In silico studies and development of a protein-based electrochemical sensor for selective and sensitive detection of aflatoxin B1.

Proteins from different species have been docked with aflatoxin B1 (AFB1) and identified 3 proteins (prostaglandin-E(2)9-reductase from Oryctolagus uniculus, proto-oncogene serine/threonine-protein kinase Pim-1 and human immunoglobulin G (hIgG)) as potential candidates to develop an electrochemical sensor. Fluorescence spectroscopy experiments have confirmed the interaction of hIgG with AFB1 with an affinity constant of 4.6 × 105 M-1. As a proof-of-concept, hIgG was immobilized on carbon nanocomposite (carbon nanotube-nanofiber, CNT-F)-coated glassy carbon electrode (GCE). FT-IR spectra, HR-TEM and BCA assay have confirmed successful immobilization of hIgG on the electrode (hIgG@CNT-F/GCE). The preparation of this protein electrochemical sensor requires only 1 h 36 min, which is fast as compared with preparing an electro immunosensor. hIgG@CNT-F/GCE has displayed an excellent AFB1 limit of detection (0.1 ng/mL), commendable selectivity in the presence of two other mycotoxins (ochratoxin A and patulin) and the detection of  AFB1 in spiked peanuts and corn samples.

Elevating pyrrole derivative synthesis: a three-component revolution.

Pyrrole is an essential chemical with considerable relevance as a pharmaceutical framework for many biologically necessary medications. The growing demand for biologically active compounds calls for a simple one-pot method for generating novel pyrrole derivatives. Nots surprisingly, several multicomponent reactions (MCRs) aim to synthesize pyrrole derivatives. However, this review presents the three-component synthesis of pyrrole derivatives, highlighting the significance of multicomponent reaction in synthesizing eclectic multi-functionalised pyrrole covering the selected literature on the three-component synthesis of substituted pyrrole from 2016 to late 2023. Furthermore, this article classifies the reactions based on the starting material with functional groups involved in the pyrrole ring formation.

Evaluation of Salivary Butylated Hydroxytoluene and Ascorbic Acid Levels in Type 2 Diabetes Mellitus Patients.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a global health concern associated with systemic as well as oral complications. The preventive antioxidants found in saliva naturally reduce the damaging effects of reactive oxygen molecules. Any disruption to the regular functioning of these antioxidants may lead to oxidative stress, which could boost an individual's vulnerability to oral diseases. Diabetes patients are vulnerable to various dental complications, such as oral mucosal disorders, dental caries, dry mouth, and periodontal disease. AIM: This study aimed to assess the salivary butylated hydroxytoluene (BHT) and ascorbic acid (AA) levels in patients with controlled and uncontrolled type 2 diabetes mellitus. MATERIALS AND METHODS: The present study included samples from patients aged 45-65. Group I consisted of 20 controlled diabetic patients, and Group II consisted of 20 uncontrolled diabetic patients. Unstimulated whole saliva samples were collected from both groups, and laboratory analysis was done. Salivary BHT and AA levels were quantified using enzyme-linked immunosorbent assay (ELISA) and spectrophotometric assay. RESULTS: Salivary butylated hydroxytoluene levels were found to be higher in the uncontrolled diabetic group than in the controlled diabetic group, and salivary AA levels were found to be higher in the controlled diabetic group than in the uncontrolled diabetic group. The mean ± standard deviation (SD) values of butylated hydroxytoluene among controlled and uncontrolled diabetic patients were 2.98 ± 0.12 and 2.99 ± 0.11 absorbance units, respectively. The mean ± SD value of AA in the controlled group was found to be 2.99 ± 0.15 absorbance units, and the mean ± SD value of AA in the uncontrolled group was 2.64 ± 0.96 absorbance units. However, it has been found that there is no statistically significant difference between salivary BHT and AA levels among controlled and uncontrolled diabetics, with p-values of 0.867 and 0.419, respectively. CONCLUSION: Values of salivary biochemical markers were distinctly different between controlled and uncontrolled diabetic groups. However, to establish a definite role of salivary BHT and AA levels as biomarkers in managing and monitoring type 2 diabetes, future studies are required, even though the trends exhibit possible alterations in biomarkers.

Image Quality Assessment of Digital Radiographs Captured by Hand-Held Devices Versus Wall-Mounted Devices: A Retrospective Comparative Study.

Background In diagnostic radiology, the image quality of radiographs is paramount for impeccable diagnosis as it is essential for efficient treatment planning and patient care. In comparison to their well-established wall-mounted equivalents, the growing use of handheld devices raises concerns regarding their diagnostic effectiveness by questioning their image quality. Hence, to fully comprehend the clinical importance of handheld X-ray equipment, it is important to look into their image quality for better diagnostic performance. Aim The study aimed to determine the image quality of handheld X-ray units and compare them with wall-mounted X-ray units in routine dental practice based on objectifiable image quality parameters. Materials and Methods For the study, 200 digital radiographic images (102 taken using handheld and 98 using wall-mounted X-ray units) were collected randomly from archives, including radiographs with cone-cut and positional errors. Five observers, three faculty members, and two postgraduates, who were all blinded, subjectively judged the image quality using a five-point rating scale for five individual parameters: contrast, sharpness, cone-cut, and error in vertical and horizontal angulations of position indicating device separately. The mean score for all observers was calculated, and statistical analysis was performed using the Mann-Whitney U test. The scoring of one faculty member experienced in oral radiology as baseline data was used to compare interobserver agreement among the other observers. Results There is a significant difference between the two groups in cone-cut and error in horizontal angulation. There is no significant difference between the two groups when parameters such as contrast, sharpness, and error in vertical angulation are considered. The images from handheld devices showed better image quality (p = 0.006) compared to the wall-mounted device. There was 87% interobserver agreement between the five observers. Conclusion The present study demonstrated a significant difference between the handheld device and the wall-mounted device when all the five parameters including errors are considered to assess the image quality. Hence, handheld devices can be used for regular clinical practice as an alternative to wall-mounted devices. Nevertheless, stringent radiation safety precautions are essential.

Artificial Intelligence: A Reliable Tool to Detect the Elongation of the Styloid Process.

Background Eagle's syndrome is characterized by the anomalous elongation of the styloid process. This condition is usually identified through the manual evaluation of orthopantomogram (OPG) images, which is time-consuming and can have interobserver variability. The application of Artificial intelligence (AI) in radiology is gaining importance and interest in recent years. The application of AI in detecting styloid process elongation is less explored, advocating for research in the same arena. Aim and objectives The study aimed to evaluate the accuracy of artificial intelligence in detecting styloid process elongation in digital OPGs and to compare the performance of the three different AI algorithms with that of the manual radiographic evaluation by the radiologist. Materials and methods A total of 400 digital OPGs were screened, and linear measurements of the styloid process length (ImageJ software (National Institute of Health, Maryland, USA)) were done for the identification of styloid process elongation by a single calibrated observer to finally include a processed image dataset including 169 images of the elongated styloid process and 200 images of the normal styloid process. A machine learning approach was used to detect the styloid process elongation using the three different AI models: logistic regression, neural network, and Naïve Bayes algorithms in Orange software (University of Ljubljana, Slovenia). Performance evaluation was done using the accuracy, sensitivity, specificity, precision, recall, F1 score, and AUC-ROC (area under the receiver operating characteristic) curve. Results Logistic regression and neural network algorithms depicted the highest accuracy of 100% with no false positives or false negatives, securing a score of 1.000 for all the metrics. However, the Naïve Bayes model demonstrated a fairly considerable accuracy, classifying 49 false positive images and 59 false negative images with an AUC (area under the curve) score of 78 %. Nevertheless, it performed better than random guessing. Conclusion Logistic regression and neural network algorithms accurately detected styloid process elongation similar to that of manual radiographic evaluation. The Naïve Bayes algorithm did not perform an accurate classification yet performed better than random guessing. AI holds a promising scope for its application in automatically detecting styloid process elongation in digital OPGs.

New insights into the electrochemical performance of precursor derived Si(Nb)OC composites as anode materials for batteries.

This work represents a first attempt to synthesize Si(Nb)OC ceramic composites through the polymer pyrolysis or the precursor-derived ceramics (PDC) route for use as a hybrid anode material for lithium-ion batteries (LIB). Electron microscopy, X-ray diffraction, and various spectroscopy techniques were used to examine the micro/nano structural features and phase evolution during cross-linking, pyrolysis, and annealing stages. During the polymer-to-ceramic transformation process, in situ formation of carbon (so-called "free carbon"), and crystallization of t-NbO2, NbC phases in the amorphous Si(Nb)OC ceramic matrix are identified. The first-cycle reversible capacities of 431 mA h g-1 and 256 mA h g-1 for the as-pyrolyzed and annealed Si(Nb)OC electrodes, respectively, exceeded the theoretical Li capacity of niobium pentaoxide or m-Nb2O5 (at approximately 220 mA h g-1). With an average reversible capacity of 200 mA h g-1 and close to 100% cycling efficiency, as-pyrolyzed Si(Nb)OC demonstrates good rate capability. X-ray amorphous SiOC with uniformly distributed nanosized Nb2O5 and graphitic carbon structure likely provides stability during repeated Li+ cycling and the formation of a stable secondary electrolyte interphase (SEI) layer, leading to high efficiency.

Fabrication of a bi-metallic metal organic framework nanocomposite for selective and sensitive detection of triclosan.

Transition metal-ion based nanocomposites are widely used owing to their ease of synthesis and cost-effectiveness in the sensor development. In this study, we have synthesized bi-metallic (iron and zinc) metal organic framework (MOF) nanorods-nanoparticles (denoted as Fe2Zn-MIL-88B) with a well-defined structure and characterized them. The bimetallic material nanocomposite (Fe2Zn-MIL-88B, nafion (Nf), and multiwalled carbon nanotube (MWCNT)) was fabricated on the electrode (glassy carbon electrode (GCE) or screen printed carbon electrode (SPCE)) surface within 10 min at room temperature. The Fe2Zn-MIL-88B/Nf/MWCNT@GCE showed an excellent electron transfer mechanism compared to a bare GCE and bare SPCE. The Fe2Zn-MIL-88B based nanocomposite electrode triggers the oxidation of the environmental carcinogenic molecule triclosan (TCS). Under optimized conditions, the sensor has a limit of detection of 0.31 nM and high selectivity to TCS in the presence of other interfering agents. The sensor has a good day-to-day TCS detection reproducibility. Fe2Zn-MIL-88B was stable even after 11 months of synthesis and detected TCS with similar sensitivity. The fabrication of the Fe2Zn-MIL-88B/Nf/MWCNT nanocomposite was successfully translated from the GCE to SPCE. TCS was detected in human plasma and commercial products such as soaps, skin care products, shampoos, and tooth pastes.

Salivary Lactate Dehydrogenase as a Potential Biomarker in Oral Potentially Malignant Disorders and Head & Neck Cancer- A Systematic Review and Meta-analysis.

BACKGROUND: The prognosis of head &neck cancer (HNC) depends on its early detection, diagnosis, and treatment, which has advocated a search for a simple, reliable, noninvasive, cost-effective tool to aid in the same. Salivary lactate dehydrogenase has gained interest in recent years, meeting the above requisite. OBJECTIVES: To evaluate the levels of salivary lactate dehydrogenase in patients with oral potentially malignant disorders (OPMD), HNC, and in the healthy control group (CG); to find the correlation, grade-wise and genderwise difference between them; and to assess whether it can be used as a potent biomarker in OPMD and HNC. MATERIALS AND METHODS: A comprehensive search of the specialized 14 databases and 4 institutional repositories was performed for including the studies evaluating salivary lactate dehydrogenase in OPMD and HNC patients either comparing or not comparing to the healthy control group in the systematic review process. The meta-analysis was performed with the eligible study data with the STATA version 16, 2019 software with 95% CI and p ≤ 0.05 in the random-effects model. RESULTS: Twenty-eight studies of case-control, interventional, or uncontrolled non-randomized design evaluating salivary lactate dehydrogenase were included. A total of 2074 subjects were included, involving HNC, OPMD, and CG. The salivary lactate dehydrogenase levels were significantly higher in HNC than in CG & oral leukoplakia (OL) (p=0.00); in OL & oral submucous fibrosis (OSMF) than CG (p=0.00); and higher in HNC than OSMF, however not significant (p=0.49). Also, the salivary lactate dehydrogenase levels had no significant difference between males and females in CG, HNC, OL, and OSMF groups(p> 0.05). DISCUSSION: It is evident that the epithelial transformations in the various OPMD and HNC, and the proceeding necrosis in the case of HNC, raises the LDH levels. It's also worth noting that when degenerative alterations continue, the SaLDH levels rise correspondingly, which are higher in HNC than in OPMD. Hence, it is essential to determine the cut-off values for SaLDH for establishing that the patient may have HNC or OPMD. It would be easy to follow-up frequently and perform investigations such as biopsy for the cases with high SaLDH levels, thereby aiding in the early detection and improving the prognosis of HNC. Moreover, the increased SaLDH levels were indicative of a lower degree of differentiation and an advanced disease leading to a poor prognosis. Salivary sample collection is less invasive, simple, and more acceptable to the patient; however, saliva collection is a time-consuming procedure as it is mostly collected by the passive spit method. Also, it is more feasible to repeat the SaLDH analysis during the follow-up, but the method has recently gained interest for over a decade. CONCLUSION: Salivary lactate dehydrogenase can be a potential biomarker for the screening, early detection, and follow-up of OPMD or HNC being simple, noninvasive, cost-effective, and readily acceptable modality. However, more studies with new standardized protocols are recommended to determine the precise cut-off levels for HNC and OPMD. Keywords (MeSH): L-Lactate dehydrogenase; Saliva; Mouth Neoplasms; Squamous Cell Carcinoma of Head and Neck; Oral; Precancerous conditions.

Effectiveness of various irrigant activation techniques on the penetration of sodium hypochlorite into lateral canals of mature permanent teeth: A systematic review and meta-analysis.

Objective: This review aimed to systematically review the effectiveness of various irrigant activation techniques (IATs) on the penetration of sodium hypochlorite (NaOCl) into the lateral canals of mature permanent teeth. Methods: Electronic databases including MEDLINE (via PubMed), Scopus, ProQuest, and Cochrane Library were searched to identify laboratory studies evaluating the penetration of NaOCl into lateral canals following the use of apical negative pressure irrigation (ANP), passive ultrasonic irrigation (PUI), sonic irrigation (SI), and/or manual dynamic activation (MDA) techniques. Meta-analysis was performed for individual IATs in comparison with CNI into the lateral canals of both straight and curved root canals. On the basis of the previous literature and parameters, the risk of bias of the selected studies was evaluated with the help of a customized tool. Results: Of the 983 records screened, 12 studies were selected to include in the systematic review, and 10 studies were selected for the meta-analysis. The total quality assessment across the included studies indicated a high quality (83.3%). Overall, the meta-analysis demonstrated IATs had significant improvement in the penetration of NaOCl into the lateral canals of straight canals (34.3%) over CNI. The subgroup analysis of individual IATs demonstrated PUI (60.9%) to be superior in the penetration into lateral canals of straight canals. Conclusions: IATs improved the irrigant penetration into lateral canals and therefore their use during routine endodontic practice is recommended. In straight canals, PUI is the most effective IAT followed by ANP, SI, and MDA techniques.

Reliability of gender determination from paranasal sinuses and its application in forensic identification-a systematic review and meta-analysis.

This systematic review aims to determine whether linear or morphometric analysis of paranasal sinuses can be used for accurate determination of gender and to appraise which sinus can be evaluated for accurate gender determination.A comprehensive search of the specialized databases (PubMed/MEDLINE, Science Direct, Clinical Key, ProQuest, Google Scholar, Epistomonikos, LILACS, OpenGrey) and other institutional repositories was performed for including the studies which assessed paranasal sinuses for gender determination. Quality assessment was carried out with the AQUA tool. The meta-analysis was performed with the eligible study data at 95% CI and p ≤ 0.05 in the random-effects model.Forty-six studies evaluating frontal sinus (13), maxillary sinus (26), frontal and maxillary sinus (5), or three paranasal sinuses (2) were included. All the included studies assessed height, length, width, and volume, respectively, and other additional parameters (area, perimeter) if wherever applicable. Frontal sinus had significantly higher values for males compared to females except for left height (LH) and left volume (LV). Maxillary sinus measurements were significantly higher in males contrasted to females except for LH. Sub-group analyses revealed that analyses involving the population had statistically significant results for all the measured parameters for both the sinuses (p < 0.05 and p = 0.00, respectively).Measurements obtained from assessing sinuses reveal that there are variations in size, among populations in different geographic regions. Hence, more studies with improved sample sizes and standardized measurement protocols should be carried out on different populations to see the diversity and their reliability.

Antioxidant and Anti-inflammatory Properties of the Two Varieties of Musa acuminata: An In Vitro Study.

Background Free radicals are involved in the process of carcinogenesis. Conventional antioxidants and anti-inflammatory drugs have the disadvantages of side effects and high costs. Banana peel contains phenolic and non-phenolic antioxidants that are pivotal in removing inflammatory components by inhibiting reactive oxygen species (ROS), protecting protease inhibitors from oxidative damage, and preventing fibroblast degradation which protects the body against the ill effects of free radicals. Aim and objectives The present study aimed to evaluate the potential antioxidant and anti-inflammatory activity of peel extracts of the Musa acuminata Red Dacca(red banana) and Musa acuminata Colla (rasthali). Materials and methods The procured unripe peels of red bananas and rasthali bananas were dried, ground into powder, and used to create aqueous and alcoholic extracts. The aqueous extract was made by dissolving 5 grams of peel powder in 25 ml of distilled water, while the alcoholic extract was prepared by heating ethanol to 100°C for 30 minutes. The extracts were combined, shaken for 24 hours, filtered, and stored at 4°C. Following extract preparation, 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay, hydrogen peroxide (H2O2) assay, bovine serum albumin (BSA) denaturation assay, and egg albumin (EA) denaturation assay were performed to evaluate the antioxidant and anti-inflammatory properties. The assays were performed in varying concentrations for the prepared extracts of red banana and rasthali and the 1:1 ratio combination extract of both varieties. The obtained data were tabulated and statistically tested using the IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, New York, United States) by the Kruskal-Wallis test with the statistical significance set at p≤0.05. Results Results highlighted variations in the antioxidant and anti-inflammatory properties of the banana peel extracts and the standard used in all the assays, but there was no statistically significant difference between the extracts and the standard (p>0.05). There was an increase in the antioxidant and anti-inflammatory activity with an increase in the concentration of both the extracts and the standard. The 1:1 ratio combination extract showed the highest antioxidant property among the banana extracts in the majority of the concentrations in the DPPH assay, whereas the rasthali extract showed the same even more than the standard in the H2O2 assay. The rasthali extract showed the highest anti-inflammatory property in all the concentrations in the BSA assay, and the 1:1 ratio combination extract showed the same in the EA assay. Conclusion The banana peel extracts showed comparable antioxidant and anti-inflammatory properties with that of the standard in all the assays with no statistically significant difference. There was a rising trend in the properties with an increase in their concentration. Red banana and rasthali peel extracts, either individually or in combination, could be a promising, effective, and cost-effective alternative or adjunct to the currently available antioxidant medications.

Effectiveness of a Visual Interactive Game on Oral Hygiene Knowledge, Practices, and Clinical Parameters among Adolescents: A Randomized Controlled Trial.

This study aimed to evaluate the effect of a novel interactive game-based visual performance technique (IGVP) and conventional oral health educational (OHE) talk on plaque control, gingival health, and oral hygiene knowledge and practices in 12−15-year-old schoolchildren. A single-blinded randomized controlled trial was undertaken in a private primary school in Belagavi, Karnataka, India. A total of 100 children aged 12−15 years were randomly assigned to either a conventional OHE talk (control group, n = 50) or the IGVP technique (test group, n = 50), using a computer-generated table of random numbers. A self-designed, pre-validated closed-ended questionnaire was collected from both groups, followed by clinical examination carried out using gingival and plaque index, pre- and post-intervention, at three months follow-up. There was a significant reduction in the mean gingival score and plaque score in the test group after intervention, indicating a 58.7% and 63.4% reduction, when compared to the control group, which had a 2.8% and 0.7% reduction, respectively (p < 0.001). The test group showed a significant increase in the percentage of knowledge gained (22.4%), compared to control group (7.8%). The IGVP technique proved to be more effective than a conventional OHE talk in the reduction of the plaque score, gingival score, and in the improvement of the knowledge of oral hygiene maintenance and its application.

Comparative evaluation of the efficacy of Nigella sativa (75% v/v) cream and clobetasol propionate (0.05% w/w) gel in oral lichen planus-a double-blinded randomized control trial.

OBJECTIVES: The a im of this study is to evaluate and compare the efficacy of Nigella sativa (75% v/v) cream and clobetasol propionate (0.05% w/w) gel for the management of oral lichen planus (OLP). STUDY DESIGN: Sixty clinically diagnosed cases of OLP were stratified into moderate cases or severe cases based on burning sensation before getting allocated to group I receiving Nigella sativa cream and group II receiving clobetasol propionate gel, two times a day for 45 days. Patients were examined every 15 days for a change in burning sensation and size of the lesion using the numeric pain rating scale (NRS) and a standard Vernier caliper, respectively. Statistical tests including Mann-Whitney U, Wilcoxon signed-rank, Friedman's, Dunn's post hoc, unpaired t, paired t, one-way repeated measures ANOVA, and Bonferroni's post hoc were applied. RESULTS: There was a statistically significant reduction in the burning sensation as well as the size of the lesion in both groups (P ≤ 0.05). There was an 87.8% (moderate cases) and 85.7% (severe cases) reduction in the mean NRS scores on the 45th day in group I when compared to the 96.5% (moderate cases) and 93.48% (severe cases) in group II. There was a 92.9% (moderate cases) and 90.7% (severe cases) reduction in the size of the lesion in group I when compared to the 92.6% (moderate cases) and 93.1% (severe cases) in group II. CONCLUSION: The topical application of Nigella sativa cream was effective and comparable to clobetasol propionate 0.05% gel in the management of OLP, without any side effects. Hence, this study recommends the use of topical Nigella sativa cream therapy in the management of OLP. CLINICAL RELEVANCE: The current mainstay of treatment for OLP is the administration of topical or systemic corticosteroids, which are known to cause side effects, demanding a search for an alternative. Nigella sativa oil cream could be a safe, promising, cost-effective, adjunctive, or alternative modality. Clinical trial registration number: CTRI/2020/07/026745 (India).

Efficacy of topical tulsi (Ocimum sanctum) paste for the management of oral submucous fibrosis - A clinical study.

Context: Oral submucous fibrosis (OSMF) is a chronic insidious oral potentially malignant disorder characterized by increased collagen deposition and reduced collagen degradation causing burning sensation and difficulty in mouth opening. Aim: To assess the efficacy of topical Tulsi (Ocimum sanctum) paste for the management of OSMF. Settings and Design: Institution-based clinical trial. Materials and Methods: The study included a total of 60 OSMF patients categorized into three Groups A, B and C (20 in each) depending on the severity according to Lai DR et al. classification. The patients were advised for topical Tulsi paste application and were evaluated for the reduction in the burning sensation and improvement in mouth opening every month for 3 subsequent months using the numeric pain rating scale (NRS) and a Vernier calliper, respectively. Statistical Analysis: The baseline and 3-month recordings were subjected to inter- and intra-group statistical analysis using Kruskal-Wallis analysis of variance (ANOVA), Mann-Whitney U, one-way ANOVA, Tukey's multiple post-hoc and Wilcoxon matched-pairs tests. Results: There was a reduction in the burning sensation and improvement in the mouth opening in all three groups. The reduction in the burning sensation was statistically significant among all the groups (P < 0.05) and the NRS scores after 3 months among the three groups were not statistically significant (P > 0.05). There was a statistically significant difference (P < 0.05) in the improvement of mouth opening between Group A and B; A and C; but not between B and C. Conclusion: Tulsi paste showed a significant reduction in the burning sensation and improvement of the mouth opening thereby proving to be a safe and promising medicament for OSMF.

Comparative efficacy of topical coconut cream and clobetasol propionate ointment for the management of oral lichen planus: A double-blinded randomized control trial.

CONTEXT: Oral lichen planus (OLP) is a quite common chronic inflammatory mucocutaneous disorder affecting the oral cavity and skin. The current treatment relies on systemic or topical corticosteroids but is known to cause side effects thereby demanding a search for an alternative. AIM: This study aims to assess and to compare the efficacy of topical Coconut (Cocos nucifera) 50% cream and Clobetasol propionate 0.05% ointment for the management of OLP. SETTINGS AND DESIGN: An institution-based double-blinded randomized control trial. MATERIALS AND METHODS: Sixty clinically diagnosed OLP patients were allotted to two groups (30 in each): Group I (Coconut cream-50%) and Group II (Clobetasol Propionate ointment-0.05%). Patients were examined every 15 days until two months for a change in the lesion size and reduction in the burning sensation. The measurement of lesion size and burning sensation was done using Adobe Photoshop software (version CS3) and Numeric Pain Rating scale (NPS), respectively. STATISTICAL ANALYSIS USED: The recordings were subjected to the statistical analysis using Wilcoxon matched-pairs and Mann-Whitney U tests for intra-group and inter-group comparisons, respectively. RESULTS: There was an 85% regression in the size of the lesion in Group I whereas Group II had it to be 95%, and a 100% reduction in the NPS score in Group I whereas Group II had it to be 95%. CONCLUSION: The Coconut cream showed a significant decrease in the size of the lesion and the burning sensation with no side effects neither any signs of toxicity reported during the treatment or follow-up, thereby proving to be a safe and promising medication for OLP.

Comparison between Dexmedetomidine and Clonidine as an Adjuvant to Ropivacaine in Ultrasound-Guided Adductor Canal Block for Postoperative Analgesia in Total Knee Replacement: A Randomized Controlled Trial.

Background: Total knee replacement (TKR) surgeries are associated with significant postoperative pain. Ultrasound-guided adductor canal block is associated with better pain scores. The addition of Clonidine and Dexmedetomidine as additives to local anesthetics was the recent focus of interest. However, there are minimal studies comparing the duration of analgesia as additives to Ropivacaine in ultrasound-guided adductor canal block for TKRs. Materials and Methods: Prospective, randomized, double-blind design was followed. One hundred and two American Society of Anesthesiologists I to III patients undergoing unilateral TKR surgeries were included in the study and randomized into two groups. Group C received Clonidine 150 mcg and Group D received Dexmedetomidine 100 mcg as an add on to 30 mL of 0.2% ropivacaine for adductor canal block. Postoperatively, duration of analgesia, sedation score, rescue analgesic requirement, hemodynamics, and any other adverse effects were monitored. Results: The total duration of analgesia in Group D (16.01 h [standard deviation [S. D]-0.5]) was significantly higher as compared to Group C (13.02 h [S. D-0.5]) (P < 0.0001). The numerical rating score (NRS) was significantly lower in Group D compared to Group C (P < 0.05) at multiple postoperative timelines. Group D (2.25(S. D-0.44)) had better sedation scores as compared to Group C (2 [S. D-0]) (P = 0.001). Conclusion: Dexmedetomidine has longer duration, lower pain, and better sedation scores as compared to clonidine in adductor canal blocks for postoperative pain relief in TKR surgeries.

A Rare Case of Mixed Connective Tissue Disease (MCTD) with Intricate Features of Lupus, Polymyositis and Rheumatoid Arthritis Presenting with Severe Myositis.

Mixed connective tissue disease (MCTD) includes clinical and laboratorial manifestations of systemic lupus erythematosus, scleroderma and polymyositis along with high titres of anti-U1RNP antibodies. In the initial phases of the disease, muscle enzyme levels increase but the disease remains generally subclinical. Presentation with myositis is uncommon. Our objective is to report a rare case of a patient who presented with a severe onset of myositis characterized by dysphagia, an increase in myopathy and joint involvement suggestive of RA. The patient was initiated on pulse corticosteroid therapy along with methotrexate in view of her elevated Creatine Kinase levels and biopsy findings that were suggestive of severe myositis. The patient showed clinical and laboratory improvement with this regimen. Though severe myositis and arthritis can occur in overlap syndrome, MCTD evolved as a separate disease entity due to presence of high titres of Anti U1-RNP antibodies. The authors emphasize that this is an extremely rare presentation of MCTD with only two previous cases seen in literature, one of a 13 year old child and the other being an adult female both of whom had evidence of myositis on presentation.