An Evaluation of the Effectiveness of Various Luting Cements on the Retention of Implant-Supported Metal Crowns.

Background and objective Cement-retained prostheses have replaced screw-retained prostheses as the preferred restoration in recent years in order to overcome the latter's limitations. In this study, four different luting cements were compared to evaluate their efficacy on the retention of cement-based metal crowns to implant abutments. Materials and methods In the right and left first molar regions, four implant analogs (Internal Hex, Adin Dental Implant Systems Ltd., Tel-Aviv, Israel) were screwed into epoxy resin casts (Araldite CY 230-1 IN, India) that were positioned perpendicular to the cast's plane. Four metal copings were created and cemented. Group A: polycarboxylate cement (DUR) (DurelonTM, 3M Espe, St. Paul, MN); Group B: PANAVIA™ F 2.0 dual-cure resin cement (Kuraray America, Inc., New York, NY); Group C: resin-modified glass ionomer (3M™ RelyX™ Luting, 3M Espe); and Group D: non-eugenol temporary resin cement (Kerr-Temp, KaVo Kerr, Brea, CA) were used to cement crowns. To check the retention capacity, samples were put through a pull-out test on an Instron universal testing machine (TSI­Tecsol, Bengaluru, India) with a crosshead speed of 0.5 mm/min. Each coping's de-cementing load was noted, and average values for every sample were computed and statistically analyzed. Results The findings demonstrated that non-eugenol temporary resin implant cement has the lowest retention value at 138.256 N, followed by resin-modified glass ionomer cement at 342.063 N, polycarboxylate luting cement at 531.362 N, and resin cement at 674.065 N. The average difference in retentive strength across all four groups was statistically very significant (p=0.001). Conclusion Based on our findings, non-eugenol temporary resin implant cement enables simple retrievability of the prosthesis in the event of a future failure and is appropriate for implant restorations with cement retention. Also, cements made of polycarboxylate and resin have the highest retention values.

Pregnancy With Uterine Fibroids: Obstetric Outcome at a Tertiary Care Hospital of Central India.

BACKGROUND: Uterine fibroids are the most frequent benign tumor of the female reproductive system, with a significantly lower frequency in pregnancy. This could be due to the fact that uterine fibroids are linked to infertility and low implantation rates following in vitro fertilization (IVF). The goal of this study was to look at the obstetrics outcomes of uterine fibroids and their consequences in a tertiary hospital. MATERIALS AND METHODS: The current study was a observational cohort study that evaluated the cases of pregnancy with fibroid. Study was undertaken at the Department of Obstetrics and Gynecology (OBGY) at a medical college in central India and it was conducted over a period of nine months from 1st November 2021 to 31st July 2022. All pregnant women who had an ultrasonography (USG)-documented uterine fibroid diagnosed prenatally or antenatally were enrolled. All demographic information, laboratory and USG results were noted and their mode of delivery, obstetric complications, if any, and neonatal outcomes were evaluated. RESULTS: A total of 110 cases were enrolled as per inclusion and exclusion criteria. The majority of patients (42.73%) were in the 26- to 30-year-old age group. In this study, the majority of cases were carried to term (80.9%). The most prevalent mode of delivery was caesarean section (61.82%). Major complications during pregnancy were threatened preterm labor (21.82%), and blood transfusion (20.00%), whereas postpartum hemorrhage (PPH) occurred in 9.09% cases, and 47 patients (42.72%) were asymptomatic throughout pregnancy. Major neonatal outcomes in our study were neonatal intensive care unit (NICU) hospitalization (20%), required neonatal resuscitation (14.55%), and neonatal mortality occurring in 1.82% cases. Gestational age at termination of pregnancy, when compared with different characteristics of fibroid, like type (p value 0.663), location (p value 0.552) and number of fibroid (p value 0.112), did not show any significant association. Similarly, maternal complications also did not show significant association (p value >0.05) with different characters of fibroid.  Conclusion: Pregnancies with fibroid are high-risk pregnancies that are linked to difficulties throughout the antepartum, intrapartum, and postpartum periods, as well as increased chances of cesarean delivery and PPH.

Cellular and molecular mechanisms, genetic predisposition and treatment of diabetes-induced cardiomyopathy.

Diabetes mellitus is a common disease affecting millions of people worldwide. This disease is not limited to metabolic disorders but also affects several vital organs in the body and can lead to major complications. People with diabetes mellitus are subjected to cardiovascular complications, such as cardiac myopathy, which can further result in major complications such as diabetes-induced cardiac failure. The mechanism underlying diabetes-induced cardiac failure requires further research; however, several contributing factors have been identified to function in tandem, such as reactive oxygen species production, inflammation, formation of advanced glycation end-products, altered substrate utilisation by mitochondria, activation of the renin-angiotensin-aldosterone system and lipotoxicity. Genetic factors such as microRNAs, long noncoding RNAs and circular RNAs, as well as epigenetic processes such as DNA methylation and histone modifications, also contribute to complications. These factors are potential targets for developing effective new therapies. This review article aims to facilitate in depth understanding of these contributing factors and provide insights into the correlation between diabetes mellitus and cardiovascular complications. Some alternative targets with therapeutic potential are discussed to indicate favourable targets for the management of diabetic cardiomyopathy.

Dynamics of the secreted frizzled related protein Sizzled and potential implications for binding to bone morphogenetic protein-1 (BMP-1).

Sizzled (Szl) is both a secreted frizzled related protein (sFRP) and a naturally occurring inhibitor of the zinc metalloproteinase bone morphogenetic protein-1 (BMP-1), a key regulator of extracellular matrix assembly and growth factor activation. Here we present a new crystal structure for Szl which differs from that previously reported by a large scale (90°) hinge rotation between its cysteine-rich and netrin-like domains. We also present results of a molecular docking analysis showing interactions likely to be involved in the inhibition of BMP-1 activity by Szl. When compared with known structures of BMP-1 in complex with small molecule inhibitors, this reveals features that may be helpful in the design of new inhibitors to prevent the excessive accumulation of extracellular matrix that is the hallmark of fibrotic diseases.

Introgressing cry1Ac for Pod Borer Resistance in Chickpea Through Marker-Assisted Backcross Breeding.

The gram pod borer Helicoverpa armigera is a major constraint to chickpea (Cicer arietinum L.) production worldwide, reducing crop yield by up to 90%. The constraint is difficult to overcome as chickpea germplasm including wild species either lacks pod borer resistance or if possessing resistance is cross-incompatible. This study describes conversion of elite but pod borer-susceptible commercial chickpea cultivars into resistant cultivars through introgression of cry1Ac using marker-assisted backcross breeding. The chickpea cultivars (PBG7 and L552) were crossed with pod borer-resistant transgenic lines (BS 100B and BS 100E) carrying cry1Ac that led to the development of BC1F1, BC1F2, BC1F3, BC2F1, BC2F2, and BC2F3 populations from three cross combinations. The foreground selection revealed that 35.38% BC1F1 and 8.4% BC1F2 plants obtained from Cross A (PBG7 × BS 100B), 50% BC1F1 and 76.5% BC1F2 plants from Cross B (L552 × BS 100E), and 12.05% BC2F2 and 82.81% (average) BC2F3 plants derived from Cross C (PBG7 × BS 100E) carried the cry1Ac gene. The bioassay of backcross populations for toxicity to H. armigera displayed up to 100% larval mortality. BC1F1 and BC1F2 populations derived from Cross B and BC2F3 population from Cross C segregated in the Mendelian ratio for cry1Ac confirmed inheritance of a single copy of transgene, whereas BC1F1 and BC1F2 populations obtained from Cross A and BC2F2 population from Cross C exhibited distorted segregation ratios. BC1F1 plants of Cross A and Cross B accumulated Cry1Ac protein ranging from 11.03 to 11.71 µgg-1 in leaf tissue. Cry1Ac-positive BC2F2 plants from Cross C demonstrated high recurrent parent genome recovery (91.3%) through background selection using SSR markers and phenome recovery of 90.94%, amongst these 30% plants, were homozygous for transgene. The performance of BC2F3 progenies derived from homozygous plants was similar to that of the recurrent parent for main agronomic traits, such as number of pods and seed yield per plant. These progenies are a valuable source for H. armigera resistance in chickpea breeding programs.

DBGC: Dimension-Based Generic Convolution Block for Object Recognition.

The object recognition concept is being widely used a result of increasing CCTV surveillance and the need for automatic object or activity detection from images or video. Increases in the use of various sensor networks have also raised the need of lightweight process frameworks. Much research has been carried out in this area, but the research scope is colossal as it deals with open-ended problems such as being able to achieve high accuracy in little time using lightweight process frameworks. Convolution Neural Networks and their variants are widely used in various computer vision activities, but most of the architectures of CNN are application-specific. There is always a need for generic architectures with better performance. This paper introduces the Dimension-Based Generic Convolution Block (DBGC), which can be used with any CNN to make the architecture generic and provide a dimension-wise selection of various height, width, and depth kernels. This single unit which uses the separable convolution concept provides multiple combinations using various dimension-based kernels. This single unit can be used for height-based, width-based, or depth-based dimensions; the same unit can even be used for height and width, width and depth, and depth and height dimensions. It can also be used for combinations involving all three dimensions of height, width, and depth. The main novelty of DBGC lies in the dimension selector block included in the proposed architecture. Proposed unoptimized kernel dimensions reduce FLOPs by around one third and also reduce the accuracy by around one half; semi-optimized kernel dimensions yield almost the same or higher accuracy with half the FLOPs of the original architecture, while optimized kernel dimensions provide 5 to 6% higher accuracy with around a 10 M reduction in FLOPs.

Assessment of the prevalence of congenital heart disease in children with pneumonia in tertiary care hospital: A cross-sectional study.

BACKGROUND AND OBJECTIVES: Pneumonia is the most common cause of death in children under five years of age. Epidemiological factors and the disease burden differ in developing and industrialized countries. The present study is a cross sectional observational study, carried out from August 2018 to August 2020 in Hindu Rao Hospital, to assess the prevalence of congenital heart disease (CHD) in patients with pneumonia in children up to 5 years. The main objectives of the study were to study the prevalence of congestive cardiac failure (CCF) in pneumonia with and without congenital heart disease. MATERIAL AND METHODS: Patients under 5 years of age, presenting with pneumonia during August 2018 to July 2020 were enrolled for study. The bio-data of each patient was documented each patient was clinically evaluated thoroughly and findings noted. Pneumonia was diagnosed on typical history, physical findings, blood investigations and chest radiographic finding of pneumonia infiltrates in either one or both lung fields. All the cases of pneumonia underwent transthoracic 2 Dimensional (2D) and Doppler echocardiography, done by the cardiologist. Any congenital heart disease so found was noted. The type and size of the defects was documented. The ventricular septal defects were classified based on the site and size. The size of the patient ductus arteriosus was also determined. These measurements were taken to evaluate the impact of defect size on pneumonia. CCF was diagnosed when the patient fulfilled the clinical diagnostic criteria of heart failure. All the cases of pneumonia underwent transthoracic 2 Dimensional (2D) and Doppler echocardiography for diagnosis of any congenital heart disease. RESULTS: Mean age of the children with pneumonia was 9.94 months with 77.5% of the cases below 1 year of age. Male predominance was seen with 56.3% males to 43.8% females. Prevalence of congenital heart disease among cases of pneumonia was 12.5% while that of congestive heart failure was 27.5%. Most common CHD observed was VSD (14 cases; 8.8%) followed by PDA, ASD and TGA (4; 2.5% and 3; 1.9% and 1; 0.6% cases respectively). A significant association was observed between presence of congenital heart disease and development of CCF. CONCLUSION: Our study demonstrates that most patients with pneumonia or recurrent pneumonia are likely to have an underlying illness at the time of pneumonia. Recurrent ALRTI often occurred in children with history of congenital heart diseases (CHD) and is also associated with Congestive Cardiac Failure. Children with CHD are more vulnerable to recurrent respiratory tract infection.

Potential of phytocompounds from Brassica oleracea targeting S2-domain of SARS-CoV-2 spike glycoproteins: Structural and molecular insights.

By 24th Sep. 2021, there are more than 229 million COVID-19 cases worldwide, the researchers are tirelessly working to discover and develop an efficient drug molecule against this devastative viral infection. This study aims to evaluate the inhibitory efficiency of the organic acids and phenolic compounds present in Brassica oleracea (Tronchuda Cabbage) against spike glycoprotein in SARS-CoV-2. Thirty-seven phytocompounds are screened on the basis of their molecular weight (<500 g/mol) and 14 ligands are docked using Autodock Vina and Autodock4 (version 4.2.6). The stability of the top five docked complexes was analyzed using classical molecular dynamics (MD) simulation. ADMET analysis is performed for the top five compounds and their targets are identified using SwissTargetPrediction. Phytoactives from B. oleracea namely Astragalin, 3-p-coumaroylquinic acid, 4-p-coumaroylquinic acid and sinapoyl-D-glucoside showed high binding affinities and free energy of binding during molecular docking and MD simulation studies (∼ 8.5-9.0 kcal/mol) for the spike glycoprotein trimer of SARS-CoV2. The ADMET analysis revealed that these phytocompounds have good solubility in the aqueous phase and that they don't penetrate the blood brain barrier. Moreover, there is no P-gp substrate inhibition, CYP1A2 inhibition, CYP2C19 inhibition, CYP2C9 inhibition, CYP2D6 inhibition and CYP3A4 inhibition observed for these compounds. Additionally, zero PAINS alerts were reported. These findings from molecular docking and MD simulation studies suggest that astragalin and coumaroylquinic acids from Tronchuda cabbage possess potential inhibitory capacity against spike glycoprotein trimer of SARS-CoV-2 and could be further taken up as lead targets for drug discovery.

Ideal Illumination for Smartphone-based Trabeculectomy Bleb Photography.

PURPOSE: Ophthalmology has seen numerous novel uses for smartphones over the years including fundus photography, telemedicine, and operative videography. However, anterior segment photography for assessing and documenting trabeculectomy bleb morphology using a smartphone has not been explored in detail. With the current study, we aim to characterize ideal illumination for the anterior segment smartphone photography in trabeculectomy patients. METHODS: Thirty status post-trabeculectomy patients were enrolled in this study. Native camera application and FiLMiC pro camera application were used on iPhone X to compare bleb images using yellow and white pen-torches as illumination source. Measured bleb area was compared using ImageJ software from the two apps in different illumination settings by charting boxplots and using one-way ANOVA test using R software to establish consistency. Bland-Altman interoperability for repeatability of bleb-area measurements was analyzed by plotting Bland-Altman plots. Signal-to-noise ratio was calculated using ImageJ for native camera images using slit-lamp camera images as reference. Subjective rating of these images was then performed by two experienced ophthalmologists and kappa coefficient was calculated for inter-operator repeatability. Statistical analysis was performed. RESULTS: The measured bleb area from images taken from both apps showed no significant difference, thereby establishing consistency, and Bland-Altman analysis indicated good repeatability and reproducibility. It was noted that SNR was lower for images shot in close illumination as compared to the ones shot in intermediate and distant illumination. Cohen's kappa coefficient was 0.7 for images with distant illumination using white light and 0.65 for images clicked with illumination at an intermediate distance using yellow light, suggesting substantial agreement between the observers. CONCLUSION: Smartphone photography is a reliable tool for morphological assessment trabeculectomy blebs. Optimal illumination helps achieve results free from digital noise and better delineation of specific morphological features. Intermediate illumination and distant illumination provides much better results in terms of high SNR while avoiding overexposure and clipping of highlight information in the images.

Pediatric hyperimmunoglobulin E syndrome (Job's syndrome) with STAT3 mutation: A case report.

INTRODUCTION: Job's syndrome or hyper-immunoglobulin E syndromes (HIES) is a rare, heterogeneous complex of primary immunodeficiency disorders. It is characterized by triad of extremely high serum immunoglobulin E (IgE) levels, recurrent cutaneous infections like chronic eczematous dermatitis, skin abscesses and recurrent sinopulmonary infections. These patients have characteristic facial appearance and many oral manifestations. Eosinophilia, retention of deciduous teeth and skeletal abnormalities are other important clinical features of this syndrome. Familial HIES is of two types depending on the type of gene involved; autosomal-dominant HIES (AD-HIES), which develops due to mutation in human signal transducer and activator of transcription 3 gene (STAT3) and autosomal recessive HIES caused by DOCK8 gene mutation, but most cases are sporadic. CASE PRESENTATION: Hereby, we present a case of 5 years old female child who presented to our hospital with extensive eczematous lesions over flexural aspect of arms and over the gluteal region extending to the lower limb. The complete clinical presentation and lab investigations have confirmed AD-HIES syndrome. A novel missense mutation in exon 17 (c.1593A > T, p.K531 N) was identified in the STAT3 gene. DISCUSSION: The therapeutic strategy is directed mainly toward the prevention and management of infections and symptoms. Children affected with HIES can develop life-threatening pulmonary infections. Pulmonary complications must be identified in the early stage of the disease to treat them effectively. Hence, early diagnosis and proper management are necessary. CONCLUSION: To date, information about paediatric HIES is limited. This case presents the clinical features, investigational procedures and management strategy for that particular condition in paediatric population.

Contrast sensitivity assessment for early detection of hydroxychloroquine toxicity.

INTRODUCTION: Hydroxychloroquine (HCQ), is known to cause visual dysfunction during its prolonged course of administration. Optical Coherence Tomography (OCT) and field tests are the commonly used screening tests. Not much is known about the role of contrast sensitivity (CS) as method for early detection of HCQ toxicity. This pilot study was designed to study the change in central and peripheral contrast sensitivity for detecting early signs of HCQ toxicity. DESIGN: Prospective study conducted at Government Medical College & Hospital, Chandigarh, India. PARTICIPANTS: Twenty eyes of 10 treatment naïve, autoimmune patients. METHODS: All patients underwent functional tests, contrast sensitivity tests: Pelli Robson and Spaeth Richman Contrast Sensitivity (SPARCS). Average and quadrant wise SPARCS score; Pelli Robson score and structural parameters viz., macular OCT parameters were compared at baseline, 3- and 6-month post treatment with HCQ. MAIN OUTCOME MEASURES: Change in CS using SPARCS and Pelli Robson were recorded at each visit and compared with the baseline. Structural and functional parameters were correlated. RESULTS: The average SPARCS scores at baseline, 3-month post HCQ and at 6-month post HCQ were 82.37 ± 8.40, 73.17 ± 9.63 and 70.37 ± 10.08, respectively. Quadrant wise change from first visit to third visit was statistically significant only in superotemporal (p = 0.002), inferotemporal (p = 0.02) and central (p = 0.01) quadrants. There was no correlation between SPARCS and Pelli Robson (S = 0.1454, p = 0.466). Similarly, there was no significant correlation between the structural and functional parameters. CONCLUSIONS: HCQ affect the CS by virtue of its action on bipolar and ganglion cells. Decrease in central and peripheral CS as measured by SPARCS can be a sign of early visual dysfunction, hence must be considered as an early indicator of HCQ toxicity.

Many faces of Wilms Tumor: Recent advances and future directions.

BACKGROUND: Wilms' tumor (WT) is the most frequently occurring paediatric renal tumor and is one of the most treatment-responsive tumors. A tumor-suppressor gene and other genetic abnormalities have been implicated in its etiology. In addition, patients with many congenital anomalies, such as Beckwith-Wiedemann syndrome, WAGR syndrome and Denys-Drash syndrome, have an increased risk of WT. METHODS AND RESULTS: Two large collaborative groups - National Wilms Tumor Study Group (NWTSG)/Children's Oncology Group (COG) and The International Society of Paediatric Oncology (SIOP) have laid down the guidelines for standardized treatment of WT, though differing in the diagnostic and therapeutic approach. The major difference in the two guidelines is the timing of surgery: SIOP recommends using preoperative chemotherapy and NWTSG/COG prefers primary surgery before any adjuvant treatments. Both these groups currently aim at intensifying treatment for patients with poor prognosticators while appropriating the therapy to reduce long-term complications for those with favourable prognostic features. As the survival rate has now reached 90%, the primary objectives of the physician are to perform nephron-sparing surgery in selected cases and to reduce the dosage and duration of chemotherapy and radiotherapy in appropriate cases. The purpose of this review is to present current standards of diagnosis and treatment of WT around the world. CONCLUSION: Further studies in future should be done to highlight the use of chemotherapy and radiotherapy under risk-stratified strategies. Further improvement in survival of these children can only be achieved by increasing awareness, early recognition, appropriate referral, and a multidisciplinary approach.

A pilot study for smartphone photography to assess bleb morphology and vasculature post-trabeculectomy.

PURPOSE: The current grading systems used for bleb morphology assessment in patients post-trabeculectomy are based on standardized slit-lamp photographs and anterior segment imaging devices. The lack of availability of these expensive and non-portable devices in resource-deficient settings is a significant deterrent in their widespread utilization for proper post-operative management. The rapidly evolving utilization of smartphone photography has significantly benefited diagnostics of posterior segment disorders and is now being increasingly utilized for monitoring anterior segment pathologies as well as post-surgical course. In this study, we study a novel use of smartphones for bleb photography for assessing the morphological characteristics as vascularity and microcysts. METHODS: In this pilot, observational study, we compared the trabeculectomy bleb images of five subjects, obtained by iPhone X (dual lens) and iPhone 6S (single lens). We captured two image sets with both smartphones first with a focussed torchlight and then with a built-in flash video light. RESULTS: The images resulting from the newer iPhone X were substantially superior than those from iPhone 6S. For the 12-megapixel dual-camera set-up on the iPhone X, the 1 × lens resulted in better images than the 2 × lens with contrast and overall clarity of the area of interest. While the macro-lens attachment had promising results at 1 × zoom, there is no added advantage of the macro-lens attachment as it resulted in considerable loss of image quality at twice the zoom. Using a 20 D lens helped attain higher magnification and better framing as it reduced the focussing distance needed to get sharp images. The images obtained from both smartphones were of higher quality when illuminated from an external source when compared to the native iPhone flash due to even exposure and fewer autofocus artefacts. CONCLUSION: Analyses of all image sets showed that the current generation in-built camera app on IOS and newer iPhone camera optics resulted in high-quality images of the ocular surface with high magnification without any loss in clarity.

Oral Health Knowledge, Attitude, and Practices among Postgraduate Students of Panjab University, Chandigarh: A Cross-sectional Study.

BACKGROUND: Dental caries and periodontal diseases are the most commonly occurring dental problems. Proper knowledge, attitude, and practices (KAPs) of oral health of young adults will help in prevention of these diseases. AIM: To comparatively evaluate the oral health KAPs related to oral health of postgraduate students of Panjab University, Chandigarh, with respect to gender and different departments. SETTING AND DESIGN: A descriptive cross-sectional survey was conducted using a questionnaire that assessed KAPs of postgraduate students, aged 17-25 years. MATERIALS AND METHODS: This survey was undertaken on 600 postgraduate students of Panjab University, Chandigarh. The sample was divided into 3 groups: group I-arts students (n = 200), group II-science students (n = 200), and group III-commerce students (n = 200). Data were collected and subjected to statistical analysis. STATISTICAL ANALYSIS USED: Chi-squared test was used for comparison between different groups. ANOVA and Kruskal-Wallis compared the data between different departments, and Mann-Whitney U test between males and females. RESULTS: The students of arts had significantly lesser knowledge of oral health compared with other departments. About 65% arts students believed that sweets/soft drinks/chips were causing tooth decay compared with 83% science and 80% commerce students (p value < 0.001). About 52.5% arts students had knowledge that blood on the toothbrush was indicative of gum disease followed by 67% science and 76% commerce students (p value < 0.001). CONCLUSION: In our study, there was no significant difference in gender with respect to KAPs of oral health but a significant difference was observed among different departments with arts students showing significantly lesser knowledge. HOW TO CITE THIS ARTICLE: Verma L, Passi S, Sharma U, et al. Oral Health Knowledge, Attitude, and Practices among Postgraduate Students of Panjab University, Chandigarh: A Cross-sectional Study. Int J Clin Pediatr Dent 2020;13(2):113-118.

Molecular Basis for Omapatrilat and Sampatrilat Binding to Neprilysin-Implications for Dual Inhibitor Design with Angiotensin-Converting Enzyme.

Neprilysin (NEP) and angiotensin-converting enzyme (ACE) are two key zinc-dependent metallopeptidases in the natriuretic peptide and kinin systems and renin-angiotensin-aldosterone system, respectively. They play an important role in blood pressure regulation and reducing the risk of heart failure. Vasopeptidase inhibitors omapatrilat and sampatrilat possess dual activity against these enzymes by blocking the ACE-dependent conversion of angiotensin I to the potent vasoconstrictor angiotensin II while simultaneously halting the NEP-dependent degradation of vasodilator atrial natriuretic peptide. Here, we report crystal structures of omapatrilat, sampatrilat, and sampatrilat-ASP (a sampatrilat analogue) in complex with NEP at 1.75, 2.65, and 2.6 Å, respectively. A detailed analysis of these structures and the corresponding structures of ACE with these inhibitors has provided the molecular basis of dual inhibitor recognition involving the catalytic site in both enzymes. This new information will be very useful in the design of safer and more selective vasopeptidase inhibitors of NEP and ACE for effective treatment in hypertension and heart failure.

Bhutan's First Emergency Air Medical Retrieval Service: The First Year of Operations.

OBJECTIVE: The Bhutan Emergency Aeromedical Retrieval (BEAR) Team is the only helicopter emergency medical service in Bhutan. This study was performed to review the clinical cases cared for by the BEAR Team, ascertain the types of interventions that were performed, and determine the outcomes of patients evacuated in its first year of operations. METHODS: This is a retrospective observational study in which medical evacuations performed in the first year of operations were analyzed. The number of airlifts activated during the study period determined the sample size (171). Data were obtained from case logs and trip sheets. RESULTS: The BEAR Team provided services to all regions of the country in its first year. The overall survival rate was 73.1%. The most common intervention required was securing a definitive airway (n = 24). The top 3 conditions requiring air medical retrieval were sepsis, acute mountain sickness, and trauma. CONCLUSION: Helicopter emergency medical services are known to decrease the time to definitive treatment. This is particularly pertinent in Bhutan, given the scattered population distribution, long transport times, and distribution of medical resources and specialty care. This study is the first of its kind in Bhutan, and this can pave way to conduct more studies involving patients transported by air ambulance.

Flavonoids and Other Polyphenols Act as Epigenetic Modifiers in Breast Cancer.

Breast cancer is a common cancer that occurs due to different epigenetic alterations and genetic mutations. Various epidemiological studies have demonstrated an inverse correlation between breast cancer incidence and flavonoid intake. The anti-cancer action of flavonoids, a class of polyphenolic compounds that are present in plants, as secondary metabolites has been a major topic of research for many years. Our review analysis demonstrates that flavonoids exhibit anti-cancer activity against breast cancer occurring in different ethnic populations. Breast cancer subtype and menopausal status are the key factors in inducing the flavonoid's anti-cancer action in breast cancer. The dose is another key factor, with research showing that approximately 10 mg/day of isoflavones is required to inhibit breast cancer occurrence. In addition, flavonoids also influence the epigenetic machinery in breast cancer, with research demonstrating that epigallocatechin, genistein, and resveratrol all inhibited DNA methyltransferase and altered chromatin modification in breast cancer. These flavonoids can induce the expression of different tumor suppressor genes that may contribute to decreasing breast cancer progression and metastasis. Additional studies are required to confirm the contribution of epigenetic modifications by flavonoids to breast cancer prevention.

Intensive Speech Therapy Programme Combined with a Speech Bulb Prosthesis in the Prosthodontic Rehabilitation of Velopharyngeal Dysfunction.

Velopharyngeal insufficiency resulting from a defect in the soft palate, acquired or congenital, causes incomplete closure of the palatopharyngeal sphincter. An individual with such a defect suffers from multiple problems in eating, speaking, breathing, as well as psychological trauma, in society. This case report describes the rehabilitation of a patient with a congenital velopharyngeal defect using a definitive speech bulb obturator and an intensive speech therapy program. The patient underwent speech therapy for a period of three months. A speech and voice assessment was conducted before and after speech therapy. A speech intelligibility test was conducted, and nasalance was measured using a nasometer. Significant improvement in speech, mastication, and velopharyngeal function was achieved after bulb reduction and speech therapy.

A Block Adaptive Near-Lossless Compression Algorithm for Medical Image Sequences and Diagnostic Quality Assessment.

The near-lossless compression technique has better compression ratio than lossless compression technique while maintaining a maximum error limit for each pixel. It takes the advantage of both the lossy and lossless compression methods providing high compression ratio, which can be used for medical images while preserving diagnostic information. The proposed algorithm uses a resolution and modality independent threshold-based predictor, optimal quantization (q) level, and adaptive block size encoding. The proposed method employs resolution independent gradient edge detector (RIGED) for removing inter-pixel redundancy and block adaptive arithmetic encoding (BAAE) is used after quantization to remove coding redundancy. Quantizer with an optimum q level is used to implement the proposed method for high compression efficiency and for the better quality of the recovered images. The proposed method is implemented on volumetric 8-bit and 16-bit standard medical images and also validated on real time 16-bit-depth images collected from government hospitals. The results show the proposed algorithm yields a high coding performance with BPP of 1.37 and produces high peak signal-to-noise ratio (PSNR) of 51.35 dB for 8-bit-depth image dataset as compared with other near-lossless compression. The average BPP values of 3.411 and 2.609 are obtained by the proposed technique for 16-bit standard medical image dataset and real-time medical dataset respectively with maintained image quality. The improved near-lossless predictive coding technique achieves high compression ratio without losing diagnostic information from the image.