Osteoporosis in Asthma and COPD.

Asthma and Chronic Obstructive Pulmonary Disease (COPD) are principally lifestyle related chronic inflammatory airway disease. They are globally associated with various systemic comorbidities and mortality. Osteoporosis is the common associated metabolic bone disease with respiratory disturbances, which affect the prognosis and increase mortality and morbidity in the patients. Apart from OSTEOPOROSIS, exhaustive attention has been paid towards other associated systemic comorbidities like cardiovascular diseases, cerebrovascular diseases, metabolic syndrome, malnutrition, skeletal muscle dysfunction (sarcopenia), anxiety, depression and so on (Iheanacho et al. in Int J Chronic Obstr Pulm Dis 15:439-460, 2020; Singh et al. in Eur Respir J 53:1900164, 2019). Osteoporosis is a significant extrapulmonary manifestation in asthma and COPD, which are grossly neglected and inadequately treated. The comorbidities have significant impact in terms of morbidity, mortality and economic burden in asthma and COPD patients, hence management of asthma and COPD should comprise thorough management, as this will also have an impact on the outcome of these patients. Various risk factors such as smoking, systemic inflammation, vitamin deficiency, and the use of oral or inhaled corticosteroid are responsible for osteoporosis in patients with asthma and COPD. The presence of osteoporosis in patients with asthma and COPD is invariably asymptomatic unless complicated by fragility fractures, therefore, it is necessary to explore the pathogenesis of osteoporosis in asthma and COPD and special attention is to be paid for early recognition of patients at high risk for osteoporosis in these patients. This chapter is focussed on osteoporosis as an extrapulmonary manifestation of asthma and COPD with an emphasis on the pathogenesis, risk factor, potential mechanism of osteoporosis, diagnosis, and prevention with passing reference to treatment as well in asthma and COPD patients.

An enhanced diabetes prediction amidst COVID-19 using ensemble models.

In the contemporary landscape of healthcare, the early and accurate prediction of diabetes has garnered paramount importance, especially in the wake of the COVID-19 pandemic where individuals with diabetes exhibit increased vulnerability. This research embarked on a mission to enhance diabetes prediction by employing state-of-the-art machine learning techniques. Initial evaluations highlighted the Support Vector Machines (SVM) classifier as a promising candidate with an accuracy of 76.62%. To further optimize predictions, the study delved into advanced feature engineering techniques, generating interaction and polynomial features that unearthed hidden patterns in the data. Subsequent correlation analyses, visualized through heatmaps, revealed significant correlations, especially with attributes like Glucose. By integrating the strengths of Decision Trees, Gradient Boosting, and SVM in an ensemble model, we achieved an accuracy of 93.2%, showcasing the potential of harmonizing diverse algorithms. This research offers a robust blueprint for diabetes prediction, holding profound implications for early diagnosis, personalized treatments, and preventive care in the context of global health challenges and with the goal of increasing life expectancy.

Efficacy of Fentanyl Transdermal Patch in Impacted Mandibular Third Molar Surgery-A Comparative Study.

Introduction: Removal of mandibular third molars surgically is one of the most frequently performed oral surgical procedures which are often accompanied with post-operative pain, swelling and trismus. Despite general progress in pain management, moderate to severe acute post-operative pain after removal of lower third molars remains a problem. Fentanyl is an extremely effective drug in the treatment of severe chronic pain such as cancer pain and post-operative pains which acts by increasing patient's tolerance to pain. Fentanyl Transdermal System (FTS) is a rectangular transdermal patch which contains high concentration of fentanyl, a potent short-acting Schedule II opiate. In this study the efficacy of transdermal fentanyl for management of post-operative pain after impacted mandibular 3rd molar surgery is evaluated. Methods: 20 patients within the age group of 18-40 years with asymptomatic impacted mandibular third molars were equally divided into 2 groups as group A & group B which underwent surgery in Local Anaesthesia. In every patient one side belonged to group A and other side belonged to group B. 50 µg FTS was applied in group A while placebo patch was applied in group B. Results: Patients in group A performed significantly better than group B in terms of mean pain intensity scores assessed by VAS and VRS along with minimum need of post-operative rescue analgesics. Conclusion: It was found that FTS resulted in significantly better pain relief, longer pain-free intervals, and lesser post-operative analgesic consumption.

Tobacco Smoking among the Online Respondent Dental Students of a Dental College: A Descriptive Cross-sectional Study.

Introduction: Smoking tobacco is most common nowadays among dental students due to stress induced by practical workloads and exams. There is limited data regarding tobacco smoking among dental students. The aim of this study was to determine the prevalence of tobacco smoking among online respondent dental students of a dental college. Methods: This was a descriptive cross-sectional study conducted on dental students from 15 July 2021 to 15 August 2021. Ethical approval was obtained from the Institutional Review Committee of K.D. Dental College and Hospital (Reference number: KDDC/Admin/2021/9990A). Data was collected through a structured questionnaire and responses were gathered using an online Google form survey with informed consent. A convenience sampling method was used. Point estimate and 95% confidence interval were calculated. Results: Among 60 online respondents, the prevalence of tobacco smoking was found to be 11 (18.33%) (17.04-24.56, 95% Confidence Interval). The percentage of participants who wanted to stop smoking now was 11 (18.33%). Conclusions: The prevalence of tobacco smoking among the online dental respondents of a dental college was similar to the other studies done in similar settings. Keywords: dental students; smoking; tobacco cessation.

Slow Heat-Based Hybrid Simulated Annealing Algorithm in Vehicular Ad Hoc Network.

Vehicular ad hoc networks (VANETs) using reliable protocols of routing have become crucial in identifying the changes to topology on a continuous basis for a large collection of vehicles. For this purpose, it becomes important to identify an optimal configuration of these protocols. There are several possible configurations that have been preventing the configuration of efficient protocols that do not make use of automatic and intelligent design tools. It can further motivate using the techniques of metaheuristics like the tools, which are well-suited to be able to solve these problems. The glowworm swarm optimization (GSO), simulated annealing (SA), and slow heat-based SA-GSO algorithms have been proposed in this work. The SA is a method of optimization, which imitates the manner in which the thermal system has been frozen down to its lowest state of energy. In the GSO, there is guidance to the rules of feasibility, where the swarm converges to its feasible regions very fast. Additionally, for overcoming any premature convergence, there is a local search strategy that is based on the SA and is used for making a search that is near to its true optimum solutions. Finally, this sluggish temperature-based SA-GSO algorithm will be employed to solve routing problems and problems of heat transfer. There is a hybrid slow heat SA-GSO algorithm with a faster speed of convergence and higher precision of computation that is more effective in solving problems of constrained engineering.

Influence of the Fly Ash Material Inoculants on the Tensile and Impact Characteristics of the Aluminum AA 5083/7.5SiC Composites.

The choice of suitable inoculants in the grain refinement process and subsequent enhancement of the characteristics of the composites developed is an important materials research topic, having wide scope. In this regard, the present work is aimed at finding the appropriate composition and size of fly ash as inoculants for grain refinement of the aluminum AA 5083 composites. Fly ash particles, which are by products of the combustion process in thermal power plants, contributing to the large-scale pollution and landfills can be effectively utilized as inoculants and interatomic lubricants in the composite matrix-reinforcement subspaces synthesized in the inert atmosphere using ultrasonic assisted stir casting setup. Thus, the work involves the study of the influence of percentage and size of the fly ash dispersions on the tensile and impact strength characteristics of the aluminum AA 5083/7.5SiC composites. The C type of fly ash with the particle size in the series of 40-75 µm, 76-100 µm, and 101-125 µm and weight % in the series of 0.5, 1, 1.5, 2, and 2.5 are selected for the work. The influence of fly ash as distinct material inoculants for the grain refinement has worked out well with the increase in the ultimate tensile strength, yield strength, and impact strength of the composites, with the fly ash as material inoculants up to 2 wt. % beyond which the tensile and impact characteristics decrease due to the micro coring and segregation. This is evident from the microstructural observations for the composite specimens. Moreover, the role of fly ash as material inoculants is distinctly identified with the X-Ray Diffraction (XRD) for the phase and grain growth epitaxy and the Energy Dispersive Spectroscopy (EDS) for analyzing the characteristic X-Rays of the fly ash particles as inoculant agents in the energy spectrum.

Nanoparticles Incorporating a Fluorescence Turn-on Reporter for Real-Time Drug Release Monitoring, a Chemoenhancer and a Stealth Agent: Poseidon's Trident against Cancer?

The rate and extent of drug release under physiological conditions is a key factor influencing the therapeutic activity of a formulation. Real-time detection of drug release by conventional pharmacokinetics approaches is confounded by low sensitivity, particularly in the case of tissue-targeted novel drug delivery systems, where low concentrations of the drug reach systemic circulation. We present a novel fluorescence turn-on platform for real-time monitoring of drug release from nanoparticles based on reversible fluorescence quenching in fluorescein esters. Fluorescein-conjugated carbon nanotubes (CNTs) were esterified with methotrexate in solution and solid phase, followed by supramolecular functionalization with a chemoenhancer (suramin) or/and a stealth agent (dextran sulfate). Suramin was found to increase the cytotoxicity of methotrexate in A549 cells. On the other hand, dextran sulfate exhibited no effect on cytotoxicity or cellular uptake of CNTs by A549 cells, while a decrease in cellular uptake of CNTs and cytotoxicity of methotrexate was observed in macrophages (RAW 264.7 cells). Similar results were also obtained when CNTs were replaced with graphene. Docking studies revealed that the conjugates are not internalized by folate receptors/transporters. Further, docking and molecular dynamics studies revealed the conjugates do not exhibit affinity toward the methotrexate target, dihydrofolate reductase. Molecular dynamics studies also revealed that distinct features of dextran-CNT and suramin-CNT interactions, characterized by π-π interactions between CNTs and dextran/suramin. Our study provides a simple, cost-effective, and scalable method for the synthesis of nanoparticles conferred with the ability to monitor drug release in real-time. This method could also be extended to other drugs and other types of nanoparticles.

Deep Feature Extraction and Classification of Android Malware Images.

The Android operating system has gained popularity and evolved rapidly since the previous decade. Traditional approaches such as static and dynamic malware identification techniques require a lot of human intervention and resources to design the malware classification model. The real challenge lies with the fact that inspecting all files of the application structure leads to high processing time, more storage, and manual effort. To solve these problems, optimization algorithms and deep learning has been recently tested for mitigating malware attacks. This manuscript proposes Summing of neurAl aRchitecture and VisualizatiOn Technology for Android Malware identification (SARVOTAM). The system converts the malware non-intuitive features into fingerprint images to extract the quality information. A fine-tuned Convolutional Neural Network (CNN) is used to automatically extract rich features from visualized malware thus eliminating the feature engineering and domain expert cost. The experiments were done using the DREBIN dataset. A total of fifteen different combinations of the Android malware image sections were used to identify and classify Android malware. The softmax layer of CNN was substituted with machine learning algorithms like K-Nearest Neighbor (KNN), Support Vector Machine (SVM), and Random Forest (RF) to analyze the grayscale malware images. It observed that CNN-SVM model outperformed original CNN as well as CNN-KNN, and CNN-RF. The classification results showed that our method is able to achieve an accuracy of 92.59% using Android certificates and manifest malware images. This paper reveals the lightweight solution and much precise option for malware identification.

Use of a Heister mouth gag as an aid to reduction in open treatment of condylar fracture.

INTRODUCTION: The management of condylar fractures remains controversial. Open treatment of condylar fractures is a routine treatment in cases of displaced or dislocated condylar and subcondylar fractures. TECHNICAL NOTE: Because of the pull of the lateral pterygoid muscle, the condylar fragment is usually located anterior and medial to the mandible. Distraction of the mandible in an inferior direction simplifies proper reduction. Various distraction devices have been described in literature. We describe a technique of using the Heister mouth gag at the surgical site to aid in reduction of displaced dislocated condylar fractures.

Successful management of a neonate with antenatally detected mature intrapericardial teratoma.

Intrapericardial teratoma is a germ-cell tumor that typically arises from the base of the heart and usually diagnosed in the fetal or neonatal period. Although benign, these tumors can be massive in size causing direct compression of the heart. Life-threatening complications such as fetal hydrops, cardiac failure, superior vena cava syndrome, and cardiac tamponade caused by these teratomas have been reported. Early surgical excision is curative. We present the images of a mature intrapericardial teratoma diagnosed in an asymptomatic neonate. The neonate was managed successfully by elective surgical excision.

Autologous platelet-rich fibrin: can it secure a better healing?

OBJECTIVE: The aim of this study was to evaluate the efficacy of platelet-rich fibrin (PRF) in the healing of impacted mandibular third molar (M3) extraction sockets. STUDY DESIGN: This study included 30 patients with bilaterally symmetric impacted M3 (N = 60) requiring transalveolar extraction. All patients were assigned numbers randomly; left-sided M3 patients with odd numbers and right-sided patients with even numbers were categorized into group A (test group), and the other side of the mouth was classified as "group B" (control group). Group A M3 extraction sockets received PRF, whereas group B sockets were closed without PRF. Patients were evaluated for pain and swelling on postoperative days 1, 3, 7, and 14. Bone healing was compared on postoperative weeks 8 and 16. Analysis of variance (ANOVA) and Tukey's multiple comparison tests were applied for statistical analysis. RESULTS: A total of 30 patients, ages 18 to 40 years, participated in this study. The overall postoperative pain score (visual analogue scale [VAS]) and facial swelling percentages were lower for group A compared with group B (P < .05). Early bone healing was also evident on postoperative radiographs obtained at weeks 8 and 16 in group A (P < .001). CONCLUSIONS: The use of autologous PRF aids in earlier and better wound healing in a controlled manner.

Rapid snare sliding technique: An easy approach to difficult percutaneous transmitral commissurotomy.

Rheumatic heart disease (RHD) is a major health hazard in most developing countries as well as sporadically in developed economies with high prevalence rates. Mitral stenosis is among the important morbid valvular conditions accounting for 25% of RHD cases. Percutaneous transmitral commissurotomy (PTMC) using Inoue balloon is the standard treatment for severe mitral stenosis with favorable Wilkins score. In certain cases it is difficult to cross mitral valve (MV) either due to dilated left atrium (LA), low septal puncture, or severe mitral valvular and subvalvular stenosis leading to prolonged procedure time or failure of PTMC procedure. We describe a case of RHD with severe mitral stenosis and dilated LA where crossing MV was difficult and successful PTMC was performed using rapid snare sliding technique to cross the MV. .

Urban and rural disparity in tobacco use and knowledge about oral cancer among adolescents: An epidemiological survey on 12 and 15-year school going students.

AIMS AND OBJECTIVES: To assess and compare the tobacco use prevalence; to understand and compare attitudes and knowledge related to tobacco use and its health impact among urban and rural students; and to assess urban and rural disparity in the use of tobacco among 12 and 15-year-old adolescents in the urban and rural schools in Chhattisgarh, India. MATERIALS AND METHODS: A cross-sectional study was conducted among 12 and 15-year-old and urban and rural school going children in Durg District. Scientifically, based on the data obtained from the pilot study, sample size was calculated. A total of 1000 children were selected to be a part of the study and were interviewed face-to-face using a detailed pretested, close-ended questionnaire. The Statistical Package for the Social Sciences version 16.0 (SPSS Pvt. Ltd, Chicago, IL, USA) was used for the statistical analyses. RESULTS: Prevalence of tobacco consumption was 48.8%. Males were involved predominantly in consuming tobacco. The knowledge and attitude was better in the school children of urban areas than the school children of rural areas; more of the urban school children were involved in smoking cigarette. Rural children outnumbered urban children in the smokeless tobacco consumption. CONCLUSION: Prevalence of tobacco consumption among school children remains high with a wide disparity among urban and rural children. There is an urgent need to have a rural orientation in the National Tobacco Control Program that is currently being developed by the Government of India and giving relevance to the youth.

Botulinum toxin in the treatment of muscle specific Oro-facial pain: a literature review.

Facial pain associated with temporomandibular joint (TMJ) and surrounding structures has been a challenge to clinicians as far as diagnosis and management is concerned. Complexity of anatomical structures within a small area, function of teeth and surrounding periodontal ligament, action of muscles, pathologies, lack of diagnostic investigations, all these complicate specific diagnosis of TMJ disorders. Various classifications have been designed and studied to help diagnose and treat TMJ related disorders, of which the simplest one is pain from TMJ proper and surrounding muscles. Many treatment modalities to treat pain arising from muscles around TMJ like splints, mouth restriction exercises, injection of sclerosing agents etc. have been used with various degrees of success. Botulinum toxin has been shown to be effective in the treatment of oro-facial pain due to muscular disorders and the same is discussed in detail in this review literature.

Comparison of orthopantomography and computed tomography image for assessing the relationship between impacted mandibular third molar and mandibular canal.

BACKGROUND: Permanent mandibular third molar are most commonly impacted teeth. In planning the surgical removal of mandibular third molar, correct diagnosis requires not only their precise spatial location, but also a thorough and accurate assessment of the intimate relationship with adjacent anatomical structures. Various imaging modalities have been used for localizing the mandibular third molar but not satisfactorily. AIM: This prospective study of 30 patients with 42 impacted mandibular third molars was carried out with the aim of finding evidence for justifying the use of computed tomography and orthopantomography as a diagnostic modality, prior to surgical intervention of impacted mandibular third molar. MATERIALS AND METHODS: Subjective evaluation of the CT and OPG images by two observed had shown that there was significant difference between the CT and OPG for radiographic visibility of mandibular canal in relation to third molar. RESULTS: Data analysis was done with Chi-square test (X(2)) and z-test to find the significant difference between the two radiographic modalities OPG and CT in localizing special relationship of impacted mandibular third molar. The comparison of OPG and CT showed z-value >1.5 in darkening of roots (1.98), deflection of root (2.00) interruption of z-value = 0 in narrowing of canal and dark, bifid apexes. Also it showed p-value <0.05 in all the radiographic signs except narrowing of mandibular canal and and dark and bifid apexes. CONCLUSION: The spiral CT image provides a unique opportunity to determine the exact position of impacted mandibular third molar and their relationship to adjacent structure in all three planes. CLINICAL SIGNIFICANCE: Computed tomography is highly instrumental in depicting the relationship of mandibular third molar with inferior alveolar nerve canal before treatment and accurate appraisal of the several aspects can be made regarding prognosis.