An integrated buoy-satellite based coastal water quality nowcasting system: India's pioneering efforts towards addressing UN ocean decade challenges.

The Indian coastal waters are stressed due to a multitude of factors, such as the discharge of industrial effluents, urbanization (municipal sewage), agricultural runoff, and river discharge. The coastal waters along the eastern and western seaboard of India exhibit contrasting characteristics in terms of seasonality, the magnitude of river influx, circulation pattern, and degree of anthropogenic activity. Therefore, understanding these processes and forecasting their occurrence is highly necessary to secure the health of coastal waters, habitats, marine resources, and the safety of tourists. This article introduces an integrated buoy-satellite based Water Quality Nowcasting System (WQNS) to address the unique challenges of water quality monitoring in Indian coastal waters and to boost the regional blue economy. The Indian National Centre for Ocean Information Services (INCOIS) has launched a first-of-its-kind WQNS, and positioned the buoys at two important locations along the east (Visakhapatnam) and west (Kochi) coast of India, covering a range of environmental conditions and tourist-intensive zones. These buoys are equipped with different physical-biogeochemical sensors, data telemetry systems, and integration with satellite-based observations for real-time data transmission to land. The sensors onboard these buoys continuously measure 22 water quality parameters, including surface current (speed and direction), salinity, temperature, pH, dissolved oxygen, phycocyanin, phycoerythrin, Coloured Dissolved Organic Matter, chlorophyll-a, turbidity, dissolved methane, hydrocarbon (crude and refined), scattering, pCO2 (water and air), and inorganic macronutrients (nitrite, nitrate, ammonium, phosphate, silicate). This real-time data is transmitted to a central processing facility at INCOIS, and after necessary quality control, the data is disseminated through the INCOIS website. Preliminary results from the WQNS show promising outcomes, including the short-term changes in the water column oxic and hypoxic regimes within a day in coastal waters off Kochi during the monsoon period, whereas effluxing of high levels of CO2 into the atmosphere associated with the mixing of water, driven by local depression in the coastal waters off Visakhapatnam. The system has demonstrated its ability to detect changes in the water column properties due to episodic events and mesoscale processes. Additionally, it offers valuable data for research, management, and policy development related to coastal water quality.

Unprecedented Multifunctionality in Novel Monophase Micro/Nanostructured Ti-Zn Alloy.

It is always challenging to integrate multiple functions into one material system. However, those materials/devices will address society's critical global challenges and technological demands if achieved with innovative design strategies and engineering. Here, one such material with a broader spectrum of desired properties appropriate for seven applications is identified and explored, and a glucose-sensing-triggered energy-storage mechanism is demonstrated. To date, the Titanium (Ti)-Zinc (Zn) binary alloys are investigated only as mixed phases and for a maximum of three applications. In contrast, the novel single phase of structurally stable 50 Ti-50 Zn (Ti0.5 Zn0.5 ) is synthesized and proven suitable for seven emerging applications. Interestingly, it is thermally stable up to 750 °C and possesses excellent mechanical, tribological properties and corrosion resistance. While exceptional biocompatibility is evident even up to a concentration of 500 µg mL-1 , the antibacterial activity against E. coli is also seen. Further, rapid detection and superior selectivity for glucose, along with supercabattery behavior, unambiguously demonstrate that this novel monophase is a remarkable multifunctional material than the existing mixed-phase Ti-Zn compounds. The coin-cell supercapacitor shows outstanding stability up to 30 000 cycles with >100% retention capacity. This allows us to prototype a glucose-sensing-triggered energy-storage-device system for wearable point-of-care diagnostic applications.

Quantification of Calcium Ions From the Irrigants Activated With Erbium-Doped Yttrium Aluminum Garnet (Er:YAG) Laser in the Root Dentin: An In Vitro Atomic Absorption Spectrophotometer Study.

OBJECTIVE: The present study aims to assess the quantity of calcium cation eliminated from the root canal by 0.2% chitosan nanoparticles (CNPs) (Sigma Aldrich, Mumbai, Maharashtra, India) and 17% ethylenediaminetetraacetic acid (EDTA) (Pyrax 17% EDTA Solution, Pyrax Polymars, Roorkee, Haridwar, Uttarakhand, India) which are activated with an erbium-doped yttrium aluminum garnet (Er:YAG) laser (LiteTouch™, Light Instruments Ltd., Yokneam Elite, Israel) for smear layer removal using a flame atomic absorption spectrophotometer (AASF) (Deeksha Analytical Pvt Ltd, Gokula Extension, Bengaluru, Karnataka, India). METHODOLOGY: Using the crown-down technique, 60 non-carious single-rooted premolars were instrumented with rotary files and irrigated with 3% sodium hypochlorite. Based on the type of irrigation activation used, all the specimens were arbitrarily divided into five groups with 12 teeth in each group, as follows: G1, 17% EDTA activated with Er:YAG laser; G2, 17% EDTA without laser activation; G3, 0.2% CNP activated with Er:YAG laser; G4, 0.2% CNP without laser activation; and G5, controlled-deionized water. The AASF analysis for the removal of calcium ions in the irrigants was evaluated by collecting the overall quantity of each irrigating solution from the root canals. A one-way analysis of variance (ANOVA) and a Tukey post hoc test were done to determine the AASF data. RESULTS: 17% EDTA activated with Er:YAG laser (130.18 ± 10.3) and 0.2% CNP activated with Er:YAG laser (121.13 ± 3.9) showed the greatest concentration of calcium ions with no statistically significant difference. The lowest concentration of calcium ions was observed in 0.2% CNPs without laser activation (118.64 ± 2.9), while 17% EDTA (125.50 ± 3.0) without laser activation showed an intermediate outcome. The control group did not remove any calcium ions. CONCLUSION: The findings in the present study suggest that EDTA and CNPs, which were activated with lasers, yielded the greatest release of calcium ions equally. Hence, laser-activated CNPs can be employed for essential smear layer removal.

Genetic and Epigenetic Basis of Drug-Induced Liver Injury.

Drug-induced liver injury (DILI) is a rare but severe adverse drug reaction seen in pharmacotherapy and a major cause of postmarketing drug withdrawals. Advances in genome-wide studies indicate that genetic and epigenetic diversity can lead to inter-individual differences in drug response and toxicity. It is necessary to identify how the genetic variations, in the presence of environmental factors, can contribute to development and progression of DILI. Studies on microRNA, histone modification, DNA methylation, and single nucleotide polymorphisms related to DILI were retrieved from databases and were analyzed for the current research and updated to develop this narrative review. We have compiled some of the major genetic, epigenetic, and pharmacogenetic factors leading to DILI. Many validated genetic risk factors of DILI, such as variants of drug-metabolizing enzymes, HLA alleles, and some transporters were identified. In conclusion, these studies provide useful information in risk alleles identification and on implementation of personalized medicine.

Effect of Preemptive Multimodal Analgesia Regimen on Post-operative Epidural Demand Boluses in Lower Limb Orthopaedic Surgeries.

Introduction Excruciating pain is associated with lower limb orthopaedic surgeries involving femoral shaft fractures. Postoperative pain management is still ineffective in low-resource settings where the use of epidural and opioid-free analgesia is impractical. Literature is scarce with respect to the effect of a preemptive multimodal analgesia regimen on the requirement of postoperative epidural demand boluses. Hence, the present study aimed to evaluate the effect of pre-emptive multimodal analgesia in reducing the requirement of epidural demand boluses postoperatively, and to find out the time required to receive the first epidural bolus. Material and methods This double-blinded randomized control study included 48 subjects. Patients aged 18-60 years with lower limb fractures requiring surgery under combined spinal-epidural anesthesia were included. Patients were divided into two groups through random allocation. Group A: Preemptive multimodal group received intravenous paracetamol 1 g, IV diclofenac 75 mg diluted in 100ml NS, IV tramadol 50 mg diluted in 100ml NS and tab pregabalin 75 mg orally, 30 mins before surgery. Group B: Placebo group received 3 pints of 100ml NS IV and tab ranitidine 150 mg, 30 mins before surgery. Intraoperatively, combined spinal-epidural anaesthesia was administered taking all the aseptic precautions. Visual analogue scale (VAS) was recorded immediately on shifting to a postoperative room, and then at 1, 4, 8, 12, and 24 hr for both groups. Epidural boluses (10 ml of 0.125% bupivacaine with 2 µg/ml of fentanyl) were given whenever the patient's visual analogue scale was more than 4. The time at which the first epidural bolus was required by the patient was recorded. The total number of epidural boluses given over 24 hours based on VAS was recorded for both, the preemptive and placebo groups. If the patient still complained of pain, IV diclofenac 75 mg was given if the VAS was more than 4, while IV diclofenac 75 mg along with IV tramadol 50 mg was given if the VAS was more than 6. Patient satisfaction with anesthesia care, in general, was assessed 24 hrs postoperatively. Results A total of 48 subjects were included in the study. During the immediate-postoperative period, and at 8, 12 and 24 hr, the median VAS was significantly low in group A as compared to group B. A significant increase in the demand for epidural bolus immediate-postoperatively was observed in group B (70.83%) compared to group A (4.17%) (p-value of <0.001). At 8 hr, 12hr, and 24hr, patients in group A found a significantly less need for epidural boluses compared to Group B. The mean total number of epidural boluses taken in group A was significantly less compared to group B (1.79 ± 0.41 VS 3.33 ± 0.48, p-Value <0.001). In group A, all patients reported no requirement for diclofenac and tramadol. In group B, 8.33% required diclofenac 75 mg, while the remaining 91.66% had no requirement for diclofenac and tramadol. The difference in patient satisfaction with anaesthesia care in general between the two study groups was found to be significant with a p-value of 0.027. Patients in Group A were very satisfied compared with those in group B. Conclusions The study found that the pre-emptive multimodal analgesia group had better postoperative pain control because they required fewer epidural boluses and no extra analgesics postoperatively. This group was more satisfied with the anaesthesia care in general.

Quantitative assessment of transforming growth factor-ß1 release from dentin matrix upon conditioning with ethylene diamine tetra-acetate, doxycycline hydrochloride, and propolis: An in vitro study.

Background: Transforming growth factor-beta 1 (TGF-ß1) is a key morphogen in regenerative endodontics that plays a central role in regulating cellular functions. Various chelating agents have been shown to release this growth factor upon conditioning. The objective of the study was to evaluate TGF-ß1 release from the dentin matrix upon conditioning with ethylene diamine tetra-acetate (EDTA), doxycycline hydrochloride, and propolis. Materials and Methods: Forty-two human 3rd molar teeth were collected and coronal portion of the teeth was sectioned to obtain dentin blocks with dimensions 2 mm × 2 mm × 2 mm. The blocks were then randomly divided into three groups depending on the conditioning agent used; Group 1: 17% EDTA, Group 2: doxycycline hydrochloride (100 mg/mL), and Group 3: propolis (250 µg/mL). Conditioned blocks were placed in 0.5 mL of phosphate buffered saline and incubated for 1 week for quantification. Results: Highest TGF-ß1 release was noted for propolis (0.21 ng/mL), followed by doxycycline hydrochloride (0.18 ng/mL) and 17% EDTA (0.14 ng/mL). Conclusion: Doxycycline hydrochloride and propolis significantly enhanced the release of TGF-ß1 from the dentin matrix compared to EDTA (P < 0.05). No significant difference was observed between doxycycline hydrochloride and propolis (P > 0.05). Doxycycline and propolis can be used as effective alternatives to EDTA during regenerative endodontic procedures.

Zirconia surface infiltration with low-fusing glass: A surface treatment modality to enhance the bond strength between zirconia and veneering ceramic.

Background: The pursuit of esthetics and superior mechanical properties prompted the layering of Yttrium stabilized Zirconia with ceramic material. However, the bioinert nature of zirconia causes the chipping off of this ceramic layer. Selective infiltration etching (SIE) of zirconia provides good bond strength between zirconia and veneering ceramic. Materials and Methods: One hundred and fifty zirconia specimens of dimensions 5 × 5 × 10 mm were divided into 5 groups. Group 1: Air abrasion with 30 µ Al2O3 for 15 s with 0.4 bar pressure. Group 2: SIE and heat-induced maturation (HIM) as demonstrated by Abousheilb. Group 3: Sintered zirconia specimens were taken up for air abrasion followed by SIE/HIM. Group 4: Air abrasion and SIE performed on unsintered specimens followed by heat treatment at 1500°C. Group 5: Air abrasion performed on unsintered zirconia specimens followed by heat treatment at 1500°C followed by SIE/HIM. The samples were then layered with ceramic and subjected to shear bond strength (SBS) analysis. Results: The mean and standard deviation were calculated for the data. The mean SBS among the groups was compared using ANOVA. The post hoc Bonferroni test was applied to compare between the groups. The mean SBS was highest for Group 5 (47.89 ± 6.53) followed by Group 2 (34.94 ± 3.04), Group 3 (32.56 ± 6.04), Group 1 (29.12 ± 7.37), and Group 4 (27.56 ± 7.54). ANOVA test showed statistically significant differences among the groups (F = 48.86, P = 0.00). Conclusion: SIE/HIM when combined with sandblasting with appropriate heat treatment demonstrated a significant increase in bond strength. This prolongs the longevity of the restoration, thereby meeting the clinical needs.

A Shift to Synergistic Surface Treatment Using Laser to Enhance the Bonding of Zirconia to Veneering Ceramic: An In Vitro Study.

AIM: The aim of this study was to evaluate the effect of combination of surface treatment using laser along with other modalities of surface treatment on shear bond strength of zirconia to veneering ceramic. MATERIALS AND METHODS: Milled and sintered zirconia cylinders (n = 150) were used in the study which were divided into six groups that were subjected to various surface treatments. Samples in group I were subjected to sandblasting. In group II Laser (Er: YAG) surface treatment was performed. Samples in group III were subjected to sandblasting followed by laser ablation. In group IV laser ablation was carried out followed by liner application, and samples in group V were subjected to laser ablation followed by argon plasma treatment. Instron machine was used to test the shear bond strength (SBS). One-way ANOVA and Bonferroni test were used for statistical analysis. RESULT: Samples in group III showed highest values for SBS followed by groups I, IV, and V with less SBS value for group II. CONCLUSION: Thus, the results conclude the use of combination of surface treatment using laser to be an effective modality to enhance the shear bond strength of zirconia. CLINICAL SIGNIFICANCE: Synergistic surface treatment using laser increases the bond strength of zirconia prosthesis to veneering ceramic improving its clinical longevity.

T helper cells in depression: central role of Th17 cells.

Depression is one of the most common neuropsychiatric disorders in the world. While conventional pharmaceutical therapy targets monoaminergic pathway dysfunction, it has not been totally successful in terms of positive outcomes, remission, and preventing relapses. There is an increasing amount of evidence that neuroinflammation may play a significant part in the pathophysiology of depression. Among the key components of the neuroinflammatory pathways already known to be active are the T helper (Th) cells, especially Th17 cells. While various preclinical and clinical studies have reported increased levels of Th17 cells in both serum and brain tissue of laboratory model animals, contradictory results have argued against a pertinent role of Th17 cells in depression. Recent studies have also revealed a role for more pathogenic and inflammatory subsets of Th17 in depression, as well as IL-17A and Th17 cells in non-responsiveness to conventional antidepressant therapy. Despite recent advances, there is still a significant knowledge gap concerning the exact mechanism by which Th17 cells influence neuroinflammation in depression. This review first provides a short introduction to the major findings that led to the discovery of the role of Th cells in depression. The major subsets of Th cells known to be involved in neuroimmunology of depression, such as Th1, Th17, and T regulatory cells, are subsequently described, with an in-depth discussion on current knowledge about Th17 cells in depression.

Magnetic resonance imaging versus cone beam computed tomography in diagnosis of periapical pathosis - A systematic review.

OBJECTIVE: The diagnosis of any dental pathology can vary from being simple to challenging. While the use of cone beam computed tomography (CBCT) is well established, magnetic resonance imaging (MRI) remains a proof of concept. This systematic review aims to compare the diagnostic ability of MRI with CBCT in diagnosing periapical pathosis. MATERIALS AND METHODS: This systematic search was performed using the electronic databases of MEDLINE, Cochrane Library, Google Scholar, and Science Direct to identify relevant articles from 2010 to 2020. The search terms used were magnetic resonance imaging, cone beam computed tomography, diagnosis, and periapical diseases. RESULT: In total, 3218 potentially relevant abstracts and titles were identified. After removing duplicates, 1288 articles were reviewed for titles and abstracts, and 29 articles were selected for full-text reading. From those, 19 articles were finally selected that included original research studies, case reports, and case series and were included for systematic review. Most of the studies included in this review suggested that the combined use of CBCT and MRI is needed for a better and more precise diagnosis of complex periapical pathoses. The main advantage of MRI is its ability to image soft tissues usingnonionizing radiation, and the main disadvantage in the case of CBCT is overdiagnosis of the lesion. CONCLUSION: MRI has various advantages over CBCT with similar diagnostic utility. When diagnosing periapical pathogens, both MRI and CBCT are needed for an accurate diagnosis.

Efficacy of Laser Photoacoustic Streaming in Paediatric Root Canal Disinfection - An Ex-Vivo Study.

BACKGROUND: Various techniques have been employed to enhance the root canal disinfection rate using sodium hypochlorite (NaOCl) as an irrigant. Photon initiated photo-acoustic streaming using lasers is a newer method of endodontic disinfection. AIM: The aim of this study is to evaluate and compare the efficacy of photo-initiated photoacoustic streaming and conventional irrigation technique using 2.5% NaOCl for root canal disinfection in primary teeth. SETTING AND DESIGN: Laboratory setting and ex-vivo design. MATERIALS AND METHODS: Twenty extracted primary teeth were selected in which Enterococcus faecalis incubation was done in the root canals and bacterial counts were obtained before the intervention. The teeth were randomly allocated into two groups. Group I samples were irrigated with conventional syringe method using 2.5% NaOCl and Group II samples were irrigated using photon-initiated photo-acoustic streaming method with erbium-doped yttrium aluminum garnet laser (wavelength - 2940 nm). Postintervention samples were obtained, and bacterial colony count was done. Wilcoxon Signed- Ranks Test and Mann-Whitney test were applied to test the intragroup and intergroup differences in the bacterial counts. RESULTS: Postintervention results showed no bacterial growth in the canals irrigated using Laser (P = 0.004) whereas, fewer bacterial colonies were observed in NaOCl group (P = 0.005). There was statistically significantly higher reduction in E. faecalis counts in Laser Activated irrigation (LAI) group compared to NaOCl group (P < 0.05). CONCLUSION: Total elimination of E. faecalis counts was obtained by the use of laser activated NaOCl irrigation in the infected root canals, hence, it can be considered as an effective method for pediatric endodontic disinfection.

Effect of triple antibiotic paste and calcium hydroxide on the rate of healing of periapical lesions: A systematic review.

Aim: The rate of healing of periapical lesion after the antibacterial dressing with triple antibiotic paste and calcium hydroxide was assessed. Materials and Methods: Case reports which used triple antibiotic paste and calcium hydroxide as the intracanal dressing was searched in PubMed, Google Scholar and Cochrane Oral Health's Trials Register up to August 2020, without language and period restriction. Two authors independently reviewed all identified titles and abstracts for eligibility. Tables were generated to summarize the included studies. Results: Sixteen (n = 16) articles met the eligibility criteria. Nonsurgical endodontic treatment was carried out in eleven cases with triple antibiotic paste and in nineteen cases calcium hydroxide was used. Results of the study after analyzing the case reports indicate that both triple antibiotic paste and calcium hydroxide are equally effective as intracanal medicament. In cases where calcium hydroxide failed to eliminate symptoms, triple antibiotic paste was found to be effective. Conclusion: As far as the effect on the healing of the periapical lesions is concerned, all the studies showed a high success rate. Available scientific data indicates nonsurgical treatment can be adopted as a routine measure to conservatively treat large periapical lesions of endodontic origin.

The mechanism of bending in a plastically flexible crystal.

Mechanically adaptable molecular crystals have potential applications in flexible smart materials and devices. Here, we report the mechanism of plastic deformation in single crystals of a small organic molecule (N-(4-ethynylphenyl)-3-fluoro-4-(trifluoromethyl)benzamide) that can be repeatedly irreversibly bent and returned to its original shape without concomitant delamination or loss of integrity. Along with the quantification of the crystals' local and bulk mechanical properties (hardness, indentation modulus and Young's modulus), micro-focus synchrotron X-ray diffraction mapping show that upon deformation, molecular layers lined with trifluoromethyl groups cooperatively slip past one another resulting in their impressive plastic malleability.

Guest Solvent-dependence of the Nanomechanical Response in Substituted Dihydropyrimidinone Crystals.

The nanomechanical responses of two crystalline phases of a dihydropyrimidine analogue (1) were similar irrespective of the presence (or absence) of the guest solvent. In contrast, the mechanical responses of two differently solvated forms of the second related (2) crystals were significantly different. These contrasting behaviors are rationalized in terms of intermolecular interactions and energy distributions.

Effect of Headspace and Trapped Volatile Organic Compounds (VOCs) of the Chinese Caterpillar Mushroom, Ophiocordyceps sinensis (Ascomycetes), against Soil-Borne Plant Pathogens.

Headspace volatile metabolites produced by Ophiocordyceps sinensis were tested against soil-borne plant pathogens (namely, Fusarium oxysporum f. sp. lycopersici, F. oxysporum f. sp. cubense, Thanatephorus cucumeris, Athelia rolfsii, and Macrophomina phaseolina). Diffusible volatile metabolites produced by O. sinensis inhibited 52% and 48% of the mycelial growth of F. oxysporum f. sp. lycopersici and F. oxysporum f. sp. cubense, respectively. In addition to inhibiting mycelial growth, the headspace volatile metabolites also induced several morphological changes in the culture characteristics and mycelia of the tested fungi. Stunted and depressed colony growth was observed for F. oxysporum f. sp. cubense and F. oxysporum f. sp. lycopersici. The headspace volatile compounds produced by O. sinensis were trapped in a glass cartridge (Porapak Q). The trapped compounds were eluted from the column by using hexane and then, by using gas chromatography-mass spectrometry, were identified as tetratetracontane, 1(2H)-naphthalenone, 3, 4-dihydro-3-methyl, 3-hexenoic acid, 1-methyl-3-ethyladamantane, and phenol, 3-ethyl.

Inhibition of protein kinases by anticancer DNA intercalator, 4-butylaminopyrimido4',5':4,5thieno(2,3-)quinoline

Targeting protein kinases (PKs) has been a promising strategy in treating cancer, as PKs are key regulators of cell survival and proliferation. Here in this study, we studied the ability of pyrimido[4',5':4,5]thieno(2,3-)quinolines (PTQ) to inhibit different PKs by performing computational docking andscreening. Docking studies revealed that 4-butylaminopyrimido[4',5':4,5]thieno(2,3-)quinoline (BPTQ) has a higher order of interaction with the kinase receptors than other PTQ derivatives.screening confirms that BPTQ inhibits VEGFR1 and CHK2, with the ICvalues of 0.54 and 1.70 µmol/L, respectively. Further, cytotoxicity of BPTQ was measured by trypan blue assay. Treatment with BPTQ decreased the proliferation of HL-60 cells with an ICvalue of 12 µmol/L and induces apoptosis, as explicated by the fall in the mitochondrial membrane potential, annexin V labeling and increased expression of caspase-3. Taken together, these data suggest that BPTQ possess ability to inhibit PKs and to induce cell death in human promyelocytic leukemia cells.

Salicylic acid derivatives as potential anti asthmatic agents using disease responsive drug delivery system for prophylactic therapy of allergic asthma.

Asthma is a multi-factorial and complicated lung disorder of the immune system which has expanded to a wider ambit unveiling its etiology to be omnipresent at both ends of the spectrum involving basic pharmacology and in-depth immunology. As asthma occurs through triggered activation of various immune cells due to different stimuli, it poses a great challenge to uncover specific targets for therapeutic interventions. Recent pharmacotherapeutic approaches for asthma have been focused on molecular targeting of transcription factors and their signaling pathways; mainly nucleus factor kappa B (NFκB) and its associated pathways which orchestrate the synthesis of pro-inflammatory cytokines (IL-1ß, TNF-α, GM-CSF), chemokines (RANTES, MIP-1a, eotaxin), adhesion molecules (ICAM-1, VCAM-1) and inflammatory enzymes (cyclooxygenase-2 and iNOS). 5-aminosalicylic acid (5-ASA) and sodium salicylate are known to suppress NFκB activation by inhibiting inhibitor of kappa B kinase (IKκB). In order to target the transcription factor, a suitable carrier system for delivering the drug to the intracellular space is essential. 5-ASA and sodium salicylate loaded liposomes incorporated into PEG-4-acrylate and CCRGGC microgels (a polymer formed by crosslinking of trypsin sensitive peptide and PEG-4-acrylate) could probably suit the needs for developing a disease responsive drug delivery system which will serve as a prophylactic therapy for asthmatic patients.

Treatment of Unstable Intertrochanteric Fractureswith Proximal Femoral Nail Antirotation II: Our Experience in Indian Patients.

INTRODUCTION: Unstable intertrochanteric fractures are difficult to manage and the choice of implant is critical for fracture fixation. The purpose of this study was to evaluate the functional and radiological outcome of proximal femoral nail antirotationII (PFNA II) in the treatment of unstable intertrochanteric fractures. MATERIALS AND METHODS: We reviewed 45 patients of unstable intertrochanteric fractures, who were treated with the PFNA II between 2011 and 2013. Of which, 3 patients were died within 6 months of follow up. Hence, 42 patients were available for the study including 26 men and 16 women. The mean age was 61 years (range, 35 -90). Clinical evaluation was done using Harris hip score. The position of the blade in the femoral head was evaluated using Cleveland zones and tip apex distance. The fracture reduction was assessed using the Garden Alignment Index and postoperative fracture gap (mm) measurement. RESULTS: The mean follow up period was 15.3 months (range, 9-27). Excellent to good results were accounted for 78% of cases according to Harris hip score. No cases of cut out or breakage of the implant noted. Implant removal was done in 2 patients due to persistent anterior thigh pain. CONCLUSION: We recommend PFNA II for fixation of unstable intertrochanteric fractures with less operative time and low complication rate. However, proper operative technique is important for achieving fracture stability and to avoid major complications.