Tomato seed oil enriched mayonnaise: structural, rheological, and biochemical characterization.

Two types of mayonnaise viz. eggless and egg based were prepared by substituting refined soybean oil by tomato seed oil (TSO) at varying concentrations (0-30%). Aim of the study was to utilise the potential of TSO in replaced of refined oil. With respect to oil particle distribution pattern in both types of mayonnaise, higher specific surface area (Dmean ~ 11.49 µm) and homogenous distribution of oil droplets was noted in egg-based mayonnaise. Rheological behavior depicted shear thinning properties in all types of mayonnaise with low viscosity (1.08 Pa s and 2.29 Pa s) being exhibited by tomato seed oil (TSO) incorporated mayonnaise. Nutritionally, significant increase of 65.5 and 26% in lycopene content while 29 and 34% increase in carotenoid content was noted upon incorporation of TSO in eggless and egg-based mayonnaise. Good storage and oxidative stability were demonstrated by TSO egg-based and eggless mayonnaise in terms of acid value and free fatty acids, also the peroxide value was also found lower than their respective control at the end of storage. Overall, tomato seed oil could be used as a non-conventional source of oil for such food applications owing to its close proximity with other vegetable oils and better nutritional profile like dominance of linoleic fatty acid i.e., 54.23% assayed via gas chromatography. Supplementary Information: The online version contains supplementary material available at 10.1007/s13197-023-05771-7.

Outcomes and Predictors of Severe Hyperoxemia in Patients Receiving Mechanical Ventilation: A Single-Center Cohort Study.

Rationale: Supplemental oxygen is among the most commonly administered therapies in intensive care units (ICUs). High supplemental oxygen exposure has been associated with harm in observational human studies and animal models, yet no consensus exists regarding which dose and duration of high oxygen constitutes harmful hyperoxemia, and little is known regarding the clinical factors that predict potentially injurious exposure. Objectives: To determine the dose and duration of the arterial partial pressure of oxygen (PaO2) associated with mortality among mechanically ventilated patients and to identify the clinical factors that predict this exposure. Methods: We performed a retrospective cohort study of patients who received invasive mechanical ventilation at a single academic institution in 2017 and 2018. We used a generalized additive model to visualize the relationship between the measured PaO2 via arterial blood gas measurements and 30-day mortality. We used multivariable logistic regression to identify patient- and hospital-level factors that predict exposure to harmful hyperoxemia. Results: We analyzed 2,133 patients with 33,310 arterial blood gas measurements obtained during mechanical ventilation. We identified a U-shaped relationship between PaO2 and mortality, in which PaO2 was positively correlated with mortality above a threshold of 200 mm Hg. A total of 1,184 patients (55.5%) had at least one PaO2 measurement above this threshold. If patients spent an entire day exposed to PaO2 > 200 mm Hg, they had 2.19 (95% confidence interval [CI], 1.33-3.60; P = 0.002) greater odds of 30-day mortality in an adjusted analysis. Any exposure to severe hyperoxemia (PaO2 > 200 mm Hg) was associated with mortality (odds ratio, 1.29; 95% CI, 1.04-1.59; P = 0.021). The strongest clinical predictor of severe hyperoxemia exposure was the identity of the ICU in which mechanical ventilation was delivered. Conclusions: Exposure to high arterial oxygen concentrations is common among mechanically ventilated patients, and the dose and duration of PaO2 ⩾ 200 mm Hg is associated with mortality. Severe hyperoxemia is highly variable across ICUs and is far more common in clinical practice than in recent randomized trials of oxygen-targeting strategies. Efforts to minimize this common and injurious exposure are needed.

Efficacy of Liquorice and Propolis Extract Used as Cavity Cleaning Agents against Streptococcus mutans in Deciduous Molars Using Confocal Microscopy: An In Vitro Study.

BACKGROUND/INTRODUCTION: Cavity disinfection before restoration aids in reducing the number of residual bacteria, thus, decreasing the rate of secondary caries. Propolis, at low concentrations, inhibits the growth of cariogenic bacteria. Liquorice roots are known to have antimicrobial, anti-inflammatory, and antioxidant properties. AIM AND OBJECTIVES: Evaluation and comparison of antimicrobial efficacy of liquorice and propolis extract gels used as cavity cleaning agents against Streptococcus mutans in deciduous molars by confocal laser scanning microscopy (in vitro study). MATERIALS AND METHODS: Liquorice and propolis extracts were converted into gels after recording the minimum inhibition concentration. Class I cavity was prepared on 135 extracted deciduous molars and subjected to inoculation with S. mutans. Teeth were randomly divided into groups I, II, and III which were treated with gels of liquorice, propolis, and distilled water, respectively, for 60, 120, and 180 seconds each. Specimens were sectioned and stained with fluorescent dyes and observed under a confocal laser scanning microscopy (CLSM). The data obtained were statistically evaluated. RESULTS: The mean nonviable/viable bacterial count and the depth of penetration were found to be maximum in group I and minimum in group III. A statistically significant difference was found to be between groups I and II and groups I and III, while with groups II and III, it was nonsignificant at all 60, 120, and 180 seconds. The bacterial depth penetration between groups I and II at 180 seconds was nonsignificant. CONCLUSION AND CLINICAL SIGNIFICANCE: Though liquorice showed better antimicrobial potential as compared to propolis extract, both can be used efficiently as cavity disinfectants. HOW TO CITE THIS ARTICLE: Godbole E, Tyagi S, et al. Efficacy of Liquorice and Propolis Extract Used as Cavity Cleaning Agents against Streptococcus mutans in Deciduous Molars Using Confocal Microscopy: An In Vitro Study. Int J Clin Pediatr Dent 2019;12(3):194-200.

Incorporating baseline functional status to improve validity of neurological outcome assessments following cardiac arrest.

BACKGROUND: Neurological status at hospital discharge is routinely used to assess patient outcome after cardiac arrest. However, attribution of impairment to the arrest is valid only if baseline neurological status is known. This study evaluated whether incorporating baseline neurological status improves performance of a widely employed neurological outcome scale for quantifying arrest-attributable morbidity. METHODS: Retrospective cohort study of two U.S. hospitals. Neurological function was assessed via Cerebral performance category (CPC), an ordinal five-point scale with 1 indicating sufficient cognition to lead an independent life and 5 representing brain death. Hospitalized adult patients who suffered in-hospital cardiac arrest for which cardiopulmonary resuscitation was attempted between 2011-2015 were included. Patients were identified through a quality improvement registry that captures all inpatient arrests in the two hospitals. RESULTS: Of 486 patients who suffered in-hospital cardiac arrest, 124 (25.5%) had baseline abnormal neurological function (pre-hospitalization CPC>1). Although 54 patients had a normal discharge CPC of 1, 80 patients had no change in CPC from their prior baseline (11.1% vs. 16.5% met criterion for "normal" outcome defined as CPC of 1 vs. change-in-CPC of 0; McNemar p < .01; kappa for agreement: .78, 95% CI .69-.86). Across several formulations of criteria for "good" neurological outcome, similar discordance existed between conventional definitions considering only discharge CPC and modified definitions that included change-in-CPC from baseline. CONCLUSIONS: Incorporating change-in-CPC into criteria for "good" neurological outcome post-arrest yields discordant results from traditional approaches that consider discharge CPC only and increases face validity of reporting arrest-related morbidity.

Effectiveness of Various Tongue Cleaning Aids in the Reduction of Tongue Coating and Bacterial Load: A Comparative Clinical Study.

AIM: To remove tongue biofilm and improve breath odor, specific instruments (tongue scrapers) or toothbrushes are used. MATERIALS AND METHODS: This study compared the effectiveness of a manual toothbrush that has a tongue scraper on the back of its head and two commercially available tongue scrapers in reducing the tongue coating and aerobic and anaerobic microbiota of the tongue dorsum. A randomized, negative controlled, double-blind, parallel design study for three different treatment interventions was conducted. RESULTS: All tongue cleaners showed a significant reduction in Winkle's tongue coating scores with significant values of reduction (p <0.001) of the anaerobic bacterial count with plastic and metal tongue scraper when compared to brush scrapper. CONCLUSION: There was an effective reduction of bacterial load on tongue dorsum with the use of tongue cleaners, with maximum load reduction by using plastic tongue cleaners. CLINICAL SIGNIFICANCE: The results of the present study may be helpful for the dentists while prescribing tongue cleaners to their patients in their clinical practice.

Surface analysis of gutta percha after disinfecting with sodium hypochlorite and silver nanoparticles by atomic force microscopy: An in vitro study.

BACKGROUND: Sodium hypochlorite (5.25% NaOCl) and silver nanoparticles (70 ug/ml AgNPs) have a broad spectrum of antimicrobial efficacy for disinfecting gutta percha (GP) point, so this study was conducted to analyze the assay surface topography of GP when disinfected with AgNPs and 5.25% of NaOCl using atomic force microscopy (AFM). MATERIALS AND METHODS: In this in vitro study a total of thirty cones were taken. The samples were divided into three treatment groups: Group I and II with 70 µg/ml AgNPs and 5.25% NaOCl. The time duration was 1 min. Untreated GP points served as control group. After treatment of 1 min for each solution, the samples were positioned in the AFM. For comparison, the root mean square (RMS) was used to investigate the structure of the GP points. Unpaired t-test and ANOVA test were used. The differences among the groups were tested by Tukey's honestly significant difference test and were considered significant when P < 0.05. RESULTS: 5.25% NaOCl created RMS value of 202.48 nm at 1 min as compared to 70 µg/ml of AgNPs and control which produced RMS value of 44.48 nm and 24.1 nm, respectively (<0.0001). CONCLUSION: The study showed irregularity in the surface of GP with NaOCl and lesser deterioration with AgNPs which could affect the postoperative prognosis. In this study, it was found that NaOCl causes 10 times more surface topography deterioration of GP when compared to AgNPs at 700 times lesser concentration.

Shock subtypes by left ventricular ejection fraction following out-of-hospital cardiac arrest.

BACKGROUND: Post-resuscitation hemodynamic instability following out-of-hospital cardiac arrest (OHCA) may occur from myocardial dysfunction underlying cardiogenic shock and/or inflammation-mediated distributive shock. Distinguishing the predominant shock subtype with widely available clinical metrics may have prognostic and therapeutic value. METHODS: A two-hospital cohort was assembled of patients in shock following OHCA. Left ventricular ejection fraction (LVEF) was assessed via echocardiography or cardiac ventriculography within 1 day post arrest and used to delineate shock physiology. The study evaluated whether higher LVEF, indicating distributive-predominant shock physiology, was associated with neurocognitive outcome (primary endpoint), survival, and duration of multiple organ failures. The study also investigated whether volume resuscitation exhibited a subtype-specific association with outcome. RESULTS: Of 162 patients with post-resuscitation shock, 48% had normal LVEF (> 40%), consistent with distributive shock physiology. Higher LVEF was associated with less favorable neurocognitive outcome (OR 0.74, 95% CI 0.58-0.94 per 10% increase in LVEF; p = 0.01). Higher LVEF also was associated with worse survival (OR 0.81, 95% CI 0.67-0.97; p = 0.02) and fewer organ failure-free days (ß = - 0.67, 95% CI - 1.28 to - 0.06; p = 0.03). Only 51% of patients received a volume challenge of at least 30 ml/kg body weight in the first 6 h post arrest, and the volume received did not differ by LVEF. Greater volume resuscitation in the first 6 h post arrest was associated with favorable neurocognitive outcome (OR 1.59, 95% CI 0.99-2.55 per liter; p = 0.03) and survival (OR 1.44, 95% CI 1.02-2.04; p = 0.02) among patients with normal LVEF but not low LVEF. CONCLUSIONS: In post-resuscitation shock, higher LVEF-indicating distributive shock physiology-was associated with less favorable neurocognitive outcome, fewer days without organ failure, and higher mortality. Greater early volume resuscitation was associated with more favorable neurocognitive outcome and survival in patients with this shock subtype. Additional studies with repeated measures of complementary hemodynamic parameters are warranted to validate the clinical utility for subtyping post-resuscitation shock.

Favorable Neurocognitive Outcome with Low Tidal Volume Ventilation after Cardiac Arrest.

RATIONALE: Neurocognitive outcome after out-of-hospital cardiac arrest (OHCA) is often poor, even when initial resuscitation succeeds. Lower tidal volumes (Vts) attenuate extrapulmonary organ injury in other disease states and are neuroprotective in preclinical models of critical illness. OBJECTIVE: To evaluate the association between Vt and neurocognitive outcome after OHCA. METHODS: We performed a propensity-adjusted analysis of a two-center retrospective cohort of patients experiencing OHCA who received mechanical ventilation for at least the first 48 hours of hospitalization. Vt was calculated as the time-weighted average over the first 48 hours, in milliliters per kilogram of predicted body weight (PBW). The primary endpoint was favorable neurocognitive outcome (cerebral performance category of 1 or 2) at discharge. MEASUREMENTS AND MAIN RESULTS: Of 256 included patients, 38% received time-weighted average Vt greater than 8 ml/kg PBW during the first 48 hours. Lower Vt was independently associated with favorable neurocognitive outcome in propensity-adjusted analysis (odds ratio, 1.61; 95% confidence interval [CI], 1.13-2.28 per 1-ml/kg PBW decrease in Vt; P = 0.008). This finding was robust to several sensitivity analyses. Lower Vt also was associated with more ventilator-free days (ß = 1.78; 95% CI, 0.39-3.16 per 1-ml/kg PBW decrease; P = 0.012) and shock-free days (ß = 1.31; 95% CI, 0.10-2.51; P = 0.034). Vt was not associated with hypercapnia (P = 1.00). Although the propensity score incorporated several biologically relevant covariates, only height, weight, and admitting hospital were independent predictors of Vt less than or equal to 8 ml/kg PBW. CONCLUSIONS: Lower Vt after OHCA is independently associated with favorable neurocognitive outcome, more ventilator-free days, and more shock-free days. These findings suggest a role for low-Vt ventilation after cardiac arrest.

Management of complex root canal curvature of bilateral radix entomolaris: three-dimensional analysis with cone beam computed tomography.

The meticulous knowledge of anatomic characteristics and their variations is essential for the clinician. Radix entomolaris (RE) is one such anomaly where an extra root is present on the distolingual aspect of the mandibular first molar. 18-year-old patient was referred for the root canal treatment of mandibular right and left first molars. Intraoral periapical radiograph revealed additional periodontal spacing crossing distal root of 36. A CBCT was advised and it confirmed the presence of extra roots both in 36 and 46. CBCT is useful in endodontics as it aids in the identification of essential anatomic structures and determination of radius and angle of root canal curvature which is linked to fracture of the instrument. The classical triangular access cavity was modified to a trapezoidal form to locate the extra canal. All canals were instrumented with controlled memory nickel titanium instruments and obturation was done with single cone technique.

Sedative effects of oral midazolam, intravenous midazolam and oral diazepam.

OBJECTIVES: To evaluate and compare the behavioral changes and effect of sedative techniques in pediatric dental patients using Oral Midazolam, Intravenous Midazolam and Oral Diazepam as sedative agents. MATERIALS AND METHODS: Triple blind randomized control trial with 40 patients aged between 2-10 years, exhibiting definitely negative behavior was considered Patients were randomly assigned to one of the four treatment groups. Group I received midazolam 0.5 mg/kg orally, Group II received 0.5 mg/kg diazepam orally, Group III received 0.06 mg/kg midazolam intravenously and Group IV received oral placebo. Behavioral changes (sleep, crying, movement, and overall behavior) and effect of sedative techniques on pediatric patients were assessed. RESULTS: All the patients in group 3 were significantly better in post administrative behavior viz. sleep, crying and movement. Over all behavior scores for group 3 patients were significantly better than other three groups (p < 0.001). Positive behavior of patients in group 2 and 3 did not show significant difference but positive behavior in group 3 was significantly (p < 0.05) more than group 2. Placebo group showed the highest negative behavior. CONCLUSION: Sedative effects of oral midazolam and oral diazepam were comparable, where as intravenous midazolam produced more sedation. Anxiolysis was found to be more in both the midazolam groups than the diazepam group. Most number of positive changes were observed in midazolam groups as compared to diazepam group.

Robot-assisted thoracoscopic thymectomy for treating myasthenia gravis in children.

INTRODUCTION: In the United States, the prevalence of myasthenia gravis (MG) is approximately 14-20 per 100,000. One treatment option involves a thymectomy, which can lead to remission of symptoms. The amount of thymic tissue removed is correlated with a better outcome for patients. Thus, it is critical that the procedure used when performing a thymectomy maximize the resection of thymic tissue. Robotic-assisted thoracoscopic thymectomy provides a minimally invasive platform that avoids the mortality and morbidity of a median sternotomy while providing better visualization and a more delicate dissection than is available in a standard thoracoscopic procedure. PATIENTS AND METHODS: Following Institutional Review Board approval, in total, 9 patients who underwent robotic thymectomy were reviewed. Intraoperative statistics such as operative time and blood loss were reviewed from operative records. Postoperative outcomes such as hospital stay, discharge medications, and complications were reviewed from hospital charts. Lastly, disease response was evaluated in consultation with a pediatric neurologist who specializes in MG. RESULTS: Age at operation ranged from 2 to 15 years of age (average, 9.4 years). A majority of patients had an MGFA classification of II or greater (n=5). All patients were on pyridostigmine preoperatively, and 7 of 9 (77%) were taking prednisone. Mean operative time was 160.1±6.1 minutes. Average postoperative hospital stay was 1.1±0.3 days. One patient had a documented persistent pneumothorax on postoperative Day 1, which was treated with nasal cannula oxygen for an additional day. There were no additional operative complications, and all patients were discharged home on acetaminophen with codeine for pain control. Eight of 9 patients had improvement in MG symptoms after the procedure. CONCLUSIONS: Robotic-assisted thoracoscopic thymectomy is a safe and effective operation for children with MG. Robotic assistance allows for articulating instruments, three-dimensional visualization, and minimal blood loss. These factors may allow for a more complete resection compared with a standard thoracoscopic thymectomy.

A rare case of gingival fibromatosis associated with hypertrichosis and a dysmorphic face.

Several forms of hypertrichosis have been described with and without gingival hyperplasia; some of them are recognized as genetic disorder and associated with syndromes. In all reported cases the most striking differences from other are the craniofacial features. We present a case of a 6-year-old boy with hypertrichosis associated with gingival hyperplasia and a characteristic, coarse face and we consider this case to be a distinctive entity.