Uterine Rupture: A Case Series From a Tertiary Care Center in Northern India.

Uterine rupture is a rare, preventable catastrophic condition in obstetrics. It is associated with high fetal and maternal morbidity and mortality. Its timely diagnosis and swift management may result in better outcomes. Here, we study the presentations and outcomes of three cases of ruptured uterus in the third trimester. Three cases of uterine rupture were presented in the Department of Obstetrics & Gynaecology between the 1st of April 2022 and the 31st of March 2023 in the third trimester, at 29, 33, and 37 weeks, respectively. The mean age of the patients was 25.33 (19-29) years. All three patients had a history of scarred uterus and were diagnosed with clinical suspicion of rupture. Other symptoms were hematuria and absent fetal cardiac activity in the second case; in the third case, she had tenderness in her previous cesarean section scar. Two out of three patients required urinary bladder repair and uterus repair. All patients did well after surgery, leading to no mortality. Our case series findings suggest that the clinical presentations of ruptured uterus vary. A history of previous cesarean section, and findings suggestive of peritonitis like tachycardia, shock, pallor, and absence of an intact uterus should raise suspicion of a ruptured uterus. Searching for non-gynecological causes in such clinical presentations might delay the crucial surgical intervention that leads to mortality, morbidity, and future obstetrics function.

Evaluation of the Role of Dentures & Dietary Advice on Nutritional Status of Complete Edentulous Patients Using MNA®-SF: An Observational Study.

Aim This study aims to evaluate the role of dentures and dietary advice on the nutritional status of complete edentulous patients using the mini nutritional assessment-short form (MNA®-SF). Objective The objective of this study is to assess patients' nutrition using MNA®-SF before denture insertion and nutritional advice, to evaluate patients' nutrition using MNA®-SF after denture insertion and nutritional advice at one month and three months, and to assess and compare pre- and post-insertion differences in nutrition using MNA®-SF. Material and Method An observational study was conducted among 50 completely edentulous patients using the MNA®-SF questionnaire. They were asked the questions at baseline and then after they were given complete dentures, after which they were recalled after one month and three months to assess the nutritional status using MNA®-SF. All the questions were in the native language, so it was easy to understand the question and respond to it. Result It was found that the patient's nutritional status had significant changes, which shows that the dietary advice and complete denture affected the patient's nutritional status. Conclusions This study helped assess the efficacy and application of MNA®-SF in completely edentulous patients. In this study, we provided nutritional guidance to patients in addition to complete denture prostheses to encourage them to have healthy eating habits.

Radicular Cyst: A Cystic Lesion Involving the Hard Palate.

A radicular cyst, also known as a periapical cyst or root end cyst, is a type of odontogenic cyst that is typically associated with permanent teeth. The radicular cyst usually is associated with maxillary central incisors followed by mandibular first molars. It occurs as a result of bacterial infection and pulpal necrosis which leads to inflammatory stimulation of the epithelial cell rests of Malassez along the periodontal ligament area of the tooth. Most cases of the radicular cyst are asymptomatic and they are diagnosed accidentally during routine radiographic examination. This article presents a case report of a 42-year-old male with an apical periodontal cyst associated with the maxillary anterior region. Early diagnosis and treatment planning is necessary. This article signifies the role of the surgeon in the early diagnosis and treatment plan of the cyst.

Bidirectional Effect of Triphala on Modulating Gut-Brain Axis to Improve Cognition in the Murine Model of Alzheimer's Disease.

SCOPE: The emerging role of gut microbiota and their metabolites in the modulation of the gut-brain axis has received much attention as a new hope for the treatment of hard-to-treat chronic neurodegenerative diseases like Alzheimer's disease. The naturally occurring polyphenols can restore the gut-brain axis by modulating gut microbiota and brain neurotransmitters. The Indian traditional medicine Triphala, a rich source of polyphenols, has been used on humans based on Prakriti or disease conditions for many years. METHODS AND RESULTS: In this study, the dual mode (morning and evening) action of Triphala is used to provide scientific evidence of its superior preventive and therapeutic efficacy in C57BL/6 and 5xFAD, APP/PS1 transgenic mouse model of Alzheimer's disease. The study observes that Triphala treatment has significantly improved cognitive function, by modulating the APP pathway, reducing inflammation, and restoring the gut-brain axis by increasing the gut microbiota phyla of Bacteroides, Proteobacteria, Actinobacteria, etc., involved in maintaining the gut homeostasis. CONCLUSIONS: The study paves a new path for using dual modes of Triphala alone or in combination to treat incurable AD.

Applications of Chitosan Nanoparticles in Dentistry: A Review.

Recently, nanotechnology has garnered significant interest across various fields due to its emerging and diverse applications. Numerous investigators have proposed that chitosan nanoparticles (CSNPs) stand out as some of the most promising nanomaterials for facilitating various activities. Chitosan, a natural biopolymer established through the deacetylation of chitin, has been extensively studied using interdisciplinary approaches for a wide range of applications. Chitosan biomaterials exhibit distinctive attributes, including biodegradability, muco-adhesion, and biocompatibility, as well as a broad spectrum of antibacterial and antifungal properties. Furthermore, chitosan stands as the sole naturally occurring cationic polysaccharide, and it can be chemically tailored into various derivatives, depending on the intended role and utilization. The potential applications of chitosan are vast and intriguing, with many yet to be fully explored and understood. The unique characteristics of chitosan have sparked growing attentiveness in pharmaceutical industries and biomedical areas around the globe. The characteristics of chitosan like its biocompatibility, and anti-inflammatory effects hold the potential to yield promising outcomes in wound healing and periodontal care following tooth extractions. The objective of this study is to provide an overview of potential applications of chitosan in the field of dentistry.

Retraction: Implementation of Postpartum Hemorrhage Emergency Care Using a Bundle Approach at a Tertiary Care Hospital in North India.

[This retracts the article DOI: 10.7759/cureus.26819.].

Acute pancreatitis masquerading as mesentric growth in COVID-19 patient: A case report.

COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It commonly affects the respiratory system, producing pneumonia-like symptoms. Among extrapulmonary manifestations, involvement of the gastrointestinal tract is common with symptoms of nausea, vomiting, diarrhea, and abdominal pain. Coronavirus acts by targeting the ACE-2 receptors in the alveoli of the lungs, but because these receptors are also present in other organs, such as the pancreas, it can affect the pancreas as well, thus causing acute pancreatitis. We here discuss a case of a 72-year-old hypertensive male with COVID-19 who presented with atypical presentation of acute abdominal pain and a few episodes of vomiting. Laboratory investigations were inconclusive. Imaging findings were suggestive of small bowel obstruction and perforation; thus, an exploratory laparotomy was done in which a mesenteric growth was found, reported as acute pancreatitis on histopathology. Therefore, attention should be paid to the pancreatic involvement and atypical presentations in COVID-19 patients.

Implementation of Postpartum Hemorrhage Emergency Care Using a Bundle Approach at a Tertiary Care Hospital in North India.

Background The major cause of maternal death globally is postpartum hemorrhage (PPH). When PPH develops, early detection of bleeding and rapid treatment with evidence-based guidelines can prevent most PPH-related severe morbidity and mortality. The bundle care approach for PPH management could be a potential solution to inefficient and uneven evidence-based practice implementation worldwide. Bundle care is a collection of discrete, evidence-based interventions given to every eligible person simultaneously or in quick succession and requires teamwork, communication, and cooperation. The primary objective of this study was to analyze whether implementing a PPH bundle of care may reduce maternal morbidity and mortality in our institution. Methods This was a single-center retrospective pre-post case-control study was carried out at a tertiary care center and teaching hospital in Varanasi, eastern Uttar Pradesh state, India. From January 2021 to June 2021, pretraining data (PRE) were collected retrospectively on all births from the department of Obstetrics and Gynecology, Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University. Subsequently, medical and paramedical personnel of our hospital were trained in Postpartum Hemorrhage Emergency Care Using a Bundle Approach (PPH EmC) as per the guidelines laid down by the World Health Organization (WHO) for PPH management and implemented in July 2021. Post-training data (POST) were then collected retrospectively on all deliveries at our hospital from August 2021 to January 2022. All the data within two periods were computed and analyzed. The results were then compared for any significant changes in the incidences of maternal mortality and morbidity in terms of the rates of blood transfusion required and the type of management used (medical or medical-surgical), use of tranexamic acid, and additional uterotonics. The results were expressed as proportions, and p≤0.05 was considered statistically significant using IBM SPSS Statistics for Windows, version 24.0 (IBM Corp., Armonk, NY, USA). Results A total of 1304 women gave birth from January 2021 to January 2022, of whom 107 patients (61 in the PRE and 57 in the POST group) were diagnosed and treated for PPH. There was no significant difference in the incidence of PPH in the PRE and POST groups (p=0.581). There was a significant increase in the use of tranexamic acid (p=0.041) and a significant reduction in blood transfusion rates (p=0.032) after the implementation of bundled care in the POST group. The odds of PPH non-occurrence after pre- and post-test was 1.103 (95% CI=0.747 to 1.635). No significant difference was observed in maternal mortality in the PRE and POST groups (p=0.96). The requirement for radical surgical treatment of PPH, which included hysterectomies, was also significantly reduced, from 27.27% in the PRE group to 11.54% in the POST group (p=0.032). Conclusions PPH care bundles might improve the morbidity of PPH with the use of fewer resources and fewer interventions required. While these data are promising, further studies are needed to analyze bundle care's long-term effects.

Comparison of Cleaning Efficiency of Root Canal Using Different Rotary NiTi Instrumentation System: A Scanning Electron Microscopic Study.

BACKGROUND: To ensure that endodontic treatment is as effective as possible, it is important to remove any smear layer that forms as part of the instrumentation procedure. This layer might reduce the overall effectiveness of endodontic therapy. AIM OF THE STUDY: For this research, two distinct types of rotary NiTi files were compared: WaveOne Gold (WOG) (Dentsply Maillefer, Ballaigues, Switzerland) and F360 (Komet Brasseler GmbH & Co., Lemgo, Germany) for its capacity to eliminate trash and the smear layer. MATERIALS AND METHODS: Two groups (n=20 each) of 40 mandibular second premolar teeth were employed in this investigation, with each group receiving a random allocation of teeth. The F360 system and the WaveOne Gold system are two sets of instruments. The samples were irrigated with a mixture of sodium hypochlorite (NaOCl) (5.25%) and citric acid (40%). Finally, all samples in the centre of the coronal, middle, and apical thirds were examined by scanning electron microscopy (SEM). Mann-Whitney U tests were used to analyse the data. RESULTS: F360 instrument showed a statistically significant difference for smear layer removal among all thirds of the root canal whereas WOG resulted in a significant difference when the apical third was compared to the middle and coronal third. Significant differences were found in the middle and apical third in terms of smear layer removal between the two groups. Both F360 and WOG instruments showed statistically significant differences for debris removal among all thirds of the root canal. No significant differences were found in the coronal, middle, and apical third in terms of debris removal between the two groups. CONCLUSION: WOG resulted in cleaner canals compared to the F360 file system at coronal, middle, and apical third.

Plant development and crop protection using phytonanotechnology: A new window for sustainable agriculture.

Most developing nations' economies are built on agriculture and most of their citizens rely on it for survival. Global agricultural systems are experiencing tough and unprecedented challenges in the age of changing climate. Every year, the world's population grows, necessitating increased agrarian productivity. As a result, there has been a movement toward utilizing emerging technologies, such as nanotechnology. Nanotechnology with plant systems has inspired great interest in the current scenario in developing areas that come under the umbrella of agriculture and develop environmental remediation strategies. Plant-mediated synthesized nanoparticle (NPs) are eco-friendly, less time consuming, less expensive, and provide long-term product safety. Simultaneously, it provides tools that have the potentiality as "magic bullets" containing nutrients, fungicides, fertilizers, herbicides, or nucleic acids that target specific plant tissues and deliver their payload to the targeting location of the plant to achieve the intended results for environmental monitoring and pollution resistance. In this perspective, the classification and biological activities of different NPs on agroecosystem are focused. Furthermore, absorption, transport, and modification of NPs in plants were thoroughly examined. Some of the most promising new technologies e.g., nanotechnology to increase crop agricultural input efficiency and reduce biotic and abiotic stresses are also discussed. Potential development and implementation challenges were explored, highlighting the importance of using a systems approach when creating suggested nanotechnologies.

Evaluation of cytotoxicity and genotoxicity effects of refractory pollutants of untreated and biomethanated distillery effluent using Allium cepa.

Environmental pollution caused by the discharge of raw and partly treated distillery effluent has become a serious and threatening problem due to its high pollution load. The aim of the present study was to assess the physicochemical load in alcohol distillery effluent before and after biomethanation treatment and the cyto- and genotoxicity effects of refractory pollutants emanated in raw/untreated and biomethanated distillery effluent on the ultrastructural and biochemical responses of Allium cepa root tip cells. Physicochemical analysis revealed high biochemical oxygen demand (BOD: 47840-36651 mg L-1), chemical oxygen demand (COD: 93452-84500 mg L-1) and total dissolved solids (TDS: 64251-74652 mg L-1) in raw and biomethanated effluent along with metal(loid)s (Fe: 456.152-346.26; Zn: 1.654-1.465; Cu: 0.648-0.562; Ni: 1.012-0.951, and Pb: 0.264 mg L-1) which were beyond the safe discharge values prescribed by the environmental regulatory agencies. The UV-Visible and Fourier transform infrared spectrophotometry analyses confirmed the high levels of organic, inorganic, and mixed contaminants discharged in raw and biomethanated distillery effluents. Furthermore, GC-MS analysis characterised chemical contaminants, such as hexadecanoic acid, butanedioic acid, bis(trimethylsilyl) ester; hexadecane, 2,6,11,15-tetramethyl, stigmasterol, and ß-sitosterol trimethylsilyl ether that have been reported as androgenic-mutagenic, and endocrine disrupting chemicals by the United States Environmental Protection Agency (U.S. EPA). The cytotoxicity measured by A. cepa showed dose depended inhibition root growth inhibition and simultaneous reduction in mitotic index in tested effluents. The chromosomal aberrations studies resulted in laggard chromosomes, sticky chromosomes, vagrant chromosomes, chromosome loss, c-mitosis, chromosome bridge, abnormal metaphase, and disturbed anaphase as found in a dose-dependent manner. Furthermore, dose-dependent enhancement in the levels of malondialdehyde, hydrogen peroxide, and antioxidative enzymes, such as superoxide dismutase, ascorbate peroxidase, and catalase were found to be higher in raw effluents treated root cells compared to biomethanated distillery effluent. Analysis of ultrastructural changes in root tip cells by TEM analysis revealed dramatic changes in the morphology of cell organelles and accumulation of metallic elements in and on the surface tissues. The results concluded that the discharged distillery effluents retained certain toxic pollutants which imposed cytotoxic and genotoxic hazards to A. cepa. Thus, for the sake of environmental protection, the raw as well as the disposed biomethanated effluent must be efficiently treated before its dumping into the terrestrial ecosystem.

Fractal and EMD based removal of baseline wander and powerline interference from ECG signals.

This paper presents novel methods for baseline wander removal and powerline interference removal from electrocardiogram (ECG) signals. Baseline wander and clean ECG have been modeled as 1st and 2nd-order fractional Brownian motion (fBm) processes, respectively. This fractal modeling is utilized to propose projection operator based approach for baseline wander removal. Powerline interference is removed by using a hybrid approach of empirical mode decomposition method (EMD) and wavelet analysis. Simulation results are presented to show the efficacy of both the methods. The proposed methods have been shown to preserve ECG shapes characteristic of heart abnormalities.