Long-acting porcine ACTH stimulated salivary cortisol reduces the overdiagnosis of adrenal insufficiency compared to serum cortisol in cirrhosis liver.

BACKGROUND: There are no reliable methods in clinical practice to diagnose adrenal insufficiency (AI) in patients with cirrhosis owing to variable cortisol-binding protein levels. This leads to unreliable results in ACTH stimulated serum cortisol test. We aimed to estimate the long-acting porcine (LA)ACTH-stimulated serum and salivary cortisol levels of patients at different stages of cirrhosis using second generation electrochemiluminescence and to determine the prevalence of true adrenal insufficiency in these patients. DESIGN, PATIENTS AND MEASUREMENTS: We included 135 noncritical patients with cirrhosis (45 each from CHILD A, B and C) and 45 healthy controls. Serum and salivary samples were collected at baseline in the morning and at 1 and 2 h after LA-ACTH injection. RESULTS: In healthy subjects, the 2.5th centile of 2 h ACTH stimulated serum and salivary cortisol were 19.8 and 0.97 µg/dL, which were used as cut-offs for defining AI based on serum and saliva respectively. The median (interquartile-range) 2-h stimulated salivary cortisol in Child A, B, C categories and controls were 1.36(1.23-2.38), 1.46(1.18-2.22), 1.72(1.2-2.2) and 2.12(1.42-2.72) µg/dL respectively. Six subjects (4.4%) were diagnosed to have AI based on stimulated salivary cortisol cut-off, whereas 39 (28.9%) cirrhosis subjects had inadequately stimulated serum cortisol. Three patients (symptomatic) required steroid replacement therapy. Hypoalbuminemia was identified as a major risk factor for the misdiagnosis of adrenal insufficiency by serum cortisol-based testing. CONCLUSIONS: Long-acting porcine ACTH stimulated salivary cortisol reduces the overdiagnosis of adrenal insufficiency compared to serum cortisol in cirrhosis liver. Stimulated salivary cortisol is a promising investigation for evaluation of adrenal function in cirrhosis and more studies are required for its further validation before clinical use.

Diabetic striatopathy in type 1 diabetes mellitus: a rare conundrum.

Diabetic striatopathy is a clinicoradiological syndrome characterised by acute hyperkinetic movement disorder in the form of hemichorea-hemiballism with basal ganglia abnormalities in neuroimaging. The hallmark basal ganglia abnormalities appear as hyperdensities in CT brain and hyperintensities in MRI brain, which could mislead the clinician towards an erroneous diagnosis of cerebral haemorrhage. It is classically described in elderly patients with type 2 diabetes mellitus, and its occurrence in type 1 diabetes is extremely rare. This case report entails the clinical details of a young man in his 20s with type 1 diabetes mellitus who had uncontrolled blood glucose levels and presented with a recent onset of abnormal movements in his left upper and lower limbs. The semiology, biochemistry and radiological investigation findings and treatment are detailed. A clear understanding of the condition could lead to an early diagnosis, spare the patient unnecessary investigations and improve treatment outcomes.

Clinical Assessment of SDF Effect in Arresting Dental Caries in Deciduous Teeth.

Objectives: Current research was done to evaluate the effectiveness of 38% silver diamine fluoride (SDF) on carious lesions in deciduous teeth. Materials and Method: The study included kids who had at least one carious lesion in accordance to the International Caries Detection and Assessment System II. A 38% SDF (FAgamin, Tedequim Company, Córdoba, Argentina) solution was applied directly to the lesion on the deciduous teeth as per the manufacturer's instructions. A follow-up evaluation was performed after one, three, and six months. Clinical results were used to assess the efficacy of SDF. The obtained data were statistically evaluated. Result: When it came to halting dental caries in primary teeth, 38% SDF was 92% effective. Conclusion: In conclusion, 38% SDF can be used to effectively stop caries in primary teeth.

Evaluation of the Characteristics of Nano Hybrid Composite Resin Modified with Graphene after Thermomechanical Loading Cycle.

To evaluate the characteristics of a thermomechanically loaded composite resin enhanced with graphene nanoparticles. A total of 60 specimens were manufactured with Test group TG1 (20), TG2 (20), and control group CG (20). All samples were subjected to surface roughness using a three-dimensional (3D) Optical profilometer and flexural strength. All specimens were subjected to thermomechanical cyclic loading. Microhardness measurement was performed with a microhardness tester. The average microhardness and flexural strength were higher in test groups TG1 and TG2 and lowest in control group CG. There was an improvement in surface roughness, flexural strength, and microhardness in the test group after the addition of graphene nanoparticles compared to the control group. Conclusion: The addition of graphene nanoparticles to composite resin significantly improved flexural strength and microhardness. The physical and chemical properties of the composite showed marked improvement.