Comparison of fracture resistance of simulated immature teeth using four different commercially available apexification materials - An in vitro study.

Introduction: The aim of this study was to compare the fracture resistance of simulated immature teeth using four different apical plug materials, i.e. Pro- Root MTA, Neo- MTA Plus, Biodentine, and Bioactive Glass. Materials and Methods: 80 extracted human maxillary anterior teeth were divided into 4 groups for this study. They were prepared using Peeso reamers to simulate immature teeth and to mimic Cvek's stage 3 of root development. A 5 mm apical barrier was placed using different materials. The remaining canal was obturated using gutta-percha and AH plus sealer. The final samples were stored at 37°C and 100% humidity for 4 weeks. Fracture resistance of the teeth was measured in Newtons using a universal testing machine. The comparison of fracture resistance between the four groups was done using Kruskal Walis ANOVA followed by post hoc Mann Whitney U test for pairwise comparison. Results: Biodentine group showed the highest fracture resistance as compared to the other three groups and the difference was highly significant (P < 0.001). Conclusions: Biodentine can be advocated over MTA as an effective material for the management of teeth with wide open apex. Bioactive glass also has shown promising results in increasing the fracture resistance of simulated immature teeth.

Rickets - A case report.

Rickets is a disorder caused by a lack of vitamin D, calcium or phosphate. It leads to softening and weakening of the bones. Dental manifestation of rickets includes enamel hypoplasia and delayed tooth eruption. The most important oral findings are characterised by spontaneous gingival and dental abscesses occurring without a history of trauma or caries. Radiographic examination revealed large pulp chambers, short roots, poorly defined lamina dura and hypoplastic alveolar ridge. These dental abscesses are common, and therefore, extraction and pulpectomy are the treatment of choice. Oral manifestations of rickets should be diagnosed early by both physicians and dentists to prevent severe dental complications. This article aims to report a case of rickets in a 3-year-old girl, describing the dental findings and the treatment to be performed in these cases.

Identification of Novel Impurity of Ziprasidone.

Ziprasidone hydrochloride is a second-generation antipsychotic drug employed for the treatment of schizophrenia and acute mania or mixed episodes associated with bipolar disorder. During the scale-up of ziprasidone hydrochloride, an unknown impurity was observed in the batches ranging from 0.10% to 0.15% by HPLC-UV analysis. The structure of an unknown impurity was proposed as 3,3'-methylenebis(5-(2-(4-(benzo[d]isothiazol-3-yl)piperazin-1-yl)ethyl)-6-chloroindolin-2-one) which is named as methylene ziprasidone dimer (MZD impurity). It was isolated from an enriched sample by preparative HPLC, and its structure was elucidated by comprehensive analysis of HRMS, 1D NMR (1H, 13C), DEPT-135, 2D NMR (COSY, HSQC, HMBC) spectroscopy. A plausible mechanism for the formation of isolated impurity is proposed.

Extensive sonographic ulnar nerve enlargement above the medial epicondyle is a characteristic sign in Hansen's neuropathy.

OBJECTIVE: Earlier studies have shown sonographic enlargement of the ulnar nerve in patients with Hansen's neuropathy. The present study was performed to determine whether sonography or electrophysiological studies can detect the specific site of ulnar nerve pathology in leprosy. METHODS: Eighteen patients (thirty arms) with Hansen's disease and an ulnar neuropathy of whom 66% had borderline tuberculoid (BT), 27% lepromatous leprosy (LL) and 7% mid-borderline (BB) leprosy were included in the study. Cross-sectional area (CSA) of ulnar nerve was measured every two centimeters from wrist to medial epicondyle and from there to axilla. All patients underwent standard motor and sensory nerve conduction studies of the ulnar nerve. Thirty age and sex matched controls underwent similar ulnar nerve CSA measurements and conduction studies. RESULTS: Ulnar nerve was clinically palpable in 19 of the 30 arms of patients. Motor and sensory nerve conduction studies of the ulnar nerve showed a reduced compound motor action potential and sensory nerve action potential amplitude in all patients. Motor Conduction Velocity (MCV) in patients were slower in comparison to controls, especially at the elbow and upper arm, but unable to exactly locate the site of the lesion. In comparison to controls the ulnar nerveCSA was larger in the whole arm in patients and quite specific the maximum enlargement was seen between nulnar sulcus and axilla, peaking at four centimeters above the sulcus. CONCLUSIONS: A unique sonographic pattern of nerve enlargement is noted in patients with ulnar neuropathy due to Hansen's disease, while this was not the case for the technique used until now, the electrodiagnostic testing. The enlargement starts at ulnar sulcus and is maximum four centimeters above the medial epicondyle and starts reducing further along the tract. This characteristic finding can help especially in diagnosing pure neuritic type of Hansen's disease, in which skin lesions are absent, and alsoto differentiate leprosy from other neuropathies in which nerve enlargement can occur.

Regional inequity in complete antenatal services and public emergency obstetric care is associated with greater burden of maternal deaths: analysis from consecutive district level facility survey of Karnataka, India.

BACKGROUND: This equity focused evaluation analyses change in inter-district inequity of maternal health services (MHS) in Karnataka state between 2006-07 & 2012-13, alongside association of MHS inequity with distribution of maternal deaths. METHODS: Repeated cross-sectional analysis of inequity and decomposition was done on nine district level MHS indicators using Theil's T index. Data was obtained from population linked district level facility surveys and health information systems. RESULTS: Inequity in births attended by skill birth attendants decreased the most (83.16%) among six other MHS indicators. Community provision of comprehensive emergency obstetric care strategy remained stagnant. Districts with higher complete antenatal care share and C-sections in public settings had lesser share of state's maternal deaths (R2 = 0.29, p = 0.004). 5 districts suffered perpetual inequity of MHS with relatively greater burden of maternal deaths. CONCLUSION: First 6 years of national rural health mission increased coverage of MHS and decreased regional inequity albeit non-uniformly. Distribution of system driven interventions of complete ANC and C-sections appear to determine decrease of maternal mortality in Karnataka.

Immunogenicity of human and bovine insulin in type 1 diabetes mellitus patients.

BACKGROUND: The advantages of synthetic insulin (human insulin) over bovine insulin in the treatment of type 1 diabetes mellitus (DM) are much debated in terms of potency and purity. Immunogenicity is one of several factors that determine potency and safety. This study was designed to investigate and study the difference in immunogenicity of human and bovine insulin. We investigated anti-insulin antibody (AIAB) status in 69 type 1 DM patients receiving insulin therapy. Group 1 had 33 patients treated with bovine insulin, and group 2 had 32 patients treated with human insulin. All patients had received their respective insulin therapy for a minimum period of 1 year and had no history of change in insulin type. Forty-three subjects from the normal population were the control group. METHODS: AIABs were assayed in serum samples of all subjects using a semiquantitative radioimmunoassay kit. The Kruskal-Wallis non-parametric and Mann-Whitney U tests were used to study the difference in immunogenicity of human and bovine insulins. RESULTS: The Kruskal-Wallis test showed that antibody titers in the three groups significantly differed (P<0.001). The Mann-Whitney U test showed no significant difference in AIAB titer between the treatment groups. AIAB titers in the two treatment groups differed significantly from that of the control group, independently (P<0.001). High titers of AIABs are present in patients receiving bovine and human insulin compared to that of the normal population. CONCLUSIONS: Bovine and human insulins are antigenic, and there is no significant difference in AIAB titer. Prospective studies are required to determine the long-term clinical significance of these antibodies.

Production of endoglucanase by the native strains of Streptomyces isolates in submerged fermentation

Cellulase is a complex enzyme system, commercially produced by filamentous fungi under solid-state and submerged cultivation. It has wide applicability in textile, food and beverage industry for effective saccharification process. In this study, cellulolytic enzyme activity, particularly endoglucanase of 26 Streptomyces strains isolated from garden soil was examined, including two isolates selected on the basis of potential cellulolytic activity on Bennett's agar medium. To enhance the endoglucanase formation in broth culture, different conditions including carbon and nitrogen sources, and growth conditions were tested. The maximum endoglucanase activity (11.25-11.90 U/mL) was achieved within 72-88 h in fermentation medium containing Tween-80, followed by phosphate sources. Both cellulolytic Streptomyces isolates gave almost equal quantity of enzyme in all trials. However the effect of medium ingredients on endoglucanase induction diverged with strains in some extent.

A celulase é um sistema enzimático complexo, produzido comercialmente a partir de fungos filamentosos através de cultivo em estádio sólido e submerso. Tem uma grande aplicação na indústria têxtil e de alimentos e bebidas no processo de sacarificação. Nesse estudo, examinou-se a atividade celulolítica, especialmente de englucanase, de 26 cepas de Streptomyces isoladas de solo, incluindo duas cepas selecionadas por sua atividade celulolítica no ágar Bennett. Para estimular a produção de englucanase em meio de cultura, diferentes condições de cultivo, incluindo fonte de carbono e nitrogênio e condições de crescimento, foram avaliadas. A atividade máxima de glucanase (11,25 a 11,90 U/mL) foi obtida em 72-88h em meio de cultura contendo Tween-80, seguido por fontes de fosfato. Ambas as cepas celulolíticas de Streptomyces produziram quase a mesma quantidade de enzima em todos os experimentos. Entretanto, o efeito dos ingredientes do meio na indução da glucanase divergiu de acordo com a cepa.

Production of endoglucanase by the native strains of Streptomyces isolates in submerged fermentation.

Cellulase is a complex enzyme system, commercially produced by filamentous fungi under solid-state and submerged cultivation. It has wide applicability in textile, food and beverage industry for effective saccharification process. In this study, cellulolytic enzyme activity, particularly endoglucanase of 26 Streptomyces strains isolated from garden soil was examined, including two isolates selected on the basis of potential cellulolytic activity on Bennett's agar medium. To enhance the endoglucanase formation in broth culture, different conditions including carbon and nitrogen sources, and growth conditions were tested. The maximum endoglucanase activity (11.25-11.90 U/mL) was achieved within 72-88 h in fermentation medium containing Tween-80, followed by phosphate sources. Both cellulolytic Streptomyces isolates gave almost equal quantity of enzyme in all trials. However the effect of medium ingredients on endoglucanase induction diverged with strains in some extent.

Study Protocol: insulin and its role in cancer.

BACKGROUND: Studies have shown that metabolic syndrome and its consequent biochemical derangements in the various phases of diabetes may contribute to carcinogenesis. A part of this carcinogenic effect could be attributed to hyperinsulinism. High levels of insulin decrease the production of IGF-1 binding proteins and hence increase levels of free IGF-1. It is well established that bioactivity of free insulin growth factor 1 (IGF-1) increases tumor turnover rate. The objective is to investigate the role of insulin resistance/sensitivity in carcinogenesis by studying the relation between insulin resistance/sensitivity and IGF-1 levels in cancer patients. We postulate that hyperinsulinaemia which prevails during initial phases of insulin resistance (condition prior to overt diabetes) increases bioactivity of free IGF-1, which may contribute to process of carcinogenesis. METHODS/DESIGN: Based on our pilot study results and power analysis of the same, we have designed a two group case-control study. 800 proven untreated cancer patients (solid epithelial cell tumors) under age of 50 shall be recruited with 200 healthy subjects serving as controls. Insulin resistance/sensitivity and free IGF-1 levels shall be determined in all subjects. Association between the two parameters shall be tested using suitable statistical methods. DISCUSSION: Well controlled studies in humans are essential to study the link between insulin resistance, hyperinsulinaemia, IGF-1 and carcinogenesis. This study could provide insights to the role of insulin, insulin resistance, IGF-1 in carcinogenesis although a precise role and the extent of influence cannot be determined. In future, cancer prevention and treatment strategies could revolve around insulin and insulin resistance.

Takotsubo syndrome in African-American women with atypical presentations: a single-center experience.

BACKGROUND: Takotsubo syndrome is comprised of the clinical presentation of an acute myocardial infarction with electrocardiographic (ECG) changes of acute ischemia, chest pain, positive biomarkers, a pathognomonic left ventricular apical wall motion abnormality, and no culprit coronary disease at cardiac catheterization. HYPOTHESIS: This study aimed at a further definition of the clinical characteristics of this syndrome in African-American (AA) patients based on our experience at a single center. METHODS: Patients who presented with this syndrome between June 2003 and June 2005 were evaluated. All patients underwent coronary angiography and noninvasive cardiac investigation, including transthoracic two-dimensional echocardiography. RESULTS: Five AA women (mean age 65 years) presented with the characteristics of the syndrome. No patient experienced chest pain, with three presenting with shortness of breath and two with nausea. Hypertension was the most common risk factor for coronary artery disease (CAD) in these patients. All but one patient had ST elevation on ECG, and troponin I elevation was present in all. Cardiac catheterization showed no obstructive CAD. The most common trigger was exacerbation of a current medical condition. All five patients developed deep, broad, diffuse T-wave inversions with a prolonged QT interval. There was no mortality during the hospital stay. CONCLUSIONS: Takotsubo syndrome is experienced by AA patients. Female AA patients may experience atypical symptoms at presentation. The development of broad, diffuse, T-wave inversions with a prolonged QT interval within 2-48 h of presentation should be considered an additional criterion when diagnosing Takotsubo syndrome.