Evaluation of Anesthetic Efficacy of 4% Articaine, 0.5% Bupivacaine and 0.5% Ropivacaine During Surgical Removal of Impacted Mandibular Third Molars: A Randomized Comparative Clinical Study.

Introduction: The aim of this study was to compare the anesthetic efficacy of 4% articaine, 0.5% bupivacaine and 0.5% ropivacaine (with 1:200,000 adrenaline) during surgical removal of impacted mandibular third molars. Materials and methods: The study included 75 patients randomly divided into three equal groups of 25 patients each. The study variables were: onset of anesthetic action, duration of surgery and anesthesia and postoperative analgesia. A visual analog scale was used to assess pain at different time intervals. Statistical analysis revealed insignificant difference among groups in terms of volume of anesthetic solution used, quality of anesthesia, surgical difficulty and duration of surgery. Results: The mean onset time was significantly (P < 0.001) shorter for articaine (1.14 min) than ropivacaine (2.18 min) and bupivacaine (2.33 min). However, the duration of anesthesia as well as analgesia was significantly (P < 0.001) longer for bupivacaine (483.6 min and 464 min) and ropivacaine (426.6 min and 459 min) as compared to articaine (232.8 min and 191.4 min), respectively. Also, on comparing three groups pain scores at 6th postoperative hour were significant (P < 0.01). Conclusion: Ropivacaine and bupivacaine can be safely used in patients where longer duration of surgery is anticipated.

Exploring the Labyrinth: Imaging in Systemic Vasculitis.

Systemic vasculitis is an immune-mediated group of disorders broadly classified based on the involved vessel type. It has myriad clinical presentations, adding to the challenge of timely diagnosis and management. Thus, imaging has taken center stage in the diagnosis of these disorders as there is a lack of definitive clinical diagnostic markers. Various available imaging modalities can be used for diagnosis and follow-up on these patients. The coronavirus disease 2019 (COVID-19) has added a new dimension to the already existing problem of vasculitis. The virus has shown great affinity for the vascular endothelium, leading to multisystem organ vasculitis. There has been a spike in vasculitis cases in the COVID-19 pandemic era, thus necessitating more research and studies in this field for a better understanding of the disease. In this review, we wish to summarize the various imaging spectrums of classical systemic vasculitis along with the new addition of COVID-19-related vasculitis to the already long list.

Evaluation of nail fold capillaroscopy changes in patients with diabetic retinopathy and healthy controls, and its correlation with disease duration, HbA1c levels and severity of diabetic retinopathy: An observational study.

Background Diabetic retinopathy (DR) is an important microvascular complication of long-term type 2 diabetes mellitus (T2DM) leading to blindness if not properly diagnosed and managed. It can develop as early as 7 years before the diagnosis of diabetes. Nail fold capillaroscopy (NFC) is a non-invasive technique for observing capillary microvasculature and there are few studies which have explored the use of NFC in diabetes mellitus patients. Objective To study the nail fold capillaroscopic alterations in patients with T2DM having diabetic retinopathy and compare them to healthy controls. The secondary objective was to correlate the NFC findings with the duration of diabetes, haemoglobin A1c (HbA1c) levels and the severity of DR. Materials and methods This cross-sectional observational study enrolled 200 patients - 100 cases with T2DM having diabetic retinopathy (as per the American Diabetes Association criteria and Diabetic Retinopathy Disease Severity Scale) and 100 healthy age and sex-matched controls. All patients were subjected to NFC and ophthalmological assessment. Results NFC revealed that patients with DR showed significantly higher frequencies of tortuous, dilated, bushy, meandering, angulated capillaries, avascular areas and micro-haemorrhages as compared to healthy controls (p < 0.05). In proliferative DR (PDR), the frequency of tortuous, bushy capillaries, and avascular areas was statistically high and the capillary density was reduced as compared to non-proliferative DR. The DR patients with longer disease duration (>20) years had a significantly higher frequency of tortuous capillaries, avascular areas, meandering, angulated and dilated capillaries. The frequency of tortuosity, avascular areas, and bushy areas was significantly higher in patients with poor glycaemic control (HbA1c >11). Limitations A larger sample size study with different demographic populations could have provided a broader picture of NFC changes in T2DM patients with DR. Discussion NFC may act as a surrogate marker of retinal involvement in patients with DM and should be performed at regular intervals. Conclusion NFC is a quick, simple, safe, and non-invasive method to assess the capillaroscopic alterations in diabetic patients which inturn can help in assessing the severity of DR.

Breaking the Barrier: Understanding Esophageal Ruptures.

Esophageal rupture, though rare, presents as a critical medical emergency demanding swift recognition and intervention. This condition entails a breach in the integrity of the esophageal wall, leading to leakage of its contents into the mediastinum or surrounding structures. Its etiology often involves a combination of factors, including forceful vomiting, foreign body ingestion, or medical procedures like endoscopy. Timely diagnosis through imaging modalities like CT scans, contrast esophagography, or endoscopy is crucial for prompt management and favorable outcomes. Offering aggressive care in the setting of futile treatment for esophageal perforations raises several ethical, medical, and practical implications. If the prognosis is deemed futile due to factors such as extensive tissue damage, underlying comorbidities, or delayed presentation, aggressive care may only prolong suffering without meaningful improvement in outcomes. Opting for palliative measures in such cases focuses on enhancing the patient's quality of life and providing comfort rather than pursuing futile treatments.

Nursing Intervention Strategies and Their Effectiveness on Restless Leg Syndrome and Psycho-Social Problems in Chronic Kidney Disease Patients.

Background: Chronic kidney disease is a global health problem affecting 843.6 million people with 1 million deaths and the 12th leading non-communicable cause of death worldwide. Insomnia is a disturbing problem found in chronic kidney disease patients, leading to physiological problems like fatigue, edema, and restless leg syndrome most of the time. The objective of this study was to assess the effectiveness of nursing intervention strategies on physiological and psycho-social problems. Materials and Methods: A quantitative research approach with quasi-experimental pre-test and post-test design was used to assess the effectiveness of nursing intervention strategies on physiological and psycho-social problems among 30 chronic kidney disease patients, 15 in control and experimental each, admitted in a selected hospital of Punjab. Convenience sampling was used to assign the samples, and data were collected through an interview schedule by using standardized scales. IEC number: 2017/08/5051. Results: The result of the study showed that the baseline restless leg syndrome mean score was 9.67, whereas the psycho-social problem baseline mean score was 79.80, and after post-test, the mean score was reduced to 7.67 in physiological and 66.87 in psycho-social problems in the experimental group. Intervention was found to be effective in reduction of physiological and psycho-social symptoms of chronic kidney disease patients significantly (P ≤ 0.05). Conclusions: The study showed that nursing intervention strategies were effective in reduction of physiological and psycho-social symptoms.

To Evaluate the Efficacy of Biomarkers as Monitoring Tool in Patients with Fascial Space Infections of Odontogenic Origin: A Clinical Study.

Introduction: The objective was to evaluate the efficacy of biochemical markers (WBC, CRP and fibrinogen) and the course of odontogenic space infections in 50 patients. Material and Methods: Blood samples were taken preoperatively and postoperatively at day 0, day 4, day 8 and day 12 for measuring the levels of all three biomarkers. The trends of the biomarkers were observed and compared with assessment parameters such as dental etiology, number of teeth involved, number of spaces involved, mouth opening and pain. Active pus discharge, dysphagia, hoarseness and swelling were assessed and scored accordingly. Results: The data were subjected to paired 't' test, McNemar's and Pearson's bivariate correlation as appropriate. Statistical analysis found strong correlation between laboratory values of markers and parameters used to measure severity of infection. All three biomarkers (WBC, CRP and fibrinogen) are significant markers for hospital stay (p < 0.01). Prospective analysis indicates that only one biomarker cannot be used to rule out specific diagnosis. Conclusion: The combination of three biochemical markers assessed in the present study (WBC, CRP and fibrinogen) should be used as prognostic factor in assessment, clinical severity and efficacy of treatment regime for patients as these can reliably predict the clinical course of odontogenic infection.

Systemic delivery of proteins using novel peptides via the sublingual route.

Therapeutic proteins often require needle-based injections, which compromise medication adherence especially for those with chronic diseases. Sublingual administration provides a simple and non-invasive alternative. Herein, two novel peptides (lipid-conjugated protamine and a protamine dimer) were synthesized to enable sublingual delivery of proteins through simple physical mixing with the payloads. It was found that the novel peptides promoted intracellular delivery of proteins via increased pore formation on the cell surface. Results from in vitro models of cell spheroids and human sublingual tissue substitute indicated that the novel peptides enhanced protein penetration through multiple cell layers compared to protamine. The novel peptides were mixed with insulin or semaglutide and sublingually delivered to mice for blood glucose (BG) control. The effects of these sublingual formulations were comparable to the subcutaneous preparations and superior to protamine. In addition to peptide drugs, the novel peptides were shown to enable sublingual absorption of larger proteins with molecular weights from 22 to 150 kDa in mice, including human recombinant growth hormone (rhGH), bovine serum albumin (BSA) and Immunoglobulin G (IgG). The novel peptides given sublingually did not induce any measurable toxicities in mice.

Ultrasound in Causes of Stridor in Children.

Airway ultrasound (US) is an easily available, portable, radiation-free imaging modality for quick, non-invasive, dynamic evaluation of the airway without sedation. This is useful in children with stridor, which is an emergency due to upper airway obstruction requiring immediate management. Several causes of stridor including laryngomalacia, laryngeal cyst, subglottic hemangioma, vocal cord palsy, and lymphatic malformations can be evaluated accurately. Thin musculature and unossified cartilages in children provide a good acoustic window. Thus, airway US is valuable, but underutilized for the evaluation of children with stridor. In this case-based review, we describe the technique, indications, anatomy, and pathologies on airway US.

Comparative analysis of the antibacterial efficacy and bioactive components of Thuja occidentalis obtained from four different geographical sites.

The purpose of this study was to determine whether or not there were significant differences in the antibacterial potential of Thuja occidentalis collected from four distinct geographical sites, namely Chamba (Himachal Pradesh, India), Jalandhar (Punjab, India), Aurangabad (Bihar, India) and Kakching (Manipur, India). The plant extracts were prepared in three different solvents: ethanol, methanol, and acetone. The antibacterial potential of the plant extracts was tested against five different bacterial species using well diffusion test. The minimum inhibitory and bactericidal concentrations of the plant sample exhibiting maximum zone of inhibition against different bacterial strains were calculated. Further, the total phenols, flavonoids, and antioxidant efficacy (using DPPH assay) were also analysed biochemically. The activity of different antioxidant enzymes including SOD, CAT and APX were also recorded as these enzymes protect the cells from free radical damage. GC-MS analysis was also performed on all plant extracts to identify the bioactive components. The results showed that the T. occidentalis collected from the Kakching, Manipur, East side of India showed the highest zone of inhibition against all the bacterial strains, followed by Chamba, Jalandhar, and lastly Aurangabad. To analyse the impact of phytochemicals on the antibacterial efficacy, a correlation was drawn between the biochemical parameters and zone of inhibition using Karl Pearson's method. Most bacterial species demonstrated a positive correlation between antibacterial effectiveness (zone of inhibition) and biochemical markers. The GC-MS study revealed positive correlation between zone of inhibition and peak area percentages of α-Pinene, ß-caryophyllene, Germacrene-D, and Humulene in all bacterial species indicating that these chemicals may play a key role in the bactericidal potential of T. occidentalis. Based on the results of this investigation, it is evident that the antibacterial effectiveness of T. occidentalis varies with its geographical location which may be attributed to the differences in the phytochemical makeup.

Prediction and analysis of cis-regulatory elements in Dorsal and Ventral patterning genes of Tribolium castaneum and its comparison with Drosophila melanogaster.

Insect embryonic development and morphology are characterized by their anterior-posterior and dorsal-ventral (DV) patterning. In Drosophila embryos, DV patterning is mediated by a dorsal protein gradient which activates twist and snail proteins, the important regulators of DV patterning. To activate or repress gene expression, some regulatory proteins bind in clusters to their target gene at sites known as cis-regulatory elements or enhancers. To understand how variations in gene expression in different lineages might lead to different phenotypes, it is necessary to understand enhancers and their evolution. Drosophila melanogaster has been widely studied to understand the interactions between transcription factors and the transcription factor binding sites. Tribolium castaneum is an upcoming model animal which is catching the interest of biologists and the research on the enhancer mechanisms in the insect's axes patterning is still in infancy. Therefore, the current study was designed to compare the enhancers of DV patterning in the two insect species. The sequences of ten proteins involved in DV patterning of D. melanogaster were obtained from Flybase. The protein sequences of T. castaneum orthologous to those obtained from D. melanogaster were acquired from NCBI BLAST, and these were then converted to DNA sequences which were modified by adding 20 kb sequences both upstream and downstream to the gene. These modified sequences were used for further analysis. Bioinformatics tools (Cluster-Buster and MCAST) were used to search for clusters of binding sites (enhancers) in the modified DV genes. The results obtained showed that the transcription factors in Drosophila melanogaster and Tribolium castaneum are nearly identical; however, the number of binding sites varies between the two species, indicating transcription factor binding site evolution, as predicted by two different computational tools. It was observed that dorsal, twist, snail, zelda, and Supressor of Hairless are the transcription factors responsible for the regulation of DV patterning in the two insect species.

Distinguishing Swine Flu (H1N1) from COVID-19: Clinical, Virological, and Immunological Perspectives.

This article provides an in-depth examination on the differences between the influenza A strain, H1N1 (also called Swine Flu) and Covid-19 focusing on the immune response and clinical symptoms. Flu symptoms due to influenza A strain, H1N1, were initially discovered in 2009. This variant of influenza A is believed to have emerged through reassortment, a process where the resulting virus inherits gene segments from each of its parental viruses. This reassortment event has resulted in a variant with altered characteristics, potentially affecting the level of immunity in humans. The symptoms of this strain typically manifest 1-4 days after exposure and include fever, cough, sore throat, runny/stuffy nose, body aches, fatigue, and gastrointestinal symptoms such as diarrhea. The transmission dynamics of this new variant, including human-to-human transmission, are still under investigation by health authorities. Individuals with weakened immune systems are generally more susceptible to severe illness. Risk factors associated with swine flu can include older adults, young children, pregnant women, and individuals with obesity. Historical variants of swine flu, such as the 2015 variant in India, have been associated with significant case numbers and deaths, often due to respiratory failure. Since the epidemic of Covid-19 due to SARS-CoV2 in early 2020, several symptoms of COVID-19 and swine flu overlap. In this article, we critically reviewed the differences and similarities in the immune response and clinical symptoms due to H1N1 virus and SARS-CoV2 in human.

In-silico identification and comparison of transcription factor binding sites cluster in anterior-posterior patterning genes in Drosophila melanogaster and Tribolium castaneum.

The cis-regulatory data that help in transcriptional regulation is arranged into modular pieces of a few hundred base pairs called CRMs (cis-regulatory modules) and numerous binding sites for multiple transcription factors are prominent characteristics of these cis-regulatory modules. The present study was designed to localize transcription factor binding site (TFBS) clusters on twelve Anterior-posterior (A-P) genes in Tribolium castaneum and compare them to their orthologous gene enhancers in Drosophila melanogaster. Out of the twelve A-P patterning genes, six were gap genes (Kruppel, Knirps, Tailless, Hunchback, Giant, and Caudal) and six were pair rule genes (Hairy, Runt, Even-skipped, Fushi-tarazu, Paired, and Odd-skipped). The genes along with 20 kb upstream and downstream regions were scanned for TFBS clusters using the Motif Cluster Alignment Search Tool (MCAST), a bioinformatics tool that looks for set of nucleotide sequences for statistically significant clusters of non-overlapping occurrence of a given set of motifs. The motifs used in the current study were Hunchback, Caudal, Giant, Kruppel, Knirps, and Even-skipped. The results of the MCAST analysis revealed the maximum number of TFBS for Hunchback, Knirps, Caudal, and Kruppel in both D. melanogaster and T. castaneum, while Bicoid TFBS clusters were found only in D. melanogaster. The size of all the predicted TFBS clusters was less than 1kb in both insect species. These sequences revealed more transversional sites (Tv) than transitional sites (Ti) and the average Ti/Tv ratio was 0.75.

Increased renal elimination of endogenous and synthetic pyrimidine nucleosides in concentrative nucleoside transporter 1 deficient mice.

Concentrative nucleoside transporters (CNTs) are active nucleoside influx systems, but their in vivo roles are poorly defined. By generating CNT1 knockout (KO) mice, here we identify a role of CNT1 in the renal reabsorption of nucleosides. Deletion of CNT1 in mice increases the urinary excretion of endogenous pyrimidine nucleosides with compensatory alterations in purine nucleoside metabolism. In addition, CNT1 KO mice exhibits high urinary excretion of the nucleoside analog gemcitabine (dFdC), which results in poor tumor growth control in CNT1 KO mice harboring syngeneic pancreatic tumors. Interestingly, increasing the dFdC dose to attain an area under the concentration-time curve level equivalent to that achieved by wild-type (WT) mice rescues antitumor efficacy. The findings provide new insights into how CNT1 regulates reabsorption of endogenous and synthetic nucleosides in murine kidneys and suggest that the functional status of CNTs may account for the optimal action of pyrimidine nucleoside analog therapeutics in humans.

Impact of Structured Reporting of Skeletal Survey in Skeletal Dysplasia: A Single Institution Experience.

Background Structured reporting has the advantages of reducing ambiguity in written radiology reports with greater uniformity and comparability of reports amongst different institutes. It has multiple facets: structured format, structured content, and standardized language. While structured reporting initiative has been used in various radiology subspecialties such as oncology, cardiothoracic, abdominal and interventional radiology; skeletal dysplasia is a domain that remains largely untouched by this concept. Purpose To evaluate the impact of structured reporting in skeletal dysplasia. Methods and Materials This was an ethically approved pragmatic clinical trial. A defined number (75) of clinically diagnosed and/or genetically confirmed skeletal dysplasia radiographs were evaluated by two radiologists (reader A and reader B) with 5-and 7-years' experience in general radiology, respectively. A pre-defined structured reporting format for skeletal dysplasia was used as an interventional tool. Both the readers interpreted the radiographs before and after the training session. In addition to diagnosis, diagnostic confidence was noted using a semiquantitative scale. Improvement in diagnostic accuracy and diagnostic confidence after training were assessed. McNemar's test was used to assess the statistical significance of difference in proportion of correct diagnoses in pre- and post-education phases. An interrater reliability analysis using the Kappa statistic was performed to determine interobserver agreement between readers both in pre- and post-education phases. Results In the post-education phase, the proportion of accurate diagnosis improved from 48% (36/75) to 64% (48/75) for reader A, and from 44% (33/75) to 60% (45/75) for reader B as compared with the pre-education phase. Amongst the cases with a correct radiologic diagnosis, an increase in diagnostic confidence was noted in 18 cases for reader A, and 15 cases for reader B. In none of the cases, there was a reduction in diagnostic confidence after training. A McNemar's test determined that there was a statistically significant difference in the proportion of correct diagnoses in pre- and post-education phases, p < 0.001. The interobserver agreement between the readers was found to increase from Kappa = 0.33 ( p = 0.004) using non-structured reporting in pre-education phase to Kappa = 0.46 ( p < 0.001) using structured reporting in the post-education phase. Conclusion A structured reporting of skeletal survey can improve accuracy and confidence in diagnosing skeletal dysplasia.

Development and characterization of solvent-based 3D printed polylactic acid/45S5 bioactive glass composites for soft and hard tissue engineering.

With the benefit of offering hydrolysis breakdown and bio-resorption of its products, polylactic acid (PLA) is among the most frequently utilized polymers for many biomedical applications. Composites made of polylactic acid (PLA) and bioactive substances such as bioactive glass (BG) are developing as novel biomaterials because they comprise the mechanical properties and bioactivity of bioactive glass (BG) with the conformability and bio absorption of PLA. In this work, composites of PLA/BG were produced by employing the solvent-based three-dimensional printing process. To accomplish this, 0-2 wt% of BG particles (size ≤ 2 µm) were added to PLA. The resulting composite mix was then fed into a solvent-based 3D printer for the layer-by-layer construction of composites. According to the SEM/EDX investigation, BG particles were evenly dispersed throughout the polymer matrix which resulted in the interfacial bonding between them. FTIR and XRD analysis showed that PLA and BG did not interact chemically. All the composites were evaluated for cytocompatibility by in vitro cellular tests, which also proved their suitability as a substrate for NIH 3T3 cell adherence and growth. The composites were also found to be good in terms of hemocompatibility and platelet adhesion. In conclusion, additional studies on these materials were encouraged by the successful outcomes, which suggested that 3D-printed composite scaffolds consisting of PLA and BG particles might be useful in soft and hard tissue engineering.

Exploiting the Biophysical Cues toward Dual Differentiation of hMSC's within Geometrical Patterns.

A wide variety of cues from the extracellular matrix (ECM) have been known to affect the differentiation of stem cells in vivo. In particular, the biophysical cues and cell shape have been known to affect the stem cell function, yet very little is known about the interplay between how these cues control differentiation. For the first time, by using photolithography to pattern poly(ethylene glycol) (PEG), patterns of square and triangular geometries were created, and the effect of these structures and the biophysical cues arising were utilized to differentiate cells into multiple lineages inside a same pattern without the use of any adhered protein or growth factors. The data from these studies showed that the cells present at the edges were well elongated, exhibit high aspect ratios, and differentiated into osteogenic lineage, whereas the cells present at the center exhibit lower aspect ratio and were primarily adipogenic lineage regardless of the geometry. This was correlated to the higher expression of focal adhesion proteins at the edges, the expression of which have been known to affect the osteogenic differentiation. By showing MSC lineage commitment relationships due to physical signals, this study highlights the importance of these cues and cell shape in further understanding stem cell behavior for tissue engineering applications.

Morrison's Pouch: Anatomy and Radiological Appearance of Pathological Processes.

Morrison's pouch is the intraperitoneal space in the supramesocolic compartment located between the right liver lobe and right kidney. Pathological conditions that can involve this peritoneal space include fluid collections, infectious or inflammatory processes, and neoplasms. Frequent involvement by disease entities can be attributed to its dependent location, communication with the inframesocolic compartment, close proximity to the adjacent organs and peritoneal fluid dynamics. Knowledge of the appearance of pathological entities on various imaging modalities helps the radiologist in making the correct diagnosis.