Cleft lip and palate surgery simulator: Open source simulation model.

Objective: Cleft lip and palate is the most common craniofacial birth anomaly and requires surgery in the first year of life. However, craniofacial surgery training opportunities are limited. The aim of this study was to present and evaluate an open-source cleft lip and palate hybrid (casting and three-dimensional (3D) printing) simulation model which can be replicated at low cost to facilitate the teaching and training of cleft surgery anatomy and techniques. Design: The soft tissue component of the cleft surgery training model was casted using a 3D printed 5-component mold and silicone. The bony structure was designed to simulate the facial anatomy and to hold the silicone soft tissue. Setting: Two groups, one group of trainees and one group of expert surgeons, at University Hospital Basel in Switzerland and Pontifical Catholic University of Chile in Santiago, Chile, tested the cleft lip and palate simulation model. Participants completed a Likert-based face and content validity questionnaire to assess the realism of the model and its usefulness in surgical training. Results: More than 70 % of the participants agreed that the model accurately simulated human tissues found in patients with unilateral cleft lip and palate. Over 60 % of the participants also agreed that the model realistically replicated surgical procedures. In addition, 80-90 % of the participants found the model to be a useful and appropriate tool for teaching the anatomy and surgical techniques involved in performing unilateral cleft lip and palate repair. Conclusion: This open-source protocol provides a cost-effective solution for surgeons to introduce the cleft morphology and surgical techniques to trainees on a regular basis. It addresses the current financial barrier that limits access to commercially available models during the early stages of surgeon training prior to specialization in the field.

Níveis de conscientização da comunidade rural, desafios e estratégias adotadas para combater o COVID-19: uma e-survey transversal / Rural community awareness levels, challenges and strategies adopted to combat COVID-19: A cross-sectional E-survey

COVID-19 tem um efeito generalizado nas economias rurais em todo o mundo. Tem afetado a renda familiar e os negócios em todos os setores das economias rurais. O lockdown devido ao surto de COVID-19 limita a atividade física regular e ao ar livre, e ainda pode levar a um risco aumentado de condições crônicas de saúde. A atividade física e a ioga desempenham papel vital para quebrar o tédio causado pelo lockdown e, assim, podem melhorar a qualidade de vida. OBJETIVO: Identificar o nível de consciência e desafios enfrentados pelas pessoas de comunidades rurais devido ao surto COVID-19. MATERIAIS E MÉTODOS: Um total de 36 participantes foram recrutados pelo método de amostragem de conveniencia de cinco aldeias diferentes no Distrito, Ambala, Haryana, Índia. Os questionários da pesquisa eletrônica foram distribuídos por meio do aplicativo móvel de mensagens WhatsApp. O questionário foi elaborado incorporando a escala Likert de três pontos com três domínios, 1) Conscientização, 2) Desafios e, 3) Estratégias e 12 itens. A validação do questionário foi realizada pelos juízes por meio do método Delphi survey até S-CVI / Ave > 0,8. A tendência central e a dispersão da variável contínua idade foram expressas em média com intervalo de confiança (IC) de 95%. Os dados categóricos foram relatados em frequências, porcentagem (%) e tamanho da amostra (n). Os níveis de significância foram estabelecidos em 0,05 para minimizar o erro Tipo 1. RESULTADOS: Índice de validade de conteúdo do questionário, S-CVI / Ave = 0,90. Ao entrar em contato com 36 participantes em potencial, um total de 27 respostas da pesquisa foram registradas. Consequentemente, a taxa de resposta (RR) foi encontrada em 75%. A média com IC de 95% de idade foi de 30,8 (27,3; 34,3) anos. Um total de 94% (n = 25) dos moradores estavam cientes do COVID-19, 88% (n = 24) estavam enfrentando desafios e 86% (n = 23) dos participantes estavam adotando as melhores estratégias que incluem, de zona de contenção, uso de máscara artesanal composta de roupas, consumo de fitoterápicos tradicionais como potenciadores de imunidade para profilaxia e envolvimento em atividade física regular e ioga . CONCLUSÃO: As populações rurais que está ciente de COVID-19 e ter conhecimento adequado sobre COVID-19. Eles estavam enfrentando desafios devido ao COVID-19 e preparados com as melhores estratégias / métodos de combate ao COVID-19.

COVID-19 has a widespread effect on rural economies all over the world. It has affecting household incomes, and businesses in every sector of rural economies. Lockdown due to COVID-19 outbreak limiting the outdoor and regular physical activity, and further can leads to increased risk of chronic health conditions. Physical activity and yoga play a vital role in breaking the boredom due to COVID-19 lockdown and thereby, improves the quality of life. OBJECTIVE: To identifying the level of awareness and challenges faced by the people of rural communities due to the COVID-19 outbreak. MATERIALS AND METHODS: A total of 36 participants were recruited by convenient sampling method from five different villages in District, Ambala, Haryana, India. E-survey questionnaires were circulated through WhatsApp messaging mobile-based application. The questionnaire was formed incorporating the three-point Likert scale with three domains, 1) Awareness, 2) Challenges and, 3) Strategies and 12 items. The questionnaire validation was carried out by the experts through Delphi survey method until S-CVI/Ave > 0.8. The central tendency and dispersion of continuous variable age were expressed in mean with a 95% confidence interval (CI). Categorical data were reported in frequencies as a percentage (%) and sample size (n). The levels of significance were set at 0.05 to minimize Type 1 error. RESULTS: The content validity index of the questionnaire, S-CVI/Ave = 0.90. By contacting 36 potential participants, a total of 27 survey responses were recorded. Hence, the response rate (RR) was found to be 75%. The mean with 95% CI of age was 30.8 (27.3 to 34.3) years. A total of 94% (n=25) of villagers were aware of COVID-19, 88% (n=24) were facing challenges, and 86% (n=23) of participants are adopting the best strategies which includes, sealing of containment zone, usage of homemade mask made up of clothes, consuming traditional herbal medicine as immunity boosters for prophylaxis and involving in regular physical activity and yoga. CONCLUSION: The rural populations were aware of COVID-19 and having adequate knowledge about COVID-19. They were facing challenges due to COVID-19 and prepared with the best strategies/methods to combat COVID-19.

Ensaio clínico randomizado: padrão ouro de desenhos experimentais - importância, vantagens, desvantagens e preconceitos / Randomized clinical trial: gold standard of experimental designs - importance, advantages, disadvantages and prejudice

Ensaios clínicos randomizados (ECR) são o padrão ouro para desenho experimental de estudo ou ensaio clínico. Apenas por meio de uma investigação do tipo ECR é possível avaliar e demonstrar a relação de causa-e-efeito entre um conjunto de variáveis independentes e dependentes. O ECR adicionou vantagens em relação aos outros modelos experimentais, principalmente devido à presença de um grupo controle. Existem várias críticas à validade interna das pesquisas em saúde, incluindo preconceitos e desvantagens que são apontadas para seu descrédito. OBJETIVO: O objetivo do presente estudo é informar características, vantagens, desvantagens e desvios deste método científico. MATERIAL E MÉTODOS: Análise crítica de método científico com base em revisão narrativa da literatura. Foi consultada a base de dados Medline por meio dos portais PubMed e Scopus, sem data de início e até julho de 2020, para extração das informações relativas aos ECR. Apenas artigos de língua inglesa foram incluídos, usando as palavras-chave "estudo randomizado controlado", "ensaio clínico randomizado", "projeto experimental" e "estudo experimental", intercaladas pelos operadores booleanos "AND ," "OR" e "NOT". Anais de conferências e resumos não foram considerados para a análise dos dados. RESULTADOS: Dos ECR selecionados, foram extraídas características, vantagens, desvantagens, importância e vantagens dos controles em pesquisa, o princípio de equilíbrio, ensaios clínicos randomizados na população pediátrica, ECR na população geriátrica, ameaças à validade interna e medidas para minimização de viéses e preconceitos em ECR. CONCLUSÃO: Tópicos relevantes dos ECR foram explicados nesta revisão que devem guiar pesquisadores clínicos.

Randomized controlled trial (RCT) is the gold standard of experimental design or clinical trial design. Only by RCT in research, the cause-and-effect relationship between a set of independent and dependent variables could be demonstrated. RCT has added advantages over other experimental designs due to the presence of the control group. The importance of control in health research trials and its advantages to be elaborated. Though various threats to internal validity in health research trials could be minimized by RCT, various biases in RCT and disadvantages add to its discredit. OBJECTIVE: The aim of the present narrative review is to brief the characteristics, advantages, disadvantages, and various biases in RCT. METHODS: This review does not follow the PRISMA statement, as it was a narrative review. Two databases, namely, Medline through PubMed and Scopus, were searched from inception to July 2020 for the information pertaining to RCTs and included in this narrative review. Only English language articles were searched with the keywords, "Randomized controlled trial," "Randomized clinical trial," "experimental design," and "experimental study." These keywords are linked together by the Boolean words, "AND," "OR" and "NOT." Conference proceedings and only abstracts were not considered for the review. RESULTS: RCTs were explained under characteristics, advantages, disadvantages, importance, and advantages of controls in research, the principle of equipoise, RCTs in the pediatric population, RCTs in the geriatric population, threats to internal validity and steps to minimize them and various biases in RCTs. CONCLUSION: The narrative presentation of RCTs under various important topics have been explained in this review.

Mending aesthetics in anterior region - A case report

Lately esthetic rehabilitation has come to be a demanding treatment as a way to correct malposed as well as missing anterior dentition, the advent of creating an esthetic smile has become a part of routine dental practice. An attractive or appealing smile sincerely enhances the recognition of an individual in our society with the aid of enhancing the initial impact in interpersonal relationships. Any esthetic correction calls for right expertise and knowledge. Such rehabilitation can be achieved successfully with the aid of numerous treatment approaches. Orthodontic treatment is one of the most conservative approach for such cases but it is not an acceptable treatment option for most of the patients due to various reasons like long treatment time, financial constraints, appearance during the therapy, and relapse after the treatment. Alternatively, endodontic approach combined with prosthodontics offers a brief, reliable and economic treatment modality for such cases. Placement of implants has also become a treatment of choice for replacement of teeth in esthetic zone with advantages like preservation of unrestored adjacent teeth and halting the resorption of edentulous spaces to provide support for the prosthesis. This case report illustrates the multidisciplinary approach for rehabilitating aesthetics in anterior region.

Efectos del tratamiento homeopático individualizado en la hipertensión esencial de estadio I: ensayo aleatorizado, simple ciego, controlado con placebo / Effects of Homeopathic Treatment Individualized in Hypertension Stage I Essential: Randomized Trial, Single Blind, Placebo controlled

Fundamentos: la hipertensión arterial es el cuarto principal factor de riesgo de muerte e incapacidad, así como el responsable de más de 1.6 millones de fallecimientos en la India. Los informes de casos clínicos, los estudios observacionales y los ECA evidencian los efectos de los medicamentos homeopáticos en la hipertensión. Objetivos: los resultados de este estudio se añaden a la evidencia de la eficacia del uso de los medicamentos homeopáticos individualizados en la hipertensión de estadio I. Materiales y métodos: Se ha realizado un ensayo aleatorizado, simple ciego y controlado por placebo entre octubre de 2013 y marzo de 2018. El parámetro primario fue evaluar los cambios en la presión sistólica (PS) y la presión diastólica (PD) mensualmente durante tres meses. 217 pacientes de los 2,127 pacientes examinados cumplieron los criterios de selección y fueron aleatorizados para recibir un medicamento en potencias Q (o potencias LM) más indicaciones para la modificación del estilo de vida (MEV) (116 pacientes) o bien placebo + MEV (101 pacientes). La modificación del estilo de vida incluyó actividad física y dieta como parte de la pauta terapéutica. El análisis fue de intención de tratamiento. Resultados: Las mediciones ANOVA repetidas entre los grupos mostraron una diferencia estadística significativa (Lambda de Wilks 0.85, F=12.12, dF=213, P=0.0001) tanto en la PS como en la PD a favor de la Homeopatía individualizada. La prueba t independiente post hoc mostró una reducción media significativa de la PS [diferencia media 7.12 mmHg, IC del 95%; CI 4.72 a 9.53, P=0.0001] y un descenso medio de la PD [diferencia media 5.76 mmHg, IC del 95%: 4.18 a 7.23, P=0.0001] a favor del grupo con Homeopatía más MEV. Los medicamentos más utilizados fueron: Sulphur (n=24), Natrium muriaticum (n=21), Lycopodium (n=16), Nux vomica (n=12) y Phosphorus (n=10). Conclusiones: Se ha constatado que la Homeopatía individualizada junto con la MEV fue más eficaz que el placebo junto con la MEV en los pacientes que sufren hipertensión en estadio I. Se precisan más ensayos en un marco estricto. (AU)

Background: Hypertension (HTN) is a leading risk factor for death and disability and responsible for over 1.6 million deaths in India. Clinical case reports, observational studies and randomised controlled trials show the effects of homoeopathic medicine in HTN. Objectives: The results of this study will add to the evidence of effectiveness of individualised homoeopathic medicine in Stage I HTN. Methods: A single-blind, randomised, placebocontrolled trial was undertaken from October 2013 to March 2018. The primary outcome measure was to evaluate the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) every month for 3 months. Of 2,127 patients screened, 217 patients who fitted the inclusion criteria were randomised to receive either homoeopathic Q potencies (or LM potencies) plus lifestyle modification (LSM)=116 or placebo + LSM=101. LSM included physical activity and diet as part of the treatment regimen. Analysis was by intention to treat. Results: Repeated-measure ANOVA between the groups showed statistically significant difference (Wilk lambda 0.85, F=12.12, df=213, P=0.0001), in both SBP and DBP favouring Individualised Homoeopathy (IH) along with LSM. Post hoc independent t-test showed a significant mean reduction in SBP (mean difference 7.12 mmHg, 95% confidence interval [CI] 4.72-9.53, P=0.0001) and DBP (mean difference 5.76 mmHg, 95% CI: 4.18-7.23, P=0.0001) favouring Homoeopathy plus LSM group. Sulphur (n=24), Natrum muriaticum (n=21), Lycopodium (n=16), Nux vomica (n=12) and Phosphorus (n=10) were the most useful medicines. Conclusion: IH in LM potency along with LSM was found effective over placebo along with LSM in the patients suffering from Stage I HTN. Further trials in rigorous setting are warranted. (AU)

Infant Formula Feeding Increases Hepatic Cholesterol 7α Hydroxylase (CYP7A1) Expression and Fecal Bile Acid Loss in Neonatal Piglets.

Background: During the postnatal feeding period, formula-fed infants have higher cholesterol synthesis rates and lower circulating cholesterol concentrations than their breastfed counterparts. Although this disparity has been attributed to the uniformly low dietary cholesterol content of typical infant formulas, little is known of the underlying mechanisms associated with this altered cholesterol metabolism phenotype. Objective: We aimed to determine the molecular etiology of diet-associated changes in early-life cholesterol metabolism with the use of a postnatal piglet feeding model. Methods: Two-day-old male and female White-Dutch Landrace piglets were fed either sow milk (Sow group) or dairy-based (Milk group; Similac Advance powder) or soy-based (Soy group; Emfamil Prosobee Lipil powder) infant formulas until day 21. In addition to measuring serum cholesterol concentrations, hepatic and intestinal genes involved in enterohepatic circulation of cholesterol and bile acids were analyzed by real-time reverse-transcriptase polymerase chain reaction and Western blot. Bile acid concentrations were measured by liquid chromatography-mass spectrometry in serum, liver, and feces. Results: Compared with the Sow group, hepatic cholesterol 7α hydroxylase (CYP7A1) protein expression was 3-fold higher in the Milk group (P < 0.05) and expression was 10-fold higher in the Soy group compared with the Milk group (P < 0.05). Likewise, fecal bile acid concentrations were 3-fold higher in the Soy group compared with the Milk group (P < 0.05). Intestinal mRNA expression of fibroblast factor 19 (Fgf19) was reduced in the Milk and Soy groups, corresponding to 54% and 67% decreases compared with the Sow group. In the Soy group, small heterodimer protein (SHP) protein expression was 30% lower compared with the Sow group (P < 0.05). Conclusions: These results indicate that formula feeding leads to increased CYP7A1 protein expression and fecal bile acid loss in neonatal piglets, and this outcome is linked to reduced efficacy in inhibiting CYP7A1 expression through FGF19 and SHP transcriptional repression mechanisms.

Synergistic activity of doped zinc oxide nanoparticles with antibiotics: ciprofloxacin, ampicillin, fluconazole and amphotericin B against pathogenic microorganisms.

Combination therapy of antibiotics and nanoparticles can be used against multi drug resistant microorganisms. Nanoparticles (NPs) have been reported to show antimicrobial activity. The antimicrobial activities of doped ZnO nanoparticles (ZnO NPs) were studied against fungi, gram-positive and gram-negative bacteria using the standard microdilution method. The interaction between the nanoparticle and the antibiotic was estimated by calculating the fractional inhibitory concentration (FIC index) of the combination through checkerboard assay. Experimental results demonstrated that 10% doped zinc oxide nanoparticles (ZnO NPs) exhibited the maximum antimicrobial effect in contrast with that of the 1% loading and pure ZnO nanoparticles. The enhancement in antimicrobial effect was seen when combined with antibiotic. Synergistic and additive effects were found. No antagonistic effect was found. More synergistic effect was observed when combined with ciprofloxacin than ampicillin. Fungus showed only additive effect. The results are quite in terms with MIC clearly depicting that high doping agent is most suitable for combined therapy. 100% synergistic interaction was observed in higher doping with both ciprofloxacin and ampicillin. This study provides a preliminary report of the synergistic activity of nanoparticles with antibiotics against different pathogenic strains. This provides groundwork for further studies on the combination therapy of nanoparticles with antibiotics.

Assessment and Analysis of QuikSCAT Vector Wind Products for the Gulf of Mexico: A Long-Term and Hurricane Analysis.

The northern Gulf of Mexico is a region that has been frequently impacted in recent years by natural disasters such as hurricanes. The use of remote sensing data such as winds from NASA's QuikSCAT satellite sensor would be useful for emergency preparedness during such events. In this study, the performance of QuikSCAT products, including JPL's latest Level 2B (L2B) 12.5 km swath winds, were evaluated with respect to buoy-measured winds in the Gulf of Mexico for the period January 2005 to February 2007. Regression analyses indicated better accuracy of QuikSCAT's L2B DIRTH, 12.5 km than the Level 3 (L3), 25 km wind product. QuikSCAT wind data were compared directly with buoy data keeping a maximum time interval of 20 min and spatial interval of 0.1° (≈10 km). R² values for moderate wind speeds were 0.88 and 0.93 for L2B, and 0.75 and 0.89 for L3 for speed and direction, respectively. QuikSCAT wind comparisons for buoys located offshore were better than those located near the coast. Hurricanes that took place during 2002-06 were studied individually to obtain regressions of QuikSCAT versus buoys for those events. Results show QuikSCAT's L2B DIRTH wind product compared well with buoys during hurricanes up to the limit of buoy measurements. Comparisons with the National Hurricane Center (NHC) best track analyses indicated QuikSCAT winds to be lower than those obtained by NHC, possibly due to rain contamination, while buoy measurements appeared to be constrained at high wind speeds. This study has confirmed good agreement of the new QuikSCAT L2B product with buoy measurements and further suggests its potential use during extreme weather conditions in the Gulf of Mexico.