Correlation of fetal ventricular size and need for postnatal cerebrospinal fluid diversion surgery in open spina bifida.

OBJECTIVES: Open spina bifida is a common cause of hydrocephalus in the postnatal period. In-utero closure of the fetal spinal defect decreases the need for postnatal cerebrospinal fluid (CSF) diversion surgery. Good prenatal predictors of the need for postnatal CSF diversion surgery are currently lacking. In this study, we aimed to assess the association of fetal ventriculomegaly and its progression over the course of pregnancy with the rate of postnatal hydrocephalus requiring intervention. METHODS: In this retrospective study, fetuses with a prenatal diagnosis of open spina bifida were assessed longitudinally. Ventricular diameter, as well as other potential predictors of the need for postnatal CSF diversion surgery, were compared between fetuses undergoing prenatal closure and those undergoing postnatal repair. RESULTS: The diameter of the lateral ventricle increased significantly throughout gestation in both groups, but there was no difference in maximum ventricular diameter at first or last assessment between fetuses undergoing prenatal closure and those undergoing postnatal repair. There was no significant difference in the rate of progression of ventriculomegaly between the two groups, with a mean progression rate of 0.83 ± 0.5 mm/week in the prenatal-repair group and 0.6 ± 0.6 mm/week in the postnatal-repair group (P = 0.098). Fetal repair of open spina bifida was associated with a lower rate of postnatal CSF diversion surgery (P < 0.001). In all subjects, regardless of whether they had prenatal or postnatal surgery, the severity of ventriculomegaly at first and last assessments was associated independently with the need for postnatal CSF diversion surgery (P = 0.005 and P = 0.001, respectively), with a greater need for surgery in fetuses with larger ventricular size, even after controlling for gestational age at assessment. CONCLUSIONS: In fetuses with open spina bifida, fetal ventricular size increases regardless of whether spina bifida closure is performed prenatally or postnatally, but the need for CSF diversion surgery is significantly lower in those undergoing prenatal repair. Ventriculomegaly is associated independently with the need for postnatal CSF diversion in fetuses with open spina bifida, irrespective of timing of closure. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Mechanistic insights into Candida biofilm eradication potential of eucalyptol.

AIM: Candida-associated fungal infections are prevalent in hospitalized and immune-compromised patients. Their biofilm architecture and high rate of antifungal resistance make treatment challenging. Eucalyptol (EPTL), a monoterpene majorly present in the essential oil of eucalyptus is well known for curing respiratory infections. Hence, the present study investigated the anti-biofilm efficacy of EPTL against the laboratory strains and clinical isolates of Candida to delineate its mode of action. METHODS: The effect of EPTL on the viability, biofilm formation, and mature biofilm of Candida strains was studied. Furthermore, its effect on cell cycle arrest, mitochondrial membrane potential (MMP), ROS generation, germ tube formation, ergosterol content and transcriptional expression of selected genes was also investigated. RESULTS: EPTL exhibited anti-biofilm activity against mature and developing biofilm of Candida albicans and Candida glabrata along with their clinical isolates. The biochemical components and enzyme activity were differentially modulated in EPTL-treated biofilm extracellular matrix. EPTL generated ROS and arrested cell cycle at the G1 /S phase in both the species, while altered MMP was recorded in C. glabrata. Transcriptional analysis evidenced for differential gene expression of selected ABC transporters, secreted hydrolytic enzymes, and cell wall biogenesis in C. albicans/C. glabrata upon treating with EPTL. CONCLUSION: The current data on anti-biofilm activity of EPTL establish its candidacy for drug development or as an adjuvant with existing antifungal formulations. SIGNIFICANCE AND IMPACT OF THE STUDY: Present investigation elucidates the mode of action of Eucalyptol as antifungal agent and would stand as a candidate for management of topical fungal infection.

Outcome of monochorionic twin pregnancy complicated by Type-III selective intrauterine growth restriction.

OBJECTIVE: Type-III selective intrauterine growth restriction (sIUGR) is associated with a high and unpredictable risk of fetal death and fetal brain injury. The objective of this study was to describe the prospective risk of fetal death and the risk of adverse neonatal outcome in a cohort of twin pregnancies complicated by Type-III sIUGR and treated according to up-to-date guidelines. METHODS: We reviewed retrospectively all monochorionic diamniotic twin pregnancies complicated by Type-III sIUGR managed at nine fetal centers over a 12-year period. Higher-order multiple gestations and pregnancies with major fetal anomalies or other monochorionicity-related complications at initial presentation were excluded. Data on fetal and neonatal outcomes were collected and management strategies reviewed. Composite adverse neonatal outcome was defined as neonatal death, invasive ventilation beyond the resuscitation period, culture-proven sepsis, necrotizing enterocolitis requiring treatment, intraventricular hemorrhage Grade > I, retinopathy of prematurity Stage > II or cystic periventricular leukomalacia. The prospective risk of intrauterine death (IUD) and the risk of neonatal complications according to gestational age were evaluated. RESULTS: We collected data on 328 pregnancies (656 fetuses). After exclusion of pregnancies that underwent selective reduction (n = 18 (5.5%)), there were 51/620 (8.2%) non-iatrogenic IUDs in 35/310 (11.3%) pregnancies. Single IUD occurred in 19/328 (5.8%) pregnancies and double IUD in 16/328 (4.9%). The prospective risk of non-iatrogenic IUD per fetus declined from 8.1% (95% CI, 5.95-10.26%) at 16 weeks, to less than 2% (95% CI, 0.59-2.79%) after 28.4 weeks and to less than 1% (95% CI, -0.30 to 1.89%) beyond 32.6 weeks. In otherwise uncomplicated pregnancies with Type-III sIUGR, delivery was generally planned at 32 weeks, at which time the risk of composite adverse neonatal outcome was 29.0% (31/107 neonates). In twin pregnancies that continued to 34 weeks, there was a very low risk of IUD (0.7%) and a low risk of composite adverse neonatal outcome (11%). CONCLUSIONS: In this cohort of twin pregnancies complicated by Type-III sIUGR and treated at several tertiary fetal centers, the risk of fetal death was lower than that reported previously. Further efforts should be directed at identifying predictors of fetal death and optimal antenatal surveillance strategies to select a cohort of pregnancies that can continue safely beyond 33 weeks' gestation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Long-term postnatal outcome of fetuses with prenatally suspected septo-optic dysplasia.

OBJECTIVES: Septo-optic dysplasia (SOD) is a clinical syndrome characterized by varying combinations of optic nerve hypoplasia, pituitary gland hypoplasia and abnormal cavum septi pellucidi. It is suspected on prenatal imaging when there is non-visualization or hypoplasia of the septal leaflets. Long-term postnatal outcomes of fetuses with prenatally suspected SOD have been documented poorly. The aims of this study were to describe the natural history of deficient septal leaflets, to quantify the incidence of postnatally confirmed SOD and to document the visual, endocrine and long-term neurodevelopmental outcomes of these infants. METHODS: This was an observational retrospective study of all fetuses with prenatal imaging showing isolated septal agenesis, assessed at a single tertiary center over an 11-year period. Pregnancy, delivery and neonatal outcomes and pre- and postnatal imaging findings were reviewed. Neonatal evaluations or fetal autopsy reports were assessed for confirmation of SOD. Ophthalmologic, endocrine, genetic and long-term developmental evaluations were assessed. Imaging findings and outcome were compared between infants with and those without postnatally confirmed SOD. RESULTS: Of 214 fetuses presenting with septal absence on prenatal ultrasound and magnetic resonance imaging (MRI), 18 (8.4%) were classified as having suspected isolated septal agenesis suspicious for SOD. Uniform prenatal MRI findings in cases with suspected SOD included remnants of the leaflets of the cavum septi pellucidi, fused forniceal columns, normal olfactory bulbs and tracts and a normal optic chiasm. Twelve fetuses were liveborn and five (27.8%) had postnatally confirmed SOD. Only two of these five fetuses had additional prenatal imaging features (pituitary cyst, microphthalmia and optic nerve hypoplasia) supporting a diagnosis of SOD. The other three confirmed SOD cases had no predictive prenatal or postnatal imaging findings that reliably differentiated them from cases without confirmed SOD. Visual and endocrine impairments were present in two (40%) and four (80%) cases with confirmed SOD, respectively. In those with visual and/or endocrine impairment, developmental delay (median age at follow-up, 2.5 (interquartile range, 2.5-7.0) years) was common (80%) and mostly severe. Neonates with isolated septal agenesis and a lack of visual or endocrine abnormalities to confirm SOD had normal development. CONCLUSIONS: Only a quarter of fetuses with isolated septal agenesis suggestive of SOD will have postnatal confirmation of the diagnosis. Clinical manifestations of SOD are variable, but neurodevelopmental delay may be more prevalent than thought formerly. © 2020 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

A novel combination of plant growth regulators for in vitro regeneration of complete plantlets of guar [Cyamopsis tetragonoloba (L.) Taub].

A novel combination of plant growth regulators comprising indole-3-butyric acid (IBA), 6-benzylaminopurine (BA) and gibberellic acid (GA3) in Murashige and Skoog basal medium has been formulated for in vitro induction of both shoot and root in one culture using cotyledonary node explants of guar, (Cyamopsis tetragonoloba). Highest percentages of shoot (92%) and root (80%) induction were obtained in the medium containing (mg/L) 2 IBA, 3 BA and 1 GA3. Shoot regeneration from the cotyledonary node explants was observed after 10-15 days. Regeneration of roots from these shoots occurred after 20 to 25 days. The regenerated plantlets showed successful acclimatization on transfer to soil. This protocol is expected to be helpful in carrying out various in vitro manipulations in this economically and industrially important legume.

Exopolysaccharide analysis of biofilm-forming Candida albicans.

AIM: The major objective of the study was to analyse exopolysaccharide produced by a biofilm forming-clinical strain of Candida albicans. METHODS AND RESULTS: The biofilm-forming ability of C. albicans recovered from infected intrauterine devices (IUDs) was evaluated using XTT (2,3-bis[2-methoxy-4-nitro-5-sulfophenyl]-2H-tetrazolium-5-carboxanilide) reduction assay. The morphological characteristics of the biofilm were assessed using scanning electron microscopy (SEM), atomic force microscopy (AFM) and confocal laser scanning microscopy (CLSM). Biochemical characterization of the exopolysaccharide was carried out by gel permeation chromatography, gas chromatography (GC), Fourier transform infrared (FTIR) spectroscopy and nuclear magnetic resonance (NMR) spectroscopy. Microscopic studies of C. albicans biofilm revealed complex, heterogeneous three-dimensional structure, in which yeast cells and hyphal elements were entrenched within exopolysaccharides matrix. Chromatographic analysis data indicated C. albicans exopolysaccharide (c. 300 kDa) to be made up of four major sugar units. The FTIR spectrum revealed specific absorbance of O-H, C-H, O=C=O, C=O, C-N and C-C ring stretching. (1) H and (13) C NMR data showed the presence of ß (1→6) and ß (1→3) linkages in the exopolysaccharide chain that were assigned to α-D-glucose and ß-D-glucose, α-D-mannose, α-L-rhamnose and N-acetyl glucosamine (ß-D-GlcNAc), respectively. CONCLUSIONS: Study suggested the production of a water soluble c. 300 kDa exopolysaccharide by C. albicans made up of glucose, mannose, rhamnose and N-acetyl glucosamine subunits. SIGNIFICANCE AND IMPACT OF THE STUDY: The study could assist in the development of novel therapeutics aimed at disrupting C. albicans biofilms that will translate into improved clearance of Candida-related infections.

Characterization of biofilm formed on intrauterine devices.

PURPOSE: Intrauterine device (IUD) is one of the most convenient contraceptive procedures used by women of Asian and African countries. Previous surveys have revealed that 75% of the IUDs recovered from patients suffering from reproductive tract infections (RTIs) were covered with a consortium of microbes. This study was designed to characterize these microbes and recommend remedial measures. METHODS: Quantitative measurement of biofilm formation was assessed by a microtitre plate assay on 86 samples of microorganisms dislodged from IUDs of patients with RTIs. Susceptibility of biofilm to various antimicrobial agents was also quantified. Scanning electron microscopy (SEM) was used to scrutinize the microorganisms adherent to IUDs. RESULTS: The organisms associated with IUDs were predominantly composed of Staphylococcus aureus (16%), Staphylococcus epidermidis (18%), Pseudomonas aeruginosa (5%), Escherichia coli (27%), Neisseria gonorrhoeae (2%), Candida albicans (20%) and Candida dubliniesis (12%). SEM studies indicated that these organisms were organized into biofilms. Studies on the in vitro adherence pattern by crystal violet staining on 96 well microtitre plates revealed that the biofilms were stably established after 60 hours. These biofilms are resistant to an array of antibiotics tested. CONCLUSION: Biofilm formation may be one of the major causes for persistent infection and antibiotic resistance in IUD users.

Immunohistochemical study of vestibular gingival blood vessel density and internal circumference in smokers and non-smokers.

BACKGROUND: This study was undertaken to determine: 1) if sections stained with monoclonal antibody to CD34 can be used for measurement of gingival blood vessel density and circumference and 2) if long-term smoking affects either of these 2 parameters. METHODS: Vestibular gingival biopsy samples were obtained from 17 adults (5 smokers and 12 non-smokers) who were undergoing routine periodontal surgery independently of this study. Hematoxylin and eosin staining was used for histological assessment of inflammation, while immunohistochemical staining with CD34 mouse monoclonal antibody was used to mark the endothelial cells of the blood vessels within each sample. Stringent selection criteria were applied to the 17 biopsy samples, and 7 (from 3 smokers and 4 non-smokers) were chosen to have their vascular density (number of vessels/unit area) and internal vessel circumference (IC) measured under a blinded protocol. RESULTS: Repeated measurements of vascular density and internal circumference showed small standard deviations, indicating the high reproducibility of the measurement technique. The smoker group showed a higher proportion of small (IC < 50 microns) and a lower proportion of large blood vessels (IC > 100 microns), which was statistically significant (P = 0.0403 and P < 0.001, respectively). The difference between the vascular density of smokers and non-smokers was not significant (P = 0.092). CONCLUSIONS: The present study indicates that the CD34 immunohistochemical staining technique is a simple and reproducible method for the measurement of density and internal circumference of gingival blood vessels. Based on this technique, cigarette smokers show a higher percentage of smaller blood vessels and a lower percentage of larger vessels, but similar vascular density, to non-smokers.

Inductively coupled plasma emission spectroscopic and flame photometric analysis of goat epididymal fluid.

AIM: The elemental composition of the epididymal luminal fluid (ELF) in adult goat (Capra indica) was investigated. METHODS: ELF was collected by micropuncture from twelve sites along the epididymal duct. The elemental contents was analyzed with inductively coupled plasma (ICP) emission spectroscopy, a microanalytical technique that can simultaneously measure many elements in minute volumes of sample. The Na and K concentrations were determined by flame photometry. RESULTS: ICP spectroscopy showed the presence of copper, calcium, nickel, iron, magnesium, chromium, titanium and zinc in ELF, with fluctuating levels at different sites along the length of the epididymis. Cadmium, cobalt, lead and manganese were not found. The Na+/K+ ratio was seen to be higher at the initial segments of the epididymis and lower at the distal. CONCLUSION: It is proposed that the observed characteristic distribution of elements in ELF may have far reaching implications in sperm maturation and storage known to occur in the epididymis.

Prevalence of nifedipine-induced gingival hyperplasia.

This study investigated the prevalence of gingival hyperplasia in subjects who were undergoing treatment with a calcium channel blocker, nifedipine, in dentate and edentulous subjects. In addition, the relationship between gingival hyperplasia and 5 other variables (duration of nifedipine intake, dose, age, oral hygiene index, and number of teeth) was investigated. Results of statistical analyses showed overwhelming evidence that the percent of nifedipine subjects with gingival hyperplasia was greater than that of the control subjects (P < 0.05) and that, across treatment group, the percent of dentate subjects with hyperplasia was significantly higher than that for edentulous subjects (P < 0.05). The chi2 test showed a strong univariate relationship between gingival hyperplasia and, separately, oral hygiene and number of teeth. For 24% of the subjects with gingival hyperplasia index (GHI) values of 2 or 3, gingivectomy was performed, and the tissues were prepared for histological examination. Microscopic examination of the biopsy material showed findings similar to those from previously reported cases of nifedipine- or phenytoin-induced hyperplasia.

The effectiveness of the Nd:YAG laser in the treatment of dental hypersensitivity.

Dentin hypersensitivity is one of the most painful and least predictably treated chronic conditions in dentistry. The effectiveness of laser therapy in the reduction of dentin hypersensitivity and its effects on pulpal vitality were studied. Nineteen subjects participated in the randomized, double-blind study, and were followed up for three months. Two sites were treated. One received helium neon (He:Ne) laser treatment and the other received He:Ne plus Nd:YAG (He:Ne+Nd:YAG) laser treatment. Laser treatment consisted of 30 millijoules (mJ) to 100 mJ per pulse, at 10 pulses per second (pps) in increments of 10-40 seconds each over a total treatment time of less than two minutes, without local anesthesia. Hypersensitivity was assessed by mechanical stimulus (using a sharp explorer), and thermal stimulus (using a blast of cold air from a dental syringe). Pulpal vitality was measured using an electrical stimulus. The results indicate that immediately following laser treatment and for three months thereafter, the subjects' perceived level of discomfort decreased. He:Ne treatment reduced dentin hypersensitivity to air by 63 per cent and to mechanical stimulation by 61 per cent over three months. The He:Ne + Nd:YAG treatment reduced dentin sensitivity to air by 58 per cent and to mechanical stimulation by 61 per cent. All teeth remained vital after laser treatment, with no adverse reactions or complications. He:Ne and He:Ne + Nd:YAG laser treatment can be used to reduce dentin hypersensitivity without detrimental pulpal effects.

Localized juvenile periodontitis: a case analysis and rational approach to treatment.

This case involves a 14-year-old female patient affected with localized juvenile periodontitis. Treatment consisted of periodontal flap surgery in conjunction with tetracycline therapy. A successful result was obtained and maintained. The case depicts the fact that in many instances localized juvenile periodontitis can be treated with confidence and a high degree of predictability. It should also be noted that, like all treatment modalities, the treatment of this disease as discussed in this case is not the panacea and will undergo considerable changes in the future; however, in light of current knowledge, this combined treatment approach appears to be effective in LJP patients.

Serological investigation of refractory human adult periodontitis.

This study examined the difference between the serum antibody profiles in refractory adult periodontitis patients (group A), and compared to those (group B) who responded well to conventional periodontal treatment. The levels of specific IgG antibody to Actinobacillus actinomycetemcomitans, Bacteroides gingivalis, Fusibacteriumnucleatum, and Eikenella corrodens were assessed in a group of 19 patients (group A) and 11 patients (group B). Specific IgG serum antibody levels were estimated using biotin-avidin linked immunosorbent assay (BALISA). Results indicated that Actinobacillus actinomycetemcomitans, and Bacteroides gingivalis had very high levels of specific circulating antibody in the sera of both groups of patients; whereas, Fusobacterium nucleatum and Eikenella corrodens showed considerable lower levels of antibody than the other two antigens. However, the differences between the two groups with regard to the antibody levels against different bacterial antigens were not statistically significant.