Spontaneous Pneumomediastinum in a Patient With Undiagnosed Ankylosing Spondylitis.

Spontaneous pneumomediastinum (SPM) is an uncommon condition characterized by air in the interstices of the mediastinum. Management generally involves supportive care; however, if a patient inspires high concentrations of oxygen, the mediastinal air will be absorbed faster. A 23-year-old man who presented with acute-onset breathlessness with a history of more than a year of lower backache was diagnosed with SPM and accompanying ankylosing spondylitis (AS) by a chest CT and spinal MRI and was treated conservatively. This case is being reported for its uniqueness, as SPM with underlying AS is rare.

Platelet indices as prognostic markers of ischemic stroke and their correlation with lipid profile.

OBJECTIVE: Stroke is the cause of one in eight deaths and adds a dreadful burden of disability for the patients. Ischemic stroke is caused by a loss of blood supply to brain due to sudden occlusion of the arterial system, caused by an emboli or thrombus. Our aim was to correlate platelet indices, total cholesterol ratio, and various comorbidities with stroke. METHODS: A cross-sectional study was performed from 2020-2022 with 132 stroke patients admitted to the SRM Medical College Hospital and Research Center, India. Detailed clinical examination was performed. Venous blood samples were drawn at the time of admission to estimate platelet count, mean platelet volume (MPV), platelet distribution width (PDW), and platelet crit (PCT). Overnight fasting serum samples were obtained for lipid profiling. RESULTS: Among the participants in our study, maximum belonged to the age group 50 to 59 years (34.1%) and majority were males (79.5%). In terms of comorbidities, 85.6% of the participants had diabetes, 42.4% had hypertension and 22% had dyslipaedemia. All platelet and lipid parameters were found to be similar between patients with and without comorbidities. While all platelet indices increased with the increase in severity of stroke, we found that PDW is most reliable in predicting stroke with an area under the receiver operator curve of 0.942, with a sensitivity and specificity of 92.1% at cut-off value 14. All platelet parameters also significantly increased in patients with severe lipid dysfuction, establishing a correlation between lipid profile, platelet indices and stroke. CONCULSION: We found a significant relationship between all platelet parameters and stroke. Thus, we believe that patients with risk factors for atherosclerosis should have their platelet indices assessed periodically before the development of cerebrovascular events. Furthermore, dyslipidemia if properly treated, is a modifiable risk factor for stroke, which can decrease morbidity and mortality leading to a healthier society.

Prevalence of different types of interproximal contacts in the permanent dentition - a study cast evaluation.

Background: A new classification called OXIS was proposed for categorizing the interproximal contacts of primary molars, modified for the primary canines and its prevalence was established. No such information is available for the permanent dentition. Hence, the aim was to establish the variations in interproximal contacts of the permanent dentition and thereby modify the OXIS classification of primary molars and primary canines to the permanent dentition. Methods: We propose a study-cast-based classification of interproximal contacts of the permanent dentition. Three hundred and forty-three pretreatment casts of patients based on an inclusion and exclusion criteria were selected. Contacts of posterior teeth were classified based on OXIS classification of interproximal contacts, and its modification was used for anterior teeth. Results: Among the posterior contacts, the 'O' type of contact was least prevalent, while most prevalent was the 'S' type for second molar-first molar contact, 'I' type for the first molar-second premolar contact, and 'X' type for the second premolar-first premolar contact. Among the anterior contacts, least prevalent was 'S1' type for the first premolar-canine contact, and I type for the canine-lateral incisor and the lateral incisor-central incisor contacts. There was no statistical significance between right- and left-side contacts ( P > 0.05) while significance was seen between maxillary and mandibular contacts ( P < 0.05). Similarity of contacts ranged from 5.17% to 10.05%. Conclusion: The OXIS classification is applicable to posterior permanent teeth, and its modification is representative of anterior permanent teeth.

Systemic inflammatory response syndrome criteria (SIRS) and sepsis 3 criteria for assessing outcomes in sepsis: A prospective observational study.

Background: Sepsis is a major cause of death in hospitalised patients worldwide. Most studies for assessing outcomes in sepsis are from the western literature. Sparse data from Indian settings are available comparing the systemic inflammatory response syndrome (SIRS), Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) (sepsis 3 criteria) for assessing outcomes in sepsis. In this study, we aimed to compare the SIRS criteria and sepsis 3 criteria to assess disease outcome at day 28 (recovery/mortality) in a North Indian tertiary care teaching hospital. Methods: A prospective observational study was performed in the Department of Medicine from 2019 to early 2020. Patients admitted to the medical emergency with clinical suspicion of sepsis were included. Systemic inflammatory response syndrome, qSOFA and SOFA scores were calculated at the time of presentation to the hospital. Patients were followed through the course of their hospital stay. Results: Out of 149 patients, 139 were included in the analysis. Patients who died had significantly higher mean SOFA, qSOFA scores and mean change in SOFA score than patients who survived (P value <0.01). There was no statistical difference between recovery and deaths at similar SIRS scores. A 40.30% fatality rate was recorded. Systemic inflammatory response syndrome had low Area Under Curve (AUC) (0.47) with low sensitivity (76.8) and specificity (21.7). SOFA had the maximum AUC (0.68) compared to qSOFA (0.63) and SIRS (0.47). SOFA also had the maximum sensitivity (98.1) while the qSOFA score had the maximum specificity (84.3). Conclusion: SOFA and qSOFA scores had superior predictive ability as compared to the SIRS score in assessing mortality in sepsis patients.

Modified OXIS classification for primary canines.

Background: A new classification called OXIS was proposed for categorising the interproximal contacts of primary molars, and its prevalence was established. The aim of this study was to establish the variations in interproximal contacts of primary canines and thereby modify the OXIS classification of primary molars to primary canines. Additionally, we aimed to estimate the applicability of modifications to primary anterior teeth. Methods: A retrospective study was conducted with sectional die models obtained from a previous study of 1,090 caries-free children. Two calibrated examiners evaluated a total of 4,674 contacts from the occlusal aspect. The contacts were scored according to the former OXIS classification, with two modifications incorporated to encompass the morphological differences and rotations of primary canines and other primary anterior teeth. Results: The most prevalent contact was O (62.1%), followed by X (19.6%), I (12.6%), S type I (4.1%), and S type II (1.6%). Inter-arch comparison by means of the Chi-square test revealed significant differences for all types of contacts ( P < .001). Conclusions: The interproximal contacts of canines were categorised as O, X, I, S I, and S II. The OXIS classification of primary molars was modified to befit the variations in primary canines. This study showed the presence of different types of contacts in primary canines. Identification of these contacts and their complexity has warranted a need for this to be studied as an inherent risk factor for caries risk assessment.

Comparative study of two doses of intrathecal dexmedetomidine as adjuvant with low dose hyperbaric bupivacaine in ambulatory perianal surgeries: A prospective randomised controlled study.

BACKGROUND AND AIMS: Dexmedetomidine (DMT), as intrathecal adjuvant has been shown to successfully prolong duration of analgesia but delay the motor recovery. Hence, this study was designed to find out the dose of DMT which can provide satisfactory analgesia without prolonging motor block. METHODS: A total of 50 patients scheduled for elective perianal surgeries were randomly allocated to Groups C or D (n = 25). Group D received hyperbaric bupivacaine 0.5% 4 mg + DMT 5 µg and Group C received hyperbaric bupivacaine 0.5% 4 mg + DMT 3 µg intrathecally. Onset and duration of sensory and motor blockade, duration of analgesia, time for ambulation and first urination were recorded. Adverse effects if any were noted. RESULTS: Demographic characters, duration of surgery were comparable. The onset of sensory block to S1 was 9.61 ± 5.53 min in Group C compared to 7.69 ± 4.80 min in Group D (P = 0.35). Duration of sensory (145.28 ± 83.17 min - C, 167.85 ± 93.75 min - D, P = 0.5) and motor block (170.53 ± 73.44 min - C, 196.14 ± 84.28 min, P = 0.39) were comparable. Duration of analgesia (337.86 ± 105.11 min - C, 340.78 ± 101.81 min - D, P = 0.9) and time for ambulation (252.46 ± 93.72 min - C, 253.64 ± 88.04 min - D, P = 0.97) were also comparable. One patient in each group had urinary retention requiring catheterization. No other side effects were observed. CONCLUSION: Intrathecal DMT 3 µg dose does not produce faster ambulation compared to intrathecal DMT 5 µg though it produces comparable duration of analgesia for perianal surgeries.

Cariogenic potential of milk and infant formulas: a systematic review.

AIM: To assess the cariogenic potential of cow's milk, human milk and infant formulas in comparison to sucrose in animal models. METHODS: Electronic search of the following databases were undertaken: PubMed-MEDLINE, MeSH and ingentaconnect. In addition, the reference lists of all eligible studies were searched. Characteristics such as animal species were used; comparisons and outcomes measured were analysed. RESULTS: The search yielded a total of 13 articles of which six studies met the inclusion criteria and seven were excluded. All the six included studies used rat models for assessing the cariogenic potential of the test groups. Cow's milk was compared with sucrose in all of the six studies, reporting cow's milk to be less cariogenic than sucrose. Two studies compared human milk to sucrose and reported human milk to be less cariogenic than sucrose, but more than that of cow's milk. Although infant formulas were compared with sucrose in four studies, their cariogenic potential was a matter of some ambiguity. CONCLUSION: The evidence suggests that cow's milk and human milk are less cariogenic than sucrose, with cow's milk being the least cariogenic. The cariogenic potential of infant formulas varied across the studies, with some being as cariogenic as sucrose.

Dissecting the role of the S1P/S1PR axis in health and disease.

Sphingosine-1-phosphate (S1P) is a pleiotropic sphingophospholipid generated from the phosphorylation of sphingosine by sphingosine kinases (SPHKs). S1P has been experimentally demonstrated to modulate an array of cellular processes such as cell proliferation, cell survival, cell invasion, vascular maturation, and angiogenesis by binding with any of the five known G-protein-coupled sphingosine 1 phosphate receptors (S1P1-5) on the cell surface in an autocrine as well as a paracrine manner. Recent studies have shown that the S1P receptors (S1PRs) and SPHKs are the key targets for modulating the pathophysiological consequences of various debilitating diseases, such as cancer, sepsis, rheumatoid arthritis, ulcerative colitis, and other related illnesses. In this article, we recapitulate these novel discoveries relative to the S1P/S1PR axis, necessary for the proper maintenance of health, as well as the induction of tumorigenic, angiogenic, and inflammatory stimuli that are vital for the development of various diseases, and the novel therapeutic tools to modulate these responses in oral biology and medicine.

siRNA, miRNA, and shRNA: in vivo applications.

RNA interference (RNAi), an accurate and potent gene-silencing method, was first experimentally documented in 1998 in Caenorhabditis elegans by Fire et al., who subsequently were awarded the 2006 Nobel Prize in Physiology/Medicine. Subsequent RNAi studies have demonstrated the clinical potential of synthetic small interfering RNAs (siRNAs) or short hairpin RNAs (shRNAs) in dental diseases, eye diseases, cancer, metabolic diseases, neurodegenerative disorders, and other illnesses. siRNAs are generally from 21 to 25 base-pairs (bp) in length and have sequence-homology-driven gene-knockdown capability. RNAi offers researchers an effortless tool for investigating biological systems by selectively silencing genes. Key technical aspects--such as optimization of selectivity, stability, in vivo delivery, efficacy, and safety--need to be investigated before RNAi can become a successful therapeutic strategy. Nevertheless, this area shows a huge potential for the pharmaceutical industry around the globe. Interestingly, recent studies have shown that the small RNA molecules, either indigenously produced as microRNAs (miRNAs) or exogenously administered synthetic dsRNAs, could effectively activate a particular gene in a sequence-specific manner instead of silencing it. This novel, but still uncharacterized, phenomenon has been termed 'RNA activation' (RNAa). In this review, we analyze these research findings and discussed the in vivo applications of siRNAs, miRNAs, and shRNAs.