Serum and urine galactose deficient-IgA1 as alternative biomarkers in the management of IgA nephropathy.

INTRODUCTION: Immunoglobulin A (IgA) nephropathy (IgAN) results from abnormal accumulation of immune complexes containing galactose deficient IgA1 (Gd-IgA1) in the kidneys. About 40% of patients develop end-stage kidney disease within 20 years of renal biopsy. At present, the diagnosis and risk stratification of patients (using the international IgAN risk prediction tool) rely on renal biopsy, which is an invasive procedure. Also, treatment decisions are still dependent on proteinuria, which is not specific for IgA nephropathy. We discussed the role of serum and urine Gd- IgA1 in the diagnosis of IgAN, its association with disease progression and changes with treatment in patients with IgA nephropathy. MATERIALS AND METHODS: A systematic search of PubMed and Scopus databases was done to identify the articles that are relevant to the topic including systematic reviews and original articles. RESULTS: Several studies showed that both serum and urine Gd-IgA1 differentiate IgA nephropathy patients from healthy people and other glomerulonephropathies. Thus, it is useful as a less invasive diagnostic biomarker, although detection methods varied between studies with different sensitivities. There are various reports of its use as a prognostic parameter. Evidence is emerging for its use as a monitoring parameter for treatment. CONCLUSION: Galactose deficient IgA1 is a promising biomarker in the management of IgA nephropathy, although a more robust and standardised means of estimation is required.

Diagnostic characteristics of the 20-minute whole blood clotting test in detecting venom-induced consumptive coagulopathy following carpet viper envenoming.

INTRODUCTION: Envenoming by Echis spp. (carpet or saw-scaled vipers) causes haemorrhage and coagulopathy and represents a significant proportion of snakebites in the savannah regions of West Africa. Early diagnosis of envenoming is crucial in the management of these patients and there is limited evidence on the utility of the 20-minute whole blood clotting test (20WBCT) in diagnosing venom-induced consumptive coagulopathy (VICC) following envenoming by Echis ocellatus. METHODS: A prospective observational cohort study was conducted at the Kaltungo General Hospital in North-eastern Nigeria from September 2019 to September 2021. Standardised 20WBCTs were conducted by trained hospital staff and citrated plasma samples were collected at numerous timepoints. Prothrombin time (PT) and international normalised ratio (INR) were determined using a semi-automated analyser and INR values were calculated using international sensitivity indices (ISI). The sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and likelihood ratios of the 20WBCT compared to an INR ≥ 1.4 were calculated, alongside 95% confidence intervals. RESULTS: We enrolled 121 patients into our study, with a median age of 26 (18.0-35.0) years and a male predominance (75.2%). The 20WBCT was positive (abnormal) in 101 out of 121 patients at timepoint 0h, of which 95 had an INR ≥ 1.4, giving a sensitivity of 87.2% (95%CI 79.4-92.8). Among patients with a negative 20WBCT (normal), six had an INR < 1.4 giving a specificity of 50% (95%CI 21.1-78.9). The positive and negative likelihood ratios were 1.7 (95%CI 1.6-1.9) and 0.3 (95%CI 0.1-0.4) respectively. CONCLUSION: The 20WBCT is a simple, cheap, and easily accessible bedside test with a high sensitivity for the detection of patients with venom induced consumptive coagulopathy (VICC) following envenoming by E. ocellatus, although false positives do occur. Repeated 20WBCTs can identify patients with new, persistent, and rebound coagulopathy.

Closed-loop control systems for pumps used in portable analytical systems.

The demand for accurate control of the flowrate/pressure in chemical analytical systems has given rise to the adoption of mechatronic approaches in analytical instruments. A mechatronic device is a synergistic system which combines mechanical, electronic, computer and control components. In the development of portable analytical devices, considering the instrument as a mechatronic system can be useful to mitigate compromises made to decrease space, weight, or power consumption. Fluid handling is important for reliability, however, commonly utilized platforms such as syringe and peristaltic pumps are typically characterized by flow/pressure fluctuations and slow responses. Closed loop control systems have been used effectively to decrease the difference between desired and realized fluidic output. This review discusses the way control systems have been implemented for enhanced fluidic control, categorized by pump type. Advanced control strategies used to enhance the transient and the steady state responses are discussed, along with examples of their implementation in portable analytical systems. The review is concluded with the outlook that the challenge in adequately expressing the complexity and dynamics of the fluidic network as a mathematical model has yielded a trend towards the adoption of experimentally informed models and machine learning approaches.

Ebselen abolishes vascular dysfunction in influenza A virus-induced exacerbations of cigarette smoke-induced lung inflammation in mice.

People with chronic obstructive pulmonary disease (COPD) are susceptible to respiratory infections which exacerbate pulmonary and/or cardiovascular complications, increasing their likelihood of death. The mechanisms driving these complications remain unknown but increased oxidative stress has been implicated. Here we investigated whether influenza A virus (IAV) infection, following chronic cigarette smoke (CS) exposure, worsens vascular function and if so, whether the antioxidant ebselen alleviates this vascular dysfunction. Male BALB/c mice were exposed to either room air or CS for 8 weeks followed by inoculation with IAV (Mem71, 1 × 104.5 pfu). Mice were treated with ebselen (10 mg/kg) or vehicle (5% w/v CM-cellulose in water) daily. Mice were culled 3- and 10-days post-infection, and their lungs lavaged to assess inflammation. The thoracic aorta was excised to investigate endothelial and smooth muscle dilator responses, expression of key vasodilatory and oxidative stress modulators, infiltrating immune cells and vascular remodelling. CS increased lung inflammation and caused significant vascular endothelial dysfunction, which was worsened by IAV infection. CS-driven increases in vascular oxidative stress, aortic wall remodelling and suppression of endothelial nitric oxide synthase (eNOS) were not affected by IAV infection. CS and IAV infection significantly enhanced T cell recruitment into the aortic wall. Ebselen abolished the exaggerated lung inflammation, vascular dysfunction and increased T cell infiltration in CS and IAV-infected mice. Our findings showed that ebselen treatment abolished vascular dysfunction in IAV-induced exacerbations of CS-induced lung inflammation indicating it may have potential for the treatment of cardiovascular comorbidities seen in acute exacerbations of COPD (AECOPD).

Cheiloscopy and Dactyloscopy as Behavior Assessment Tool in Dental Settings: A Cross-sectional Study.

PURPOSE: Assessment of children's behavior in the dental setting and its correlation with thumb print and lip print. MATERIALS AND METHODS: The behavior pattern, lip print pattern, and thumb print pattern of 518 children aged 5-12 years were recorded in their first dental visit. The behavior pattern, lip print pattern, and thumb print pattern were determined using Frankl's Behavior Rating Scale, Tsuchihashi's classification, and Cummin's classification, respectively. The data were tabulated according to the classified criteria and statistically analyzed. RESULTS: It was observed that positive and definitely positive Frankl Behavior was associated with the children bearing an arch pattern of thumb print, whereas their lip pattern had no association with their behavior pattern, particularly in dental sittings. CONCLUSION: Thumb print pattern can aid as a behavior marker before a child's first dental appointment and this can prove beneficial for both the child and the clinician in providing a high quality of dental care and modify behavior for future dental appointments. HOW TO CITE THIS ARTICLE: Navit S, Pramanik S, Khan SA, et al. Cheiloscopy and Dactyloscopy as Behavior Assessment Tool in Dental Settings: A Cross-sectional Study. Int J Clin Pediatr Dent 2021;14(2):238-242.

Correction to: Short-term outcome associated with disease severity and electrolyte abnormalities among critically ill children with acute kidney injury.

Following publication of the original article [1].

Comparison of Pain and Anxiety Level Induced by Laser vs Rotary Cavity Preparation: An In Vivo Study.

AIM: To evaluate and compare the pain perception, anxiety level, and acceptance of Er,Cr:YSGG laser (2780 nm) with a conventional rotary method during cavity preparation in children. MATERIALS AND METHODS: In a randomized controlled trial, using split-mouth design thirty 6- to 12-year-old children with 60 carious molars were examined. In one quadrant, cavity was prepared conventionally by airotor while, in the other quadrant, Er,Cr:YSGG laser was used. Anxiety was assessed by measuring pulse rate using a fingertip pulse oximeter, while the pain was measured on the Wong-Baker Faces Pain Rating Scale. After the cavity preparation by both the methods, the child was asked about the preference for future treatment of a carious lesion. RESULTS: Pulse rate was found significantly higher in the airotor group but no significant difference in pulse rate was found in the laser group when compared to the baseline pulse rate. The mean value of pain in the airotor group was slightly higher than the laser group. Fifty-seven percent of children preferred Er,Cr:YSGG laser for cavity preparation in the future. CONCLUSION: During cavity preparation, Er,Cr:YSGG laser comes out to be more effective and acceptable, as it is less anxiety-provoking and may cause less pain when compared with the airotor. CLINICAL SIGNIFICANCE: Er,Cr:YSGG laser helps the children to remain calm during the cavity preparation. HOW TO CITE THIS ARTICLE: Alia S, Khan SA, Navit S, et al. Comparison of Pain and Anxiety Level Induced by Laser vs Rotary Cavity Preparation: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(6):590-594.

Effect of Obstructive Sleep Apnea on Condylar Malformation, Vertebral Column, and Head Posture: A Cephalometric Evaluation.

AIMS AND OBJECTIVES: Obstructive sleep apnea (OSA) is by far the most common sleep-related breathing disorder, affecting 2-4% of the adult population. The present study aims to compare the descriptive morphology of the cervical column in subjects with normal craniofacial morphology with those having condylar hypoplasia with OSA and to evaluate a positive correlation between the cervical columns, the cranial base angle, and the posture of the head and neck in subjects of condylar hypoplasia. MATERIALS AND METHODS: The present study comprised of lateral cephalogram of 40 subjects divided into two equal groups-control groups (n = 20) and OSA with condylar hypoplasia (n = 20). RESULTS AND OBSERVATION: The condylar hypoplasia group has fusion anomalies of 65% and 35% has a posterior arch deficiency. The cervical lordosis, inclination of the cervical column is found to have a positive statistically significant correlation in condylar hypoplasia subjects. CONCLUSION: Morphological deviations and deviation pattern of the cervical column occurred significantly more often in subjects with condylar hypoplasia as compared with normal craniofacial morphology which can be verified by the increased cranial base angle, cervical lordosis, the inclination of the upper cervical spine, and cranial base angle were positively correlated with a fusion of cervical column. CLINICAL SIGNIFICANCE: Specific types of craniofacial morphology and head postures such as a reduced posterior airway space, an abnormally long soft palate, a low position of the hyoid bone, and an extended head posture are considered predisposing factors of OSA. As posture of the head and neck is considered to be associated with OSA, OSA may be associated with fusion of the cervical column. Hence, to know the result of malformation in the cervical column prove to be important with regard to phenotypical subdivision, diagnosis, and treatment of OSA. HOW TO CITE THIS ARTICLE: Divya, Navit P, Singh R, et al. Effect of Obstructive Sleep Apnea on Condylar Malformation, Vertebral Column, and Head Posture: A Cephalometric Evaluation. Int J Clin Pediatr Dent 2020;13(S-1):S64-S68.

Little Color, Little Flavor of Different kinds of Commercially Available Flavored Milk and their Consumption Effect on Salivary pH Value in Children: An In Vivo Study.

AIM: This study aimed to compare the effect of different flavored kinds of milk on salivary pH value in 6 to 14 years old children. MATERIALS AND METHODS: The impact of these different kinds of flavored milk on the salivary pH is evaluated between two groups of children, caries-active group (n = 35) constituted children who had decayed missing filled tooth (DMFT) ≥2, and the caries-free group (n = 35) constituted children who had DMFT = 0. Four different flavors of milk are taken for the study, and plain sweetened milk is chosen as the control baseline. The endogenous pH of the salivary samples is measured at baseline and after consumption of the flavored milk immediately and then at 5-, 10-, 15-, and 30-minute intervals. The results are statistically analyzed by using the paired t-test and analysis of variance (ANOVA). RESULTS: It is shown in the present study that caries-active group subjects had a more evident salivary pH fall than the caries-free group subjects which was statistically significant. For caries-active group, subject's salivary pH value took a longer duration to return to baseline pH as compared to caries-free subjects. However, salivary pH value is restored to standard/baseline value after 30 minutes for all the flavored milk taken in both groups; hence, their intake can be regarded safe for the oral environment. CONCLUSION: It is concluded from the current study that the consumption of flavored milk can be considered as non-cariogenic for children. CLINICAL SIGNIFICANCE: In the present study, the salivary pH fall in both caries-active and caries-free subjects was found above the critical pH level. Hence, all these flavored milk used in the study did not cause a threat to oral environment health as there was no significant decrease in salivary pH value so their consumption can be regarded as safe for children. HOW TO CITE THIS ARTICLE: Navit S, Agarwal S, Khan SA, et al. Little Color, Little Flavor of Different kinds of Commercially Available Flavored Milk and their Consumption Effect on Salivary pH Value in Children: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(S-1):S87-S91.

Effect of Diode Laser Office Bleaching on Mineral Content and Surface Topography of Enamel Surface: An SEM Study.

AIM: To assess the effects of different bleaching procedures on the mineral component and surface topography of the enamel using scanning electron microscope (SEM) and energy-dispersive X-ray spectrometry (EDX). MATERIALS AND METHODS: Forty samples of approximately 3 × 3 mm size from the coronal portion of 20 extracted human anterior teeth were obtained. The samples were divided into two control groups and three experimental groups. In group I or positive control (n = 5), no bleaching or phosphoric acid treatment to the enamel surface was done. Group II samples or negative controls (n = 5) were treated with 37% phosphoric acid. In group III (n = 10), the tooth was treated with 35% hydrogen peroxide (HP) without any activation. Group IV (n = 10) was treated with 37.5% HP with LED light activation and group V (n = 10) was treated with 45% HP with diode laser activation. The calcium (Ca) and phosphorus (P) levels of each sample were measured using an EDX system prior to bleaching treatments. All the samples were again subjected to the EDX analysis after the bleaching treatment and two samples (after EDX analysis) from each group were subjected to the SEM analysis. RESULT: No significant difference was seen in phosphorus levels before and after the bleaching. However, significant increase in calcium levels was observed after bleaching activated with LASER and LED light. The SEM observations revealed maximum surface alterations on the enamel after chemically activated bleaching. CONCLUSION: The LASER-activated bleaching agent seems to be more surface-friendly and less time-consuming as compared to other bleaching systems. HOW TO CITE THIS ARTICLE: Suresh S, Navit S, Khan SA, et al. Effect of Diode Laser Office Bleaching on Mineral Content and Surface Topography of Enamel Surface: An SEM Study. Int J Clin Pediatr Dent 2020;13(5):481-485.

Short-term outcome associated with disease severity and electrolyte abnormalities among critically ill children with acute kidney injury.

BACKGROUND: Acute kidney injury (AKI) in critically ill children is associated with increased mortality and morbidity. In this study we evaluated the effect of AKI severity on the incidence of short-term mortality and morbidity. METHODS: Multicenter prospective cohort study was conducted over two years period. We used the Kidney Disease Improving Global Outcomes (KDIGO) to diagnose and stage AKI. RESULTS: A total of 511 out of 1367 included children (37.4%; 95% CI: 34.8-40.0) were diagnosed with AKI. They were categorized into three KDIGO stages: stage I (mild) in 47.5% (95% CI: 43.2-52.0), stage II (moderate) in 32.8% (95% CI: 28.8-37.1) and stage III (severe) in 19.7% (95% CI: 16.4-23.5). Stage II and III AKI had higher risk of mortality and longer length of stay (LOS) in hospital. Children with stage III AKI were more likely to require mechanical ventilation, referral to pediatric nephrology and discharge with abnormal creatinine level (above 100 uml\L). Hypervolemia, hypocalcemia, anemia, and acidosis were found to be independent risk factors of mortality. CONCLUSION: The extent of severity of AKI is directly associated with increased mortality, LOS and short-term morbidity.

Outcome of pediatric acute kidney injury: a multicenter prospective cohort study.

BACKGROUND: Acute kidney injury (AKI) is a common problem encountered in critically ill children with an increasing incidence and evolving epidemiology. AKI carries a serious morbidity and mortality in patients requiring admission to a pediatric intensive care unit (PICU). METHODS: We undertook a prospective cohort study of PICU admissions at three tertiary care hospitals in the Kingdom of Saudi Arabia over 2 years. The Kidney Disease Improving Global Outcomes (KDIGO) definition was used to diagnose AKI. RESULTS: A total of 1367 pediatrics PICU admissions were included in the study. AKI affected 511 children (37.4%), with 243 children (17.8%) classified as stage I (mild), 168 patients (12.3%) stage II (moderate), and 100 children (7.3%) were classified as stage III (severe). After adjustment for age, sex, and underlying diagnosis, in-hospital mortality was six times more likely among patients with AKI as compared to patients with normal renal function (adjusted OR: 6.5, 95% CI: 4.2-10). AKI was also a risk factor for hypertension (adjusted OR: 4.1, 95% CI: 2.8-5.9) and prolonged stay in the PICU and hospital, as it increased the average number of admission days by 10 (95% CI: 8.6-11) days in the PICU and 12 (95% CI: 10-14) days in the hospital. CONCLUSIONS: One-third of PICU admissions were complicated with AKI. AKI was associated with increased hospital mortality and the length of stay in both PICU and hospital.

U.S. drug shortages for medications used in adult critical care (2001-2016).

PURPOSE: We describe trends in U.S. shortages impacting critical care drugs from 2001 to 2016. MATERIALS AND METHODS: Shortages within the scope of critical care were identified using data from the University of Utah Drug Information Services. Shortage characteristics were described using standard descriptive statistics and regression analysis. RESULTS: Of 1969 shortages reported, 1004 (51%) were for drugs used in critical care. New shortages fell from 2001 to 2004, then increased, peaking in 2011 (116). For critical care shortages, 247 (24.6%) involved drugs used for high acuity conditions. The majority of drugs on shortage were parenteral, (720; 71.7%) and 393 (39.1%) were single source drugs. Alternatives were available for 887 (88.3%) drugs, although 250 (24.9%) alternatives were impacted by shortages. Infectious disease drugs were the most common drugs on shortage, with 200 (19.9%) shortages, with a median duration of 7.7months (IQR=2.8-17.3). By the end of the study, 896 (89.2%) shortages were resolved and 108 (10.8%) remained active. The median duration for active shortages was 13.6months (IQR=5.8-58.4) while the duration for resolved shortages was 7.2months (IQR=2.8-17.3). CONCLUSIONS: Although the number of new shortages peaked in 2011 and is now declining, there remain a substantial number of active shortages impacting critical care drugs.

Orientation and stability of a bi-functional aromatic organic molecular adsorbate on silicon.

In this work we combine scanning tunneling microscopy, near-edge X-ray absorption fine structure spectroscopy, X-ray photoemission spectroscopy and density functional theory to resolve a long-standing confusion regarding the adsorption behaviour of benzonitrile on Si(001) at room temperature. We find that a trough-bridging structure is sufficient to explain adsorption at low coverages. At higher coverages when steric hindrance prevents the phenyl ring lying flat on the surface, the 2+2 cycloaddition structure dominates.

Incorporating permaculture and strategic management for sustainable ecological resource management.

Utilization of natural assets to the best efficient level without changing natural balance has become a critical issue for researchers as awareness on climate change takes central position in global debate. Conventional sustainable resource management systems are based on neoclassical economic approach that ignores the nature's pattern and therefore are not actually capable of sustainable management of resources. Environmentalists are lately advocating incorporation of Permaculture as holistic approach based on ethics, equitable interaction with eco-systems to obtain sustainability. The paper integrates philosophy of permaculture with strategic management frameworks to develop a pragmatic tool for policy development. The policy design tool augments management tasks by integrating recording of natural assets, monitoring of key performance indicators and integration of sectorial policies in real time, bringing out policy as a truly live document. The tool enhances the edifice process, balancing short term viewpoints and long term development to secure renewability of natural resources.

MRA-based 3D-printed heart model-an effective tool in the pre-surgical planning of DORV.

A three-dimensional (3D) printed heart model based on contrast-enhanced MR angiography data was obtained in an 8-month-old male child with double-outlet right ventricle. The model could successfully show the spatial relationship between the aortic annulus, the pulmonary valve and the ventricular septal defect. The patient underwent complete intracardiac repair based on the 3D model. MR angiography images could be successfully used to create a true-size 3D heart model, which significantly helped in assessing the routability of the ventricular septal defect to the aorta, leading to successful intracardiac repair in our patient.

Synchronous infection of the aorta and the testis: emphysematous epididymo-orchitis, abdominal aortic mycotic aneurysm, and testicular artery pseudoaneurysm diagnosed by use of MDCT.

We report clinical details and imaging findings for a case of emphysematous epididymo-orchitis with co-existing mycotic abdominal aortic aneurysm and a testicular artery pseudoaneurysm in a diabetic 65-year-old male. We report imaging findings from ultrasonography (USG) and contrast-enhanced multidetector computed tomography (MDCT). Use of MDCT to identify, confirm, and define the extent of the disease, and its utility in understanding the pathogenesis of this rare condition are highlighted. For such lethal infections, early diagnosis and intervention can be lifesaving; imaging can be of crucial importance in this.

Horse-shoe lung-rediscovered via volume rendered images.

Horseshoe lung, usually associated with pulmonary venolobar syndrome, is a rare congenital anomaly involving the fusion of the postero-basal segments of the right and left lungs across the midline. The fused segment or the isthmus lies posterior to the pericardium and anterior to the aorta. The associated pulmonary venolobar syndrome involves anomalous systemic arterial supply and anomlaous systemic venous drainage of the right lung. With the advent of MDCT imaging, we can diagnose this rare condition as well all its associated anomalies non-invasively. Volume-rendered techniques greatly simplify the complex anatomy and provide easy understanding of the same.

Current biomedical waste management practices and cross-infection control procedures of dentists in India.

OBJECTIVES: To investigate the knowledge, attitudes and behaviour of dentists working in dental clinics and dental hospitals regarding biomedical waste management and cross-infection control. METHODS: A national survey was conducted. Self-administered questionnaires were sent to 800 dentists across India. RESULTS: A total of 494 dentists responded, giving a response rate of 61.8%. Of these, 228 of 323 (70.6%) general dentists reported using boiling water as a sterilising medium and 339 (68.6%) dentists reported disposing of hazardous waste such as syringes, blades and ampoules in dustbins and emptying these into municipal corporation bins. CONCLUSIONS: Dentists should undergo continuing education programmes on biomedical waste management and infection control guidelines. Greater cooperation between dental clinics and hospitals and pollution control boards is needed to ensure the proper handling and disposal of biomedical waste.