Application of radiopaque micro-particle fillers for 3-D imaging of periodontal pocket analogues using cone beam CT.

BACKGROUND: Periodontitis is an infectious/inflammatory disease most often diagnosed by deepening of the gingival sulcus, which leads to periodontal pockets (PPs) conventional manual periodontal probing does not provide detailed information on the three-dimensional (3-D) nature of PPs. OBJECTIVES: To determine whether accurate 3-D analyses of the depths and volumes of calibrated PP analogues (PPAs) can be obtained by conventional cone beam computed tomography (CBCT) coupled with novel radiopaque micro-particle fillers (described in the companion paper) injected into the PPAs. METHODS: Two PPA models were employed: (1) a human skull model with artificial gingiva applied to teeth with alveolar bone loss and calibrated PPAs, and (2) a pig jaw model with alveolar bone loss and surgically-induced PPAs The PPAs were filled with controlled amounts of radiopaque micro-particle filler using volumetric pipetting Inter-method and intra-method agreement tests were then used to compare the PPA depths and volumes obtained from CBCT images with values obtained by masked examiners using calibrated manual methods. RESULTS: Significant inter-method agreement (0.938-0.991) and intra-method agreement (0.94-0.99) were obtained when comparing analog manual data to digital CBCT measurements enabled by the radiopaque filler. SIGNIFICANCE: CBCT imaging with radiopaque micro-particle fillers is a plausible means of visualizing and digitally assessing the depths, volumes, and 3-D shapes of PPs This approach could transform the diagnosis and treatment planning of periodontal disease, with particular initial utility in complex cases Efforts to confirm the clinical practicality of these fillers are currently in progress.

Development of radiopaque, biocompatible, antimicrobial, micro-particle fillers for micro-CT imaging of simulated periodontal pockets.

OBJECTIVES: Approximately 109 bacteria can be harbored within periodontal pockets (PP) along with inflammatory byproducts implicated in the pathophysiology of systemic diseases linked to periodontitis (PD). Calculation of this inflammatory burden has involved estimation of total pocket surface area using analog data from conventional periodontal probing which is unable to determine the three-dimensional (3-D) nature of PP. The goals of this study are to determine the radiopacity, biocompatibility, and antimicrobial activity of transient micro-particle fillers in vitro and demonstrate their capability for 3-D imaging of artificial PP (U.S. Patent publication number: 9814791 B2). METHODS: Relative radiopacity values of various metal oxide fillers were obtained from conventional radiography and micro-computed tomography (µCT) using in vitro models. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays were used to measure the biocompatibility of calcium tungstate (CaWO4) particles by determination of viable keratinocytes percentage (%) after exposure. After introducing an antibacterial compound (K21) to the radiopaque agent, antimicrobial tests were conducted using Porphyromonas gingivalis (P. gingivalis) and Streptococcus gordonii (S. gordonii) strains and blood agar plates. RESULTS: CaWO4 micro-particle-bearing fillers exhibited an X-ray radiopacity distinct from tooth structures that enabled 3-D visualization of an artificial periodontal pocket created around a human tooth. MTT assays indicated that CaWO4 micro-particles are highly biocompatible (increasing the viability of exposed keratinocytes). Radiopaque micro-particle fillers combined with K21 showed significant antimicrobial activity for P. gingivalis and S. gordonii. SIGNIFICANCE: The plausibility of visualizing PP with 3-D radiographic imaging using new radiopaque, biocompatible, transient fillers was demonstrated in vitro. Antibacterial (or other) agents added to this formula could provide beneficial therapeutic features along with the diagnostic utility.

Physician's advice on quitting smoking in HIV and TB patients in south India: a randomised clinical trial.

Setting: National Institute for Research in Tuberculosis, Madurai, India. Objective: To determine the efficacy of physician's advice on quitting smoking compared with standard counselling in patients with tuberculosis (TB) and patients with human immunodeficiency virus (HIV) infection. Design/Methods: This was a clinical trial conducted in Madurai, south India, among 160 male patients (80 with TB and 80 with HIV), randomised and stratified by nicotine dependence (low/high according to the Fagerström scale), who received physician's advice with standard counselling or standard counselling alone for smoking cessation. Abstinence at 1 month was assessed by self-report and carbon monoxide breath analysis. Results: The patients' mean age was 39.4 years (SD 8.5). Overall, 35% of the patients had high nicotine dependence. Most patients (41%) smoked both cigarettes and bidis. In a combined analysis including both the HIV and the TB groups, quit rates were 41% of the 68 patients in the physician group and 35% of the 68 patients in the standard counselling arm. Conclusions: Physician's advice to quit smoking delivered to patients with TB or HIV is feasible and acceptable. Smoking cessation could easily be initiated in TB patients in programme settings. Future studies should assess long-term abstinence rates with a larger sample size to demonstrate the efficacy of physician's advice.

Contexte : National Institute for Research in Tuberculosis (NIRT), Madurai, Inde.Objectif : Déterminer l'efficacité des conseils d'un médecin comparés aux conseils standard d'arrêt du tabac chez des patients atteints de tuberculose (TB) et chez des patients infectés par le virus de l'immunodéficience humaine (VIH).Schéma/Méthodes : Cet essai clinique a été réalisé à Madurai, dans le sud de l'Inde. Cent soixante patients masculins (80 TB et 80 VIH) ont été randomisés, stratifiés en fonction de leur dépendance à la nicotine (faible/élevée selon l'échelle de Fagerström) pour bénéficier soit des conseils d'un médecin avec des conseils standard ou des conseils standard seuls pour l'arrêt du tabac. L'abstinence à un mois a été évaluée par déclaration des patients et analyse du monoxyde de carbone dans l'air expiré.Résultats : L'âge moyen (DS) a été de 39,4 (±8,5) ans. Dans l'ensemble, 35% des patients avaient une dépendance élevée à la nicotine. La majorité des patients (41%) fumait à la fois des cigarettes et des bidis (cigarettes indiennes). En analyse combinée (à la fois le groupe VIH et TB), les taux de cessation ont été de 41% sur 68 patients dans le groupe « médecin ¼ et de 35% de 68 patients dans le bras « conseil standard ¼ (non significatif).Conclusions: Les conseils d'un médecin en matière d'arrêt de tabac délivrés aux patients atteints de TB ou de VIH sont faisables et acceptables. L'arrêt du tabac pourrait bien être mis en œuvre dans le contexte des programmes chez les patients TB. De futures études devraient évaluer le taux d'abstinence à long terme avec des échantillons de plus grande taille afin de démontrer l'efficacité des conseils d'un médecin.

Marco de referencia: El Instituto Nacional de Investigación en Tuberculosis de Madurai, en la India.Objetivo: Comparar la eficacia de los consejos que da el médico con el asesoramiento corriente sobre el abandono del tabaco, en pacientes aquejados de tuberculosis (TB) o infección por el virus de la inmunodeficiencia humana (VIH).Métodos: El ensayo clínico inicial se llevó a cabo en Madurai, en el sur de la India. Se escogieron de manera aleatoria 160 pacientes de sexo masculino (80 con diagnóstico de TB y 80 de infección por el VIH), se estratificaron en función de la dependencia de la nicotina (baja y alta, según la escala de Fagerström) y se asignaron a un grupo que recibiría consejos del médico además del asesoramiento corriente sobre el abandono del tabaco o un grupo que solo recibiría el asesoramiento corriente. Al cabo de un mes, se evaluó la abstinencia a partir de la información proporcionada por los pacientes y la medición de monóxido de carbono en el aire espirado.Resultados: El promedio de edad de los participantes fue 39,4 años (desviación estándar 8,5 años). En general, el 35% de los participantes exhibía una alta dependencia de la nicotina. La mayoría fumaba cigarrillos y también bidis (41%). En el análisis conjunto (ambos grupos: TB y VIH), las tasas de abandono fueron 41% en los 68 pacientes del grupo que recibió consejo médico y 35% en los 68 pacientes del grupo que obtuvo asesoramiento corriente (diferencia no significativa).Conclusión: El consejo sobre el abandono del tabaco ofrecido por el médico a los pacientes con diagnóstico de TB o infección por el VIH es factible y bien aceptado. Es posible iniciar intervenciones de abandono del tabaco con los pacientes TB en el marco programático. Futuros estudios podrían evaluar las tasas de abstinencia a largo plazo con muestras más grandes, a fin de demostrar la eficacia del consejo dado por los médicos.

Loss to follow-up among children in pre-ART care under the National AIDS Programme, Tamil Nadu, South India.

Setting: Children aged <15 years constitute 7% of all people living with the human immunodeficiency virus (HIV) in India. A previous study from an antiretroviral therapy (ART) centre in south India reported 82% loss to follow-up (LTFU) among children in pre-ART care (2006-2011). Objective: To assess the proportion of LTFU within 1 year of registration among HIV-infected children (aged < 15 years) registered in all 43 ART centres in the state of Tamil Nadu, India, during the year 2012. Design: This was a retrospective cohort study involving a review of programme records. Results: Of 656 children registered for HIV care, 20 (3%) were not assessed for ART eligibility. Of those remaining, 226 (36%) were not ART eligible and entered pre-ART care. Among these, at 1 year of registration, 50 (22%) were LTFU, 40 (18%) were transferred out and 136 (60%) were retained in care at the same centre. The child's age, sex, World Health Organization stage or occurrence of opportunistic infection were not associated with LTFU. Conclusion: One in five children registered under pre-ART care were lost to follow-up. Stronger measures to prevent LTFU and reinforce retrieval actions are necessary in the existing National HIV Programme.

Contexte: Les enfants âgés de <15 ans constituent 7% de toutes les personnes vivant avec le virus de l'immunodéficience humaine (VIH) en Inde. Une étude précédente émanant d'un centre de thérapie antirétrovirale (TAR) d'Inde du Sud a rapporté 82% de pertes de vue (LTFU) parmi les enfants en soin pré-ART (2006­2011).Objectif: Evaluer la proportion de LTFU dans l'année suivant l'enregistrement parmi les enfants (âgés de <15 ans) infectés par le VIH enregistrés dans les 43 centres du TAR de l'état du Tamil Nadu, Inde, pendant l'année 2012.Schéma: Une étude rétrospective de cohorte impliquant une revue des dossiers du programme.Résultats: Sur 656 enfants enregistrés pour une prise en charge du VIH, 20 (3%) n'ont pas été évalués pour leur éligibilité au TAR. Parmi les autres, 226 (36%) n'ont pas été éligibles au TAR et sont entrés en soins pré-TAR. Parmi eux, à une année de l'enregistrement, 50 (22%) ont été LTFU, 40 (18%) ont été transférés et 136 (60%) sont restés en soins dans le même centre. L'âge de l'enfant, le sexe, le stade de l'Organisation mondiale de la santé et la survenue d'infections opportunistes n'ont pas été associés avec le LTFU.Conclusion: Un enfant sur cinq enregistré en prise en charge pré-TAR a été LTFU. Les mesures de prévention des LTFU et les efforts de localisation doivent être renforcés au sein du programme national VIH existant.

Marco de referencia: Los niños < l5 años de edad representan el 7% de todas las personas positivas frente al virus de la inmunodeficiencia humana (VIH) en la India. En un estudio anterior realizado en un centro de tratamiento antirretrovírico (TAR) en el sur del país, se notificó una tasa de pérdida durante el seguimiento de 82% en los niños que acudían a la atención pre-TAR (del 2006 al 2011).Objetivo: Evaluar la proporción de pérdidas durante el seguimiento durante el primer año después del registro de los niños infectados por el VIH (<15 años de edad) en todos los 43 centros de suministro de TAR en el estado de Tamil Nadu, en la India, en el año 2012.Método: Un estudio retrospectivo de cohortes a partir de los registros del programa.Resultados: De los 656 niños registrados en la atención de la infección por el VIH, en 20 no se evaluó su aptitud para recibir el TAR (3%). De los niños restantes, 226 no cumplían los requisitos del TAR (36%) y se inscribieron en la atención pre-TAR. De este grupo, un año después del registro, 50 niños se habían perdido durante el seguimiento (22%), 40 se habían transferido a otro centro (18%) y 136 permanecían en la atención en el mismo centro (60%). La edad de los niños, el sexo, el estadio clínico de la enfermedad según la escala de la Organización Mundial de la Salud y la aparición de una infección oportunista no se asociaron con la pérdida durante el seguimiento.Conclusión: Uno de cada cinco niños registrados en la atención pre-TAR se perdió durante el seguimiento. Es preciso fortalecer las medidas que prevengan estas pérdidas y las intervenciones de recuperación de los pacientes en el programa nacional contra el VIH que existe en el país.

Epicardial fat thickness: A surrogate marker of coronary artery disease - Assessment by echocardiography.

OBJECTIVE: Epicardial fat is considered as indicator of cardiovascular risk. Several studies have tested the association between epicardial fat thickness (EFT) and coronary artery disease. The aim of our study is to test the hypothesis that echocardiographic EFT is a marker of coronary artery disease. METHODS: One hundred and ten patients (70 males and 40 females with mean age of 51.5±10.6 and 52.6±9.6, respectively) admitted for coronary angiogram underwent assessment of epicardial fat thickness by echocardiography. Routine clinical examination, evaluation of risk factor profile, and anthropometric variables were also done. Epicardial fat thickness was measured on the free wall of right ventricle in parasternal long- and short-axis views at end-systole for 3 cardiac cycles. RESULTS: Mean epicardial fat thickness in angiographically normal patients and acute coronary syndromes were 4.4±1.2 and 6.9±1.9, respectively. Epicardial fat thickness in males and females were not statistically different. Burden of coronary arterial lesions denoted by Gensini score shows linear association with epicardial fat thickness and the severity of the coronary disease. CONCLUSION: Epicardial fat is independently and linearly associated with CAD and its severity.

Quinones as photosensitizer for photodynamic therapy: ROS generation, mechanism and detection methods.

Photodynamic therapy (PDT) is based on the dye-sensitized photooxidation of biological matter in the target tissue, and utilizes light activated drugs for the treatment of a wide variety of malignancies. Quinones and porphyrins moiety are available naturally and involved in the biological process. Quinone metabolites perform a variety of key functions in plants which includes pathogen protection, oxidative phosphorylation, and redox signaling. Quinones and porphyrin are biologically accessible and will not create any allergic effects. In the field of photodynamic therapy, porphyrin derivatives are widely used, because it absorb in the photodynamic therapy window region (600-900 nm). Hence, researchers synthesize drugs based on porphyrin structure. Benzoquinone and its simple polycyclic derivatives such as naphthaquinone and anthraquinones absorb at lower wavelength region (300-400 nm), which is lower than porphyrin. Hence they are not involved in PDT studies. However, higher polycyclic quinones absorb in the photodynamic therapy window region (600-900 nm), because of its conjugation and can be used as PDT agents. Redox cycling has been proposed as a possible mechanism of action for many quinone species. Quinones are involved in the photodynamic as well as enzymatic generation of reactive oxygen species (ROS). Generations of ROS may be measured by optical, phosphorescence and EPR methods. The photodynamically generated ROS are also involved in many biological events. The photo-induced DNA cleavage by quinones correlates with the ROS generating efficiencies of the quinones. In this review basic reactions involving photodynamic generation of ROS by quinones and their biological applications were discussed.

Antioxidant study of quercetin and their metal complex and determination of stability constant by spectrophotometry method.

Quercetin found chelate cadmium ions, scavenge free radicals produced by cadmium. Hence new complex, quercetin with cadmium was synthesised, and the synthesised complex structures were determined by UV-vis spectrophotometry, infrared spectroscopy, thermogravimetry and differential thermal analysis techniques (UV-vis, IR, TGA and DTA). The equilibrium stability constants of quercetin-cadmium complex were determined by Job's method. The determined stability constant value of quercetin-cadminum complex at pH 4.4 is 2.27×10(6) and at pH 7.4 is 7.80×10(6). It was found that the quercetin and cadmium ion form 1:1 complex in both pH 4.4 and pH 7.4. The structure of the compounds was elucidated on the basis of obtained results. Furthermore, the antioxidant activity of the free quercetin and quercetin-cadmium complexes were determined by DPPH and ABTS assays.

FT-IR spectral studies on polluted soils from industrial area at Karaikal, Puducherry State, South India.

Fourier transform infrared spectroscopy (FT-IR) has been carried out to analyze the chemical composition of soil samples. The soil samples were collected from an industrial environment at Karaikal, Union Territory of Pondicherry, South India. The FT-IR results indicate that soils have different composition, i.e., namely kaolinite, quartz, montmorillonite, aragonite, hematite, feldspar and calcite, respectively. From the spectral pattern, the chemical compositions of soil samples were identified. The quantitative estimations of kaolinite (1032 cm(-1) and 1634 cm(-1)), quartz (779 cm(-1), 692 cm(-1) and 464 cm(-1)), montmorillonite (3421 cm(-1)), organic material (2922 cm(-1)) and hematite (532 cm(-1)) were calculated using particular peaks of FT-IR studies spectrum. From the XRD pattern, the chemical compositions of soil samples were confirmed. In the study reveals that kaolinite and quartz minerals were predominant whereas montmorillonite and hematite are in moderate level, and organic materials are found in trace. Quantitative analyses of soils show that quartz (36%), kaolinite (34%), hematite (13%), montmorillonite (12%), illite (3%) and organic material (2%) are present in all the soil samples at various sites.

Drug related crisis in myasthenia gravis.

Myasthenia gravis is an autoimmune disorder where antibodies against the nicotinic Ach receptor resulting in impaired transmission at the NM junction. A number of drugs have been reported to cause neuromuscular blockade and/or to increase weakness in myasthenia gravis. We report a case of myasthenia gravis in which the calcium channel blocker-nifedipine caused the worsening of the symptoms.

Photodynamic effects of two hydroxyanthraquinones.

The aim of this work was to investigate the photodynamic action of electron-rich anthraquinones, viz., cynodontin (CYN) and cynodontin-5,8-dimethylether (CYNM). Both optical and EPR methods are used to detect the generation of singlet oxygen. Based on RNO bleaching, relative to rose bengal (RB), singlet oxygen generating efficiencies of CYN and CYNM are derived to be 0.055 and 0.254, respectively. The formation of superoxide anion via electron transfer to O2 was monitored by optical spectroscopy, using SOD-inhibitable cytochrome c reduction assay. The production of O2-* is enhanced in the presence of electron donors such as EDTA and NADH. Photolysis of CYN and CYNM in DMSO, in the presence of 5,5-dimethyl-1-pyrroline-N-oxide (DMPO), generates a multi-line EPR spectrum, characteristic of spin adduct mixture of O2-* and *OH. Both optical and ESR measurements indicate that O2-* (Type I) and 1O2 (Type II) paths are involved in CYN and CYNM photodynamic action.

Drug susceptibility of Mycobacterium leprae: a retrospective analysis of mouse footpad inoculation results from 1983 to 1997.

We analysed the results of mouse foot pad (MFP) tests performed between 1983 and 1997 in our laboratory for the cases referred with clinical suspicion of relapse/drug resistance. A total of 214 cases, with clinical suspicion of relapse/drug resistance were investigated for susceptibility to the drugs of MDT by MFP inoculation. Among 96 inoculations that showed conclusive results, 81 (84%) were fully sensitive to dapsone, suggesting that most of the clinically suspected relapse is due to drug susceptible Mycobacterium leprae. Of the remaining 15 strains (16%) found resistant to dapsone, 13 (87%) were of high grade resistance and one strain each of intermediate grade and low grade dapsone resistance, suggesting that most of the dapsone resistance is secondary in nature. No case of rifampicin resistance was found. Only one case of combined dapsone and unconfirmed clofazimine resistance was found. No other combined multidrug resistance was observed in our analysis.

Improving question formulation for use in evidence appraisal in a tertiary care setting: a randomised controlled trial [ISRCTN66375463].

BACKGROUND: The specificity of clinical questions is gauged by explicit descriptions of four dimensions: subjects, interventions, comparators and outcomes of interest. This study determined whether adding simple instructions and examples on clinical question formulation would increase the specificity of the submitted question compared to using a standard form without instructions and examples. METHODS: A randomised controlled trial was conducted in an evidence-search and appraisal service. New participants were invited to reformulate clinical queries. The Control Group was given no instructions. The Intervention Group was given a brief explanation of proper formulation, written instructions, and diagrammatic examples. The primary outcome was the change in the proportion of reformulated questions that described each the dimensions of specificity. RESULTS: Fifty-two subjects agreed to participate in the trial of which 13 were lost to follow-up. The remaining 17 Intervention Group and 22 Control Group participants were analysed. Baseline characteristics were comparable. Overall, 20% of initially submitted questions from both groups were properly specified (defined as an explicit statement describing all dimensions of specificity). On follow-up, 7/14 questions previously rated as mis-specified in the Intervention Group had all dimensions described at follow-up (p = 0.008) while the Control Group did not show any changes from baseline. Participants in the Intervention Group were also more likely to explicitly describe patients (p = 0.028), comparisons (p = 0.014), and outcomes (p = 0.008). CONCLUSIONS: This trial demonstrated the positive impact of specific instructions on the proportion of properly-specified clinical queries. The evaluation of the long-term impact of such changes is an area of continued research.

Consumer health information. What the research is telling us.

BACKGROUND: Consumer health information is a necessary component of patient care and consumer participation. OBJECTIVE: To outline the findings of the 'Assessing the Quality of Consumer Health Information Project' and discuss strategies for improving consumer information. DISCUSSION: The pamphlets identified in this study were not developed with consumer input with consequent deficits apparent. Providers and consumers appeared to use the information for very different purposes but both groups were critical of the ambiguous terminology and lack of quantified data. The provision of relevant information is a fundamental prerequisite of consumer participation in decision making in health care. Such information needs to be available, accurate, and understandable.

In vitro selection of signaling aptamers.

Reagentless biosensors that can directly transduce molecular recognition to optical signals should potentiate the development of sensor arrays for a wide variety of analytes. Nucleic acid aptamers that bind ligands tightly and specifically can be readily selected, but may prove difficult to adapt to biosensor applications. We have therefore attempted to develop selection methods that couple the broad molecular recognition properties of aptamers with signal transduction. Anti-adenosine aptamers were selected from a pool that was skewed to contain very few fluoresceinated uridines. The primary family of aptamers showed a doubling of relative fluorescence intensity at saturating concentrations of a cognate analyte, ATP, and could sense ATP concentrations as low as 25 microM. A single uridine was present in the best signaling aptamer. Surprisingly, other dyes could substitute for fluorescein and still specifically signal the presence of ATP, indicating that the single uridine functioned as a general "switch" for transducing molecular recognition to optical signals.

Stroke following scorpion sting.

A 30 year old male presented with crossed buccofacial apraxia, apraxia for speech, Left UMN facial palsy and hemiplegia following scorpion sting. A cerebrovascular accident can develop following a scorpion sting due to venom-induced cerebral thrombosis.