Court evidence via video conferencing by doctors: Savings of time, money and energy.

Background: . Doctors are called to courts to give evidence as experts. This is time-consuming and impedes routine patient care. The court ordered the state to instal a video conferencing system for the benefit of doctors in hospitals for this purpose. We aimed to quantify the costs and benefits of the video conferencing system for doctors to give evidence as expert witness in courts. Methods: . We analysed the tele-evidence system at our institution from the societal point of view examining whether the arrangements were positive for the taxpayers and second from the point of view of a cost-break-even analysis. Results: . Over a period of 1 year, 482 tele-evidences were recorded from our site. Most of the doctors appearing for court evidence were males (84%) and the majority were in government health services (84.4%). These expert witnesses included specialists (83.8%), followed by super-specialists (10.4%) and non-specialists (5.8%). The subject experts who were called the most were radiologists (19.5%), forensic experts (18.3%), surgeons (18.0%), orthopaedic surgeons (12.4%) and neurosurgeons (6.6%). Average savings per tele-evidence were ₹2620; 181 km of travel was prevented and 4 hours and 12 minutes of time was saved. Conclusions: . Given our limited resources, video conferencing saves costs, time and travel.

Effectiveness of Controlled Release Chlorhexidine Chip as an Adjunctive to Scaling and Root Planning for the Treatment of Chronic Periodontitis.

BACKGROUND: Chlorhexidine is considered one of the options for the management of periodontal diseases. This present study was conducted to assess the usefulness of controlled-release chlorhexidine chip in addition to scaling and root planning (SRP) while comparing with SRP alone in the treatment of chronic periodontitis clinically, microbiologically and radiographically. MATERIALS AND METHODS: This study included 20 patients age ranged from 30 to 55 years with chronic periodontitis. A total of 40 sites were selected. Two bilateral pockets with probing depth 4-6 mm were put in test and control groups in all subjects. SRP plus Periochip™ was used in the test group and SRP alone in the control group. In all subjects, all the analysis such as clinical parameters, the radiographic and anaerobic culture of P. gingivalis, T. denticola, and T. forsythia were performed and compared in both groups at baseline and 3 months interval. RESULTS: There was a significant improvement in all clinical and radiographic parameters in the test group in comparison to control group. Total colony counts also reduced significantly. At baseline, Tf was recovered from 15 test group sites and 16 control group sites, Pg from 14 test group and 14 control group sites, Td from 16 test group and 15 control group sites. At 3 months, Tf was recovered from 4 test group and 10 control group sites, Pg from 3 test group and 9 control group sites, Td from 4 test group and 8 control group site. CONCLUSION: Periochip™ placement as an adjunct to SRP, showed promising results when compared to SRP alone. CLINICAL SIGNIFICANCE: Periochip is considered the best treatment option in the treatment of chronic periodontitis.

Macrophage migration inhibitory factor is essential for osteoclastogenic mechanisms in vitro and in vivo mouse model of arthritis.

Macrophage migration inhibitory factor (MIF) enhances activation of leukocytes, endothelial cells and fibroblast-like synoviocytes (FLS), thereby contributing to the pathogenesis of rheumatoid arthritis (RA). A MIF promoter polymorphism in RA patients resulted in higher serum MIF concentration and worsens bone erosion; controversially current literature reported an inhibitory role of MIF in osteoclast formation. The controversial suggested that the precise role of MIF and its putative receptor CD74 in osteoclastogenesis and RA bone erosion, mediated by locally formed osteoclasts in response to receptor activator of NF-κB ligand (RANKL), is unclear. We reported that in an in vivo K/BxN serum transfer arthritis, reduced clinical and histological arthritis in MIF(-/-) and CD74(-/-) mice were accompanied by a virtual absence of osteoclasts at the synovium-bone interface and reduced osteoclast-related gene expression. Furthermore, in vitro osteoclast formation and osteoclast-related gene expression were significantly reduced in MIF(-/-) cells via decreasing RANKL-induced phosphorylation of NF-κB-p65 and ERK1/2. This was supported by a similar reduction of osteoclastogenesis observed in CD74(-/-) cells. Furthermore, a MIF blockade reduced RANKL-induced osteoclastogenesis via deregulating RANKL-mediated NF-κB and NFATc1 transcription factor activation. These data indicate that MIF and CD74 facilitate RANKL-induced osteoclastogenesis, and suggest that MIF contributes directly to bone erosion, as well as inflammation, in RA.

HSP90 inhibitors enhance differentiation and MITF (microphthalmia transcription factor) activity in osteoclast progenitors.

The HSP90 (heat-shock protein 90) inhibitor 17-AAG (17-allylamino-demethoxygeldanamycin) increases osteoclast formation both in vitro and in vivo, an action that can enhance cancer invasion and growth in the bone microenvironment. The cellular mechanisms through which 17-AAG exerts this action are not understood. Thus we sought to clarify the actions of 17-AAG on osteoclasts and determine whether other HSP90 inhibitors had similar properties. We determined that 17-AAG and the structurally unrelated HSP90 inhibitors CCT018159 and NVP-AUY922 dose-dependently increased RANKL [receptor activator of NF-κB (nuclear factor κB) ligand]-stimulated osteoclastogenesis in mouse bone marrow and pre-osteoclastic RAW264.7 cell cultures. Moreover, 17-AAG also enhanced RANKL- and TNF (tumour necrosis factor)-elicited osteoclastogenesis, but did not affect RANKL-induced osteoclast survival, suggesting that only differentiation mechanisms are targeted. 17-AAG affected the later stages of progenitor maturation (after 3 days of incubation), whereas the osteoclast formation enhancer TGFß (transforming growth factor ß) acted prior to this, suggesting different mechanisms of action. In studies of RANKL-elicited intracellular signalling, 17-AAG treatment did not increase c-Fos or NFAT (nuclear factor of activated T-cells) c1 protein levels nor did 17-AAG increase activity in luciferase-based NF-κB- and NFAT-response assays. In contrast, 17-AAG treatment (and RANKL treatment) increased both MITF (microphthalmia-associated transcription factor) protein levels and MITF-dependent vATPase-d2 (V-type proton ATPase subunit d2) gene promoter activity. These results indicate that HSP90 inhibitors enhance osteoclast differentiation in an NFATc1-independent manner that involves elevated MITF levels and activity.

Profile of infective microorganisms causing ventilator-associated pneumonia: A clinical study from resource limited intensive care unit.

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common cause of hospital acquired infection and death among patients admitted in ICU. Microorganisms responsible for VAP vary from place to place. Gram-negative bacteria (GNB) have emerged as a major group of pathogen causing VAP and over the years carbapenem group of antibiotics has emerged as one of the important antibiotics used in the critically ill patients. There have been reports of increased occurrence of infection by carbapenem-resistant bacteria in health care settings in recent times. AIM: The aim of the study was to assess the incidence of VAP, their microbiological profile with reference to carbapenemase producing GNB in the intensive care unit of a tertiary care hospital, their relation to initial emperical antibiotic therapy, sensitivity patterns, and outcome. MATERIALS AND METHODS: This prospective study was carried out over the period of 1 year (July 2010-June 2011) on 100 randomly selected patients above the age of 18 years admitted in the emergency/ICU and requiring intubation and mechanical ventilation for more than 72 hours. The diagnosis of VAP was established on the basis of clinical and radiological parameters as per Centre of Disease Centres (CDC) guidelines. A baseline sample was obtained after initial endotracheal intubation. Thereafter, the culture sent on the first day of occurrence of clinical sign of VAP. Culture was done on blood agar and MacConkey agar. All imipenem-resistant strains were further confirmed by Modified Hodge test and combined disc for confirmation of respective carbapenemase. RESULTS: Incidence of VAP was found to be 51%. GNB mainly Citrobacter 28 (52.83%) and Klebsiella pneumoniae 7 (13.21%), were the most commonly isolated pathogens. The prevalence of carbapenemase-producing GNB was alarmingly high 24/50 (48%). The entire carbapenemase producers showed high degree of cross resistance to antibiotics with some sensitivity to Polymyxin B (94 %) and Tigecycline (96%). CONCLUSION: High incidence of VAP and the potential carbapenemase-producing GNB are real threat in our ICU. The emergence of microorganisms known for its inherent resistance among most of the common first-line antibiotics calls for a alarm in all upcoming tertiary care hospitals.

Membrane-bound receptor activator of NFκB ligand (RANKL) activity displayed by osteoblasts is differentially regulated by osteolytic factors.

Osteoclast formation is central to bone metabolism, occurring when myelomonocytic progenitors are stimulated by membrane-bound receptor activator of NFκB ligand (RANKL) on osteoblasts. Osteolytic hormones induce osteoblast RANKL expression, and reduce production of RANKL decoy receptor osteoprotegerin (OPG). However, rather than RANKL and OPG mRNA or protein levels, to measure hormonally-induced osteoclastogenic stimuli the net RANKL activity at the osteoblast surface needs to be determined. To estimate this we developed a cell reporter approach employing pre-osteoclast RAW264.7 cells transfected with luciferase reporter constructs controlled by NFκB (NFκB-RAW) or NFATc1 (NFAT-RAW)-binding promoter elements. Strong signals were induced in these cells by recombinant RANKL over 24h. When NFκB-RAW cells were co-cultured on osteoblastic cells (primary osteoblasts or Kusa O cells) stimulated by osteolytic factors 1,25(OH)(2) vitamin D(3) (1,25(OH)(2)D(3)) and prostaglandin E(2) (PGE(2)), a strong dose dependent signal in NFκB-RAW cells was induced. These signals were completely blocked by soluble recombinant RANKL receptor, RANK.Fc. This osteoblastic RANKL activity was sustained for 3 days in Kusa O cells; with 1,25(OH)(2)D(3) withdrawal, RANKL-induced signal was still detectable 24 h later. However, conditioned medium from stimulated osteoblasts induced no signal. TGFß treatment inhibited osteoclast formation supported by 1,25(OH)(2)D(3)-treated Kusa O cells, and likewise blocked RANKL-dependent signals in NFAT-RAW co-cultured with these cells. These data indicate net RANKL stimulus at the osteoblast surface is increased by 1,25(OH)(2)D(3) and PGE(2), and suppressed by TGFß, in line with their effects on RANKL mRNA levels. These results demonstrate the utility of this simple co-culture-based reporter assay for osteoblast RANKL activity.

Study of sexual assault cases among below 18 years age group during September 2018 to September 2020 in Government Medical College, Patiala, Punjab, India: cross-sectional study.

Introduction: there are instances commonly reported where sexual offences are committed against persons below 18 years of age, who are deemed as children. The adverse effects of child sexual abuse are psychological, physical, behavioural and interpersonal. Methods: this study was conducted in the casualty unit over a period of two years (September 2018 to September 2020), total 35 cases of sexual assault examined out of these 21 (60%) cases fall under the category where below 18 years age group is victim. Results: out of 21 cases, 19 (90.47%) were of female sexual assault and 2 (9.53%) were of male sexual assault. The age of victim ranged from 2 years to 18 years. Median age of the study population is 14 years. Interquartile range is 6 years. The most vulnerable age group was 12-18 years (71.4%). Most of the victims were Hindus (47.6%) and Sikhs (47.6%). 61.9 % cases belong to rural background. In 71.5% of cases, the act was committed by familiar persons. Maximum 28.5% cases were medico-legally examined within one day of incidence. Hymen was torn in only 5 (26.3%) cases. Conclusion: young girls are found out to be most vulnerable group. Young girls should receive special attention especially from poor settlements and lower social strata. Most important is that the general attitude of society needs to be changed in favors of the dignity of women and children. Social awareness, sensitization and protection programs should be a high priority.

Purine Nucleoside Phosphorylase mediated molecular chemotherapy and conventional chemotherapy: a tangible union against chemoresistant cancer.

BACKGROUND: Late stage Ovarian Cancer is essentially incurable primarily due to late diagnosis and its inherent heterogeneity. Single agent treatments are inadequate and generally lead to severe side effects at therapeutic doses. It is crucial to develop clinically relevant novel combination regimens involving synergistic modalities that target a wider repertoire of cells and lead to lowered individual doses. Stemming from this premise, this is the first report of two- and three-way synergies between Adenovirus-mediated Purine Nucleoside Phosphorylase based gene directed enzyme prodrug therapy (PNP-GDEPT), docetaxel and/or carboplatin in multidrug-resistant ovarian cancer cells. METHODS: The effects of PNP-GDEPT on different cellular processes were determined using Shotgun Proteomics analyses. The in vitro cell growth inhibition in differentially treated drug resistant human ovarian cancer cell lines was established using a cell-viability assay. The extent of synergy, additivity, or antagonism between treatments was evaluated using CalcuSyn statistical analyses. The involvement of apoptosis and implicated proteins in effects of different treatments was established using flow cytometry based detection of M30 (an early marker of apoptosis), cell cycle analyses and finally western blot based analyses. RESULTS: Efficacy of the trimodal treatment was significantly greater than that achieved with bimodal- or individual treatments with potential for 10-50 fold dose reduction compared to that required for individual treatments. Of note was the marked enhancement in apoptosis that specifically accompanied the combinations that included PNP-GDEPT and accordingly correlated with a shift in the expression of anti- and pro-apoptotic proteins. PNP-GDEPT mediated enhancement of apoptosis was reinforced by cell cycle analyses. Proteomic analyses of PNP-GDEPT treated cells indicated a dowregulation of proteins involved in oncogenesis or cancer drug resistance in treated cells with accompanying upregulation of apoptotic- and tumour- suppressor proteins. CONCLUSION: Inclusion of PNP-GDEPT in regular chemotherapy regimens can lead to significant enhancement of the cancer cell susceptibility to the combined treatment. Overall, these data will underpin the development of regimens that can benefit patients with late stage ovarian cancer leading to significantly improved efficacy and increased quality of life.

Understanding peri-implantitis: a strategic review.

The high survival rate of osseointegrated dental implants is well documented, but it is becoming increasingly clear that successfully integrated implants are susceptible to disease conditions that may lead to loss of the implant. Although placement and restoration usually are included in the domain of the periodontal, oral and maxillofacial surgery, or prosthetic specialist, given the increasing numbers of patients treated with osseointegrated fixtures, it is increasingly likely that maintenance of these implants by the general dentist will become much more common. However, the surrounding tissues may be subject to inflammatory conditions similar to periodontal disease and so require maintenance. This article discusses the background, cause, and diagnosis of peri-implant disease, as well as the maintenance, care, and treatment of peri-implant infection in osseointegrated implants.

POSNOC-POsitive Sentinel NOde: adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy: a randomised controlled trial of axillary treatment in women with early-stage breast cancer who have metastases in one or two sentinel nodes.

INTRODUCTION: ACOSOG-Z0011(Z11) trial showed that axillary node clearance (ANC) may be omitted in women with ≤2 positive nodes undergoing breast conserving surgery (BCS) and whole breast radiotherapy (RT). A confirmatory study is needed to clarify the role of axillary treatment in women with ≤2 macrometastases undergoing BCS and groups that were not included in Z11 for example, mastectomy and those with microscopic extranodal invasion. The primary objective of POsitive Sentinel NOde: adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy (POSNOC) is to evaluate whether for women with breast cancer and 1 or 2 macrometastases, adjuvant therapy alone is non-inferior to adjuvant therapy plus axillary treatment, in terms of 5-year axillary recurrence. METHODS AND ANALYSIS: POSNOC is a pragmatic, multicentre, non-inferiority, international trial with participants randomised in a 1:1 ratio. Women are eligible if they have T1/T2, unifocal or multifocal invasive breast cancer, and 1 or 2 macrometastases at sentinel node biopsy, with or without extranodal extension. In the intervention group women receive adjuvant therapy alone, in the standard care group they receive ANC or axillary RT. In both groups women receive adjuvant therapy, according to local guidelines. This includes systemic therapy and, if indicated, RT to breast or chest wall. The UK Radiotherapy Trials Quality Assurance Group manages the in-built radiotherapy quality assurance programme. Primary endpoint is 5-year axillary recurrence. Secondary outcomes are arm morbidity assessed by Lymphoedema and Breast Cancer Questionnaire and QuickDASH questionnaires; quality of life and anxiety as assessed with FACT B+4 and State/Trait Anxiety Inventory questionnaires, respectively; other oncological outcomes; economic evaluation using EQ-5D-5L. Target sample size is 1900. Primary analysis is per protocol. Recruitment started on 1 August 2014 and as of 9 June 2021, 1866 participants have been randomised. ETHICS AND DISSEMINATION: Protocol was approved by the National Research Ethics Service Committee East Midlands-Nottingham 2 (REC reference: 13/EM/0459). Results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ISRCTN54765244; NCT0240168Cite Now.

Comparative evaluation of efficacy and soft tissue wound healing using diode laser (810 nm) versus conventional scalpel technique for second-stage implant surgery.

BACKGROUND: This study was aimed to compare the efficacy and soft tissue wound healing using diode lasers (810 nm) versus conventional scalpel approach as uncovering technique during the second-stage surgery in implants. This was a prospective, randomized study which was conducted on 20 subjects in which the implants were already placed using a two-stage technique. Implant sites were examined and the patients were randomly divided into two groups. MATERIALS AND METHODS: Patients were randomly divided into two groups, i.e., Group A and Group B. In Group A, implants were uncovered as a part of Stage II surgery with conventional scalpel technique, and in Group B, implants were uncovered using 810 nm diode laser. Clinical parameters such as need and amount of local anesthesia, duration of surgery, intraoperative bleeding, pain index, wound healing index (HI), and time for impression taking were recorded at various intervals. RESULTS: Statistical differences for clinical parameters were seen between Group A and Group B showing uncovery of implant with laser more effective, and for time of impression taking, difference was statistically significant showing that impressions were taken early in case of Group A because of better healing which was recorded with help of HI, but the difference in time of healing between Group A and Group B was not statistically significant. CONCLUSION: The use of a diode laser (810 nm) in the second-stage implant surgery can minimize surgical trauma, reduce the amount of anesthesia, improve visibility during surgery due to the absence of bleeding, and eliminate postoperative discomfort.

Effects of Scaling and Root Planing on Gingival Status during Menstrual Cycle- A Cross-Sectional Analytical Study.

INTRODUCTION: Variations in sex steroid hormones, noticeable through the menstrual cycle of women, may impact periodontal health. A relationship between female sex hormone levels and periodontal changes during puberty, pregnancy, and menopause has been reported. Little research on gingival status at different periods of menstrual cycle, but very less work has been done to observe the effect of scaling on gingival status during different periods of menstrual cycle. MATERIALS AND METHODS: Thirty female subjects, aged 18-25 years were selected for a three month study. In Stage 1, clinical parameters {Plaque Index (PI), Gingival Index (GI), Modified Sulcular Bleeding Index (mSBI) and Probing depth (PD)} were recorded at three different time intervals {OV (Ovulation), PM (Premenstruation), M (Menstruation)} of their menstrual cycle, without scaling and polishing. In Stage 2, all clinical parameters were recorded at their subsequent menstrual cycle after scaling and polishing. RESULTS: In interstage analysis, OV 1 > OV 2, PM 1 > PM 2 and M 1> M 2. In intrastage analysis, for PI, mean difference between all values was not statistically significant. For mSBI, PM 1 > OV 1 > M 1, also PM 2 > OV 2 > M 2. For GI, PM 1 > OV 1 > M 1, also PM 2 > OV 2 > M 2. For PD, mean difference was not statistically significant. CONCLUSION: Ovarian hormones influence gingival status of females, with an increase observed primarily during PM and OV phases of menstrual cycle. Scaling leads to a subsequent decrease in gingival inflammation.

Osteoclast formation elicited by interleukin-33 stimulation is dependent upon the type of osteoclast progenitor.

Osteoclasts are bone resorbing multinucleated cells (MNCs) derived from macrophage progenitors. IL-33 has been reported to drive osteoclastogenesis independently of receptor activator of NFκB ligand (RANKL) but this remains controversial as later studies did not confirm this. We found IL-33 clearly elicited functional dentine-resorbing osteoclast formation from human adult monocytes. However, monocytes from only 3 of 12 donors responded this way, while all responded to RANKL. Human cord blood-derived progenitors and murine bone marrow macrophages lacked an osteoclastogenic response to IL-33. In RAW264.7 cells, IL-33 elicited NFκB and p38 responses but not NFATc1 signals (suggesting poor osteoclastogenic responses) and formed only mononuclear tartrate-resistant acid phosphatase positive (TRAP(+)) cells. Since TGFß boosts osteoclastogenesis in RAW264.7 cells we employed an IL-33/TGFß co-treatment, which resulted in small numbers of MNCs expressing key osteoclast markers TRAP and calcitonin receptors. Thus, IL-33 possesses weak osteoclastogenic activity suggesting pathological significance and, perhaps, explaining previous conflicting reports.

Evaluation of OSSIFI® as Alloplastic Bone Graft Material in Treatment of Periodontal Infrabony Defects.

INTRODUCTION: The shift in therapeutic concepts from resection to regeneration has significantly impacted the practice of periodontology. Human studies have revealed that hydroxyapatite bone cement holds great promise as a grafting alloplastic material. AIMS AND OBJECTIVES: To evaluate the efficacy of OSSIFI(®) (combined beta tricalcium phosphate plus hydroxyapatite) in the treatment of periodontal infrabony defects. MATERIALS AND METHODS: Ten study subjects were selected and divided into two groups. Group I (PD>7mm) and Group II (PD≤ 7mm). Both Groups I and II were treated by regenerative periodontal surgery using OSSIFI(®) as graft material. Plaque index, gingival index, pocket depth, clinical attachment levels were recorded clinically and bone fill, radiographically, at baseline, three months and six months. RESULTS AND CONCLUSION: Statistically significant reduction in pocket depth, plaque index, gingival index was seen after six months. There was significant bone fill seen from 3-6months with significant gain in clinical attachment levels.

Aggressive adenomatoid odontogenic tumor of mandible showing root resorption: A histological case report.

Adenomatoid odontogenic tumor (AOT) is a benign odontogenic tumor with slow but progressive growth. The three variants: Follicular, extra follicular (both central type), and peripheral present with identical histologic findings. This case report describes a patient with a large AOT in the mandible of the extra follicular type which is the less common of the two central types. It also strikes as an unusual case as it shows significant root resorption of the involved displaced teeth which is not generally reported in AOT's.