Accelarated Orthodontic Treatment Using Microosteoperforations: A Comparative Study.

Background: Accelerated orthodontic treatment has gained popularity in recent years as patients seek shorter treatment durations. Microosteoperforations (MOPs) have emerged as a minimally invasive technique to expedite tooth movement. This study aims to compare the effectiveness of MOPs in accelerating orthodontic treatment with conventional methods. Materials and Methods: A randomized controlled trial was conducted on 60 orthodontic patients requiring dental alignment. The participants were divided into two groups: Group A (MOPs) and Group B (conventional orthodontic treatment). In Group A, MOPs were performed at the beginning of the treatment. Both groups received monthly orthodontic adjustments. Treatment duration, rate of tooth movement, and patient discomfort were measured and compared between the two groups. Results: The study found that in Group A, the treatment duration was reduced by 30% compared to Group B (P < 0.05). The rate of tooth movement in the MOPs group was 1.5 times higher than the conventional group (P < 0.01). Additionally, patient-reported discomfort levels were similar between the two groups. No adverse events related to MOPs were observed during the study. Conclusion: MOPs significantly accelerate orthodontic treatment, reducing treatment duration by 30% and increasing the rate of tooth movement by 1.5 times compared to conventional methods. Importantly, MOPs are well-tolerated by patients, making them a valuable option for expediting orthodontic treatment with minimal discomfort. This study highlights the potential benefits of integrating MOPs into orthodontic practice to improve treatment efficiency and patient satisfaction.

Prior Screening for Latent Tuberculosis Among Patients Diagnosed With Tuberculosis Disease: Missed Opportunities?

Background: California has the largest number of tuberculosis (TB) disease cases in the United States. This study in a large California health system assessed missed opportunities for latent tuberculosis (LTBI) screening among patients with TB disease. Methods: Kaiser Permanente Southern California patients who were ≥18 years old with membership for ≥24 months during the study period from 1 January 2008 to 31 December 2019 were included. Prior LTBI test (tuberculin skin test or interferon-γ release assay) or diagnosis code prior to TB disease diagnosis was assessed among patients with observed TB disease (confirmed by polymerase chain reaction and/or culture). In the absence of current treatment practices, more patients screened for LTBI may have developed TB disease. We estimated hypothetical TB disease cases prevented by multiplying LTBI progression rates by the number of LTBI-positive patients prescribed treatment. Results: A total of 1289 patients with observed TB disease were identified; 148 patients were LTBI positive and 84 were LTBI negative. Patients not prescreened for LTBI made up 82.0% of observed TB disease cases (1057/1289). Adding the hypothetical maximum estimate for prevented cases decreased the percentage of patients who were not prescreened for LTBI to 61.7% [1057/(1289 + 424)]. Conclusions: One-fifth of patients were screened for LTBI prior to their active TB diagnosis. Assuming the upper bound of cases prevented through current screening, almost 62% of TB disease patients were never screened for LTBI. Future work to elucidate gaps in LTBI screening practices and to identify opportunities to improve screening guidelines is needed.

Human gingival mesenchymal stem cells retain their growth and immunomodulatory characteristics independent of donor age.

Aging has been reported to deteriorate the quantity and quality of mesenchymal stem cells (MSCs), which affect their therapeutic use in regenerative medicine. A dearth of age-related stem cell research further restricts their clinical applications. The present study explores the possibility of using MSCs derived from human gingival tissues (GMSCs) for studying their ex vivo growth characteristics and differentiation potential with respect to donor age. GMSCs displayed decreased in vitro adipogenesis and in vitro and in vivo osteogenesis with age, but in vitro neurogenesis remained unaffected. An increased expression of p53 and SIRT1 with donor age was correlated to their ability of eliminating tumorigenic events through apoptosis or autophagy, respectively. Irrespective of donor age, GMSCs displayed effective immunoregulation and regenerative potential in a mouse model of LPS-induced acute lung injury. Thus, we suggest the potential of GMSCs for designing cell-based immunomodulatory therapeutic approaches and their further extrapolation for acute inflammatory conditions such as acute respiratory distress syndrome and COVID-19.

Report of a Rare Case of Beta-Thalassemia Major With Subperiosteal Hematomas.

Beta-thalassemia represents a range of hemoglobinopathies that are a consequence of an impairment in the synthesis of beta-globin chains. They result in different degrees of hemolysis and ineffective erythropoiesis, depending on the underlying mutations. They can lead to severe complications mainly resulting from anemia. However, there is no bleeding tendency in this disorder, and it is uncommon to see hematoma formation in affected patients. To our knowledge, subperiosteal hematomas have been rarely described in the context of beta-thalassemia. Herein, we report a unique case of a 19-year-old boy who was diagnosed with transfusion-dependent beta-thalassemia and secondary hemochromatosis and developed atraumatic subperiosteal hematomas along the humerus.

Uptake of hepatitis C virus treatment in a multi-state Medicaid population, 2013-2017.

OBJECTIVE: To examine trends in the direct acting antiviral (DAA) uptake in a multi-state Medicaid population with hepatitis C virus (HCV) prior to and after ledipasvir/sofosbuvir (LDV/SOF) approval and changes in prior authorization (PA) requirements. DATA SOURCES: Analyses utilized enrollment, medical, and pharmacy claims in four states, December 2013-December 2017. STUDY DESIGN: An interrupted time series examined trends in uptake (1+ claim for a DAA) before and after two events: LDV/SOV approval (October 2014) and lifting of PA requirements for 40% of members (July 2016). Analyses were also performed in subgroups defined by the number and dates of change in PA requirements in members' Medicaid plans. DATA COLLECTION/EXTRACTION METHODS: Members aged 18-64 years with an ICD code for HCV were included in the sample from diagnosis date until treatment initiation or Medicaid disenrollment. PRINCIPAL FINDINGS: The annual sample size ranged from 38,302 to 45,005 with approximately 30% ages 18-34 years and 40% female. In December 2013, 0.08% was treated, rising to 0.74% in December 2017 (p < 0.001). Uptake increased from 0.34%/month in October 2014 to 0.70%/month after LDV/SOF approval, (p < 0.001), and increased relative to the pre-LDV/SOV trend through June 2016 (p = 0.04). Uptake increased to 1.18%/month after PA change, (p < 0.001) and remained flat through 2017 (p = 0.64). Cumulatively, 20.1% were treated by December 2017. In plans with few/no requirements through 2017, uptake increased to 1.19%/month after LDV/SOF approval (p < 0.001) and remained flat through 2017 (p = 0.11), with 22.2% cumulatively treated. Among plans that lifted PA requirements from three to zero in mid-2016, uptake did not increase after LDV/SOF approval (p = 0.36) but did increase to 1.41%/month (p < 0.001) after PA change, with 18.1% cumulatively treated. CONCLUSIONS: HCV Treatment increased through 2017. LDV/SOF approval and lifting PA requirements led to an increase in uptake followed by flat monthly utilization. Cumulative uptake was higher in plans with few/no PA requirements relative to those with three requirements through mid-2016.

A Cautionary Tale: Unveiling Valentino's Syndrome.

INTRODUCTION: In the emergency room, acute pain in the abdomen is one of the most common symptoms that patients present with, and it is a result of a myriad of causes, leading to an exhaustive differential diagnosis. A perforated peptic ulcer is a rare cause of acute right iliac fossa or lower quadrant abdominal pain. It causes leakage of gastrointestinal contents in the area, resulting in localized inflammation and pain that is clinically similar to acute appendicitis. This condition is known as Valentino's syndrome. AIM: This study aims to highlight clinical and radiological features for patients with Valentino's syndrome, improving diagnostic accuracy. METHODS: The authors conducted a retrospective analysis of all diagnosed cases of Valentino's syndrome from multiple facilities within the same organization for the research study. A total of 14 nonsequential cases were gathered. The term "Valentino's syndrome" was used to search in the PubMed and Google Scholar databases for the review of literature, and only 17 cases were found and reviewed. RESULTS: Of the 31 patients, 83.9% were male, with a mean age of 39 years. Of all patients who presented with abdominal pain, 25.8% had it in the lower right abdomen. Vomiting (38.7%), nausea (35.4%), fever (16.1%), and constipation were all associated symptoms (12.9%). All cases were clinically diagnosed as acute appendicitis. Many patients had elevated levels of white blood cells, neutrophils, and CRP. Computed tomography (CT) scan was used in 70.9% of the cases, followed by ultrasound (58%) and x-ray (45.1%), where pneumoperitoneum and duodenal perforations were common. Graham's patch was used in 48.3% of the cases, appendectomy was used in 16.1% of the cases, and conservative care was used in 19.3% of the cases. Most patients were given proton pump inhibitors and antibiotics for Helicobacter pylori. CONCLUSION: Timely diagnosis of Valentino's syndrome via CT imaging is critical because it leads to immediate perforation repair. Patients' mortality and morbidity may be reduced if they are aware of the condition and receive an accurate, rapid preoperative diagnosis.

Report of a Rare Case of Focal Depressed Fracture of the Tibia in an Adult.

Focal depressed fracture of the proximal tibial metaphysis without any articular involvement is a rare condition. We present a case of a 46-year-old man with a lacerated wound over the right proximal tibia after a history of slip and fall. The imaging involved to diagnose the condition included an X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) to exclude a pathological fracture and to better delineate the relationship between the fractured bone and the surrounding structures. Conservative management was indicated and implemented with a positive outcome.

A Phase-2 Exploratory Randomized Controlled Trial of INOpulse in Patients with Fibrotic Interstitial Lung Disease Requiring Oxygen.

Rationale: Patients with fibrotic interstitial lung disease often progress to the point of requiring supplemental oxygen. This is invariably accompanied by an impaired quality of life and limitations on activities of daily living. Objectives: This study aimed to assess the improvement in physical activity in patients with interstitial lung disease requiring supplemental oxygen treated with pulsed inhaled nitric oxide via INOpulse (Bellerophon Therapeutics). In addition, it sought to explore the safety and clinical benefits of INOpulse on multiple patient-reported outcomes. Methods: Ambulatory patients with fibrotic lung disease on supplemental oxygen were randomized in a 2:1 ratio to inhaled nitric oxide at 45 µg/kg ideal body weight/h (iNO45) or placebo for 4 months (3 months after baseline) of blinded treatment. The study assessed multiple exploratory efficacy endpoints, including moderate to vigorous physical activity as measured by actigraphy and patient-reported outcomes using the University of California San Diego shortness of breath questionnaire and the St. George's Respiratory Questionnaire (SGRQ). Results: A total of 44 patients (30 iNO45 and 14 placebo) were enrolled. A placebo-corrected clinical benefit of 12.3 min/d increase in MVPA was observed in the iNO45 group. Clinically meaningful beneficial trends were observed for the University of California San Diego shortness of breath questionnaire (6.05 points) and the SGRQ total (3.75) scores, as well as the SGRQ activity (5.84), and SGRQ impact (6.30) domains. Conclusions: INOpulse was well tolerated and associated with maintenance of physical activity and improved symptomatology in patients with interstitial lung disease who require supplemental oxygen. Further validation of this beneficial effect warrants further study in a phase-3 trial that is currently underway.

Sequelae of a Rare Case of Penetrating Parotid Gland Injury: Ultrasound and Magnetic Resonance Imaging Features.

Parotid gland trauma is a rare condition due to the anatomical location of the parotid gland. Imaging of the parotid gland trauma is restricted to ultrasound (US), sialogram, and computed tomography scans in the published literature. We present a case of penetrating parotid gland injury caused by a fishhook. The foreign object was removed under local anesthesia and the patient was managed conservatively with antibiotics and tetanus toxoid vaccine. A swelling appeared in the left parotid region after two weeks that was diagnosed using US and magnetic resonance imaging as granulation tissue formation in the injured parotid gland.

Late Cystic Metastasis of an Ovarian Granulosa Cell Tumor to the Liver.

Granulosa cell tumor (GCT) is a unique form of sex cord tumor that is mostly unilateral and of low-grade malignancy. Most GCT recurrence is with pelvic or peritoneal dissemination. Liver metastasis is rarely reported. This study reports a rare case of GCT with liver metastasis nine years post initial presentation. We also discuss surgical intervention, radiological findings, histology, treatment approaches, and review of similar reported cases.

Lipodystrophy of Abdominal Pannus: A Severe Complication of Phosphatidyl Choline Injections.

"Injection lipolysis" or "mesotherapy" is done for introducing various substances into deeper layers of the skin with the aim to dissolve subcutaneous fat. However, the safety profile of these chemicals is poorly regulated. Therefore, they may cause side effects or long-term sequelae that can be disastrous for the patient. We present such a case that required surgical management to salvage it and to give an aesthetically acceptable result.

Aortopulmonary window: Clues to fetal diagnosis.

Being a planar structure, fetal diagnosis of aorto-pulmonary window poses great challenge. A few echocardiographic signs can help to clinch the diagnosis.

Sustainable Superheated Water Hydrolysis of Black Soldier Fly Exuviae for Chitin Extraction and Use of the Obtained Chitosan in the Textile Field.

Interest in insects as waste biomass bioconverters and their use as valuable resources for fat, proteins, and chitin has increased considerably in the last few years. In this study, proteins were extracted from defatted black soldier fly (BSF) (Hermetia illucens) exuviae by green hydrolysis using superheated water at 150 °C for 20 h, and the remaining chitin was deacetylated into chitosan and used as a finishing agent for polyester fabrics. A total amount of 7% fat, 40% proteins, and 20% chitin was obtained from BSF exuviae. Different hydrolysis times ranging from 1 to 20 h were tried until the complete purification of chitin. The purity of chitin and the obtained chitosan after deacetylation was assessed by Fourier transform infrared spectroscopy and thermal analysis. A preliminary study was successfully carried out to use the obtained chitosan as a finishing agent for polyester pretreated fabrics using citric acid as a grafting agent. The presence of chitosan on the fabric was verified by scanning electron microscopy and by dyeing of the pretreated polyester fabric using a reactive dye with sulfonated groups that are able to be absorbed by electrostatic attraction because of the created cationic nature of the fiber surface treated by chitosan.

Utility of Endotracheal Tube Cuff Pressure Monitoring in Mechanically Ventilated (MV) Children in Preventing Post-extubation Stridor (PES).

OBJECTIVE: To study if protocolized monitoring of endotracheal tube (ETT) cuff pressure every 6 hours is better than adjusting endotracheal tube cuff inflation by the only bedside clinical assessment. MATERIALS AND METHODS: This was a single-center prospective randomized controlled study done between July 1, 2017 and March 31, 2019. Children between 1 month and 18 years, intubated with cuffed ETT by our trained doctors were included. After obtaining consent, patients were randomized into two groups, standard group (SG) and cuff pressure monitoring group (MG). Sample size was calculated with 80 patients in each group with a power of 80%, significance level (alpha 0.05 and beta 0.2). In the SG, ETT cuff inflation was adjusted by clinical assessment (bedside minimal leak technique and monitoring the percentage of leak displayed on ventilator display) at 6 hours interval. In the MG, cuff pressures were monitored by the device every 6 hours to maintain between 20 and 25 mm Hg. RESULTS: Out of 543 mechanically ventilated children during the study period, 266 were eligible and randomized for study. During the study, 89 patients died and 17 were left against medical advice, leaving 80 patients in each group. Incidence of post-extubation stridor (PES), re-intubation rate, ventilator-associated pneumonia (VAP) rate, ventilator days, and length of pediatric intensive care unit (PICU) stay were analyzed and found no advantage of protocolized monitoring of cuff pressures in the reduction of any of the above variables. CONCLUSION: Our findings if confirmed by large multicentric studies can bring an end to routine ETT cuff pressure measurements and emphasize more on clinical assessment. Clinical trial registry (CTRI/2019/05/019098).Indian Journal of Critical Care Medicine (2021): 10.5005/jp-journals-10071-23737. HOW TO CITE THIS ARTICLE: Shaikh F, Janaapureddy YR, Mohanty S, Reddy PK, Sachane K, Dekate PS, et al. Utility of Endotracheal Tube Cuff Pressure Monitoring in Mechanically Ventilated (MV) Children in Preventing Post-extubation Stridor (PES). Indian J Crit Care Med 2021;25(2):181-184.

Report of a Rare Case of Computed Tomography Diagnosis of Hydrocarbon Pneumonitis.

The practice of manually siphoning diesel from fuel tanks is widespread among car mechanics in Asian countries. To date, there are just a few reports in the literature about hydrocarbon pneumonitis caused by diesel fuel aspiration. An early diagnosis based on clinical suspicion, imaging results, and histopathology can help prevent permanent damage to the lungs.

Rare Case of Primary Anterior Abdominal Wall Abscess: Ultrasound, CT, and MRI Features.

Primary anterior abdominal wall (AAW) abscess is a rare condition that can present clinically as an abdominal disorder and baffle even the most experienced clinicians. We discuss ultrasound, CT, and MRI features of a rare case of primary anterior abdominal wall abscess that was confirmed by histopathological findings.

Stenotrophomonas maltophilia Gd2: A potential and novel isolate for fibrinolytic enzyme production.

The bacterium with an ability to produce extracellular fibrinolytic protease was isolated and identified as Stenotrophomonas maltophilia Gd2 based on ribotyping. The in-vitro fibrinolytic profile of this enzyme depicted 73% of fibrin clot dissolution within 4 h. Fibrinolytic enzyme yield influenced by different physiological (incubation time, temperature, agitation and pH), nutritional (macronutrients such as carbon and nitrogen sources) and biological (inoculums age and inoculums concentration) parameters of fermentation which were optimized based on one-factor-at-a-time (OFAT) approach. The enzyme yield improved from 886 to 1795 FU ml-1 upon OFAT; optimized conditions include temperature - 33 °C, pH - 8.0, incubation time - 36 h, agitation - 150 RPM, 3% v/v inoculums and age of inoculum - 18 h. Further optimization of enzyme production was achieved with implementation of Plackett-Burman media designing where the production levels increased to 3411 FU ml-1 and noticed that peptone, pH, dextrose and K2HPO4 was found to be significant factor. This ms reports the highest fibrinolytic enzyme yield with S. maltophilia to that of literature reports.

Binocular Visual Discomfort after First Eye Cataract Surgery: An Inattentive Burning Issue.

Cataract surgery is the most frequent surgical procedure performed among the elderly. Aniseikonia and anisometropia increased after the first eye cataract surgery. The study was performed to evaluate unwanted visual status after first eye cataract surgery. It was an observational and cross-sectional study performed among the cataract surgery patients attending in out patient department (OPD) of Dr K Zaman BNSB Eye Hospital, Mymensingh from July 2018 to September 2018 for post-operative follow up. Five hundred patients were selected randomly. Patients with gross corneal diseases were excluded from the study. Three hundred forty one patients (68.2%) were with first eye cataract surgery, among them 319 patients (63.8%) had different degree of cataract in other eye. One hundred forty three patients (44.7%) had good presenting vision (≥6/18) in operated eye and much reduced vision in other eye due to cataract, experienced binocular visual discomfort when opened two eyes, which was not experienced by the patients who had reduced vision in both eyes or good vision in both eyes. Cataractous eye interfered with visual function of the pseudophakic eye. So, cataract Surgery for both eyes in separate events is the appropriate treatment for the patients with bilateral cataract to eliminate visual disability and to achieve comfortable visual outcome.

DNA Interaction, in vitro Antibacterial and Cytotoxic Activities of Ru(III) Heterochelates.

Ruthenium(III) complexes [Ru(bphtpy)(PPh3)Cl3] (bphfpy = diphenylfuranylpyridine derivatives) were synthesized and characterized by LCMS, IR spectroscopy, elemental analysis and magnetic measurements. All the complexes were screened for their antibacterial activity in terms of minimum inhibitory concentration against two Gram-positive and three Gram-negative bacterial species. DNA binding study by absorption titration and viscosity measurement shows that complexes bind in an intercalating mode, which is also confirmed by molecular docking. All the complexes were also screened for the DNA nuclease property of pUC19 plasmid DNA. The cytotoxicity study of the synthesized complexes was performed to elucidate the LC50 values to find out the toxicity profile of the complexes.

Half Sandwich Rhodium(III) and Iridium(III) Complexes as Cytotoxic and Metallonuclease Agents.

Half sandwich complexes of the type [(η5-C5Me5)M(L1-3)Cl]Cl.2H2O were synthesized using [{(η5-C5Me5)M(µ-Cl)Cl}2], where M = Rh(III)/Ir(III) and L1-3 = pyrimidine-based ligands. The complexes were characterized by spectral analysis. DNA interaction studies by absorption titration and hydrodynamic measurement and suggest intercalative mode of binding of complexes with CT-DNA. The molecular docking study also supports intercalation of the complexes between the stacks of nucleotide base pairs. The gel electrophoresis assay demonstrated the ability of the complexes to interact and cleave plasmid DNA. Minimum inhibitory concentrations (MIC) of the complexes were investigated by the microdilution broth method. The cytotoxic properties of the metal complexes were evaluated using brine shrimp lethality bioassay.