Pulmonary hypertension: An update of Dx and Tx guidelines.

Here is how to reduce risk factors that can lead to pulmonary hypertension; play a pivotal role in diagnosis; and know when disease requires a referral.

Current perspectives of ubiquitination and SUMOylation in abiotic stress tolerance in plants.

Post-translational modification (PTM) is a critical and rapid mechanism to regulate all the major cellular processes through the modification of diverse protein substrates. Substrate-specific covalent attachment of ubiquitin and Small Ubiquitin-Like Modifier (SUMO) with the target proteins, known as ubiquitination and SUMOylation, respectively, are crucial PTMs that regulate almost every process in the cell by modulating the stability and fidelity of the proteins. Ubiquitination and SUMOylation play a very significant role to provide tolerance to the plants in adverse environmental conditions by activating/deactivating the pre-existing proteins to a great extent. We reviewed the importance of ubiquitination and SUMOylation in plants, implicating its prospects in various abiotic stress regulations. An exhaustive study of molecular mechanisms of ubiquitination and SUMOylation of plant proteins and their role will contribute to the understanding of physiology underlying mitigation of the abiotic stresses and survival in plants. It will be helpful to strategize the improvement of crops for abiotic stress tolerance.

Realization of Lodging Tolerance in the Aromatic Grass, Cymbopogon khasianus Through Ploidy Intervention.

Artificial polyploidy that brings about increase in cell size confers changes in histo-morphology leading to altered phenotype, causing changes in physiological attributes and enhanced concentration of secondary metabolites. The altered phenotype is generally a manifestation of tissue hardiness reflected as robust plant type. Based on a case study undertaken on an industrially important grass, Cymbopogon khasianus (2n = 60) valued for its citral rich essential oil, here we report that the artificial polyploidy not only brings about enhancement in concentration of essential oil but also facilitates lodging tolerance. The latter is contributed by ploidy mediated changes that occur to the cells and tissues in various plant organs by way of increased wall thickening, tissue enhancement and epidermal depositions that enable robust features. An exhaustive illustrated account covering various micro-/macro-morphological, skeletal and histochemical features constituting growth and development vis-a-vis ploidy mediated changes is presented highlighting the novelties realized on account of induced polyploidy.

Artificial intelligence and anesthesia: A narrative review.

Rapid advances in Artificial Intelligence (AI) have led to diagnostic, therapeutic, and intervention-based applications in the field of medicine. Today, there is a deep chasm between AI-based research articles and their translation to clinical anesthesia, which needs to be addressed. Machine learning (ML), the most widely applied arm of AI in medicine, confers the ability to analyze large volumes of data, find associations, and predict outcomes with ongoing learning by the computer. It involves algorithm creation, testing and analyses with the ability to perform cognitive functions including association between variables, pattern recognition, and prediction of outcomes. AI-supported closed loops have been designed for pharmacological maintenance of anesthesia and hemodynamic management. Mechanical robots can perform dexterity and skill-based tasks such as intubation and regional blocks with precision, whereas clinical-decision support systems in crisis situations may augment the role of the clinician. The possibilities are boundless, yet widespread adoption of AI is still far from the ground reality. Patient-related "Big Data" collection, validation, transfer, and testing are under ethical scrutiny. For this narrative review, we conducted a PubMed search in 2020-21 and retrieved articles related to AI and anesthesia. After careful consideration of the content, we prepared the review to highlight the growing importance of AI in anesthesia. Awareness and understanding of the basics of AI are the first steps to be undertaken by clinicians. In this narrative review, we have discussed salient features of ongoing AI research related to anesthesia and perioperative care.

Prophylactic Use of Pentoxifylline and Tocopherol in Patients Undergoing Dental Extractions Following Radiotherapy for Head and Neck Cancer.

BACKGROUND: In head and neck cancer patients undergoing radiotherapy, osteoradionecrosis (ORN) of the jaw is one of the major but uncommon complications. Satisfactorily results have been observed while treating ORN patients with upcoming treatment modalities such as combination therapy of pentoxifylline and Vitamin E (PVe). It is believed that in patients undergoing dental extractions, these treatment modalities can be used prophylactically for lowering the risk of development of ORN. Hence, keeping all these things in mind, we planned the present study to assess the prophylactic role of pentoxifylline and tocopherol in patients who require dental extractions after radiotherapy for cancer of head and neck. MATERIALS AND METHODS: A total of 110 patients were included in this retrospective study, which had radiotherapy for cancer of the head and neck. After radiotherapy, a total of 450 dental extractions were done in these 110 patients. RESULTS: External beam therapy was given in 92.72% of the patients. 7.27% and 40% of the patients received intensity modulated radiotherapy combination of chemotherapy and intensity modulated radiotherapy, respectively. ORN developed only in 2 patients. Patients had taken PVe for a mean of 12 (24) weeks preoperatively and 14 (18) weeks postoperatively. The incidence was lower than that normally associated with dental extractions in irradiated patients. CONCLUSION: In patients undergoing dental extractions, after receiving radiotherapy of head and neck region, combination therapy of pentoxifylline and tocopherol are sufficiently effective.

A Cross-sectional Study to assess the Perception of Psychosocial Elements among Pediatric Patients visiting Dental Clinics.

INTRODUCTION: Children with high dental fear and perception usually encounter high prevalence of dental caries. Data showed that individuals with dental fear will probably defer dental appointments which may result in the formation of a setup of an endless loop of dental fear. Present study was aimed to assess different psycho-social parameters among pediatric patients visiting dental clinics. MATERIALS AND METHODS: In the present cross-sectional study, the data of 200 schoolchildren were collected and analyzed by means of a questionnaire. Evaluation of the oral health status was done by experienced pedodontists. All the answers were recorded and analyzed by Statistical Package for the Social Sciences (SPSS) software. RESULTS: Nearly 120 were regular attendees while remaining 80 were found to be irregular attendees. Significant difference was observed while comparing the decayed, missing, and filled teeth (DMFT) index, decayed teeth, dental fear, cognitive vulnerability, and dental prevention belief between the regular and irregular group. Significant correlation was observed between higher number of decayed teeth and increasing level of dental fear. CONCLUSION: Various psychosocial parameters, by affecting the dental visits, are associated with outcome of oral health measures. CLINICAL SIGNIFICANCE: Special attention should be paid to the pediatric patients with such kind of behavior so that their psy-chosocial attitude could be modified in favor of dental treatment.

Assessment of Alteration in Capnometry Monitoring during Intravenous Sedation with Midazolam for Oral Surgical Procedures.

INTRODUCTION: Capnography is routinely used for monitoring of patients subjected to sedation for different surgical procedures. There is still paucity of data highlighting the capnographic assessment of patients on midazolam sedation undergoing oral surgical procedures. Hence, we planned the present study to assess the alterations occurring in the end-tidal carbon dioxide (ETCO2) values monitored during intravenous (IV) sedation with midazolam during various oral surgical procedures. MATERIALS AND METHODS: The present study included assessment of alteration in ETCO2 values occurring during oral surgical procedure. After meeting the inclusion and exclusion criteria, a total of 40 participants were included in the present study. Pulse oximeter with capnograph (EmcoMeditek Pvt., Ltd., India) device was used for assessment of respiratory rate (RR) and ETCO2 values. The mean of 12 readings over a period of 1 minute before the starting of first infusion was referred to as baseline time. By evaluating the first four readings at an interval of 15 seconds during the 1st minute of infusion, we obtained the 1 minute average reading. All the data were compiled and recorded and assessed by the Statistical Package for the Social Sciences (SPSS) software. RESULTS: A total of 40 participants were included, out of which, 20 were males and 20 were females. At the baseline time, mean value of ETCO2 was 31 mm Hg, while mean value of oxygen saturation (SpO2) was 36%. Out of total 40 participants, 15 showed the presence of respiratory depression. Out of these 15 participants, ETCO2 changes from baseline were observed in 13 participants. CONCLUSION: No oxygen should be delivered, unless until required, to the healthy participants undergoing dental sedation procedures, for marinating the sensitivity of pulse oximetry during assessment of respiratory depression. CLINICAL SIGNIFICANCE: In patients undergoing sedation procedures, various monitoring techniques should be employed as respiratory depression is a commonly encountered risk factor.

Comparative Evaluation of Myeloperoxidase Enzymatic Activity in Gingival Crevicular Fluid of Subjects having Orthodontic Treatment by Different Aligning Arch Wires.

INTRODUCTION: There exist a number of factors that affect the outcome of orthodontic treatment. These factors can be assessed by various gingival markers. One such maker is myeloperoxidase (MPO). Hence, we planned the present study to assess and compare the MPO activity in the gingival crevicular fluid (GCF) of subjects undergoing orthodontic treatment by different aligning arch wires. MATERIALS AND METHODS: The present study included assessment of patients who underwent orthodontic treatment for crowding of anterior teeth. Diagnostic cast models of all the subjects were made for recording the irregularity index. All the subjects were randomly divided into three study groups with 15 patients in each group based on the type of nickel-titanium (NiTi) arch wires used. A collection of GCF samples was done in all the patients at various time intervals and it was sent to the laboratory for assessment of MPO activity. Activity of the MPO enzyme was expressed in terms of number of units per 100 µL. All the results obtained were compiled and analyzed by Statistical Package for the Social Sciences (SPSS) software. RESULTS: We observed that nonsignificant results were obtained while comparing the mean age and mean gingival score in all the study groups. However, significant results were obtained on comparing the mean MPO enzymatic activity in all the study groups at different time intervals. CONCLUSION: Both superelastic NiTi and heat-activated NiTi generate optimal forces, which are necessary for higher metabolic response of the periodontal ligament. CLINICAL SIGNIFICANCE: In the intimal stages of orthodontic treatment, both superelastic NiTi and heat-activated NiTi wires are superior in leveling and aligning the crowded teeth.

Indoor and Outdoor Allergies.

In last 30 to 40 years there has been a significant increase in the incidence of allergy. This increase cannot be explained by genetic factors alone. Increasing air pollution and its interaction with biological allergens along with changing lifestyles are contributing factors. Dust mites, molds, and animal allergens contribute to most of the sensitization in the indoor setting. Tree and grass pollens are the leading allergens in the outdoor setting. Worsening air pollution and increasing particulate matter worsen allergy symptoms and associated morbidity. Cross-sensitization of allergens is common. Treatment involves avoidance of allergens, modifying lifestyle, medical treatment, and immunotherapy.

Photo-inactivation of Escherichia coli and Enterococcus hirae using methylene blue and sodium anthraquinone-2-sulphonate: effect of process parameters.

In this study, effect of different parameters, viz. concentration of photosensitizer (PS), pH of the bacterial cell suspension and initial cell count, on photo-inactivation of Escherichia coli and Enterococcus hirae bacteria using methylene blue (MB) and sodium anthraquinone-2-sulphonate (SAQS) was investigated employing the statistically valid full factorial design of experiments. The inactivation efficiency of E. hirae using MB ranges between 10.81 and 48.55 %, whereas in the case of E. coli it ranges between 10.41 and 46.44 %. Using SAQS, the inactivation efficiency of E. hirae was within 5.26-39.03 %, and in the case of E. coli it varied in the range 4.65-37.66 %. Statistical analysis of the photo-inactivation results in the form of analysis of variance (ANOVA) and student 't' test revealed significant individual effect of these process parameters. In addition, an increase in dark incubation period with MB or SAQS resulted in enhanced photo-inactivation efficiency against both the microorganisms. Reactive oxygen species measurement and analysis of lipid peroxidation and protein carbonyl index helped in a better understanding of the photo-inactivation mechanism.

Intrathecal magnesium sulfate as a spinal adjuvant in two different doses, combined with 0.5% heavy bupivacaine for infraumbilical surgeries.

UNLABELLED: The spinal anesthesia has the definitive advantage that profound nerve block can be produced in a large part of the body by the relatively simple injection of a small amount of local anesthetic. BACKGROUND AND AIMS: The use of adjuvant drugs with local anesthetics for spinal is intended to improve the success of regional anesthesia. The present study evaluated magnesium sulfate in two different doses and fentanyl as an adjuvant to bupivacaine for spinal anesthesia. MATERIALS AND METHODS: Following Institutional Ethical Committee approval and written informed consent, a prospective randomized double-blinded study was conducted in 81 cases. Patients included were of either gender belonging to American Society of Anesthesiology (ASA) I or ASA II status undergoing elective infraumbilical surgeries of <3 h. Patients were randomized into four groups and were administered an intrathecal solution of (1) Group NS: 3 cc of 0.5% bupivacaine + 0.5 cc of NS. (2) Group F: 3 cc of 0.5% bupivacaine + 25 mcg fentanyl (0.5 cc). (3) Group M 50: 3 cc of 0.5% bupivacaine + 50 mg magnesium sulfate diluted to 0.5 cc with NS. (4) Group M 100: 3 cc of 0.5% bupivacaine + 100 mg magnesium sulfate diluted to 0.5 cc with NS. The variables assessed were visual analog pain scale, pruritus, intensity of motor block and somnolence before and after intrathecal injection at 5, 10, 15, 30, 45, and 60 min in the 1(st) h, at every 30 min in next hour and then hourly thereafter. RESULTS: The mean duration of analgesia in normal saline group, fentanyl group, M 50 and M 100 groups are 272.8 (standard error [S.E.] of mean 22.9), 360.0 (S.E. of mean 28.8), 252.5 (S.E. of mean 15.0), 276.6 (S.E. of mean 29.5) min, respectively. CONCLUSION: The addition of magnesium sulfate in the two different doses (50, 100 mg) does not affect the quality of block or duration of analgesia. However, M 100 is as effective as fentanyl as far as the duration of analgesia is concerned.

Impact of supplementing preoperative intravenous omega 3 Fatty acids in fish oil on immunomodulation in elderly patients undergoing hip surgery.

The aim of this study was to evaluate the immunomodulatory effects of supplementing intravenous omega-3 fatty acids in fish oil (IVFO) in elderly patients undergoing hip surgery. This was a single centre, randomized, controlled, comparative, phase IV study in elderly patients undergoing hip surgery. The subjects, within the age range of 50-90 years, were assigned randomly to the group receiving intravenous omega-3 fatty acids in fish oil (IVFO, Omegaven®) or the control group not receiving intravenous fish oil (n = 20 in each group). IL-6, IL-8, IL-10, and HS-CRP levels were the inflammatory markers assessed in this study. The within-group comparison was done by paired t-test and between-group comparison by unpaired t-test. At day 4, IL-6 values in the IVFO group decreased as compared to day 0. At day 4, IL-8 mean values increased for both IVFO and control groups. This increase was highly significant in the control group (P = 0.0182). IL 10 values decreased at day 4 and increased at day 8 in the IVFO group. Increase in HS-CRP levels was nonsignificant at day 4 in the IVFO group (P = 0.60) and significant at day 8 for the control group (P = 0.0084) as compared to day 0. Various biochemical parameters including albumin, protein, SGOT, SGPT, blood glucose, and urea values generated evidence regarding the safety profile of IVFO. This study suggests a role for IVFO in the short-term suppression of inflammatory mediators for patients undergoing hip surgery. However, further, larger trials may be needed to establish its definitive role in this patient population.

Topical analgesia for chest tube removal in cardiac patients.

OBJECTIVES: The aim of this study was to evaluate the efficacy of topical valdecoxib as an analgesic during chest tube removal in postcardiac surgical patients. DESIGN: A prospective, randomized, double-blind, placebo-controlled study. SETTING: The study was performed in the cardiac intensive care unit. PARTICIPANTS: Fifty-three patients undergoing elective cardiac surgery were randomized to receive either topical valdecoxib or liquid paraffin on the chest tube exit sites. INTERVENTION: Topical valdecoxib was applied to 1 of the 2 chest tube sites (mediastinal or pericardial) in a randomized manner before drain removal. Liquid paraffin was used as the control on the other tube site. The patient and observer were blinded to the drug and control. MEASUREMENTS AND MAIN RESULTS: Pain was assessed by using the visual analog scale. The heart rate and systolic blood pressure were recorded at each stage by the blinded observer. Statistical analysis of the obtained data was undertaken using the nonparametric Mann-Whitney U test. The median pain scores before, during, and after tube removal in the control group were 2, 5, and 4, respectively. The valdecoxib group had corresponding scores of 1, 2, and 2. The pain scores were significantly lower in the valdecoxib group. No differences were seen in the heart rate and systolic blood pressure between the 2 groups. No adverse effects were noted. CONCLUSIONS: Topical valdecoxib is a safe and effective topical analgesic for chest tube removal in cardiac patients.