Postoperative Cesarean Section Pain Management Using Transversus Abdominis Plane Block Versus Intrathecal Morphine: A Systematic Review and Meta-analysis.

PURPOSE: Compare and evaluate the effectiveness of transversus abdominis plane (TAP) block versus intrathecal morphine (ITM) on elective postcesarean section pain, opioid consumption, and related side effects. DESIGN: Systematic review and meta-analysis. METHODS: A search for evidence was conducted in PubMed, Google Scholar, CINAHL, Cochrane Collaboration Database, UpToDate, Health Source, and gray literature. Only randomized controlled trials (RCTs) were included in the study. The methodological quality of evidence assessment was conducted using the Risk of Bias and Grades of Recommendation, Assessment, Development, and Evaluation system. The meta-analysis used Review Manager (RevMan 5.4, The Cochrane Collaboration). FINDINGS: A total of 11 RCTs involving 1,129 patients were analyzed. Compared to ITM, TAP has a similar effect on static (mean difference [MD]; 0.37; 95% confidence interval [CI], -0.04 to 0.79; P = .08) and dynamic pain scores (MD, 0.43; 95% CI, -0.06 to 0.92; P = .09) within the first 48 hours after surgery. Additionally, the TAP block had a lower incidence of postoperative nausea and vomiting (risk ratio, 0.45; 95% CI, 0.31 to 0.66; P < .0001) and increased opioid consumption (MD, 6.78; 95% CI, 3.79 to 9.77; P < .00001). Overall, TAP block and ITM did not differ in the time to first to rescue analgesia, incidence of sedation, and pruritus. CONCLUSIONS: Evidence suggests that TAP blocks are equivalent to ITM in pain scores and more effective at lowering the incidence of postoperative nausea and vomiting, yet ITM has been shown to be more effective in reducing postoperative opioid consumption.

The opioid peptide leucine enkephalin modulates hypothalamic-hypophysial axis in the cichlid fish Oreochromis mossambicus.

In vertebrates, opioid peptides are thought to be involved in the regulation of reproduction; however, the significance of enkephalins in testicular function remains unclear. We examined the influence of δ-opioid receptor agonist leucine enkephalin (L-ENK) on the hypophysial-testicular axis of the cichlid fish Oreochromis mossambicus. Treatment with a low dose of L-ENK (60 µg) caused a significant increase in the numbers of primary and secondary spermatocytes and early and late spermatids, concomitant with intense immunolabelling of testicular androgen receptors, but did not significantly alter serum luteinizing hormone (LH) and 11-ketotestosterone (11-KT) levels compared to those of controls. Nevertheless, treatment with a high dose of L-ENK (200 µg) caused a significant reduction in the numbers of secondary spermatocytes as well as late spermatids associated with marginal immunolabelling of androgen receptors and significantly lower concentrations of serum 11-KT and LH compared to controls. In addition, the serum cortisol level was not affected in low-dose L-ENK-treated fish, but its level was significantly increased in the high-dose L-ENK-treated group. Together, these findings indicate that a low dose of L-ENK stimulates the germ cells at the meiosis stage and promotes further stages of spermatogenesis, whereas a high concentration of L-ENK inhibits spermatogenesis at the advanced stages. This effect appears to be mediated through the suppression of testicular steroidogenesis and the reduction of LH release in the pituitary gland of tilapia. The findings also suggest that elevated L-ENK levels in teleosts may exert their inhibitory influence on the hypophysial-testicular axis via glucocorticoids.

Impact of reflective writing skill on emotional quotient.

Background: The skill of reflective writing and emotional drivers of behavior is enhanced by boosting the awareness of one's feelings and emotions. Individuals having characteristic activity of reflection have more emotional quotient (EQ). EQ has more significance than intelligence quotient in personal and professional life. This study is conducted to analyze the impact of reflective writing skills on components of EQ among first-year MBBS students and to find out the impact of reflective writing between components of EQ and different levels of reflective writing skills among first-year MBBS students. Methods: An observational-analytical study was carried out for EQ self-assessment and reflections of first-year MBBS students. A paired t-test was used to check the difference between different segments of EQ. Analysis of reflections was done by modifying the REFLECT rubric method. Results: There was a significant difference in the motivation component between pre and post-test (p-value = 0.013), whereas no significant difference was observed in other components, viz. self-awareness, empathy, self-control, self-confidence, and social competency. The average total scores among EQ domains compared were more at the level of reflection than habitual and introspection levels. Conclusion: Along with intelligence quotient, EQ is critical for students' overall development. The average total scores of EQ were higher among the students who had a higher level of reflection. Developing reflective writing skills had an impact on the motivation component of the EQ of the students within a short duration.

The opioid peptide ß-endorphin interferes with the pituitary-testis axis in the Mozambique tilapia Oreochromis mossambicus.

Although the involvement of ß-endorphin (ß-ERP) in vertebrate reproduction has been suggested, its role in testicular activity is not clear in fish. We describe the influence of ß-ERP on spermatogenesis in a cichlid fish in the present paper. In comparison to the control group, the administration of ß-ERP (3 µg) caused a significant increase in the number of spermatogonia-A and spermatids. Following treatment with ß-ERP (6 µg), a significant increase in the number of spermatogonia-A was observed, whereas the numbers of all the other germ cells, excluding spermatogonia-B, significantly decreased in comparison to those in the control group. In addition, treatment of fish with 6 µg ß-ERP resulted in a significant reduction in the dimensions of the lumen and seminiferous lobules, the level of immunopositive androgen receptor (AR) expression in Sertoli cells, and the percentage of luteinizing hormone (LH) immunolabeled in the pituitary compared to those in the control group or the group treated with 3 µg ß-ERP. In contrast, the intensity of AR immunoreactivity and the percentage of LH immunolabeling were substantially increased in fish treated with 3 µg ß-ERP compared to those in the control group. These findings reveal for the first time that a low dose of ß-ERP stimulates the recruitment of spermatogonia as well as spermateleosis, whereas a high concentration affects the recruitment of germ cells prior to meiotic division in tilapia. These results suggest that ß-ERP exerts modulatory effects at the testicular and hypophysial levels through alterations in AR expression and LH secretory activity, respectively, in teleosts.

"Chatting with ChatGPT": Analyzing the factors influencing users' intention to Use the Open AI's ChatGPT using the UTAUT model.

Open AI's ChatGPT has emerged as a popular AI language model that can engage in natural language conversations with users. Based on a qualitative research approach using semistructured interviews with 32 ChatGPT users from India, this study examined the factors influencing users' acceptance and use of ChatGPT using the unified theory of acceptance and usage of technology (UTAUT) model. The study results demonstrated that the four factors of UTAUT, along with two extended constructs, i.e. perceived interactivity and privacy concerns, can explain users' interaction and engagement with ChatGPT. The study also found that age and experience can moderate the impact of various factors on the use of ChatGPT. The theoretical and practical implications of the study were also discussed.

Electrochemical, Ultrasensitive, and Selective Detection of Nitrite and H2O2: Novel Macrostructured Phthalocyanine with Composite MWCNTs on a Modified GCE.

In the current study, the synthesis of tetra-4-(2-methoxyphenoxy) carboxamide cobalt(II) amide-bridged phthalocyanine (CoTMePhCAPc) is described, as well as its characterization by Fourier transform infrared (FT-IR), UV-visible, and mass spectroscopy; powder X-ray diffraction (PXRD); thermogravimetric analysis (TGA); scanning electron microscopy (SEM); and electrochemistry. Sensing of nitrite (NO2-) and hydrogen peroxide (H2O2) simultaneously was done on CoTMePhCAPc with the composite multiwalled carbon nanotube (MWCNT)-modified glassy carbon electrode (CoTMePhCAPc/MWCNT/GCE) in the range of linear absorption (NO2- and H2O2: CV 50-750, differential pulse voltammetry (DPV) 50-750, CA 50-500 nmol L-1), lower detection limit (NO2- and H2O2: CV 10.5 and 12.5, DPV 10.5 and 11.2, CA 6.0 and 5.5 nmol L-1), and sensitivity (NO2- and H2O2: CV 0.379 and 0.529, DPV 0.043 and 0.049, CA 0.033 and 0.040 µA nM-1 cm-2). The composite electrode exhibits improved electrocatalytic behavior compared to modified electrodes for nitrite and H2O2. The CoTMePhCAPc/MWCNT/GCE sensor displays good selectivity even in the presence of an excess of interfering metal ions and biomolecules at the applied potentials of +400 mV (nitrite) and -400 mV (H2O2). Moreover, the fabricated sensor was studied with various phosphate-buffered saline (PBS) (pH 5-9) electrolyte solutions. The unknown H2O2 concentration in blood samples and apple juice and nitrite concentration in drinking water and butter leaf lettuce were all measured using the usual addition method. Docking analysis clearly indicates that the ligand shows excellent inhibition activity toward the three subjected protein molecules.

Organization of serotonergic system in Sphaerotheca breviceps (Dicroglossidae) tadpole brain.

The monoaminergic neurotransmitter 5-hydroxytryptamine (5-HT) is known to be involved in several physiological, behavioural and neuroendocrine functions in vertebrates. In this study, we investigated the distribution of 5-HT neuronal system in the central nervous system (CNS) of Sphaerotheca breviceps tadpoles at metamorphic climax stage. In the telencephalon, there was no 5-HT-immunoreactive (5-HT-ir) perikarya, but conspicuous fibres were observed in the olfactory bulb, pallium, subpallium and amygdala complexes. The preoptic area showed dense 5-HT-ir somata and cerebrospinal fluid contacting fibres, whereas a few varicose 5-HT-ir fibres were noticed in the suprachiasmatic nucleus. 5-HT-ir cells and fibres were found in the ventral, lateral dorsal subdivisions of the hypothalamus and in the nucleus tuberculi posterioris, but only 5-HT-ir fibres were localised in the periventricular area and pituitary gland. Numerous 5-HT-ir cells and/or fibres were detected in the thalamus, entopeduncular area and mesencephalic subdivisions. In the rhombencephalon, although 5-HT-ir cells and fibres were noticed in the subdivisions of the raphe nucleus and reticular formation, a moderate plexus of fibres was observed in the cerebellum, parabrachial nucleus and solitary tract. Distinct 5-HT-ir fibres, but no perikarya, were observed in the rostral spinal cord. Overall, extensively labelled 5-HT-ir cells and fibres in the CNS of the metamorphic tadpole suggest possible roles for the involvement of 5-HT in various somatosensory, behavioural and neuroendocrine functions during final stages of development.

Prevalence of frailty and its association with lifestyle factors among elderly in rural Bengaluru.

Background: There are nearly 10.4 crores elderly in India, with 65% of them living in rural areas. Accessibility to healthcare is limited in rural areas. Primary care physicians deal with a fairly large number of patients from the geriatric age group. With the steady increase in the proportion of elderly, there is a corresponding increase in the prevalence of frailty. Frailty among the elderly leads to increased dependency, adverse health outcomes and mortality. Early identification and targeted interventions by primary care physicians could prevent these adverse outcomes and even reverse its occurrence. Knowledge about environmental and lifestyle influences on frailty would further assist primary care physicians to prevent and manage it optimally. Methods: We interviewed 502 participants (>60 years of age) from four taluks of rural Bengaluru. Participants with frailty scores of 3 and above were considered frail, scores of 1-2 were considered prefrail. Association of frailty with lifestyle and environmental factors were tested using the Chi-square test. A value of P < 0.05 was considered significant. Results: Prevalence of frailty was 24.70% and prefrailty was 62.75%. Elders in age group 60 to 74 years, those living alone or with others (other than the spouse), illiterate, working elders, elderly with less than two diagnosed comorbidities, elderly with low social score and low physical activity were associated with frailty. Conclusion: The young old population seems vulnerable to frailty. Health programs aimed at prevention, early detection and treatment of morbidities and frailty will improve their health.

Ultrasound-guided estimation of gastric residual volume using Perlas's formula: A validation study in patients.

Background and Aims: Bedside ultrasound (US) is used to evaluate gastric residual volume (GRV) and assess aspiration risk. We examined the accuracy of US-guided measurement of GRV using Perlas's formula, by two trained anaesthesiologists, in patients who had consumed different types and volumes of fluids. Methods: Patients with no risk factors for delayed gastric emptying were included. Each assessor independently determined the baseline US-guided GRV. The patients were randomly allocated to receive no drink or 100 or 200 mL of water or milk. US-guided GRV was re-assessed within 5 min after the intervention. Investigators were blinded to the measurements performed by each other and to the randomisation arm. The primary outcome was the agreement between actual volumes consumed and estimated change in GRV. Results: Agreement between actual volume consumed and estimated change in GRV was poor [Intra-class correlation coefficient (ICC) 0.46, 95% confidence interval (CI) 0.09 to 0.72; P = 0.09 for assessor 1 and ICC 0.37; 95% CI 0.02 to 0.66; P = 0.03 for assessor 2]. Conclusion: US-guided GRV measurements using Perlas's formula, performed by trained anaesthesiologists may not be a reliable measure of GRV.

Serotonin (5-hydroxytryptamine)-immunoreactive neurons in the brain of the viviparous fish Gambusia affinis.

The monoaminergic neurotransmitter serotonin (5-HT) acts as a neuromodulator and is associated with a wide range of functions in fish. In this investigation, 5-HT immunoreactivity was studied in the central nervous system (CNS) of the viviparous mosquitofish Gambusia affinis. 5-HT-immunoreactive (5-HT-ir) cells/fibres were observed throughout the subdivisions of ventral and dorsal telencephalon including the olfactory bulb. Several intensely stained 5-HT-ir cells and/or fibres were detected in different areas of the hypothalamus as well as the proximal pars distalis of the pituitary gland. 5-HT-ir cells were restricted to the dorsal and ventral part of the pretectal diencephalic cluster, but only fibres were detected in the anterior, ventromedial and posterior subdivisions of the thalamic nucleus and in the preglomerular complex. In the mesencephalon, 5-HT-ir perikarya, and fibres were seen in the optic tectum, midbrain tegmentum and torus semicircularis. A cluster of prominently labelled 5-HT-ir neurons was observed in the superior raphe nucleus, whereas numerous 5-HT-ir fibres were distributed throughout the rhombencephalic divisions. In addition, a bundle of rostrocaudally running 5-HT-ir fibres was noticed in the spinal cord. This is the first detailed neuroanatomical study in a viviparous teleost, reporting a widespread distribution of 5-HT-ir somata and fibres in the CNS. The results of this study provide new insights into the evolutionarily well conserved nature of the monoaminergic system in the CNS of vertebrates and suggest a role for 5-HT in regulation of several physiological, behavioural and neuroendocrine functions in viviparous teleosts.

Comparative Evaluation of Effect of Potassium Iodide and Glutathione on Tooth Discoloration after Application of 38% Silver Diamine Fluoride in Primary Molars: An In Vitro Study.

AIM: To evaluate and compare the effect of potassium iodide (KI) and glutathione (GSH) on tooth discoloration after application of 38% silver diamine fluoride (SDF) in primary molars.Method: Total of 30 primary molars were randomly divided into three groups of 10 each. Teeth were prepared and divided into: Group A-SDF only, Group B-SDF followed immediately by application of KI, and Group C-SDF was mixed with 25 mg of GSH. Final restoration was done using glass ionomer cement. Visual examination and color assessments using spectrophotometer were recorded at three time interval points, that is, day 1, 1 week, and 4 weeks. RESULTS: Statistical analysis was done using a repeated measures analysis of variances (ANOVA) test. The spectrophotometer results showed that Group A (SDF) exhibited the greatest amount of discoloration at all time intervals, while Group C (SDF + GSH) group was effective in decreasing the discoloration. Whereas, Group B (SDF + KI) significantly reduced the discoloration over the period of time. (p = 0.008). CONCLUSION: KI can effectively reduce discoloration after application of 38% SDF. GSH can also be used as an alternative. CLINICAL SIGNIFICANCE: This two-step treatment for arresting caries can be a practical and low-cost option in areas with limited access to comprehensive dental care. HOW TO CITE THIS ARTICLE: Kamble AN, Chimata VK, Katge F A, et al. Comparative Evaluation of Effect of Potassium Iodide and Glutathione on Tooth Discoloration after Application of 38% Silver Diamine Fluoride in Primary Molars: An In Vitro Study. Int J Clin Pediatr Dent 2021;14(6):752-756.

Erratum to "Degree-based topological indices on anticancer drugs with QSPR analysis" [Heliyon 6 (6) (June 2020) e04235].

[This corrects the article DOI: 10.1016/j.heliyon.2020.e04235.].

Degree-based topological indices on anticancer drugs with QSPR analysis.

From last two to three decades, the world is facing the threat of finding treatment for Cancer. This disease is striking almost ten million people every year throughout the world. Anticancer drugs are those which are used to cure malignant disease i.e. Cancer. These anticancer drugs are available in different forms including alkalyting agents, hormones and anti metabolites. Various examinations reveals that, there will be a adjacent relationship between the characteristics of alkanes and the anticancer drugs viz. Boiling point, melting point, enthalpy etc. with their chemical structures. In this proposed work, various topological indices are defined on some anticancer drugs to help the researchers to know the physical characteristics and chemical reaction associated with them. We also discuss the QSPR analysis of thirteen degree based topological indices. Further, we showcase that the characteristics have good correlation with physico-chemical characteristics of anticancer drugs.

Domperidone treatment attenuates stress-induced suppression of reproduction in viviparous mosquitofish Gambusia affinis.

The aim of this study was to determine the effect of stress on reproduction and the possible involvement of dopaminergic systems in the reproductive stress response in the mosquitofish Gambusia affinis. Exposure of fish to aquaculture stressors (four 10 min episodes of stress, each corresponding to a different stressor such as handling, chasing, frequent netting and low water levels), for a period of 30 days caused reduction in the mean numbers of stage I-IV follicles associated with lower number of pregnant females and embryos in most of the developmental stages compared with experimental controls. Besides, increase in the intensity of labelling and the per cent area of tyrosine hydroxylase (TH; a rate-limiting enzyme in the biosynthetic pathway of catecholamines)- immunoreactive (ir) neurons was observed in the preoptic area (POA) and the nucleus preopticus (NPO) regions of the brain concomitant with reduction in the labelling of gonadotropin releasing hormone-immunoreactive (GnRH-ir) fibres in the proximal pars distalis (PPD) of the pituitary gland in stressed fish compared with experimental controls. Treatment of domperidone (DOM) caused an increase in the number of stage II and V follicles and promoted pregnancy rate concomitant with an increase in the number of embryos at various developmental stages compared with those of experimental controls. Similar treatment to stressed fish caused an increase in the number of stages I-V follicles compared with those in stress alone group. The GnRH fibres showed increased immunolabelling in stress + DOM treated fish compared with stress alone fish. On the other hand, TH-immunoreactivity in the POA and the NPO regions was reduced in stress + DOM treated fish compared with stress-alone group. These results suggest that stress inhibits follicular development and subsequent hatching success through the suppression of GnRH and that the inhibition appears to be mediated through dopamine, for the first time in a viviparous fish.

Clinical and laboratory profile of dengue viral infections in and around Mangalore, India.

BACKGROUND: Dengue (DEN) is being recognised as the world's major emerging tropical disease. Clinically, DEN may resemble other infections such as malaria, leptospirosis, and typhoid, and thus, laboratory investigations are required for definitive diagnosis. Secondary DEN infection, caused most often by dengue virus (DENV) serotypes 2 and 3, is known to present with severe disease manifestations. This study was undertaken to examine the clinical and laboratory profile of DEN viral infections and to determine the circulating serotypes in and around Mangalore, India. MATERIALS AND METHODS: Serum samples from 285 clinically suspected cases of DEN in and around Mangalore between September 2013 and January 2014 were processed for detection of DEN IgM and IgG antibodies and nonstructural 1 (NS1) antigen using commercial ELISA kits. Detection of DEN viral RNA and serotyping was done by multiplex real-time reverse-transcriptase polymerase chain reaction (RT-PCR). The clinical and haematological profiles of the patients were analysed. RESULTS: Serum samples from 83 (29%) patients were positive for DEN NS1 antigen and/or IgM antibodies. 33 (45%) out of 73 serum samples processed by multiplex real-time RT-PCR were positive for DEN viral RNA. DEN-1, -2 and -3 were the serotypes identified in this study. Fever was the most common presenting symptom followed by myalgia/arthralgia. Majority of the patients had thrombocytopaenia. CONCLUSION: Early detection of DEN can be achieved effectively using NS1 ELISA and IgM capture ELISA. Circulating DENV serotypes should be closely monitored for prevention of fatal outcomes in secondary infections.

Distribution of tyrosine hydroxylase-immunoreactive neurons in the brain of the viviparous fish Gambusia affinis.

Tyrosine hydroxylase (TH) is the common precursor enzyme involved in the biosynthetic pathway of the catecholaminergic neurotransmitters, dopamine and norepinephrine. In this investigation, the neuroanatomical distribution of TH-immunoreactivity was studied in the brain of the female mosquitofish Gambusia affinis. Numerous intensely stained TH-immunoreactive (ir) neurons were scattered in the olfactory bulb with their fibres extending towards the medial olfactory tract, whereas few telencephalic TH-ir cells with distinct fibres were observed in the dorsal nucleus of area ventralis telencephali and the posterior nucleus of area ventralis telencephali regions. Large TH-ir cell populations were seen in the suprachiasmatic nucleus and the nucleus dorsomedialis thalami regions of the diencephalon. Distinct TH-ir cells with long fibres were found at the preoptic area and the nucleus preopticus pars magnocellularis as well as the nucleus preopticus pars parvocellularis regions. Numerous intensely stained TH-ir cells were observed in the paraventricular organ and the nucleus posterior tuberis regions, whereas moderately stained cells were present in the nucleus of recessus lateralis medialis. Several TH-ir neurons were detected in medial and lateral subdivisions of the nucleus lateralis tuberis. Furthermore, the projections of the TH-ir fibres were seen in the proximal pars distalis region of the pituitary gland, where gonadotropin-secreting cells are located, suggesting the communication between TH cells and gonadotrope cells. In the rostral spinal cord, dense aggregations of the TH-ir fibres were noticed. Overall, the widespread distribution of the TH-ir neurons throughout the brain and their fibres in the spinal cord and the pituitary gland suggests diverse roles for the catecholaminergic neurons in various physiological functions including reproduction in the mosquitofish.

Easing the Excision of Earlobe Keloid.

Earlobe keloids are commonly encountered in this era where ear piercing is routine in various traditions. Various medical and surgical methods have been tried for its management. Surgically, fillet flap surgery has better acceptability worldwide. Various difficulties are faced during keloid excision, and we hereby describe few innovative modifications (use of needle, hydrodissection, pressure dressing, bolster button) using cost-effective and simple materials (needles, dynaplast, buttons) to ease the excision of keloids. These have easy adaptability and also reduce the recurrence rate of earlobe keloids.

Pancardiac tuberculosis - a case report.

Tuberculous involvement of the heart though not common has been reported in literature. Pericardium is commonly involved followed by the myocardium. Endocardial involvement is rare. We would like to report a case of a 14-year-old female with florid and extensive involvement of all the layers of the heart by tuberculosis.

Pityriasis Rosea Localized to the Skin Patches of Leprosy. A Wolf's Isotopic Response?

Pityriasis rosea is one of the commonly encountered papulo squamous disease in dermatology outpatient department. Its clinical presentations are varied, and it also has many atypical forms. We report a case of a male patient with classical Pityriasis rosea lesions limited to the patches of Hansen's disease. This is probably being reported for the first time in literature.