Evaluation of Smear Layer Removal and Antimicrobial Efficacy of HybenX Against Enterococcus Faecalis Biofilm.

To evaluate the antibacterial efficacy of HybenX, an endodontic irrigant against Enterococcus faecalis biofilm and determine its efficacy in removal of smear layer. Forty root canals were inoculated with E. faecalis for three weeks, divided into 4 groups and irrigated with: Group1: 5 ml 2.5% sodium hypochlorite; Group2: 5 ml 2% chlorhexidine gluconate; Group3: 5 ml HybenX; Group4: 5 ml distilled water (control). Dentin shavings were collected and plated on agar plates, followed by colony forming unit (CFU) determination. For smear layer removal examination, 30 single rooted teeth were instrumented and divided into 3 groups and treated with: GroupI: 5 ml of 17% EDTA; GroupII:5 ml of HybenX; and GroupIII: 5 ml of distilled water. Samples were then subjected to SEM examination. All irrigants showed a significant reduction in CFUs compared to the control group (P⟨ .001), but none compared to each other. Regarding smear layer removal in the apical third, EDTA removed smear layer more effectively than HybenX (P = .014). HybenX demonstrated good antimicrobial efficacy against E. faecalis biofilm and removed the smear layer effectively in coronal and middle third of the root canal system. HybenX can be considered as a promising irrigating agent in root canal treatment of infected teeth.

Ketogenic diet in endocrine disorders: Current perspectives.

Ketogenic diet (KD) is a high-fat, adequate-protein, and low-carbohydrate diet that leads to nutritional ketosis, long known for antiepileptic effects and has been used therapeutically to treat refractory epilepsy. This review attempts to summarize the evidence and clinical application of KD in diabetes, obesity, and other endocrine disorders. KD is usually animal protein based. An empiric vegetarian Indian variant of KD has been provided keeping in mind the Indian food habits. KD has beneficial effects on cardiac ischemic preconditioning, improves oxygenation in patients with respiratory failure, improves glycemic control in diabetics, is associated with significant weight loss, and has a beneficial impact on polycystic ovarian syndrome. Multivitamin supplementations are recommended with KD. Recently, ketones are being proposed as super-metabolic fuel; and KD is currently regarded as apt dietary therapy for "diabesity."

Fixed-dose combination in management of type 2 diabetes mellitus: Expert opinion from an international panel.

Type 2 diabetes mellitus (T2DM) is a progressive disease with multifactorial etiology. The first-line therapy includes monotherapy (with metformin), which often fails to provide effective glycemic control, necessitating the addition of add-on therapy. In this regard, multiple single-dose agents formulated as a single-dose form called fixed-dose combinations (FDCs) have been evaluated for their safety, efficacy, and tolerability. The primary objective of this review is to develop practice-based expert group opinion on the current status and the causes of concern regarding the irrational use of FDCs, in Indian settings. After due discussions, the expert group analyzed the results from several clinical evidence in which various fixed combinations were used in T2DM management. The panel opined that FDCs (double or triple) improve patient adherence, reduce cost, and provide effective glycemic control and, thereby, play an important role in the management of T2DM. The expert group strongly recommended that the irrational metformin FDC's, banned by Indian government, should be stopped and could be achieved through active participation from the government, regulatory bodies, and health ministry, and through continuous education of primary care physicians and pharmacists. In T2DM management, FDCs play a crucial role in achieving glycemic targets effectively. However, understanding the difference between rational and irrational FDC combinations is necessary from the safety, efficacy, and tolerability perspective. In this regard, primary care physicians will have to use a multistep approach so that they can take informed decisions.

Unravelling the utility of modern sulfonylureas from cardiovascular outcome trials and landmark trials: expert opinion from an international panel.

AIM: The primary objective of this review is to develop practice-based expert group opinions on the cardiovascular (CV) safety and utility of modern sulfonylureas (SUs) in cardiovascular outcome trials (CVOTs). BACKGROUND: The United States Food and Drug Administration issued new guidance to the pharmaceutical industry in 2008 regarding the development of new antihyperglycemic drugs. The guidance expanded the scope for the approval of novel antihyperglycemic drugs by mandating CVOTs for safety. A few long-term CVOTs on dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors have been completed, while others are ongoing. SUs, which constitute one of the key antihyperglycemic agents used for the management of type 2 diabetes mellitus (T2DM), have been used as comparator agents in several CVOTs. However, the need for CVOTs on modern SUs remains debatable. In this context, a multinational group of endocrinologists convened for a meeting and discussed the need for CVOTs of modern SUs to evaluate their utility in the management of patients with T2DM. At the meeting, CVOTs of modern SUs conducted to date and the hypotheses derived from the results of these trials were discussed. REVIEW RESULTS: The expert group analyzed the key trials emphasizing the CV safety of modern SUs and also reviewed the results of various CVOTs in which modern SUs were used as comparators. Based on literature evidence and individual clinical insights, the expert group opined that modern SUs are cardiosafe and that since they have been used as comparators in other CVOTs, CVOTs of SUs are not required. CONCLUSION: Modern SUs can be considered a cardiosafe option for the management of patients with diabetes mellitus and CV disease; thus CVOTs among individuals with T2DM are not required.

Widespread electromyographic abnormalities in patients with monomelic amyotrophy: a detailed EMG study.

OBJECTIVE: To evaluate subclinical electromyographic changes in unaffected muscles of the patients with monomelic amyotrophy (MMA). PATIENTS AND METHODS: 35 patients of MMA with single limb atrophy (30 patients with upper limb involvement and 5 patients with lower limb involvement) were studied at All India Institute of Medical Sciences, New Dellhi, from September 2000 to September 2002. All the patients were evaluated clinically, by detailed three limb electromyography (EMG) and by MRI scan of the spine to rule out other disorders. RESULTS: The mean age of 35 male patients was 24.17 (+/-6.8) years and the mean duration of illness was 3.64 (+/-2.7) years. Patients with upper limb involvement had segmental pattern of atrophy, predominantly distal or proximal. EMG revealed evidence of subclinical diffuse chronic reinnervative changes. All the patients (100%) had bilateral chronic reinnervative changes and 50% had chronic reinnervative changes in three limbs. CONCLUSIONS: Patients with clinically single limb MMA were found to have evidence of widespread chronic reinnervative changes on EMG.

Zolpidem at supratherapeutic doses can cause drug abuse, dependence and withdrawal seizure.

Zolpidem is a non-benzodiazepine hypnotic drug, acts selectively through omega 1 receptors of GABAA. It is thought to be safer than benzodiazepines but we report a case of zolpidem drug abuse, dependence and withdrawal seizure.

Outcomes of Category II anti-tuberculosis treatment in Indian children.

SETTING: The emerging threat of multidrug-resistant tuberculosis (MDR-TB) has cast doubt on the efficacy of Category II anti-tuberculosis treatment in retreatment cases. Data on outcomes of treatment with the Category II regimen in children are scarce. OBJECTIVE: To study outcomes of Category II anti-tuberculosis treatment in Indian children. DESIGN: Charts belonging to patients registered between 2004 and 2012 at the Paediatric Tuberculosis Clinic, All India Institute of Medical Sciences, New Delhi, India, were reviewed, and children receiving Category II anti-tuberculosis treatment were included in the study. Outcomes were recorded as treatment success and poor outcome, which included treatment failure and default. RESULTS: A total of 125 children (mean age 101.6 months, standard deviation 42.9; girls 58 [46.4%]) were initiated on Category II anti-tuberculosis treatment, mainly due to worsening clinical conditions (36.8%) and relapse (36%). Treatment success, treatment failure and default were recorded in respectively 80 (64%), 20 (16%) and 25 (20%) children. Children who were non-adherent to previous treatment tended to default from Category II treatment as well (11.8% in previous non-defaulters vs. 37.5% in previous defaulters, P = 0.004). CONCLUSION: Category II anti-tuberculosis treatment was effective in approximately 60% of children who had failed or defaulted from the previous regimen. All efforts should be made to isolate Mycobacterium tuberculosis and perform drug susceptibility testing to identify MDR-TB in children.

Excessive daytime sleepiness: an unusual presentation of myotonic dystrophy.

Two middle-aged women presented with excessive daytime sleepiness. Examination revealed features of myotonic dystrophy with a positive family history. Sleep studies revealed frequent awakenings, central apnoeas with significant oxygen desaturation.

Threshold intensity and central motor conduction time in patients with monomelic amyotrophy: a transcranial magnetic stimulation evaluation.

OBJECTIVE: To determine the Cortical threshold intensity (TI) and central motor conduction time (CMCT) in patients with monomelic amyotrophy (MMA). METHODS: TI and CMCT were evaluated by means of transcranial magnetic stimulation in 18 patients of MMA and 12 healthy controls at the clinical neurophysiology laboratory, department of neurology, All India Institute of Medical Sciences, New Delhi. RESULTS: The mean age of patients was 23.6 (SD 6. 7) years and of controls was 24.3 (SD 3.2) years (p > 0. 05). The mean TI in patients was 60.83% (SD 11.28) on ipsilateral and 60% (11.5%) on contralateral cortex stimulation. In controls, the mean TI was 66.67% (SD 11.5) on one side and 65% (11.87%) on contralateral cortex stimulation. There was no significant difference in the TI between these two groups (p > 0.05). The mean CMCT in patients was 8.3 (SD 1. 7) ms on ipsilateral and 9.4 (SD 1.6) ms on contralateral cortex stimulation (p > 0.05). In controls CMCT was 8.3 (SD 1.8) ms on one side and 8.6 (SD 1.4) ms on contralateral cortex stimulation. Upper limit of normal CMCT was 12.7 ms. CONCLUSIONS: As compared to controls there was no significant abnormality in TI and CMCT was normal in all except two patients where it was marginally prolonged. This could be because of excessive loss of anterior horn cells.

Radon variability in borehole from Multi-Parametric Geophysical Observatory of NW Himalaya in relation to meteorological parameters.

Radon has been measured continuously at an interval of 15 min at 10 m depth in a 68 m deep borehole. Five years of high resolution data of radon sampled at 15 min shows a complex trend with strong seasonal and diurnal trends. This temporal variation of radon has high emanation during summer and low concentration in winter. Diurnal radon variability was observed mainly during March-June and September-November each year. The existence of these diurnal periodicities in radon is related to the borehole temperature gradient i.e. difference between external atmospheric and internal borehole temperature at 10 m depth in the air column. The measured radon values are characterized by a diurnal cycle with a maximum in the afternoon and a minimum in the morning in all the seasons except in winter and during rainy periods. Minimum radon variations are recorded in the winter months primarily in December and January. Sudden unsystematic jumps in radon counts are observed each year in the rainy period (July and August). The atmospheric temperature was found to positively correlate with radon emanation. The data set of the borehole indicates a good correlation between atmospheric temperature and radon concentration that is observed throughout the year except in the rainy season. The spectra of radon and atmospheric temperature time series of 5 years data clearly show prominent and clear peaks at 1 and 2 cycles per day.

Vitamin D toxicity presenting as hypercalcemia and complete heart block: An interesting case report.

Vitamin D deficiency is widely prevalent across the globe. This has lead to widespread use of vitamin D supplements in populations. We present our experience of vitamin D toxicity in a subject resulting in hypercalcemia and CHB (Complete Heart Block). A 70-year-old female, known hypertensive for thirty five years and diabetic for seven years underwent total knee replacement (TKR) for osteoarthritis left knee in December 2010. For perioperative glycemic control, multiple subcutaneous injections of insulin were advised. Patient later presented with poor glycemic control, decreased appetite and constipation for last 1 month with history of episodes of transient loss of consciousness for 15 days and recurrent vomiting. Biochemical work-up showed hypercalcemia (Serum calcium 12.4 mg/dL). Sr. albumin, ALP, Sr. phosphorus and PTH levels were normal, thus suggesting PTH independent hypercalcemia. Strong suspicion led us to check vitamin D levels in dilution which were 2016 ng/mL, thus confirming vitamin D toxicity. Retrospective analysis of treatment history revealed patient receiving 4 injections of Architol (6 Lac units im) prior to presentation. Work-up for malignancy was negative, brain imaging and EEG were normal. Holter was suggestive of intermittent CHB. Patient was given hydration, injection calcitonin 100 I.U. subcutaneously, injection pamidronate 60 mg infusion, with serum calcium levels normalizing, with relief in constipation, vomiting and behavioral improvement. However, persistence of rhythm disturbances led to permanent pacemaker placement. The present case highlights the dangers of indiscriminate vitamin D usage, exposing patients to potentially life threatening complications.

Frailty is associated with longer hospital stay and increased mortality in hospitalized older patients.

INTRODUCTION: With the onset of frailty, there is often a rapid, progressive, and self- perpetuating downward spiral towards death. Frailty has enormous impact on acute hospital care and has been shown to be a more effective predictor of mortality than conventional clinical measures. METHODS: Hospitalized older patients admitted in medical wards at a teaching public hospital were studied to determine the prevalence of frailty; its association with anemia, congestive heart failure, clinically active tuberculosis and cognitive impairment; as well as its impact upon short-term outcome. RESULTS: A total of 250 older hospitalized patients were included, and their frailty status was assessed using Fried's criteria. Of these, 83 (33.2%) patients were frail, with frailty found to be significantly associated with increasing age. A lower mean level of haemoglobin (p, 0.002), higher chance of congestive heart failure (p, <0.001), lower mean MMSE score (p, <0.001), was found in frail older patients. Frail subjects had a higher median hospital stay. There were total of 5 deaths, all among the frail group. CONCLUSION: Our study showed that almost a third of hospitalized older patients are frail, and have anemia, higher frequency of CHF, cognitive impairment, longer hospital stay and higher mortality.

Compound composite odontome associated with an unerupted deciduous incisor--a rarity.

Odontomes are considered to be hamartomatous malformation rather than true neoplasm and are generally asymptomatic. Here is a case presentation of compound composite odontome with impacted deciduous teeth in an 11-year-old girl. A calcified mass was revealed in the radiograph and the case was finally diagnosed to be compound composite odontome. The mass was surgically excised.

Consequences of neck manipulation performed by a non-professional.

Case report. Documentation of complication of neck manipulation by an untrained person. Tertiary care referral teaching hospital at Lucknow, India. Clinical evaluation, plain radiography of cervical spine, spinal MRI.A 30-year-old man who fainted after neck manipulation by a barber and developed spinal cord and brainstem dysfunction. His MRI revealed an extramedullary, intradural dumbbell shaped mass on the right side at C1 and C2 level compressing the spinal cord. Public awareness should be increased about the danger of neck manipulation by an untrained person especially in the communities where it is commonly practiced.