Phalangeal microgeodic syndrome: a paediatric case series.

We present the clinical and radiological characteristics of phalangeal microgeodic syndrome in a cluster of five children during the second peak of COVID-19 pandemic in the UK. Each child presented with phalangeal swelling and erythema, prompting a comprehensive multi-disciplinary team review to analyse the clinical presentation, blood test results and imaging. The cohort's average age was 14.1 years, ranging from 10.4 to 16.6 years, with two girls and three boys. Four children experienced phalangeal involvement in the hands, whilst one was affected solely in the feet. A rheumatological work-up was performed for all. Hand X-rays performed on three children revealed distinct radiographic features like microgeodes, subperiosteal bone resorption and rarefaction in two cases. However, further MRI showed extensive changes closely correlated with the clinical signs of cutaneous vasculopathic rashes. The MRI abnormalities were notable, encompassing marrow oedema primarily affecting metaphyses and epiphyses, displaying broad transition zones. Soft tissue swelling and cortical erosions were also observed. These MRI features proved more pathognomonic in the acute clinical context. The study concluded that phalangeal microgeodic syndrome, characterised by digital swelling and erythema, might not be adequately assessed by plain X-rays. The more comprehensive MRI features, including marrow oedema and soft tissue abnormalities, appeared to be more indicative in diagnosing the condition. Considering the rarity of this syndrome and its temporal association with the COVID-19 pandemic, the study hypothesised that COVID-related thrombophilia and immune-mediated vasculopathy might act as crucial triggers for the active bony manifestations seen in this syndrome. KEY POINTS: • PMS is a rare, predominantly paediatric condition, of unknown aetiology which affects the digits. • Laboratory investigations are generally negative; however, in the appropriate clinical context, the X-ray findings of microgeodes and pattern of bone marrow oedema seen on MRI are pathognomonic. • Considering the rarity of PMS and temporal association with the COVID-19 pandemic, COVID vasculopathy may represent a previously unrecognised aetiology for PMS.

Knowledge, awareness, and practice of biomedical waste segregation in a dental office.

Biomedical waste (BMW) is any sort of litter generated in the course of human or animal research operations, such as diagnosis, treatment, or immunization, or during the development or trial of pharmaceutical products or in health camps. In dental sectors, BMW, if not adequately handled, can provide a number of health risks to dental practitioners, patients, and other dental healthcare service providers who operate in dental offices. The aim of the study is to examine the knowledge, awareness, and practice of BMW segregation among dental offices. A well-framed questionnaire containing 10 self-structured questions was formed and distributed among 100 students of dentistry through an online Google Forms link. The results were collected, tabulated, and statistically analyzed using the Software SPSS. Chi-square test was performed to assess the P value. Biological waste segregation was known to 98% of the participants, in which most of them had more than 10 years of expertise in dentistry. It is evident that dentists with a lot of experience over the years in the field of dentistry possess considerably increased awareness regarding the segregation of BMWs in their dental offices. Chi-square test done between the years of experience in dentistry and the knowledge on BMW segregation reveals that 0.031 < 0.05 is the P value, which is statistically significant. Most dentists having experience of above 10 years in the field of dentistry have excellent knowledge and practice of segregating BMWs in their dental offices.

Evaluation of flexural strength of bulk-fill composite resin after immersion in fruit juices: An in vitro study.

Resin-based composites are increasingly employed in dental restorations due to their esthetics. Flexural strength is the characteristic feature of a substance, and it can be described as the stress present in the material just before it renders in a flexure test. The purpose of this study was to determine the flexural strength of a bulk-fill composite following immersion in fruit juices. Ten samples of bulk-fill type composite filling material were created, with four samples from Restofill (Group 1) and four samples from Ivoclar Vivadent (Group 2). Out of which, four specimens of each brand were included for immersion in fruit juices; two specimens were kept as control. The eight samples were put through a flexural strength test, with four remaining as controls, before being measured for maximum force and displacement on the Instron E3000 universal testing equipment. SPSS version 23 (IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.) was used to examine the calculated flexural strength. The composite Ivoclar has a mean flexural strength of 20.52, whereas the composite Restofill has a mean flexural strength of 20.55. The P value for the independent sample t-test between the two groups, Ivoclar and Restofill, was 0.089 (>0.05), which is statistically insignificant. It is clear from this research that the bulk-fill composite resin Ivoclar has a low flexural strength when compared to the sample Restofill after immersion in fruit juices.

Efficacy of Topical Timolol versus Saline in Chronic Venous Ulcers: A Randomized Controlled Trial.

Background: Chronic venous ulcers sometimes fail to heal in spite of adequate treatment. Nonhealing is possibly because of chronic activation of ß-2 adrenergic receptor (B2-AR) in the keratinocytes by endogenously generated catecholamines, which inhibits keratinocyte migration. Blocking of B2-AR using ß-blockers has been reported to promote wound healing through keratinocyte migration, angiogenesis, and fibroblast migration. Topical timolol, a B2-AR antagonist, is used to promote wound healing. Aims and Objectives: The aim of this study was to compare the efficacy of topical timolol versus saline in chronic venous leg ulcers and to compare the mean reduction in ulcer area at the end of 4 weeks. Materials and Methods: Twenty patients were randomized into two groups. Patients in Group 1 were treated with one drop of 0.5% topical timolol every alternate days for 4 weeks. Ulcer margins were measured and ulcer area calculated every week for 4 weeks. Similar dressing and measurement were carried out for patients with saline for 4 weeks. Healing rate was assessed by the percentage of reduction of ulcer area of both groups at week 4. Results: The mean reduction in the ulcer size in timolol group was 86.80%, and in saline group 43.82% at the end of 4 weeks. Conclusion: Topical timolol is an easy, noninvasive therapy that can be recommended for chronic ulcer.

13C NMR Investigations of Hairy-Rod-Like π-Conjugated Mesogens.

Two hairy-rod π-conjugated mesogens comprising dihexylfluorene and didecyloxyterphenyl are synthesized, and their mesophase properties are examined by hot-stage optical polarizing microscope and differential scanning calorimetry techniques. Both mesogens exhibit enantiotropic nematic mesophase with broad mesophase range. A detailed 13C NMR study is carried out in solution as well as in nematic mesophase to understand changes in the orientation of the aliphatic chains. Accordingly, the unusual NMR chemical shift value of one of the methylene carbons of the hexyl chain of fluorene moiety in solution is ascribed to ring current effect changes in nematic mesophase owing to variation in the orientation of the hexyl chain. The change in conformation of lateral and alkyl chains in the nematic phase is clearly noticed compared to isotropic solution as the molecular orientation in mesophase is governed by the orientation of the long molecular axis. Furthermore, the 13C-1H dipolar couplings obtained from 2D separated local field experiments in nematic phase aided the assignments of all of the carbons of the molecules besides offering the local order. To comprehend the orientation of the fluorene unit, three order parameters are necessary whereas for the phenyl rings, two order parameters are found to be sufficient. The molecular biaxiality ( S xx - S yy) for fluorene-based mesogen is found to be higher due to the fused nature of the moiety and the presence of dihexyl chains. The orientational ordering of π-conjugated mesogens is crucial as the optoelectronic properties of them critically depend on the orientation of the constituent chromophores. The complete mapping of order parameters of fluorene, the phenyl rings and the alkyl chains showed that despite both molecules exhibiting nematic mesophase, the orientational constraints are governed by the molecular structure as well as the rigidity of the core unit, i.e., fused versus linearly connected rings.

Health-related quality of life in liver cirrhosis patients using SF-36 and CLDQ questionnaires.

AIM OF THE STUDY: To determine the factors that are likely to influence the domains of health-related quality of life (HRQOL) using SF-36 and CLDQ questionnaires in patients with liver cirrhosis. MATERIAL AND METHODS: Patients with liver cirrhosis were compared with age- and gender-matched healthy controls for physical and mental components of the SF-36 score. Effects of age, co-morbidity, namely diabetes, severity of liver disease and complications of liver cirrhosis on HRQOL using self-administered or by direct interview SF-36 and CLDQ questionnaires were studied. Statistical analysis: chi square test, ANOVA, Kruskal-Wallis test and stepwise linear regression analysis. A p value of < 0.05 was considered significant. RESULTS: Regarding SF-36 score, except for bodily pain, 149 patients had significantly low individual and composite domain scores (p value < 0.0001) compared to age/gender-matched controls. Patients below 45 years, the majority of whom belonged to Child-Turcotte-Pugh (CTP) class C with a high Model of End-Stage Liver Disease (MELD) and higher rates of complication had low SF-36 for bodily pain (KW p < 0.005) and those above 55 years for physical function (p < 0.05). Both the physical components had a major impact on mental composite score (MCS) (KW p < 0.05). The overall CLDQ score was also low in patients below 45 years old (p < 0.05). Diabetes with or without other co-morbid conditions had no effect on SF-36 or CLDQ scores, while non-diabetic co-morbid conditions did on physical domains (physical function, bodily pain and role physical) and the physical component score of SF-36 (KW p < 0.01 to < 0.0001). In linear regression, MELD had a direct and significant association with overall PCS, MCS and CLDQ. CONCLUSIONS: Age below 45 years, higher MELD and CTP score with the presence of ascites and hepatic encephalopathy affect the overall CLDQ scores.

HRQOL using SF36 (generic specific) in liver cirrhosis.

Health-related quality of life (HRQOL) is influenced by the disease state, associated complications and their management. In patients with liver cirrhosis co-morbidity, severity of liver disease and their complications are likely to affect the QOL. The aim of the study was to determine the factors that are likely to influence the domains of HRQOL using SF-36 in patients with liver cirrhosis. For the study, 149 patients with liver cirrhosis were compared with age-gender matched healthy controls for physical and mental components of SF-36 score and the effects of age, co-morbidity severity of liver disease and complications of liver cirrhosis on HRQOL were assessed using the same questionnaire. Results of the study showed that except for body pain, all the patients had a significantly low individual and composite domain score (p-value <0.0001) compared to age-gender matched controls. Patients below 45 years, Child-Turcotte-Pugh (CTP) C, a high model for end-stage liver disease (MELD) and higher rates of complication had low scores for body pain (KW p <0.005) and those above 55 years, for physical function (p <0.05). Both the physical components had a major impact on mental composite score (MCS) (KW p <0.05). Co-morbidity that included diabetes, hypertension and hypothyroid states in various combinations had no effect on SF-36 scores while co-morbid conditions like musculoskeletal pain, arthralgia etc. affected physical domains (physical function, body pain and role physical) and physical component score (PCS) (KW p <0.01 to <0.0001). By linear regression, MELD had a direct and significant association with overall PCS and mental component score (MCS).

Characteristics of gallbladder cancer in South India.

Gallbladder cancer is common in north India. It is also a well established fact that gall bladder cancer is frequently associated with gallstone disease in north India, similar to reports from the West. The magnitude of the problem of gallbladder cancer in south India and its link to gallstone disease is not clearly established. The aim of the study was to determine retrospectively, the characteristics of individuals with GBC in south India and to determine its association with gallstone disease. Retrospective data was obtained from records of proven cases of gallbladder cancer and patients undergoing cholecystectomy for gallstone disease between Jan 2001 and Dec 2010. Data retrieved included age, gender, and clinical presentation, findings on imaging, histology and details of management. The number of proven cases of gallbladder cancer each year ranged from 8 to 17. There were 38 men and 23 women. Male female ratio was 1.6:1. There were more men in the successive decades. Right upper quadrant pain (42 %) followed by jaundice (27 %) and a presence of a palpable mass (12 %) were the common clinical presentation. Pre-operative diagnosis of gall bladder cancer was possible in 80 %. Twelve patients had co-existing gallstones (19.6 %). Forty patients (50 %) had stage IV disease; only 6 patients had Stage I operable disease (9.8 %). During the same time 758 patients had cholecystectomy for gallstone disease. Only one patient had an incidental gall bladder cancer, who had an extended cholecystectomy. Gallbladder cancer is uncommon in south India and its association with gallstone is also low.