Hydroclimatic changes on multiple timescales since 7800 y BP in the winter precipitation-dominated Central Asia.

Central Asia (CA) is one of the world's most significant arid regions, which is markedly impacted by global warming. A better understanding of the dynamical processes governing its Holocene climate variability is critical for a better understanding of possible future impacts of climate change in the region. To date, most of the existing CA paleoclimate records are from the summer precipitation-dominated eastern CA (ECA), with few records from the winter precipitation-dominated western CA (WCA). Here, we present a precisely dated (~6‰) and highly resolved (<4-y) record of hydroclimatic variations from the WCA covering the period between 7,774 and 656 y BP. Utilizing multiple proxies (δ18O, δ13C, and Sr/Ca) derived from a stalagmite from the Fergana Valley, Kyrgyzstan, we reveal a long-term drying trend in WCA, which is in contrast with the wetting trend in ECA. We propose that different responses of winter and summer westerly jets to seasonal solar insolation over the past 8,000 y may have resulted in an antiphased precipitation relationship between the WCA and ECA. Our data contain dominant quasiperiodicities of 1,400, 50 to 70, and 20 to 30 y, indicating close connections between the WCA climate and the North Atlantic. We further identified a series of droughts and pluvials on centennial-to-decadal timescales, which may have influenced regional societies and trans-Eurasian culture exchanges during historical and prehistorical times.

Morbidity pattern and impact of hydroxyurea therapy among sickle cell patients in Raipur district of Chhattisgarh.

Background: Sickle cell disease (SCD) is a disorder marked by a single-point mutation in the beta-globin gene. Hydroxyurea is a globally accepted disease-modifying agent that sounds to be effective in managing clinically and probably preventing complications of SCD. The current study aims to document the morbidity pattern and impact of Hydroxyurea therapy in the Outpatient Department of Sickle Cell Institute, Raipur. Materials and Methods: This cross-sectional study was conducted among randomly selected sixty-five patients (adults and children above six years). After obtaining informed consent, relevant data were collected in a predesigned pretested questionnaire. The appropriate statistical exercise was applied for the interpretation of results and inferences. Results: Acute febrile illness 54 (83%) and 53 (81.5%) reported pain crisis observed to have the most common morbidity among the study subjects, followed by 55.4% (36), 33 (50.8%) jaundice and difficulty breathing, respectively. Joint pain was the most commonly observed complaint, particularly at the knee joint (76.9%). Other complaints such as hand-foot syndrome (24.6%), epistaxis (27.7%), and acute chest syndrome (21.5%). Vaso-occlusive crisis (72.4%), difficulty in walking (60.0%) and eyesight (35.4%), leg ulcers (9.2%), and dactylitis (3.1%) were also documented as clinical manifestations among study participants. Less than half (44.46%) had an awareness about SCD. Hydroxyurea therapy was highly significant in improving the patient's clinical picture (P < 0.01), especially following the frequency of hospitalization and the requirement for blood transfusion. Conclusion: Pain crisis is the most common morbidity among study participants with a low level of knowledge about SCD with febrile illness. Hydroxyurea therapy was found to be quite effective as a disease-modifying therapy, especially for reducing the frequency of blood transfusion and lowering hospitalization rates among SCD patients.

A study to assess the nutritional status and dietary gap among pulmonary tuberculosis patients in Raipur city.

Background: Undernutrition raises the likelihood of progressing from tuberculosis (TB) infection to active TB illness and causes weight loss. Proper food and nutrition are important in the treatment of tuberculosis patients. Active tuberculosis necessitates a substantial energy expenditure. The Tuberculosis treatment guidelines neglect the nutritional supplementation part of Tuberculosis management. The study aims to determine the factors affecting the nutritional status of pulmonary Tuberculosis patients. Material and Methods: A hospital-based cross-sectional study was conducted from December 2021 to January 2022 among the patients newly diagnosed and above 18 years of age coming to DOTS Centre (DMC) of Pt J.N.M. Medical College, Raipur. Total 120 subjects were selected by consecutive sampling method. Data was analyzed using SPSS version 24, and P value <0.05 was considered statistically significant. Result: Among 120 study subjects, malnourished was 54.16% (BMI <18.50 kg/m2), normal was 35% (BMI 18.50-24.99 kg/m2), overweight was 6.67% (BMI 25-29.99 kg/m2), and obese were 4.17% (BMI 30-34.99 kg/m2). Among 120 study subjects, the maximum number of them (96.3%) had a dietary gap in their diets which was equal in two groups of 1-50% calorie deficit and 51-100% calorie deficit. Conclusion: A high proportion of tuberculosis patients were undernourished, and even a very distal factor for undernutrition became proximal for tuberculosis patients. To control tuberculosis and to end the tuberculosis disease, an improvement in the nutritional status of the patient should be our priority. By knowing the importance of nutrition in TB patients, the primary care physicians can decrease the morbidity and mortality in TB patients.

Patient in Mayfield Head Pins Requiring Prone Bronchoscopy for Mucus Plug Obstruction: A Case Report.

Mucus plug obstruction is a common complication in prone patients associated with loss of ventilation and hemodynamic instability. This case presents a 62-year-old female with chronic bronchitis who underwent posterior cervical fusion for a type III dens fracture with extension into the pars articularis and pedicles. Glycopyrrolate was administered to assist with fiberoptic intubation. After successful intubation, bronchoscopy revealed copious endotracheal secretions requiring preoperative therapeutic removal. Despite extensive removal of thick endotracheal secretions preoperatively, obstructive mucus plugging developed intraoperatively with complete loss of end-tidal carbon dioxide (ETCO2) while the patient was in Mayfield head pins. With limited airway access, suctioning and prone flexible bronchoscopy were performed, successfully restoring ETCO2. This experience underscores the need for heightened awareness and preparedness for mucus plug obstruction in chronic bronchitis patients undergoing prone cervical spine surgeries.

DermSynth3D: Synthesis of in-the-wild annotated dermatology images.

In recent years, deep learning (DL) has shown great potential in the field of dermatological image analysis. However, existing datasets in this domain have significant limitations, including a small number of image samples, limited disease conditions, insufficient annotations, and non-standardized image acquisitions. To address these shortcomings, we propose a novel framework called DermSynth3D. DermSynth3D blends skin disease patterns onto 3D textured meshes of human subjects using a differentiable renderer and generates 2D images from various camera viewpoints under chosen lighting conditions in diverse background scenes. Our method adheres to top-down rules that constrain the blending and rendering process to create 2D images with skin conditions that mimic in-the-wild acquisitions, ensuring more meaningful results. The framework generates photo-realistic 2D dermatological images and the corresponding dense annotations for semantic segmentation of the skin, skin conditions, body parts, bounding boxes around lesions, depth maps, and other 3D scene parameters, such as camera position and lighting conditions. DermSynth3D allows for the creation of custom datasets for various dermatology tasks. We demonstrate the effectiveness of data generated using DermSynth3D by training DL models on synthetic data and evaluating them on various dermatology tasks using real 2D dermatological images. We make our code publicly available at https://github.com/sfu-mial/DermSynth3D.

Mercury deposition in central China from the Last Glacial Maximum to the early Holocene recorded in an accurately-dated stalagmite.

Characterization of transport pathways and depositional changes in Mercury (Hg) and their connection to climatic and environmental changes on various time scales are crucial for better understanding the anthropogenic impacts on the global Hg cycle in the Anthropocene epoch. In this study, we examined Hg variations recorded in a stalagmite from central China, covering the period from 25.5 to 10.9 thousand years ago. Our data show a marked increase in Hg concentrations during the late Last Glacial Maximum, which coincided with the period of highest dust deposition on the Chinese Loess Plateau. Hg concentrations were lower during Heinrich events 1 and 2 and the Younger Dryas but higher during the Bølling-Allerød and the early Holocene. We suggest that regional dust load, which enhances atmospheric dry deposition of Hg, is the primary factor influencing Hg deposition in central China on glacial-interglacial timescales. On millennial-to-centennial timescales, climate also plays a significant role. Warmer and wetter conditions increase vegetation, litterfall, and soil/rock weathering, which in turn boost mineral dissolution and soil erosion in the vadose zone. These processes collectively result in higher Hg concentrations in the stalagmite.

Treatment of Complex Desmoid Tumors in Familial Adenomatous Polyposis Syndrome by Intestinal Transplantation.

Background: Desmoid tumors are fibroblastic lesions which often have an unpredictable and variable clinical course. In the context of familial adenomatous polyposis (FAP), these frequently occur intra-abdominally, especially in the small-bowel mesentery resulting in sepsis, fistulation, and invasion of the abdominal wall and retroperitoneum. In selected cases where other modalities have failed, the most radical option is to perform a total enterectomy and intestinal transplantation (ITx). In this study, we present our center's experience of ITx for desmoid in patients with FAP. Methods: We performed a retrospective review of our prospectively collected database between 2007 and 2022. All patients undergoing ITx for FAP-related desmoid were included. Results: Between October 2007 and September 2023, 144 ITx were performed on 130 patients at our center. Of these, 15 patients (9%) were for desmoid associated with FAP (7 modified multivisceral transplants, 6 isolated ITx, and 2 liver-containing grafts). The median follow-up was 57 mo (8-119); 5-y patient survival was 82%, all with functioning grafts without local desmoid recurrence. These patients presented us with several complex surgical issues, such as loss of abdominal domain, retroperitoneal/abdominal wall involvement, ileoanal pouch-related issues, and the need for foregut resection because of adenomatous disease. Conclusions: ITx is a viable treatment in selected patients with FAP and extensive desmoid disease. The decision to refer for ITx can be challenging, particularly the timing and sequence of treatment (simultaneous versus sequential exenteration). Delays can result in additional disease burden, such as secondary liver disease or invasion of adjacent structures.

Evaluation of the Dentinal Shear Bond Strength and Resin Interface in Primary Molars after Pre-Treatment with Various Dentin Bio-Modifiers: An In Vitro Study.

Dentine adhesives have demonstrated great success with permanent teeth. Though the results in primary teeth are not well documented, some studies have demonstrated lower values of bond strength in primary teeth than those found in permanent teeth. The aim of this study was to compare and evaluate the effect of grape seed extract (6.5%) (Herbal Bio Solutions, Delhi, India), glutaraldehyde (5%) (Loba Chemie PVT. LTD., Mumbai), hesperidin (0.5%) (Herbal Bio Solutions, Delhi, India), and casein phosphopeptide-amorphous calcium phosphate (tooth mousse) (GC Corporation, Alsip, IL, USA) on the shear bond strength of dentine of primary teeth and to evaluate the resin tags at the resin tooth interface. Seventy-five caries-free human primary molars were collected, and their occlusal surfaces were ground flat. Dentin surfaces were etched using phosphoric acid. Then teeth were randomly assigned in sequential order to five groups according to the dentinal treatment method: Group I (Control group) (no treatment), Group II (5% glutaraldehyde), Group III (6.5% grape seed extract), Group IV (0.5% hesperidin), and Group V (CPP-ACP). Ten teeth from each group were assigned for Shear Bond Strength and five for SEM analysis. ANOVA and a post hoc least significant difference test (p < 0.05) were used for statistical analysis of the collected data. The grape seed extract group showed significantly increased shear bond strength than the control group (p < 0.05), and the mean length of resin tags in different dentine bio modifiers groups was also statistically significant (p < 0.05). The use of dentin bio modifiers such as 5% glutaraldehyde, 6.5% grape seed extract, 0.5% hesperidin, and CPP-ACP in the bonding process for primary teeth did not improve the dentinal bond strength.

Comparative Evaluation of Shear Bond Strength of Tricalcium Silicate-based Materials to Composite Resin with Two Different Adhesive Systems: An In Vitro Study.

Background: Establishing a strong bond between the pulp capping agent and the restorative material is crucial to the success of the procedure. Without this bond, there is a risk of bacterial infiltration into the pulp, leading to treatment failure. In the past, calcium hydroxide was commonly used for such treatments, but it faced challenges, including poor adhesion to dentin, dissolution over time, and the development of multiple tunnel defects. Mineral trioxide aggregate (MTA), introduced to dentistry in 1993, offered an alternative but came with drawbacks like challenging handling and extended setting times. However, in recent times, several new calcium silicate-based materials have emerged to address MTA's limitations. Two notable examples are Biodentine and MTA Plus. Biodentine, for instance, exhibits excellent sealing ability, while MTA Plus distinguishes itself with a finer particle size compared to traditional MTA. These innovative materials offer promising solutions to enhance the efficacy of pulp capping procedures. Aim: Therefore, in this research, we conducted a comparative analysis of the shear bond strength (SBS) between composite resin and three materials-MTA, MTA Plus, and Biodentine. We examined the effects of applying two distinct adhesive systems in order to evaluate their influence on the bond strength. Materials and methods: A total of 60 acrylic blocks were evenly distributed into three groups, each containing 20 blocks-group I received Biodentine, group II was assigned MTA, and group III received MTA Plus. The respective test materials were compacted into the holes within the blocks. Following this, the samples were incubated for a period of 72 hours. Subsequently, the samples were divided into two subgroups, each consisting of 10 blocks-the self-etch and the total-etch subgroup. The SBS values were then carefully measured for analysis. Result: The SBS of the Biodentine group demonstrated a significantly higher value when compared to the other groups. It's worth noting that when the self-etch adhesive system was employed, the SBS of all the groups experienced a significant reduction. Conclusion: Biodentine cement proves to be an effective choice for pulp capping procedures, regardless of the specific adhesive system employed. Notably, the total-etch adhesive system consistently yields higher bond strength when compared to the self-etch adhesive system. How to cite this article: Kumar V, Showkat I, Manuja N, et al. Comparative Evaluation of Shear Bond Strength of Tricalcium Silicate-based Materials to Composite Resin with Two Different Adhesive Systems: An In Vitro Study. Int J Clin Pediatr Dent 2023;16(S-3):S272-S277.

Evaluation of Three Different Regression Equations Based Mixed Dentition Analysis in Children of Moradabad City, India

Objective: To assess the accuracy and applicability of three regression equations based mixed dentition analysis in children of Moradabad city, India. Material and Methods: Actual mesiodistal width of maxillary and madibular incisors, canines and premolars of 100 children (50 male and 50 female) aged 11-14 years were measured on dental cast with electronic digital vernier caliper. The analysis of Tanaka- Johnston, Ling-Wong and Jaroontham-Godfrey regression equations were tested on the dental casts. All analyses were performed on SPSS software. Data were summarized as Mean ± standard deviation (SD) paired observations were compared by paired t-test (two-tailed test) while independent groups were compared by independent Student's t-test. The level of significance was at P < 0.001. Results: The analysis of Tanaka-Johnston, Ling-Wong, Jaroontham-Godfrey regression equations tended to overestimate the mesiodistal width of the canines and premolars with the actual measured values. Conclusion: All the three regression equations based mixed dentition overestimated the mesiodistal width of canines and premolars in Moradabad population.

Medication errors in anesthesia: unacceptable or unavoidable? / Erros de medicação em anestesia: inaceitável ou inevitável?

Abstract Medication errors are the common causes of patient morbidity and mortality. It adds financial burden to the institution as well. Though the impact varies from no harm to serious adverse effects including death, it needs attention on priority basis since medication errors' are preventable. In today's world where people are aware and medical claims are on the hike, it is of utmost priority that we curb this issue. Individual effort to decrease medication error alone might not be successful until a change in the existing protocols and system is incorporated. Often drug errors that occur cannot be reversed. The best way to ‘treat' drug errors is to prevent them. Wrong medication (due to syringe swap), overdose (due to misunderstanding or preconception of the dose, pump misuse and dilution error), incorrect administration route, under dosing and omission are common causes of medication error that occur perioperatively. Drug omission and calculation mistakes occur commonly in ICU. Medication errors can occur perioperatively either during preparation, administration or record keeping. Numerous human and system errors can be blamed for occurrence of medication errors. The need of the hour is to stop the blame - game, accept mistakes and develop a safe and ‘just' culture in order to prevent medication errors. The newly devised systems like VEINROM, a fluid delivery system is a novel approach in preventing drug errors due to most commonly used medications in anesthesia. Similar developments along with vigilant doctors, safe workplace culture and organizational support all together can help prevent these errors.

Resumo Os erros de medicação são as causas mais comuns de morbidade e mortalidade dos pacientes. Além disso, esses erros aumentam os encargos financeiros da instituição. Embora o impacto varie de nenhum dano a efeitos adversos graves, inclusive o óbito, é preciso estar atento à ordem de prioridades porque os erros de medicação são evitáveis. Na atualidade, com as pessoas cientes e os processos médicos em evidência, frear esse problema é de extrema prioridade. O esforço individual para diminuir os erros de medicação pode não obter sucesso até que uma mudança nos protocolos e sistemas existentes seja incorporada. Muitas vezes, os erros de medicação ocorridos não podem ser revertidos. A melhor maneira de "tratar" esses erros é impedi-los. Os erros de medicação (devido à troca de seringa), de overdose (devido a mal-entendido ou preconcepção da dose, mal uso de bomba e erro de diluição), de via de administração incorreta, de subdosagem e de omissão são causas comuns de erro de medicação que ocorrem no período perioperatório. A omissão e erros no cálculo de medicamentos ocorrem comumente em UTI. Os erros de medicação podem ocorrer no período perioperatório, tanto durante a preparação e administração quanto na manutenção de registros. Um grande número de erros humanos e do sistema pode ser responsabilizado pela ocorrência de erros de medicação. A necessidade do momento é parar o jogo da culpa, aceitar os erros e desenvolver uma cultura segura e "justa" para evitar os erros de medicação. Os sistemas recém-criados, como o Veinrom, um sistema de administração de líquidos, é uma nova abordagem na prevenção de erros de medicação devido aos medicamentos mais comumente usados em anestesia. Desenvolvimentos semelhantes, juntamente com médicos vigilantes, uma cultura de local de trabalho seguro e apoio organizacional, todos em conjunto podem ajudar a evitar esses erros.