Electrochemical dissolution and retrieval of broken NiTi endodontic files from root canal using chloride based isotonic fluids as electrolytes - An in vitro study.

Objective: The electrochemical dissolution method of instrument retrieval emphasizes on the dissolution of the instrument rather than sacrificing dentine. Most of the studies conducted for electrochemical dissolution used fluoride-containing electrolytes and were performed inside a beaker. In this study, we used chloride-based fluids as electrolytes. Materials and Methods: Fifty extracted mandibular first premolars were divided into five groups based on the electrolytes used. Canals were enlarged to ProTaper Universal F2, and files were intentionally broken inside the canal. These specimens were subjected to electrochemical characterization by applying the potential of 9V for 20 min. Optical images were taken to assess the change in surface topography. The results were analyzed statistically by one-way analysis of variance (analysis of variance [ANOVA]). Results: The rate of dissolution based on the electrolyte used decreased in the following order, viz. Tyrode's solution>artificial saliva>normal saline>Ringer's lactate/physiological serum. Conclusion: Apart from fluoride, chloride-based electrolytes could be an efficient alternative.

Facile synthesis of N-(α-furanyl) alkyl sulfoximines via gold catalyzed Michael addition/cyclization of enynones and sulfoximines.

Herein, we prepare a new array of N-(α-furanyl) alkyl sulfoximines via a gold catalyzed reaction of enynone with sulfoximine in moderate to very good yields. The reaction involves Michael addition of sulfoximine to enynone, followed by intramolecular cyclization. The presence of two chiral centres led to the formation of a mixture of diastereomers approximately in a 1 : 1 ratio. The salient features of the protocol include broad substrate scope, high efficiency and high yields. The synthetic utility of the protocol is explored using Suzuki-Miyaura cross-coupling and mild, metal-free opening of the furan ring.

Coronary Artery Dissection and Myocarditis Caused by Eosinophilic Granulomatosis with Polyangiitis (EGPA): A Case Report.

Eosinophilic granulomatosis with polyangiitis (EGPA) also referred to as Churg-Strauss syndrome is a rare vasculitis of the small to medium vessels. We present a rare case of acute coronary artery dissection brought on by EGPA, which generally has a poor prognosis. A 41-year-old male with history of bronchial asthma presented to the emergency room with a 2-week history of dyspnea, cough with clear phlegm, and fever. For the past eight months he had experienced episodes with similar symptoms relieved by steroids. CT chest showed bilateral upper lobe patchy opacities with extensive workup for infectious etiology being negative. He had peripheral eosinophilia with sinusitis. He had acute coronary syndrome and Coronary angiogram showed Right coronary artery dissection. After making a diagnosis of EGPA based on American college of Rheumatology criteria, he was successfully treated with high dose immunosuppression. Coronary artery dissection is a fatal and uncommon complication of EGPA which is usually diagnosed postmortem. Early recognition of this condition ante mortem and aggressive treatment can be lifesaving as demonstrated in our case.

GC-MS analysis and in silico docking of constituents of Cinnamomum malabatrum against CYP450 17α and CYP450 19 (Aromatase)- Key targets for hyperandrogenism.

Poly cystic ovary syndrome (PCOS) is considered as one of the common hormonal disorders affecting 6-20% of women in their reproductive age with characteristic features include anovulatory infertility, hyperandrogenism, cystic follicles and insulin resistance. The gene CYP play an important role in pathophysiology of hyperandrogenism associated with PCOS. An elevated androgens are reported in PCOS condition due to overexpression of the enzyme CYP450 17 α: . As well as diminished levels of aromatase (CYP450 19) were observed in several hyperandrogenic PCOS patients. The powdered leafy material of Cinnamomum malabatrum was subjected to Soxhlet extraction. The plant extract was subjected to Gas chromatography-MS analysis (GC-MS), and the chromatogram obtained revealed the presence of active chemical constituents like 1(10),9(11)-B-Homolanistadiene for the first time and other potential compounds. Hypothesis has raised to interpret the efficiency of phytoconstituents of Cinnamomum malabatrum on these enzyme targets and which may be a novel drug candidate for the treatment and maintenance of hyperandrogenism associated with PCOS. Thus, the results obtained from the in-silico study of Cinnamomum malabatrum leaf extract using computational approaches indicate that the phytoconstituents have good affinities for the selected two key targets. ADME and PASS studies has been performed for active phytoconstituents homolanistadiene, ß-sitosterol, cycloartenol and a pyrazole derivative, and results revealed the Lipinski drug-likeness and pharmacological potential. In conclusion, this work throws a new insight into the possibility of the active phytoconstituents on binding the two active CYP45017 α and CYP45019 aromatase enzymes which facilitates development of novel compounds for hyperandrogenism associated with PCOS.

Use of rotational thromboelastometry to predict the outcome of COVID-19 patients: A retrospective observational study.

Background and Aims: The hypercoagulability occurring in COVID-19 patients is detected only by Rotational thromboelastometry (ROTEM). However, the benefit of performing ROTEM in the management of disease and predicting the outcome of COVID-19 patients is yet to be established. Material and Methods: The data of 23 critically ill and 11 stable COVID-19 adult patients were extracted from the hospital information system admitted between July and August 2020 and patient charts and analyzed retrospectively. The critically ill patients were divided as a survivor and non-survivor groups. The Intrinsic pathway part of ROTEM (INTEM) and Fibrinogen part of ROTEM (FIBTEM) were performed on day 0 for both critically ill and stable patients, and on day 10 for critically ill patients. The statistical package for social science (SPSS) version 26 was used for statistical analysis. Results: The median FIBTEM amplitude at 5 min (A5) and maximum clot firmness (MCF) were elevated in both stable and critically ill patients (24 vs 27 mm, P = 0.46 and 27.5 vs 40 mm, P = 0.011) with a significant difference in FIBTEM MCF. But there was no significant difference between number of survivors and non-survivors with FIBTEM MCF >25 at day 0 and day 10. Conclusion: The Hypercoagulability state as detected by ROTEM parameters at day 0 and day 10 had no association with the outcome (mortality) of critically ill COVID-19 patients. Hence it cannot be used as a prognostic test. The increasing age, comorbidities and D-dimer values were associated with a poor prognosis in COVID-19 patients.

Assessment of Growth Factors with Three Different Platelet Preparations, Namely Platelet-Rich Fibrin, Platelet-Rich Plasma, and Lyophilized Platelet: An In vitro Study.

Assessment of growth factors with three different platelet preparations namely platelet rich fibrin, platelet rich plasma and lyophilized platelet-An invitro study Abstract Enhancing wound healing with patients own blood, particularly the platelet preparations have gained more popularity recently. These platelets excrete large amount of growth factors and cytokines that are associated with the healing process and regeneration. Even though these platelet concentrates are widely used in various forms, the mechanism behind that remains unclear. Therefore, this study aims at investigating the levels of growth factors in three different platelet preparations namely platelet rich plasma (PRP), platelet rich fibrin (PRF) and lyophilized platelets. Materials and Methods Autologous blood for preparing the platelet preparations was obtained from healthy donors aged between 25 to 35 years. The samples were then divided into three experimental groups. The preparation of PRP was done with the addition of anticoagulant and the PRF is prepared without adding it. The platelet counts in the blood were analyzed and the growth factors were quantitatively measured using ELISA reader. The statistical analysis was performed by using the Chi square test. Results In the quantitative analysis of growth factors LPL showed significant increase of the liberation of growth factors compared to PRP and PRF. Conclusions With the various recent advances in technologies for preparing these platelet concentrates this can be widely used in clinical practice more accurate in the future.

Evaluation of Crack Propagation after Root Canal Preparation with Continuous and Reciprocating Files and Final Finishing with XP Endo Finisher - An In vitro Study.

INTRODUCTION: One of the disadvantages of stainless steel instruments used for root canal preparation is the lack of flexibility and shape memory. The invention of rotary instruments has been successful in overcoming these problems to a greater extent; however, some drawbacks still remain, one of which is vertical root fracture and the cause for it is microcracks formation in dentin, which in turn causes vertical root fracture. There are enough studies for microcracks using different rotary systems and this study compared microcracks with single as well as reciprocating files followed by final finishing with XP endo finisher. Apart from other studies, we used conefocal laser scanning microscope to assess microcrack propagation before and after instrumentation with each rotary system. AIM: To evaluate microcrack propagation in mandibular molars after root canal preparation with continuous and reciprocating file systems followed by final finishing with XP Endo finisher. MATERIALS AND METHODS: Thirty mandibular molars indicated for the extraction due to periodontal causes were selected for this study. They were divided into three groups based on rotary systems used: Group A: ProTaper universal; Group B: ProTaper gold; and Group C: Waveone gold. All specimens were subjected to scanning before instrumentation to assess the presence of any existing cracks. Cone focal laser microscopic scanning is again repeated for each specimen after instrumentation with each rotary system and also after final finishing with XP Endo finisher. STATISTICAL ANALYSIS: One-way ANOVA is used. RESULTS: Crack propagation is the highest with ProTaper universal and least with waveone gold. After final finishing of canals with XP Endo finisher, crack propagation observed was negligible. CONCLUSION: The success of root canal treatment depends on effective disinfection of root canal system. XP Endo finisher can be used as a final finishing file by considering its advantageous properties, moreover crack propagation with XP Endo finisher in an previously instrumented canal is negligible.

A case of cerebrospinal fluid rhinorrhoea: a surgical challenge.

CEREBROSPINAL FLUID rhinorrhoea is defined as the leakage of CEREBROSPINAL FLUID through the nose due to communication between nasal cavity and Sub-arachnoid space. It occurs due to breach in 4 layers - mucosa of the nose and PNS, skull base, Duramater, Subarachnoid membrane. With the advent of nasal endoscope and advancement in technology, Endoscopic Endonasal closure of CEREBROSPINAL FLUID leak has reached tremendous heights due to exact localization and precise placement of graft. In this article, we are publishing a case report of Non-traumatic normal pressure CEREBROSPINAL FLUID leak of more than 1.5cm in size which was successfully closed Endoscopically by multilayered technique.

Pre-operative evaluation of peritoneal deposits using multidetector computed tomography in ovarian cancer.

OBJECTIVE: In the management of epithelial ovarian cancer (EOC), the identification of peritoneal deposits is the most important prognostic factor. We conducted a prospective study to evaluate the role of multidetector CT (MDCT) in identifying peritoneal deposits pre-operatively. METHODS: 38 previously untreated patients (median age 50 years; range 26-70 years) were evaluated with contrast-enhanced MDCT of the abdomen and pelvis. All CT scans were performed on a four-slice MDCT scanner with thin-slice image acquisition. Multiplanar coronal, sagittal or oblique images were constructed and all images were reviewed by at least two radiologists. The extent of disease was determined and mapped for all areas of the abdomen and pelvis. CT scans were reviewed and compared with surgical findings. Peritoneal deposits and thickening were separately noted for each of the nine segments of the abdomen and pelvis (i.e. bilateral hypochondria, bilateral lumbar, bilateral iliac fossa, epigastrium, umbilical region and hypogastrium) and were mainly used to determine the accuracy of MDCT in the depiction of peritoneal carcinomatosis. RESULTS: Sensitivity, specificity, positive and negative predictive values and accuracy of CT in the detection of peritoneal deposits were similar to those reported in the literature. The most common anatomical sites to have peritoneal deposits were the pouch of Douglas (18 cases) and the right subdiaphragmatic region (18 cases). CONCLUSION: Despite the improved scanning technology, image reconstruction and viewing ability of MDCT, its overall accuracy for the detection of peritoneal deposits is not significantly improved when compared with conventional CT; however, MDCT is useful in the assessment of disease at specific locations in the abdomen and pelvis.

High-dose chemotherapy with autologous stem cell transplantation for multiple myeloma: what predicts the outcome? Experience from a developing country.

We analyzed the results of 108 patients (78 males and 30 females) with multiple myeloma who underwent autologous stem cell transplantation (ASCT). The median age of patients was 52 years (range, 26-68 years). High-dose melphalan (200 mg/m(2)) was used for conditioning. In all, 66 (61%) patients had evidence of chemo-sensitive disease before transplant. After ASCT 79.6% of patients responded: complete response 36%, very good partial response 29.6%, and partial response 13.9%. Complete response rate was higher for patients with chemo-sensitive disease; 33 of 66 (50.0%) patients achieved complete response compared with 7 of 42 (14.3%) patients with progressive disease, P<0.01. Response rates to ASCT were significantly low for patients with Hb 5.5 mg/l, International Staging System stage III at diagnosis and >12 months interval from diagnosis to transplant. Grade III-IV mucositis was the major regimen-related toxicity. At a median follow-up of 70 months, the median overall survival and event free survival (EFS) were 71 and 42 months, respectively. Estimated overall survival and EFS at 60 months were 54.4+/-0.05% (s.e.) and 49.3+/-0.05% (s.e.), respectively. Survival was significantly better for patients with pre-transplant chemo-sensitive disease and for those who achieved complete response following transplant.

A new quality assessment parameter for optical coherence tomography.

AIM: To create a new, automated method of evaluating the quality of optical coherence tomography (OCT) images and to compare its image quality discriminating ability with the quality assessment parameters signal to noise ratio (SNR) and signal strength (SS). METHODS: A new OCT image quality assessment parameter, quality index (QI), was created. OCT images (linear macular scan, peripapillary circular scan, and optic nerve head scan) were analysed using the latest StratusOCT system. SNR and SS were collected for each image. QI was calculated based on image histogram information using a software program of our own design. To evaluate the performance of these parameters, the results were compared with subjective three level grading (excellent, acceptable, and poor) performed by three OCT experts. RESULTS: 63 images of 21 subjects (seven each for normal, early/moderate, and advanced glaucoma) were enrolled in this study. Subjects were selected in a consecutive and retrospective fashion from our OCT imaging database. There were significant differences in SNR, SS, and QI between excellent and poor images (p = 0.04, p = 0.002, and p<0.001, respectively, Wilcoxon test) and between acceptable and poor images (p = 0.02, p<0.001, and p<0.001, respectively). Only QI showed significant difference between excellent and acceptable images (p = 0.001). Areas under the receiver operating characteristics (ROC) curve for discrimination of poor from excellent/acceptable images were 0.68 (SNR), 0.89 (IQP), and 0.99 (QI). CONCLUSION: A quality index such as QI may permit automated objective and quantitative assessment of OCT image quality that performs similarly to an expert human observer.

Portable pupillography of the swinging flashlight test to detect afferent pupillary defects.

OBJECTIVE: To investigate the ability of a portable, personal computer-driven, pupillometer to record the pupillary response curve during the swinging flashlight test. Also, to determine whether these response curves can be used to identify and quantify relative asymmetry in the pupillary light reflex between eyes in healthy volunteers with simulated afferent pupil defects (APDs) and patients with optic neuropathies. DESIGN: Comparative, observational case series and instrument validation. PARTICIPANTS: Healthy volunteers with no known ocular disease and patients (n = 20) with various optic neuropathies noted to have relative APDs on examination. METHODS: Pupillary response curves of the right eye were recorded with a portable, electronic, infrared pupillometer from healthy volunteers (with and without simulated APDs) and patients with APDs while the light stimulus alternated between eyes, simulating the swinging flashlight test. Simulated APDs in healthy volunteers were created with increasingly dense neutral density filters in front of the left eye. MAIN OUTCOME MEASURES: Differences in constriction amplitude, latency, and constriction velocity of the pupillary response with right eye stimulation versus left eye stimulation in both groups of subjects. RESULTS: A significant correlation between neutral density filter strength and intereye differences was seen for all measurement parameters in volunteers with simulated APDs. Depending on the measurement parameter and stimulus intensity, simulated APDs of 0.6 log units or more could be distinguished from normal responses. Clinically graded true APDs had intereye differences similar to simulated APDs of the same density. Those with real and simulated APDs of 0.9 log units or more could be distinguished from healthy volunteers with 80% sensitivity and 92% specificity. Responses from those with real and simulated small APDs of 0.3 to 0.6 log units could not be distinguished reliably. CONCLUSIONS: Portable, personal-computer driven, electronic, infrared pupillography can record the swinging flashlight test accurately and identify large afferent pupillary defects. An affordable, portable, reliable device for identifying relative APDs would be useful in the identification and follow-up of patients with neurogenic vision loss.

An intelligent, interactive platform for ophthalmic teaching, telemedicine, and telecollaboration: design considerations and prototype construction.

The development of technologies permitting processing, compression, and transmission of digital images and image sequences enables powerful methodologies for local and remote medical teleconsultation. We are developing a slit-lamp-based ophthalmic augmented reality (image overlay) environment incorporating features to permit real-time, interactive teaching, telemedicine, and telecollaboration. A binocular slit-lamp biomicroscope interfaced to a CCD camera, framegrabber board, and PC permits acquisition and rendering of anterior segment and retinal images. Computer-vision algorithms facilitate robust tracking, registration, and near-video-rate image overlay of previously stored retinal photographic and angiographic images onto the real-time fundus image. Our algorithms facilitate shared control of pointing, drawing, and measuring functions registered with the retinal image video stream and direct audio communication between an examiner (student, generalist) and remote observer (instructor, specialist). Bandwidth and video compression considerations limit the frame rate and latency for video stream transmission. Excellent and acceptable performance are demonstrated in model eyes over a local area network and through a modem connection, respectively. These studies represent the first investigations towards the design and implementation of an intelligent platform for ophthalmic telemedicine and telecollaboration.