Comparison of topical purslane & topical 0.1% triamcinolone acetonide in the management of oral lichen planus - a double blinded clinical trial.

AIM AND BACKGROUND: Oral lichen planus (OLP) is a chronic autoimmune mucocutaneous disorder of unknown etiology and treatment is targeted at alleviating symptoms. At present, corticosteroids are the mainstay treatment, and their side effects hamper their long-term use, demanding alternative therapy. This study intended to assess the efficacy of topical purslane (Portulaca oleracea) at two concentrations, 5% and 10%, in OLP and to compare the level of clinical improvement in comparison to topical 0.1% triamcinolone acetonide gel. MATERIALS AND METHODS: After sample size determination, thirty-four subjects confirmed histopathologically with OLP were included in the study. They were divided into 3 groups, Group 1(Control) was treated with 0.1% triamcinolone acetonide, and Group 2(Case) and 3 (Case) were treated with topical purslane 5% and 10%, respectively. They were examined at baseline, 14 days, 30 days, 60 days, and 90 days. Clinical improvement was then analyzed at the end of 90 days using a visual analog scale (VAS) and Thongprasom's criteria. RESULTS: The study was analyzed statistically and a P value of < 0.05 was considered statistically significant. Intragroup comparison revealed a statistically significant difference between the five time periods (baseline, 14 days, 30 days, 60 days, and 90 days) for the study variables (burning sensation, pain, lesion score, clinical response, symptomatic response) for all three groups (p = 0.001). Alleviation of all symptoms and remission of the lesion were noted for all three groups at the end of three months. CONCLUSION: Purslane is a magical herb with a plethora of rich nutrients, ease in accessibility and devoid of side effects. It was concluded that its preparation is beneficial and can be a safer alternative long-term drug for the management of OLP. CLINICAL SIGNIFICANCE: With available literature evidence, our present study is the first of its kind to formulate a topical gel with purslane to treat symptomatic OLP. Our study had a longer follow-up of 3 months compared to other studies in the literature.

Characterization of Fourier Transform Infrared, Cavity Ring-Down Spectroscopy, and Optical Feedback Cavity-Enhanced Absorption Spectroscopy Instruments for the Analysis of Ammonia in Biogas and Biomethane.

Novel traceable analytical methods and reference gas standards were developed for the detection of trace-level ammonia in biogas and biomethane. This work focused on an ammonia amount fraction at an upper limit level of 10 mg m-3 (corresponding to approximately 14 µmol mol-1) specified in EN 16723-1:2016. The application of spectroscopic analytical methods, such as Fourier transform infrared spectroscopy, cavity ring-down spectroscopy, and optical feedback cavity-enhanced absorption spectroscopy, was investigated. These techniques all exhibited the necessary ammonia sensitivity at the required 14 µmol mol-1 amount fraction. A 29-month stability study of reference gas mixtures of 10 µmol mol-1 ammonia in methane and synthetic biogas is also reported.

Achilles Tendon Softness and Thickness in Patients With Hypercholesterolemia.

Background Hypercholesterolemia is a condition where blood levels of cholesterol are high. It is of two types: The first type is familial hypercholesterolemia, which is hereditary, and the second one is due to diseases like diabetes, thyroid, etc. Achilles tendon xanthomas are noted in both types of hypercholesterolemia, which can be used as an indicator that predicts early cardiovascular disease. The aim of the study is to estimate the Achilles tendon thickness (ATT) and softness among hypercholesterolemia patients and to find the correlation between ATT and total cholesterol. Methodology A hospital-based cross-sectional, analytical study was done in a tertiary care hospital, Salem, for eight months. Patients of age over 18 years of both sexes who came for screening of total cholesterol in the outpatient department were included in the study. Those patients with a history of previous leg injury involving the Achilles tendon were excluded from the study. A pre-structured questionnaire was used to collect the data, and analysis was done using Statistical Package for the Social Sciences (SPSS) v20 (IBM Corp., Armonk, NY). The analysts performed the Pearson correlation test to determine the correlation between two continuous variables. A p-value of less than 0.05 was used to indicate statistical significance. Results In this study, there are 40 participants in the normal group and about 60 participants in the secondary hypercholesterolemia group. The mean ATT value among males and females was 9.3 and 6.1 mm, respectively. A positive correlation was noted between the ATT and total cholesterol value (p-value = 0.0001). Conclusion The thickness and softness of the Achilles tendon are positively correlated with the serum total cholesterol level. Males are the group where this correlation is most significant. As a result, men have a higher risk of developing Achilles tendon thickening than women. The thickness of the Achilles tendon can therefore be one of the early signs of high cholesterol levels. The clinician can utilize this indicator to evaluate early abnormal cardiac illness.

Computational Investigation of Increased Virulence and Pathogenesis of SARS-CoV-2 Lineage B.1.1.7

New variants of SARS-CoV-2 are being reported worldwide. More specifically, the variants reported in South Africa (501Y.V2) and United Kingdom (B.1.1.7) were found to be more contagious than the wild type. There are also speculations that the variants might evade the host immune responses induced by currently available vaccines and develop resistance to drugs under consideration. The first step of viral infection in COVID-19, occurs through the interaction of receptor binding domain (RBD) of the spike protein with peptidase domain of the human ACE-2 (hACE-2) receptor. So, possibly the mutations in the RBD domain of spike protein in the new variants could modulate the protein-protein interaction with hACE-2 receptor leading to the increased virulence. In this study, we aim to get molecular level understanding into the mechanism behind the increased infection rate due to such mutations in these variants. We have computationally studied the interaction of the spike protein in both wild-type and B.1.1.7 variant with hACE-2 receptor using combined molecular dynamics and binding free energy calculations using molecular mechanics-Generalized Born surface area (MM-GBSA) approach. The binding free energies computed using configurations from minimization run and low temperature simulation show that mutant variant of spike protein has increased binding affinity for hACE-2 receptor (i.e. {Delta}{Delta}G(N501Y,A570D) is in the range -20.4 to -21.4 kcal/mol)The residue-wise decomposition analysis and intermolecular hydrogen bond analysis evidenced that the N501Y mutation has increased interaction between RBD of spike protein with ACE-2 receptor. We have also carried out calculations using density functional theory and the results evidenced the increased interaction between three pairs of residues (TYR449 (spike)-ASP38 (ACE-2), TYR453-HIE34 and TYR501-LYS353) in the variant that could be attributed to its increased virulence. The free energies of wild-type and mutant variants of the spike protein computed from MM-GBSA approach suggests that latter variant is stable by about -10.4 kcal/mol when compared to wild type suggesting that it will be retained in the evolution due to increased stability. We demonstrate that with the use of the state-of-the art of computational approaches, we can in advance predict the more virulent nature of variants of SARS-CoV-2 and alert the world health-care system.

Comparative Study of Laparoscopic versus Conventional Open Surgical Staging Procedure for Endometrial Cancer: Our Institutional Experience.

OBJECTIVE: The aim of this study was to compare laparoscopic surgical staging of endometrial cancer with conventional open methods. MATERIALS AND METHODS: The retrospective data were collected from 90 endometrial cancer patients who were operated between 2013 and 2018 in our government institution. The safety and morbidity of the two groups were compared based on mean operative time, blood loss, intraoperative complications, postoperative complication, etc., and the results were analyzed. Statistical analysis was performed using IBM SPSS statistics version 20. Clinical and pathologic factors were compared between two groups with Fisher's exact test and Student's t-test for data analysis. The survival data were analyzed using Kaplan-Meier survival curves. P < 0.05 was considered statistically significant. RESULTS: Thirty-two patients underwent laparoscopic staging, 45 underwent laparotomy, and 13 cases lap converted to open surgery. The mean operative time for the laparoscopic procedure was lower than the open procedure (P = 0.001). The mean hospital stay of patients who underwent laparoscopic staging was around 7.1 days significantly less compared to the laparotomy group. Intraoperative blood loss of patients undergoing laparoscopic surgery was significantly less than that of the laparotomy group (P = 0.015). There was no statistically significant difference in nodal retrieval between laparotomy and laparoscopy group (P = 0.172). The mean duration of hospitalization was statistically significantly greater in the laparotomy group than the laparoscopic group (13 and 7 days, P < 0.001). Based on the Kaplan-Meier survival curve, there was no difference in survival rates between the groups. Median follow-up duration was 32 months. CONCLUSION: Laparoscopic surgical staging is oncologically safe for the management of endometrial cancer with acceptable morbidity compared to the open approach with far less blood loss and shorter postoperative stay.

Proposed Guidelines for Treatment of Concomitant Distal Radius and Distal Ulna Fractures.

BACKGROUND: Concomitant distal radius and distal ulna metaphysis or head fractures (DRUF) are uncommon and acceptable results have been reported from cast immobilisation and internal fixation. METHODS: We reviewed the charts of 1094 patients treated for distal radius fracture at our institution in a two year period from 2009 to 2010. 24 patients with concomitant DRUF with were treated by cast immobilisation (group 1, n = 11), internal fixation of both bones (group 2, n = 7), internal fixation of radius alone (group 3, n = 2), and internal fixation of radius with distal ulna resection (group 4, n = 4). Patients treated by surgery underwent intraoperative assessment of distal ulna stability to determine the indication for ulna fixation. Post surgical range of motion, clinical parameters, and functional outcome scores (Gartland-Werley and modified Mayo) were measured. RESULTS: Wrist motion was comparable in each group. Radiographic parameters were better in surgical groups. 23 of 24 patients achieved excellent/good outcomes based on Gartland-Werley scores, while 12 of 24 achieved good modified Mayo wrist score. There was a case of distal ulna non-union in group 1, and another case of delayed distal radius union in group 2. CONCLUSIONS: By evaluating patients' functional requirement, and dynamic fluoroscopy examination, satisfactory outcomes can be achieved for various presentations of DRUF.

A novel method for measuring trace amounts of total sulphur-containing compounds in hydrogen.

A novel method for the analysis of total sulphur-containing impurities in a hydrogen matrix has been developed. This method has a limit of detection (LoD) significantly lower than that maximum amount fraction for sulphur-containing compounds (4 nmol mol(-1)) specified by the international standard for hydrogen to be used in fuel cell vehicles (ISO 14687-2). To measure the LoD for this method, a novel gas standard containing five different sulphur-containing compounds at low nmol mol(-1) amount fractions has been gravimetrically prepared. Stable primary gas standards that are traceable to the SI were used to successfully validate the amount fractions of the sulphur-containing compounds in this gas standards using gas chromatography with flame ionisation detection (GC-FID) and sulphur chemiluminescence detection (GC-SCD).

Cross-finger dermal pocketing to augment venous outflow for distal fingertip replantation.

Venous anastomosis in distal fingertip replantations is not always possible, and venous congestion is recognized as a potential cause of failure. Methods previously described to address this problem include amputate deepithelization and dermal pocketing postarterial anastomosis to augment venous outflow. However, attachment of the digit to the palm or abdomen resulted in finger stiffness. We describe a modification of the previous methods by utilizing dermal flaps raised from the adjacent digit in the form of a cross-finger flap. The key differences are the partial deepithelization of the replanted fingertip and subsequent replacement of the dermal flap to the donor digit to minimize donor site morbidity. During the period where the 2 digits are attached, interphalangeal joint mobilization is permitted to maintain joint mobility.

Preparation and validation of fully synthetic standard gas mixtures with atmospheric isotopic composition for global CO2 and CH4 monitoring.

We report the preparation and validation of the first fully synthetic gaseous reference standards of CO2 and CH4 in a whole air matrix with an isotopic distribution matching that is in the ambient atmosphere. The mixtures are accurately representative of the ambient atmosphere and were prepared gravimetrically. The isotopic distribution of the CO2 was matched to the abundance in the ambient atmosphere by blending (12)C-enriched CO2 with (13)C-enriched CO2 in order to avoid measurement biases introduced by measurement instrumentation detecting only certain isotopologues. The reference standards developed here have been compared with standards developed by the National Institute of Standards and Technology and standards from the WMO scale. They demonstrate excellent comparability.