trauma.

BACKGROUND: To test the diagnostic utility of the triage serum glucose in differentiating major from minor injuries. METHODS: Prospective database at Kings County Hospital, a Level I trauma center, from August 2005 to August 2008. INCLUSION CRITERIA: trauma patients 13+ years. EXCLUSION CRITERIA: diabetes or obvious life-threatening injuries requiring immediate surgery, isolated head trauma, or transferred or dead on arrival. We recorded age, sex, injury mechanism, base deficit (BD), lactate (LAC), and serum glucose and calculated Injury Severity Scores. Major injury: a change in hematocrit >10, blood transfused within 24 hours, or Injury Severity Score >15. Data were reported as mean differences (95% confidence interval [CI]). Groups were compared by Student's t test; receiver operator characteristic curves were compared by Wilcoxon test (two-tailed, [alpha] = 0.05). RESULTS: One thousand six hundred forty-nine patients with an average age of 35.5 years (13-95 years), 79.5% male, and 50% blunt trauma were studied. Patients with major (n = 278) compared with minor injury (n = 1371) had significantly (p < 0.0001) lower BD and higher LACs (p < 0.0001). Major injury patients had significantly (p < 0.0001) higher serum glucose levels (8.33 mMol/L, 95% CI: 7.94-8.69 mMol/L) compared with patients with minor injuries (6.49 mMol/L, 95% CI: 6.39-6.66 mMol/L). Areas under the curve for glucose (0.73, 95% CI: 0.70-0.76) are similar to BD (0.72, 95% CI: 0.68-0.76) and LAC (0.71, 95% CI: 0.67-0.75). CONCLUSIONS: Serum glucose was as discriminating as BD or LAC in differentiating minor from major injury. An initial glucose >/=11.1 mMol/L had a low sensitivity (15%) but a high specificity (94%) for major injury.