Recent advances in continuous flow synthesis of heterocycles.

In the current scenario, flow chemistry is emerging as a significant technology in the field of organic synthesis. This miniaturized protocol including microreactors facilitates excellent heat transfer, low solvent wastage, lesser reaction time, a safer environment for reagent handling and appreciable yields of desired products. Thus, this "enabling technology" has a great scope in the synthesis and preparation of a variety of heterocycles that require toxic reagents as starting materials. This review discusses the recent advances (2020-2021) in continuous flow strategy for synthesis and derivatization of variety of heterocyclic entities, of different ring size, using different approaches. This also highlights the advantages of different combined techniques like Microwave assisted heating, electrochemical flow cell, LED light source, NMR and FT-IR analysis, etc., that enables utilization of various mechanisms and real-time monitoring of reactions leading to improved results.

Oral Health Consequences of Use of Smokeless Tobacco in North India: A Cross-Sectional Survey

ABSTRACT Objective: To evaluate the effects of commonly used smokeless tobacco forms on oral health at habitual placement sites of smokeless tobacco compared to non-placement sites among the North Indian population. Material and Methods: This cross-sectional study was conducted among 542 individuals using smokeless tobacco recruited from the outpatient wing of the Dental College. Subjects completed a questionnaire and received an oral examination. Periodontal pocket depth, gingival index, plaque index, gingival recession, and oral mucosal changes were assessed. Kendal's Tau test, paired t-test, and chi-square test were carried out to compare different variables among placement and non-placement sites. Results: Most of the subjects were male, reporting an average of 11.26 years of SLT use. Clinical inflammation of gingiva was significantly greater (p=0.01) at placement-sites (1.64 ± 0.53) of SLT in comparison to non-placement-sites (1.40 ± 0.41). The difference in the GR and PPD at placement and non-placement-sites was also statistically significant with p=0.002 and p=0.001, respectively. Clinically, the majority of subjects had mucosal changes at the placement sites, and a statistically significant association (p=0.034) was observed between the duration of the use of smokeless tobacco and the mucosal changes. Conclusion: Smokeless tobacco use predisposes to increased risk of periodontal diseases and oral mucosal changes at the placement sites in an individual due to the local irritant effect.

HEDEA: A Python Tool for Extracting and Analysing Semi-structured Information from Medical Records.

OBJECTIVES: One of the most important functions for a medical practitioner while treating a patient is to study the patient's complete medical history by going through all records, from test results to doctor's notes. With the increasing use of technology in medicine, these records are mostly digital, alleviating the problem of looking through a stack of papers, which are easily misplaced, but some of these are in an unstructured form. Large parts of clinical reports are in written text form and are tedious to use directly without appropriate pre-processing. In medical research, such health records may be a good, convenient source of medical data; however, lack of structure means that the data is unfit for statistical evaluation. In this paper, we introduce a system to extract, store, retrieve, and analyse information from health records, with a focus on the Indian healthcare scene. METHODS: A Python-based tool, Healthcare Data Extraction and Analysis (HEDEA), has been designed to extract structured information from various medical records using a regular expression-based approach. RESULTS: The HEDEA system is working, covering a large set of formats, to extract and analyse health information. CONCLUSIONS: This tool can be used to generate analysis report and charts using the central database. This information is only provided after prior approval has been received from the patient for medical research purposes.

Daily Energy Expenditure and Its Relation to Health Care Costs in Patients Undergoing Ambulatory Electrocardiographic Monitoring.

Our increasingly sedentary lifestyle is associated with a heightened risk of obesity, diabetes, heart disease, and cardiovascular mortality. Using the recently developed heart rate index formula in 843 patients (mean ± SD age 62.3 ± 15.7 years) who underwent 24-hour ambulatory electrocardiographic (ECG) monitoring, we estimated average and peak daily energy expenditure, expressed as metabolic equivalents (METs), and related these data to subsequent hospital encounters and health care costs. In this cohort, estimated daily average and peak METs were 1.7 ± 0.7 and 5.5 ± 2.1, respectively. Patients who achieved daily bouts of peak energy expenditure ≥5 METs had fewer hospital encounters (p = 0.006) and median health care costs that were nearly 50% lower (p <0.001) than their counterparts who attained <5 METs. In patients whose body mass index was ≥30 kg/m2, there were significant differences in health care costs depending on whether they achieved <5 or ≥5 METs estimated by ambulatory ECG monitoring (p = 0.005). Interestingly, patients who achieved ≥5 METs had lower and no significant difference in their health care costs, regardless of their body mass index (p = 0.46). Patients with previous percutaneous coronary intervention who achieved ≥5 METs had lower health care costs (p = 0.044) and fewer hospital encounters (p = 0.004) than those who achieved <5 METs. In conclusion, average and peak daily energy expenditures estimated from ambulatory ECG monitoring may provide useful information regarding health care utilization in patients with and without previous percutaneous coronary intervention, irrespective of body habitus. Our findings are the first to link lower intensities of peak daily energy expenditure, estimated from ambulatory ECG monitoring, with increased health care utilization.

ß-Blocker premedication does not increase the frequency of allergic reactions from coronary CT angiography: Results from the Advanced Cardiovascular Imaging Consortium.

BACKGROUND: ß-Blockers are often used for heart rate control during coronary CT angiography (CTA). Increased frequency and severity of allergic reactions to radiocontrast media (RCM) have been reported with concomitant use of ß-blockers. OBJECTIVES: The objectives of this study were to determine whether there is a higher incidence of allergic reactions to low-osmolar nonionic RCM in patients undergoing coronary CTA with concomitant ß-blockers and to define the overall incidence and severity of allergic reactions in patients undergoing coronary CTA with and without a history of allergy to RCM. METHODS: Patients undergoing coronary CTA at 47 institutions participating in the Advanced Cardiovascular Imaging Consortium registry were analyzed. The incidence and severity of allergic reactions were compared between those patients who did and those who did not receive ß-blockers, as well as in subgroups of patients with and without a history of prior allergy to RCM. RESULTS: The incidence of allergic reaction in patients who received ß-blockers was 45 of 23,867 (0.19%) compared with those who did not receive ß-blockers, which was 9 of 5232 (0.17%; P = .84; odds ratio = 1.1). Of the patients with history of allergy to RCM, 4 of 706 patients (0.6%) on ß-blockers experienced allergic reactions compared to 1 of 77 patients (1.3%) without ß-blockers (P = .40; odds ratio = 0.43). CONCLUSIONS: ß-Blocker pretreatment had no effect on the frequency or severity of allergic reaction in patients undergoing coronary CTA, even in patients with a past history of allergy to RCM.

Salivary thiocyanate: a biochemical indicator of cigarette smoking in adolescents.

PURPOSE: Saliva is considered to be critical for the maintenance of healthy oral mucosa, and oral fluids provide an easily available, non-invasive medium for the diagnosis of a wide range of diseases and clinical situations. The purpose of this study was to estimate the thiocyanate (SCN) level in saliva of cigarette smokers and compare it with that of nonsmokers. MATERIALS AND METHODS: The present study comprised 100 subjects, of which 50 had a habit of tobacco smoking. The other 50 neither smoked nor chewed tobacco and comprised the healthy control group. The age and sex (all males) of both groups of subjects were matched. All the patients were in the age group of 25 to 40 years. The group of smokers was divided into subgroups according to duration and frequency of smoking. Duration group 1: smoking for a period of 4-7 years; duration group 2: smoking for a period of 8-15 years; duration group 3: chronic smokers, smoking for a period of more than 15 years. Frequency group 1: patients smoked half pack of cigarettes, i.e. 4-6 per day; frequency group 2: patients smoked one pack of cigarettes, i.e. 7-11 per day; frequency group 3: patients smoked more than one pack, i.e. >11, per day. Saliva was collected by the spitting method. Unstimulated whole saliva was refrigerated at 4°C and processed within 24 h. The estimation of thiocyanate in saliva was done according to Densen et al (1967). RESULTS: The present study clearly indicates a significant increase in salivary thiocyanate level in tobacco smokers as compared to nonsmokers (P < 0.0001). Comparing salivary SCN in different duration groups, the salivary SCN level was significantly lower in group 1 vs groups 2 and 3, with P < 0.0001. In terms of smoking frequency, the salivary SCN level was significantly lower in group 1 vs group 3, P < 0.0001. It is also evident that there was an increase in salivary thiocyanate levels with increased duration and frequency, thus showing a positive correlation between them. CONCLUSION: The findings of this study suggest that salivary thiocyanate can be used as a safe and acceptable prevalence measurement for cigarette smoking behaviour.

Epithelioid hemangioma (angiolymphoid hyperplasia with eosinophilia) in the oral mucosa.

Angiolymphoid hyperplasia with an eosinophilia (ALHE) is a rare benign entity whose etiology and pathogenesis is under debate. Clinically, it is characterised by cutaneous papules or nodules on the head and neck. Literature reveals very few cases of this entity in the oral mucosa. Here, we report a case of ALHE in a 25 year-old woman, who presented with a painless, 5mm x 5mm, sub mucosal erythematous nodule on left angle of mouth at lower lip. Histological examination of lip biopsy specimens revealed an increase in small vessels. The vascular walls consist of prominent endothelial cells with a histiocytoid appearance, which protruded into the lumen. Many eosinophils and lymphocytes were also seen around the vessels. The diagnosis of ALHE was made from the above findings.

Physiotherapy as an adjuvant therapy for treatment of TMJ disorders.

Physiotherapy has long been used to cure joint and muscle diseases. It has also been used to treat various diseases without inflicting mental trauma or the pain of surgery. This adjunctive therapeutic modality is widely used for patients with orofacial disorders, especially in the prevention or treatment of temporomandibular joint (TMJ) disorder, hypomobility, or ankylosis. Physiotherapy has a particular importance in the treatment of TMJ disorders such as myofascial pain and internal derangement. This review article highlights the importance of physiotherapy as an emerging adjuvant therapy in the treatment of TMJ disorders.

Giant submandibular sialoliths: a report of two cases.

Sialolithiasis is the second most common disease of the salivary glands. Sialolithiasis accounts for the most common cause of salivary gland obstruction, leading to recurrent painful swelling of the involved gland, which often becomes worse while eating. Sialoliths can occur in any of the salivary glands but appear most frequently in the submandibular gland and its duct. Very few cases of giant submandibular sialoliths have been reported in the literature. This article reports two cases of unusually large submandibular sialoliths, with clinical and radiographical signs and management. The article also reviews the various diagnostic modalities and treatment options available.