A Comparison Between Dexamethasone and Clonidine as Adjuvants to Levobupivacaine in the Supraclavicular Approach to the Brachial Plexus Block: A Double-Blind Study.

OBJECTIVE:  The objective of this clinical study is to compare the efficacy of adding dexamethasone or clonidine as an adjuvant drug to levobupivacaine in supraclavicular brachial plexus block (BPB) with regard to the onset and duration of sensory and motor blocks along with duration of postoperative analgesia. BACKGROUND:  Brachial plexus block (BPB), with or without general anesthesia, has been used widely for multiple upper limb surgical procedures, by virtue of its efficacy in terms of cost-effectiveness, efficiency, safety margins, and good postoperative analgesia. Various adjuvant drugs have been described to potentiate the analgesic effect of local anesthetic agents such as epinephrine, clonidine, dexamethasone, dexmedetomidine, or midazolam. MATERIALS AND METHODS: This is a prospective, randomized, double-blind study in which a total of 90 American Society of Anesthesiology (ASA) physical status I and II patients of either sex, aged between 18 and 60 years, were scheduled for elective upper limb surgical procedures under supraclavicular BPB. They were divided into three equivalent randomized groups with 30 patients in each group. The patients were administered either normal saline 2 mL (in group L) or clonidine 0.5 mcg/kg body weight (in group LC) or dexamethasone 8 mg (in group LD) with 30 mL of 0.5% levobupivacaine. The time of onset and duration of sensory and motor blockades along with the time duration of analgesia were compared. RESULTS: All groups were equivalent as per demographic data. The time duration for onset of sensory and motor blocks was comparable among all three included groups (12.77±2.60 minutes and 20.80±3.25 minutes, 15.93±2.08 minutes and 22.43±3.07 minutes, and 12.57±2.62 minutes and 22.47±3.10 minutes for group L, LC, and LD, respectively). The time duration of analgesia and motor blockade was significantly prolonged in the dexamethasone group (1195.33±50.01 minutes and 1173.17±43.57 minutes) and moderately prolonged in the clonidine group (696.33±36.74 minutes and 674.67±34.33 minutes) when compared to levobupivacaine group (416.33±35.98 minutes and 397.00±35.12 minutes), and the difference was statistically significant (p<0.001). CONCLUSION:  Dexamethasone appears to be a superior adjuvant drug to clonidine for brachial plexus block via supraclavicular approach as it provides prolonged duration of motor block with lesser requirement of postoperative analgesia and lack of adverse effects.

Burden, Differentials and Causes of Stillbirths in India: A Systematic Review and Meta Analysis.

India contributes the highest absolute number of stillbirths in the world. This systematic review and meta-analysis was conducted to synthesize the burden, timing and causes of stillbirths in India. Forty-nine reports from 46 studies conducted in 21 Indian states and Union Territories were included. It was found that there was no uniformity/standardization in the definition of stillbirths and in the classification system used to assign the cause. The share of antepartum stillbirths was estimated to be two-third while remaining were intrapartum stillbirths. Maternal conditions and fetal causes were found to be the leading cause of stillbirth in India. The maternal condition was assigned as the commonest cause (25%) followed by fetal (14%), placental cause (13%), congenital malformation (6%) and intrapartum complications (4%). Approximately 20% of the stillbirths were assigned as unknown or unexplained. This review demonstrates that there is a paucity of quality stillbirth data in India. Other than the state level differences in stillbirth rates, no other data is available on inequities in stillbirths in India. There is an urgent need for strengthening availability and quality of stillbirth data in India on both stillbirth rates as well as the causes. There is a need to conduct additional research to know the timing of the stillbirths, causes of death and actual burden. India needs to strengthen stillbirth audits along with registry to find out the modifiable factors and delays for making country specific preventive strategies. The policy makers, academic community and researchers need to work together to ensure accelerated and equitable reduction in stillbirths in India.

Comparative In Vitro Anticancer Study of Cisplatin Drug with Green Synthesized ZnO Nanoparticles on Cervical Squamous Carcinoma (SiHa) Cell Lines.

In this article, we aimed to develop a unique treatment approach to cure cervical cancer without harming healthy normal cells and overcome the limitations of currently available therapies/treatments. Recently, chemotherapeutics based on metal oxides have gained attention as a promising approach for treating cancer. Herein, ZnO nanoparticles were synthesized with the leaf extract of Azadirachta indica. These green synthesized ZnO nanoparticles were used for a cytotoxic study on the cervical squamous carcinoma cell line SiHa and murine macrophage cell line RAW 264.7. Moreover, a hemolytic assay was performed to check the biocompatibility of ZnO nanoparticles. The biosynthesized ZnO nanoparticles were labeled as L1, L2, L5, and L10 nanoparticles. Various assays like crystal violet, MTT assay, and AO/PI dual staining method were performed to assess the anticancer potential of ZnO. The concentration of ZnO nanoparticles was taken in the range of 100-250 µg/mL in the in vitro anticancer study on SiHa cancer cell lines. The findings of the MTT assay revealed that biosynthesized ZnO nanoparticles exhibited significant cytotoxicity against SiHa cancer cell lines dose-dependently at two incubation times (24 and 48 h). Also, a decrease in cell viability was observed with an increased concentration of ZnO. The IC50 values obtained were 141 µg/mL for L1, 132 µg/mL for L2, 127 µg/mL for L5, and 115 µg/mL for L10 nanoparticles. In addition, cisplatin drug (10 µg/mL) was also used to compare the anticancer activity with the biosynthesized L1, L2, L5, and L10 nanoparticles. The results of the crystal violet assay and AO/PI dual staining method revealed that morphological changes like cell shrinkage, poor cell adhesion, and induction of apoptosis occurred in the SiHa cancer cell lines. Furthermore, the stability of the ZnO nanoparticles at physiological pH has been assessed by recording the UV-visible spectrum at various pH values. Hence, the overall findings suggested that biosynthesized ZnO nanoparticles can be utilized for cervical squamous cancer treatment in addition to the current treatment strategies/techniques.

A review on degradation of organic dyes by using metal oxide semiconductors.

The discharge of organic dye pollutants in natural water bodies has put forward a big challenge of providing clean water to a large part of the population. As the population is increasing with time, only underground water is not sufficient to complete the water requirements of everyone everywhere. Purification of wastewater and its reuse is the only way to fulfill the water needs. Nanotechnology has been used very efficiently for wastewater treatment via photocatalytic degradation of dye molecules. In the past few years, a lot of investigations have been done to enhance the photocatalytic activity of metal oxide semiconductors for water purification. In this review, we have discussed the different methods of synthesis of various metal oxide semiconductor nanoparticles, energy band gap, their role as efficient photocatalysts, radiations used for photocatalytic reactions, and their degradation efficiency to degrade the dye pollutants. We have also discussed the nanocomposites of metal oxide with graphene. These nanocomposites have been utilized as the efficient photocatalyst due to unique characteristics of graphene such as extended range of light absorption, separation of charges, and high capacity of adsorption of the dye pollutants.

Coupling ZnO with CuO for efficient organic pollutant removal.

Fabrication of heterojunction semiconductors for the photodegradation of toxic organic dyes under sunlight exposure has earned significant recognition from researchers nowadays. On that account, we have synthesized and explored a comparative photodegradation study of ZnO/CuO nanocomposite with ZnO and CuO nanoparticles. ZnO and CuO nanoparticles have been synthesized by biosynthesis methods using Ficus benghalensis leaf extract. As-synthesized ZnO and CuO nanoparticles have been further utilized for the synthesis of ZnO/CuO nanocomposite by the mortar pestle crushing/milling method. Both biosynthesis methods and mortar pestle crushing/milling methods are simple, low-cost, and environmentally friendly. Structural, optical, and morphological analysis of all the synthesized nanomaterials have been done by powder X-ray diffraction (PXRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), Brunauer-Emmett-Teller (BET), field emission scanning electron microscopy (FESEM), energy-dispersive spectroscopy (EDS), fourier transform infrared spectroscopy (FTIR), and UV-visible spectroscopy. PXRD data reveal that synthesized ZnO nanoparticles are in the hexagonal wurtzite phase, CuO nanoparticles in the monoclinic phase, and ZnO/CuO nanocomposite in the hexagonal wurtzite as well as in monoclinic phase. FE-SEM and TEM images of ZnO/CuO nanocomposite reveal the nanorod-shaped morphology along with micro-sized and nano-sized flakes. The BET analysis shows the surface areas 18.128 m2/g for ZnO nanoparticles, 16.653 m2/g for CuO nanoparticles, and 19.580 m2/g for ZnO/CuO nanocomposite, respectively. The energy band gap values of ZnO/CuO nanocomposite are obtained 3.13 eV for ZnO and 2.76 eV for CuO, respectively. The photocatalytic behaviors of all the synthesized nanomaterials are examined against aqueous dye solutions of methylene blue (MB), rhodamine B (RhB), and methyl orange (MO) under sunlight irradiation. The results reveal that the photocatalytic degradation efficiency of ZnO/CuO nanocomposite has been found higher than with ZnO and CuO nanoparticles for all the dyes. Also, all the synthesized nanomaterials indicate higher photocatalytic degradation efficiency for methylene blue dye among all three dyes. The kinetics of photodegradation of all the dye solutions has also been investigated in the presence of ZnO, CuO, and ZnO/CuO photocatalysts separately. The results exhibit that rate constant values for all the dyes are higher with ZnO/CuO nanocomposite than with ZnO and CuO nanoparticles. ZnO/CuO nanocomposite demonstrates degradation efficiency for MB dye 99.13%, for RhB 80.21%, and for MO 67.22% after 180 min of sunlight exposure. ZnO/CuO nanocomposite and ZnO and CuO nanoparticles also show the best reusability and stability up to three cycles for photocatalytic degradation of MB dyes among all the dyes. Therefore, green synthesized ZnO/CuO nanocomposite could be used as an efficient photocatalyst for the degradation of various toxic dyes. The mineralization of different dyes using ZnO/CuO nanocomposite has been examined by FTIR analysis. Furthermore, the mineralization of MB dye has been done by total organic carbon (TOC) measurements.

Synthesis and characterization of NiO/Cr2O3 nanocomposite with effective sunlight driven photocatalytic degradation of organic dyes.

In this paper, nanocomposite NiO/Cr2O3 has been synthesized by a simple chemical reduction method to study its photocatalytic activity under sunlight irradiation. Various advanced analytical techniques including powder X-ray diffraction (PXRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy-dispersive spectroscopy (EDS), elemental mapping, Fourier transform infrared spectroscopy (FTIR), and UV-visible spectroscopy have been utilized to characterize the synthesized NiO/Cr2O3 nanocomposite. SEM images show the sheet-shaped morphology of NiO/Cr2O3 nanocomposite. These sheets have a rough surface with nano to micro size cracks. These cracks play important role in the enhancement of photocatalytic activity by increasing surface active sites for the adsorption of dye molecules on the surface of the photocatalyst. The organic dyes crystal violet (CV) and methylene blue (MB) have been chosen to study the photocatalytic behavior of NiO/Cr2O3 nanocomposite under sunlight irradiation. The photocatalytic efficiency of NiO/Cr2O3 nanocomposite has been obtained 88.47% and 93.63% against crystal violet and methylene blue respectively. The results of the photocatalytic kinetics exhibit that degradation rate constant value for crystal violet dye is higher as compared to methylene blue dye. Obtained kinetic results indicate that synthesized nanocomposite acts as an efficient photocatalyst for the degradation of both crystal violet dye and methylene blue dye. NiO/Cr2O3 nanocomposite also exhibited reusability and stability for photocatalytic degradation of both organic dyes. Photoelectrochemical measurements as photocurrent, electrochemical impedance spectroscopy (EIS), and Mott-Schottky plot were also performed for synthesized NiO/Cr2O3 nanocomposite. Consequently, this synthesized NiO/Cr2O3 nanocomposite can be utilized for environmental remediation of harmful dyes.

Immediate Dental Implants Enriched with L-PRF in the Esthetic Zone.

The aim of this article is to present the clinical application of immediate implant placement with L-PRF and immediate prosthetic loading in anterior esthetic region. A 24-year-old healthy female patient reported with a chief complaint of poor esthetics in the upper front tooth region with retained deciduous teeth. On oral examination, there were retained deciduous teeth (52, 53, and 63) with congenitally missing permanent successors. The retained deciduous teeth were extracted, and immediate implant placement was done in the extraction sockets along with L-PRF membranes in one surgical session under local anesthesia. Immediate temporization was performed with composite crowns on immediately placed dental implants. After 3 months of the healing period, the final implant-level impressions were made and the temporary composite crowns were replaced with the final zirconia porcelain crowns. A 12-month follow-up was made, and satisfactory esthetic and functional results were obtained.

Determination of pesticide and phthalate residues in tea by QuEChERS method and their fate in processing.

In this study, the quick, easy, cheap, effective, rugged, and safe (QuEChERS) method was applied for the analysis of the multiclass pesticide residues of 12 organochlorines (OCs), 9 organophosphates (OPs), 11 synthetic pyrethroids (SPs), 4 herbicides, 6 phthalates in raw tea (loose tea, branded tea and herbal tea), and tea infusion in 4 different containers (glass cup, earthen cup, plastic bag and disposal cup). In loose tea and branded tea residues, malathion (0.257 and 0.118 mg kg-1), cypermethrin (0.065 and 0.030 mg kg-1), and fenvalerate (0.032 and 0.030 mg kg-1) were detected, respectively. In herbal tea, residues of only cypermethrin (0.053 mg kg-1) and fenvalerate (0.045 mg kg-1) were detected. Tea infusion samples contained in a plastic bag were found to be contaminated with only dibutyl phthalate (DBP) (0.038 mg kg-1). Disposable cup was found to be contaminated with DBP (0.026 mg kg-1) and diethyl phthalate (DEP) (0.004 mg kg-1). Further, to know the processing behavior of pesticides, the spiked raw tea was subjected to tea infusion at different brewing times (2, 5, 10 min). The analysis demonstrated that dimethoate, dichlorvos, and malathion had shown more than 10 % of translocation at 5 min of brewing time. Further brewing for 10 min revealed the reduction in concentration of pesticides. Leaching of phthalate residues from different plastic containers was also studied at 10, 30, and 60 min. DBP, benzyl butyl phthalate (BzBP), and di-2-(ethylhexyl) phthalate (DEHP) were leached in the tea infusion samples packed in plastic bags. On the other hand, in disposable cups, leaching of DBP, DEP, and dimethyl phthalate were found. The concentration of phthalate residues increased with retention time. Pesticide and phthalate contaminants were recorded at low quantities in few samples only.

Ventilating Patient with Refractory Hypercarbia: Use of APRV Mode.

A 70-year-old patient referred to our critical care unit with the diagnosis of type II respiratory failure with shock. Patient was a known case of COPD for last 20 years. His chest radiology revealed bilateral infiltrates. Patient was managed conservatively in the form of antibiotics, vasopressor and ventilatory support with SIMV/VC mode. After ventilation with SIMV/VC mode for half an hour his blood gases revealed increasing PaCO2 levels. The same result was obtained with PC mode and ASV and his PaCO2 level reached above 170 mmHg. Then APRV mode was tried with modified settings. The results obtained were satisfactory and in next 24 hours PaCO2 decreased to <66mmHg along with an increasing P/F ratio. APRV is the not recommended as primary mode of ventilation in COPD but in resistant cases it can be helpful as it improves alveolar recruitment and pressure support is added to reduce hypercapnia.

Nucleation temperature-controlled synthesis and in vitro toxicity evaluation of L-cysteine-capped Mn:ZnS quantum dots for intracellular imaging.

Quantum dots (QDs), one of the fastest developing and most exciting fluorescent materials, have attracted increasing interest in bioimaging and biomedical applications. The long-term stability and emission in the visible region of QDs have proved their applicability as a significant fluorophore in cell labelling. In this study, an attempt has been made to explore the efficacy of L-cysteine as a capping agent for Mn-doped ZnS QD for intracellular imaging. A room temperature nucleation strategy was adopted to prepare non-toxic, water-dispersible and biocompatible Mn:ZnS QDs. Aqueous and room temperature QDs with L-cysteine as a capping agent were found to be non-toxic even at a concentration of 1500 µg/mL and have wide applications in intracellular imaging.