Sofosbuvir-based treatment is safe and effective in Indian hepatitis C patients on maintenance haemodialysis: A retrospective study.

AIM: This study evaluates the safety and efficacy of direct-acting antivirals (DAAs) including sofosbuvir, ledipasvir and daclatasvir in patients with hepatitis C viraemia who were on maintenance haemodialysis. METHODS: Data on patients who received sofosbuvir and ribavirin were analysed. Patients who experienced treatment failure with the above regimen received sofosbuvir and ledipasvir for infection with hepatitis C virus (HCV) genotype 1. Those having HCV genotype 3 infection received sofosbuvir and daclatasvir. All treatment regimens were of 12 weeks duration. Side-effects were investigated. The HCV viral load was determined by RT-PCR at 4,16 and 24 weeks after the initiation of therapy; haemoglobin levels and liver function tests were monitored at regular intervals during therapy. RESULTS: Of the 22 subjects initially treated with sofosbuvir and ribavirin, 72.72% attained sustained virologic response at 12 weeks (SVR12). Four patients experienced treatment failure and received genotype specific therapy. Patients with HCV genotype one received sofosbuvir with ledipasvir. One patient with HCV genotype 3 infection received sofosbuvir and daclatasvir. All of them attained SVR12. A statistically significant reduction in the median serum glutamic-oxaloacetic transaminase (SGOT) and Serum glutamic pyruvic transaminase (SGPT) were observed from the baseline until the end of treatment. Anaemia was observed in 45% of patients receiving ribavirin. CONCLUSIONS: Our study demonstrates that sofosbuvir-based therapy is efficacious for HCV viraemia in patients on maintenance haemodialysis. The therapy was found to be reasonably safe with no major adverse effects noted with the use of sofosbuvir, ledipasvir or daclatasvir. However, larger studies are needed to validate our results.

Management of post midface distraction occlusal discrepancy using temporary anchorage devices in a cleft patient.

Open bite deformity following a successful midface advancement by distraction osteogenesis is a common complication. Temporary anchorage devices can be deployed during the distraction and post-distraction settling phases for restoring the occlusion even in severe cases. The following report describes the management of severe anterior open bite following maxillary distraction.

Nanoparticles of pure and substituted maghemites (gamma-M(x)Fe(2_x)O3 where M = Al, Cr, Mn, Zn and 0 < or = x < or = 1.3): a comparative study.

Magnetic nanoparticles of pure and substituted iron oxides are prepared by single step autocombustion or by wet chemical methods. The nanoparticles prepared by the first process had mixed phase of hematite and maghemite whereas the later essentially gives maghemite phase. XRD patterns and TEM micrographs of the pure and substituted maghemites samples suggest about their monophasic nature and inverse spinel structure. Further, the size of the particles for the above iron oxide samples was found to be in the range of 4 to 30 nm. Saturation magnetization value for the samples was observed to be varying with the type and the amount of substitution. For example, magnetization value initially increased and then decreased for Al- and Mn-substitutions but it continuously decreased for Cr- and Zn-substitutions. Contrary to the saturation magnetization value, the Curie temperature decreased continuously with increased substitutions irrespective of the type of substitutions. Due to higher magnetization value of Mn-substituted maghemite (for x = 0.2, 78 Am2/kg), it has higher heating ability and specific absorption rate compared to Al-substituted maghemite (for x = 0.07, 70 Am2/kg) and pure maghemite (62 Am2/kg).

Hyperthermia effect and antibacterial efficacy of Fe3+ /Co2+ co-substitutions in ß-Ca3 (PO4 )2 for bone cancer and defect therapy.

The combined effect of cobalt and iron substitutions in ß-Ca3 (PO4 )2 as a potent material for application in hyperthermia and as a bone substitute is presented. Structural analysis reveals the preferential accommodation of Co2+ and Fe3+ at the Ca2+ (5) sites of ß-Ca3 (PO4 )2 until the limit of ∼10 mol % and, thereafter, prefer Ca2+ (4) lattice sites. Occupancy of both the Co2+ and Fe3+ ions induces a significant contraction of the ß-Ca3 (PO4 )2 unit cell. The Co2+ /Fe3+ co-substitutions in ß-Ca3 (PO4 )2 display magnetic characteristics that enhances hyperthermia effect. In addition, the presence of Co2+ in ß-Ca3 (PO4 )2 enunciates pronounced antibacterial efficacy against tested microorganisms. Nevertheless, the enhanced level of Co2+ in ß-Ca3 (PO4 )2 results to induce significant toxicity. The biocompatibility of the synthesized thermoseeds is verified from the hemolytic tests and cytotoxicity test performed on human sarcoma cell line MG-63. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1317-1328, 2018.

Iron doped ß-Tricalcium phosphate: Synthesis, characterization, hyperthermia effect, biocompatibility and mechanical evaluation.

The ability of ß-Tricalcium phosphate [ß-TCP, ß-Ca3(PO4)2] to host iron at its structural lattice and its associated magnetic susceptibility, hyperthermia effect, biocompatibility and mechanical characteristics is investigated. The studies revealed the ability of ß-Ca3(PO4)2 to host 5.02mol% of Fe3+ at its Ca2+(5) site. Excess Fe3+ additions led to the formation of trigonal Ca9Fe(PO4)7 and moreover a minor amount of CaFe3(PO4)3O crystallization was also observed. A gradual increment in the iron content at ß-Ca3(PO4)2 results in the simultaneous effect of pronounced hyperthermia effect and mechanical stability. However, the presence of CaFe3(PO4)3O contributes for the reduced hyperthermia effect and mechanical stability of iron substituted ß-Ca3(PO4)2. Haemolytic tests, cytotoxicity tests and ALP gene expression analysis confirmed the biocompatibility of the investigated systems.

Neutron radiation shielding properties of polymer incorporated self compacting concrete mixes.

In this work, the neutron radiation shielding characteristics of a class of novel polymer-incorporated self-compacting concrete (PISCC) mixes are evaluated. Pulverized high density polyethylene (HDPE) material was used, at three different reference volumes, as a partial replacement to river sand in conventional concrete mixes. By such partial replacement of sand with polymer, additional hydrogen contents are incorporated in these concrete mixes and their effect on the neutron radiation shielding properties are studied. It has been observed from the initial set of experiments that there is a definite trend of reductions in the neutron flux and dose transmission factor values in these PISCC mixes vis-à-vis ordinary concrete mix. Also, the fact that quite similar enhanced shielding results are recorded even when reprocessed HDPE material is used in lieu of the virgin HDPE attracts further attention.

Effects of bracket slot size during en-masse retraction of the six maxillary anterior teeth using an induction-heating typodont simulation system.

OBJECTIVE: To investigate how bracket slot size affects the direction of maxillary anterior tooth movement when en-masse retraction is performed in sliding mechanics using an induction-heating typodont simulation system. METHODS: An induction-heating typodont simulation system was designed based on the Calorific Machine system. The typodont included metal anterior and resin posterior teeth embedded in a sticky wax arch. Three bracket slot groups (0.018, 0.020, and 0.022 inch [in]) were tested. A retraction force of 250 g was applied in the posterior-superior direction. RESULTS: In the anteroposterior direction, the cusp tip of the canine in the 0.020-in slot group moved more distally than in the 0.018-in slot group. In the vertical direction, all six anterior teeth were intruded in the 0.018-in slot group and extruded in the 0.020- and 0.022-in slot groups. The lateral incisor was significantly extruded in the 0.020- and 0.022-in slot groups. Significant differences in the crown linguoversion were found between the 0.018- and 0.020-in slot groups and 0.018- and 0.022-in slot groups for the central incisor and between the 0.018- and 0.022-in slot groups and 0.020- and 0.022-in slot groups for the canine. In the 0.018-in slot group, all anterior teeth showed crown mesial angulation. Significant differences were found between the 0.018- and 0.022-in slot groups for the lateral incisor and between the 0.018- and 0.020-in slot groups and 0.018- and 0.022-in slot groups for the canine. CONCLUSIONS: Use of 0.018-in slot brackets was effective for preventing extrusion and crown linguoversion of anterior teeth in sliding mechanics.

A modified presurgical orthopedic (nasoalveolar molding) device in the treatment of unilateral cleft lip and palate.

Nasoalveolar molding (NAM) can be done effectively to reshape the nasal cartilage and mold the maxillary dentoalveolar arch before surgical cleft lip repair and primary rhinoplasty. Presurgical NAM helps as an adjunct procedure to enhance the esthetic and functional outcome of the surgical procedures. We have developed a modified NAM device to suit to the needs of the patients coming from distant places for the treatment. This device helps in reducing the number of frequent visits the patient needs to take to the craniofacial center. The purpose of this presentation is to report this treatment technique and discuss its application.

Reforming craniofacial orthodontics via stem cells.

Stem cells are the most interesting cells in cell biology. They have the potential to evolve as one of the most powerful technologies in the future. The future refers to an age where it will be used extensively in various fields of medical and dental sciences. Researchers have discovered a number of sources from which stem cells can be derived. Craniofacial problems are very common and occur at all ages. Stem cells can be used therapeutically in almost every field of health science. In fact, many procedures will be reformed after stem cells come into play. This article is an insight into the review of the current researches being carried out on stem cells and its use in the field of orthodontics, which is a specialized branch of dentistry. Although the future is uncertain, there is a great possibility that stem cells will be used extensively in almost all major procedures of orthodontics.

Outcomes of patients hospitalized to a telemetry unit.

To describe the clinical course of patients admitted to a nonintensive care telemetry unit and to determine whether telemetry identifies patients at risk for transfer to the intensive care unit (ICU), 467 patients hospitalized for cardiac monitoring in a nonintensive care telemetry unit were followed until death or discharge. The American College of Cardiology guidelines for telemetry use were applied: 65% of patients were class I (monitoring definitely indicated); 33% class II (probably indicated); and 2% class III (not indicated). In 5 patients (1%), telemetry contributed to the decision for a transfer to the ICU. In 462 patients, telemetry added no significant information. Thirty-eight patients (8.1%) were transferred to an ICU: 22 because of cardiac deterioration and 16 because of noncardiac clinical deterioration. Eighteen percent of patients in class I (95% confidence interval [CI], 14.1 to 22.8), 12% in class II (95% CI, 6.7 to 17), and none in class III (95% CI, 0 to 26) were transferred to the ICU (p = 0.03). Nine patients died (1.9%), 4 with terminal illness. Three patients died while on telemetry: 1 had metastatic lung cancer and 2 died suddenly of cardiac causes during initial evaluation on the ward. Telemetry identified the terminal rhythm in the 3 patients. Patients admitted to a non-ICU monitored ward with ischemic syndromes, heart failure, and arrhythmia rarely deteriorated. Patients who did deteriorate were recognized clinically without appreciable contribution from the monitoring process. It remains unproven that heart rhythm monitoring in general practice units improves patient care.

Role of telemetry monitoring in the non-intensive care unit.

To determine the outcomes of patients admitted to a non-intensive care telemetry unit and to assess the role of telemetry for guiding patient management decisions, data from 2,240 patients admitted to a telemetry unit were collected prospectively during 7 months. Physicians recorded the outcomes (intensive care unit transfer and mortality) and assessed whether telemetry assisted in guiding patient management. Indications for admission to the telemetry unit included chest pain syndromes (55%), arrhythmias (14%), heart failure (12%), and syncope (10%). Telemetry led to direct modifications in management in 156 patients (7%; 95% confidence interval [CI] 5.9% to 8%). Telemetry was perceived as useful but did not alter management for 127 patients (5.7%; 95% CI 4.7% to 6.6%). Two hundred forty-one patients were transferred to an intensive care unit from the telemetry unit (10.8%; 95% CI 9.5% to 12%). Nineteen patients (0.8% of all admissions; 95% CI 0.5% to 1.2%) were transferred because of an arrhythmia identified by telemetry. Routine transfer after cardiac revascularization or surgery accounted for 134 transfers; clinical deterioration accounted for 88 transfers. There were 20 deaths in the unit (0.9%; 95% CI 0.5% to 1.3%): 4 of the 20 deaths occurred while patients were being monitored. The role of telemetry in guiding patient management may be overestimated by physicians, since it detected significant arrhythmias that led to change in medications or urgent interventions in a small fraction of patients.

A study of lipid levels in Indian patients with coronary arterial disease.

A detailed cross-sectional analysis of total cholesterol and triglyceride levels was studied in 1066 consecutive male patients who underwent selective coronary arteriography in our centre to confirm or exclude coronary arterial disease. There were 877 cases of coronary arterial disease and 189 patients with normal coronary arteries. Besides descriptive statistics of lipid levels in different age groups, percentile distribution was studied. Association characteristics between lipids and other risk factors was studied by multiple regression analysis. Relative risk of lipids, controlling for the confounding variable of age as well as weight was obtained using the Mantel Haenszel chi square procedure. Results revealed the occurrence of coronary artery disease with low lipid levels in our population. The 50th percentile for total cholesterol was 205 mg/dl for the cases and 186 mg/dl for controls, while for triglycerides it was 158 mg/dl for cases and 140 mg/dl for controls. Multiple regression analysis of smoking, positive family history, diabetes, hypertension, weight and age contributed a low R square value of 2.49% for cholesterol and 4.22% for triglycerides in the cases and controls. The Mantel Haenszel chi square test procedure confirmed that low lipid levels could be seen irrespective of the age or weight of individuals. It is speculated that other factors which may include ageing, metabolic or immunologic components yet to be ascertained, could contribute additionally, to atherosclerotic coronary arterial disease in our population.

Association between cigarette smoking and coronary arterial disease in patients in India: how quantitative is it? An assessment by selective coronary arteriography.

With a view to study the association between smoking and coronary arterial disease, and to identify any quantitative relationship, we undertook a cross sectional analysis of 1105 consecutive male patients investigated by selective coronary arteriography to confirm or exclude coronary arterial disease. Pattern and distribution of disease were evaluated in 3 groups of patients who never smoked; who smoked less than 5 cigarettes per day; and who smoked 6 to 60 or more cigarettes per day. Suitable statistical tests, including adjusting for confounders, were carried out. The prevalence of disease was higher amongst smokers even after adjustment for confounders. The number of cigarettes smoked, and whether the smokers had quit, made no difference to the angiographic appearance or extent of disease. There was no difference in the distribution and severity of disease amongst smokers and non-smokers. Rate ratio of disease amongst smokers in India was higher in those patients between 26 and 45 years of age than in other age groups. Smoking could be identified as a risk marker/risk factor that accelerated the disease process in those prone to develop the disease. It may be advantageous to initiate public health and preventive measures directed specifically at the group aged between 26 to 45 years, and later to address all others who smoke.

Phase analysis of radionuclide ventriculograms in patients with coronary artery disease.

Phase analysis of radionuclide ventriculograms were performed in eighty patients with coronary artery disease (CAD) and in sixteen healthy subjects. The phase image in the normal group revealed a homogeneous pattern and a narrow bell shaped histogram. In forty one patients with CAD whose Left ventriculogram showed hypokinetic segments, phase image was abnormal in twenty six revealing well demarcated areas of contraction abnormality and a histogram showing broad base with multiple peaks. The mean phase angle and the standard deviation (S.D.) of phase histogram of the abnormal segments was significantly different from normal. Eighteen patients with CAD had akinetic segments. Phase analysis was abnormal in all. Six patients with CAD had dyskinetic segments. It is concluded that phase image analysis is very useful in detecting segmental wall motion abnormalities.

Dipyridamole radionuclide ventriculography for localisation of coronary artery disease.

Nineteen consecutive patients who had coronary arteriography underwent dipyridamole stress testing with 0.14 mg/kg/min infusion over 4 minutes during computer assisted radionuclide ventriculography. Global ejection fraction, diastolic function and regional ejection fraction were calculated by a semiautomatic method. There were 17 patients with severe left anterior descending disease of which 12 involved the proximal segment of the LAD, 15 patients with left circumflex disease and 13 patients with right coronary artery disease. Abnormalities in resting or stress induced regional ejection fraction was used for localisation of severe coronary artery disease. The overall sensitivity was 75 per cent with a specificity of 75 per cent, a positive predictive value of 90 per cent and a negative predictive value of 45 per cent. For LAD disease the sensitivity was 94 per cent with a 100 per cent specificity while proximal segment of LAD had a sensitivity of 100 per cent and a specificity of 57 per cent. Identification of left circumflex disease had a sensitivity of 47 per cent and a 100 per cent specificity and right coronary artery had a 85 per cent sensitivity and a 50 per cent specificity. Four patients developed ST changes, 6 developed chest discomfort and 1 patient developed giddiness. All 7 were promptly reversed with intravenous aminophylline. Thus dipyridamole radionuclide ventriculography is a highly sensitive and specific method for localisation of CAD.

Low dose metoprolol in acute myocardial infarction.

A study of the effects of low dose Metoprolol was undertaken in 37 patients with acute myocardial infarction. These patients were randomly divided into three groups depending on the dose of the drug per kg body weight. Group I, consisting of 18 patients, received 0.36 to 0.65 mg per kg per day, Group II (10 patients) received 0.66 to 0.99 mg/kg/day, and Group III (9 patients) 1 to 1.81 mg/kg/day. To assess the degree of beta blockade achieved, the parameters that were evaluated were the fall in blood pressure and heart rate. There was a fall in systolic blood pressure which ranged from 7 to 17%, and fall in heart rate of 6.6 to 12.8% in the 3 groups over the 48-hour study period. These observations were compared with the results obtained from the Goteberg Metoprolol trial and Metoprolol in acute myocardial infarction (MIAMI) trials wherein 200 mg of Metoprolol per day were used. Our preliminary observations suggest that Indian patients may not need such a high dose, and Metoprolol at 50-100 mg per day would probably be sufficient to get the desired effect.

Systolic time intervals in dilated cardiomyopathy.

Systolic Time Intervals (STI) were recorded in 45 patients with Dilated Cardiomyopathy (DCMY) to evaluate left ventricular function. Shortening of LVETI was seen in 37 (82%), prolongation of PEPI in 42 (93%), and increase in PEP/LVET ratio in 43 (95%) patients of DCMY. Global left ventricular dysfunction could be identified in all the patients (100%) with the combination of PEPI and PEP/LVET ratio. On follow up evaluation of 14 patients, change in STI status was seen to correlate with clinical status of the patients. STI as a non-invasive indicator of left ventricular function are useful in diagnosis and follow up of patients with DCMY.

Severity of mitral regurgitation in mitral valve prolapse syndrome. A Doppler echocardiographic study.

Thirty-three consecutive patients with mitral valve prolapse with a systolic murmur were evaluated using pulsed doppler echocardiography to quantify the severity of mitral regurgitation. There were thirteen (39%) patients with mild regurgitation, twelve patients (36%) with moderate regurgitation and eight patients (24%) with severe regurgitation. It was noticed that, all the patients with severe regurgitation had posterior leaflet prolapse. In contrast, patients with anterior leaflet prolapse had either mild or moderate regurgitation only. Our results suggest that the degree of mitral regurgitation differs depending on the leaflet that shows the prolapse, which may be of importance in the followup of patients with mitral valve prolapse.

Assessment of impaired left ventricular diastolic function in patients with coronary artery disease, using radionuclide angiography.

Left ventricular (LV) diastolic filling at rest was assessed in 76 patients with coronary artery disease (CAD) and 16 healthy subjects using radionuclide angiography. Peak LV filling rate (PFR), expressed in end diastolic volume per second (EDV/sec), was subnormal in CAD patients (1.95 +/- 0.51 as compared to the normal 3.11 +/- 0.36, P < 0.001) and time to PFR (TPFR) was prolonged (171.1 +/- 79 msec versus 106.6 +/- 25 msec normal, P < 0.001). These indices were also abnormal in 60 patients with normal resting LV ejection fraction (PFR 2.17 +/- 0.48 EDV/sec, TPFR 163.9 +/- 68 msec). Abnormal LV filling at rest (PFR EDV/sec or TPFR 160 msec) was found in 88 percent of all patients with CAD, 85 percent of patients with normal resting LV ejection fraction, and 83 percent of patients without Q waves on resting electrocardiogram. Thus, LV diastolic filling, evaluated non invasively by radionuclide angiography, appears to be abnormal in a high percentage of patients with CAD independent of LV systolic function or previous myocardial infarction.

Electrocardiographic left atrial enlargement--correlation with echo.

To assess the utility of electrocardiogram in identifying left atrial enlargement, electrocardiogram of 600 consecutive patients were correlated with their M-mode echocardiographic findings. Left atrial enlargement, as reflected by P terminal force in V1 had sensitivity of 79%, specificity 91%, predictive value 85% and accuracy of 86%. Patients older than 30 years with large left atrium (greater than 5.0 cm) had atrial fibrillation more frequently than younger patients (P less than 0.001). It is concluded that P terminal force in V1 is a reliable indicator of left atrial enlargement.