A Case of Immunoglobulin G4-Related Disease Presenting as a Parapharyngeal Mass.

Immunoglobulin G4-related disease (IgG4-RD) is a fibroinflammatory condition characterized by tissue infiltration with lymphocytes and IgG4-secreting plasma cells. The presentation of IgG4-RD is heterogenous, making it difficult to diagnose. IgG4-RD presenting as a parapharyngeal mass is extremely rare. This report discusses the case of a 69-year-old African American female presenting with intermittent bilateral frontal headaches. Initial imaging revealed an ill-defined parapharyngeal mass encasing the left internal carotid artery and left internal jugular vein. Subsequent biopsy and immunohistochemistry showed a high concentration of IgG4-positive plasma cells with storiform fibrosis, despite normal serum IgG4 levels. The patient opted for conservative management. The localized parapharyngeal mass has remained stable over two years on annual imaging. This case report highlights that IgG4-RD can have varied and nonspecific presentations requiring high clinical suspicion to diagnose. Histopathology and IgG4 staining are vital to confirm the diagnosis of IgG4-RD, particularly in atypical cases not meeting the standard inclusion criteria.

Phytochemical analysis and fertility enhancement effects of aerial parts of Fagonia arabica in male and female rats.

In this study, fertility enhancing effect of ethanol extract of aerial parts of Fagonia arabica was evaluated. 24 female and 12 male virgin Wistar rats (Average wt 150-250g) were selected. Dose was given daily for 23 days in 4 groups of animal. After 23 days, they were cohabitated for mating. Then dosing was continued for further 5 days. On 5th day of mating, sperm counting was done by observing vaginal smear under the microscope which showed fertility enhancement in male. Female were kept separately until delivery. The number of pubs born provided female fertility enhancement as compared to control. Average sperm count in 1 cm2 were counted in group A, B, C and control as 14.000±1.732, 12.000±1.000, 23.333±1.528 and 11.000±1.000 respectively. Number of pubs were counted in Group A, B, C and D as 8.667±2.082, 7.333±1.528, 7.333±1.528 10.000±2.000 and 5.333±0.577 respectively and fertility index was calculated for Group A, B and C as 62.516%, 37.502% and 87.512% respectively. Result showed that the orally administered dose of Fagonia arabica possess highly significant fertility enhancing activity in male and female rats after observing improvement in the sperm count and number of pubs as compared to control.

Relationship of natural occlusal plane with different anatomical landmarks.

OBJECTIVE: To evaluate the parallelism of natural maxillary occlusal plane with inter-pupillary line and ala-tragus line, and to evaluate the anatomic relationship of natural mandibular occlusal plane with retromolar pad among dentate subjects. METHODS: The cross-sectional study was conducted from September 2017 to February 2018 at Fatima Jinnah Dental College, Karachi, and comprised front and profile photographs of subjects aged 20-28 years while holding the camper's plane against the maxillary occlusal plane. The photographs were imported in a software and an interpupillary line was drawn and the angle with Camper's plane was measured. On both profile pictures, lines were drawn from base of the ala to the superior, middle and inferior points on the tragus. The angle between ala-tragus line and Camper's plane were measured. Intra-orally, height of the mandibular occlusal plane in relation to the retromolar pad was evaluated using a stainless steel scale. Data was analysed using SPSS 23. RESULTS: Of the 109 subjects with a mean age of 23.03±1.36 years, 76(69.72%) were females. Horizontal parallelism of occlusal plane with inter-pupillary line was observed with a mean angle of 1.17±1.27 degrees. The angle between the occlusal plane and the inferior ala-tragus line was 4.25 degrees on the right side, and 4.50 degrees on the left. Intraorally, mandibular occlusal plane coincided with the inferior 48(44%) and the middle third 48(44%) of the retromolar pad. CONCLUSIONS: Inter-pupillary line and retromolar pad area should be used as a guide in the determination of plane of occlusion. The ala-tragus line was not found to be a reliable guide.

Analysis of different characteristics of smile.

INTRODUCTION: Analysis of smile is imperative in the diagnosis and treatment planning phases of aesthetic dentistry. AIM: To evaluate the components of smile among students of a dental institution. METHODS: Frontal view digital photographs with posed smile of 157 dental students were assessed using Adobe Photoshop7.0. Smile characteristics evaluated included; smile line, smile arc, smile design, upper lip curvature, labiodental relationship and number of teeth displayed. Data were analyzed using SPSS version 23.0. Pearson chi-square test was used to determine the gender based differences for various parameters. RESULTS: Average smile line (43.3%), consonant smile arcs (45.2%), cuspid smiles (45.9%), upward lip curvature (43.9%), maxillary anterior teeth not covered by lower lip (60.5%) and teeth displayed up to first premolars (35.7%). Gender based differences were not statistically significant except for smile arc (p value = 0.02) and number of teeth displayed (p value < 0.001). There was a significant relationship between lip curvature and smile pattern (p value < 0.001) and lip curvature and smile arc (p value = 0.01) revealing that upward lip curvature was associated with commissure type smiles and consonant smile arcs. CONCLUSIONS: The smile characteristics should be considered before beginning the aesthetic treatment of the patient to obtain adequate results in oral rehabilitation.

The effect of different aromatic conjugated bridges on optoelectronic properties of diketopyrrolopyrrole-based donor materials for organic photovoltaics.

A series of twelve Acceptor-π-Donor-π-Acceptor (A-π-D-π-A) topology-based donor molecules, where diketopyrrolopyrrole (DPP) as donor core unit is connected through furan which acts as conjugated π-bridge (CB) to aromatic derivatives (Ar) as acceptor units, have been investigated by making substitutions in acceptor units by using density functional theory(DFT) and time-dependent density functional theory (TD-DFT) for organic solar cell applications. The comparative study of optoelectronic properties indicates that thiadiazole with pyridine units containing molecules (M6b) exhibit lower energy of highest occupied molecular orbital (HOMO) and lowest unoccupied molecular orbital (LUMO) energy levels than those of oxadiazole and pyridine containing units (M6b). Among our investigated donors, the smallest Eg of 1.60 eV was observed for both M6a and M6b with distinctive broad absorption at 843 and 857 nm, respectively. Overall, smaller electron transfer (λe) values in contrast to hole transfer (λh) demonstrate that these donor compounds would be best for λe. The calculated open circuit voltage (Voc) is 2.45 and 2.17 eV, regarding bisPCBM and PC60BM (phenyl-C61-butyric acid methyl ester) acceptors. Thus, these theoretical calculations not only endorse the deep consideration between the chemical structures and optoelectronic characteristics of the donor-acceptor systems but also suggest appropriate materials for high-performance Organic Photovoltaics (OPV). Graphical abstract.

Relationship of Preceptor Ad-hoc Entrustment Decisions to Students' Clinical Skills Performance.

This article was migrated. The article was marked as recommended. Using a workplace evaluation instrument that included clinical skills evaluation and supervisory EPA scale, this study provided empirical evidence of the relationship between preceptor evaluation of student clinical ability and their entrustment decisions at the medical student level, and advanced the understanding of general conditions that ad-hoc entrustment decision are based upon. A total of 4217 evaluations from 353 third-year medical students were included in the study. The analyses focused on entrustment decisions for seven EPAs (EPA1, 2, 3, 5, 6, 7, and 9) and the relationship with related clinical skill (e.g. history taking) performance. Pearson's correlations showed statistically significant and positive correlations within clerkships (r= 0.43-0.75) and across clerkships (r= 0.70-0.77). Analyses of individual entrustment level and skill rating also revealed that the lowest level of entrustment was predominantly associated with the rating of developing on corresponding skills, whereas the highest level of entrustment with the rating of approaching advanced/ advanced; the link between the three middle entrustment levels and particular skill ratings were less salient. Overall, these patterns of association between individual entrustment level and skill rating varied by EPAs as well as level of entrustment. Limitations of the current study were also discussed.

Patient's Knowledge and Use of Oral Non-Steroidal Anti-Inflammatory Drugs in a Rheumatology Clinic.

INTRODUCTION: We evaluated the knowledge of non-steroidal anti-inflammatory drugs (NSAIDs) including their dosage, side effects, contraindications, and drug interactions among the patients in an outpatient rheumatology clinic. METHODS: Patients in a rheumatology clinic completed a short survey assessing their knowledge of over-the-counter NSAIDs. RESULTS: The survey was provided to 400 participants and 275 (68.5%) were using over-the-counter (OTC) NSAIDs. The majority of the participants identified their commonly used NSAID. Almost a third were unaware of the contraindication of NSAIDs such as peptic ulcer disease, chronic kidney disease, and hypertension. Nearly 53.9% participants denied having any discussion of OTC medications with their providers. Two-thirds of the respondents reported seeing only the medication packaging for the dose determination (67.8%). CONCLUSIONS: The gap in patient knowledge of the potential side effects and the lack of discussion of OTC medications by the providers may be predisposing the patients to preventable side effects from NSAIDs.

Isolation and culture of dental pulp stem cells from permanent and deciduous teeth.

OBJECTIVE: To isolate dental pulp mesenchymal stem cells (MSCs) from non-infected human permanent and deciduous teeth. METHODS: It was an in-vitro experimental study. Human teeth were collected from 13 apparently healthy subjects including nine adults and four children. After decoronation dental pulps were extirpated from teeth and cultured via explant method in a stem cell defined media. Data was analyzed by descriptive statistics. RESULTS: As above MSCs emerged exhibiting fibroblast-like morphology. In vitro culture was positive for 100% (9/9) and 75% (3/4) of the permanent and deciduous teeth respectively. First cell appeared from deciduous teeth pulp in 10±6.2 days while permanent teeth pulp took 12.4±3.7 days. Together, 26.6±3.6 and 24.5±3.5 days were required for permanent and deciduous tooth pulp stem cells to be ready for further assays. CONCLUSIONS: The protocol we developed is easy and consistent and can be used to generate reliable source of MScs for engineering of calcified and non-calcified tissue for regenerative medicine approaches.

Chewable cough tablets with improved palatability: A comparative phase II clinical trial.

Cough is the common disease condition which affects patients of every age. Numerous OTC medications available in community pharmacies however no antiviral treatment and even antibiotics has been shown to be effective without pre-existing lung infection. The treatment approach of medicinal herbs has been recognized for many decades and even longer for the treatment and prevention of cough. The aim of this study was to evaluate the safety and efficacy of Mukalbion poly herbal chewable tablets for the treatment of cough with improved palatability against a marketed brand (Poly herbal). For the formulation development of test group, the herbs were supplied by the Procurement department of Herbion Pakistan Pvt. Ltd. Althea officinalis (roots), Hedera helix (leaves) and Sisymbrium irio (seeds) were used for the manufacturing of Mukalbion (poly herbal, test group) chewable tablet. The comparative control clinical trial was carried out during a time frame of 07 months with sample size of 70 patients as per epidemiological software for sample size and each group contained 35 (±5) patients. Chewable tablets were administered and evaluated for effectiveness after 15 days of treatment. The data were collected by the patients through clinical trial questionnaire. The validated quality of life questionnaire (LCQ) was also used for assessment. The results were analyzed by applying paired sample T test by using IBM SPSS version 20.00. The p value was <0.005 at 95% confidence interval for cough variables including cough bouts, viscosity of sputum, chest congestion, sore throat and shortness of breath. The LCQ cough scale score was higher in test group as compared to control group. The test group also showed well tolerated in term of palatability. None of the patient claimed any of the side effects and no compliance were observed against the marketed brand.

Coincidence of Dental Midline with Facial Midline in a Sample of Pakistani Population.

OBJECTIVE: To determine the frequency of coincidence of facial and dental midlines in a sample of Pakistani subjects. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Prosthodontics, Fatima Jinnah Dental College and Hospital, Karachi, from October to December 2017. METHODOLOGY: Subjects of either gender (n=117) were selected from pool of otherwise healthy dental students. Facial portrait photographs using a DSLR camera were obtained while keeping the teeth in maximum inter-cuspation position. Auto-CAD software was used to analyse the coincidence of facial, maxillary and mandibular midlines. SPSS Version 23.0 was used for data analysis. The coincidence of the midlines were determined using Pearson correlation test. Level of significance was set at 0.05. RESULTS: The coincidence of maxilla-mandible midlines was 64.1% (75/117); whereas, coincidence of facial midline with maxillary and mandibular midlines were 47.9% (56/117) and 46.1% (54/117), respectively. Left sided deviations of dental midlines were more frequent than the right side. CONCLUSION: The coincidence of inter-maxillary midlines was seen in two-thirds of the participants only. The dental midlines were coincident with the facial midline in less than half of the sample.

Formulation development of sugar free antacid chewable tablets for diabetes induced acidity in patients.

Sugar free chewable tablets are considered to be desired medication for diabetic population having acid reflex problems. The main objective of this study is to develop a patient complaint tablet dosage form which is sugar free, chewable and easy to use. The formulation is designed for hyperglycemic and dysphasic patients along acidity or stomach ulcer. For manufacturing Aluminum Hydroxide (Kyowa Japan), Magnesium Hydroxide (Taurus chemicals India) Simethicone, Povidone (JRS pharma) Sorbitol powder, Magnesium stearate, Dilcalcium phosphate anhydrous, SSG (JRS pharma) and Aspartame were used. The granules formed by wet granulation method and tablets are compressed by rotary compression machine. The pre-formulation studies of granules (Angle of repose, Bulk/Tapped density, Carr's compressibility index and Hausner's ratio), uniformity of content (assay), acid neutralizing capacity, Identification by FTIR spectroscopy all are found within the limits as per USP specifications. All three formulation batches are stable under accelerated and ambient stability conditions for 6 months and 24 months respectively. The formulation development of sugar free oral chewable antacid tablet is pharmaceutically stable and can further analyze for safety and efficacy studies.

Improved sensing characteristics of methane over ZnO nano sheets upon implanting defects and foreign atoms substitution.

Thanks to the growing interests of metal oxide sensors in environmental and industrial uses, this study presents the sensing mechanism of methane gas (CH4) on recently synthesized two-dimensional form of ZnO, ZnO nano sheets (ZnO-NS). The adsorption energy of CH4 on pristine ZnO-NS, calculated by means of van der Waals corrected first-principles calculations, is found to be insufficient restricting its application as an efficient nano sensor. However, the creation of (O/Zn) vacancies and the substitution of foreign dopants into ZnO-NS considerably intensify the binding energy of CH4. Through a comprehensive energetic analysis, it is observed that among all the substituents, boron (B), sulphur (S) and gallium (Ga) improves the binding of CH4 to 2.75, 6.1 and 7.5 times respectively than its values on pristine ZnO-NS. In addition to the CH4 binding energies falling ideally between physisorption and chemisorption range, a prominent variation in the electronic properties before and after CH4 exposure indicates the promise of substituted Zn-NS as a useful nano sensors.

Fracture risk in men with congestive heart failure risk reduction with spironolactone.

OBJECTIVES: The purpose of this study was to determine whether spironolactone use is associated with fractures in men with congestive heart failure (CHF). BACKGROUND: In rats with aldosteronism, spironolactone preserves skeletal strength. However, in humans, the relationship of spironolactone to fractures is not known. METHODS: The medical records of all male patients with CHF from 1999 to 2005 treated at the Veterans Affairs Medical Center, Memphis, Tennessee, were reviewed (n = 4,735). Odds ratios with 95% confidence intervals of having a fracture associated with spironolactone use were estimated using conditional logistic regression. RESULTS: We identified 167 cases with a single-incident fracture and matched these by age and race to 668 control subjects without fractures. After adjustment for covariates, spironolactone use was inversely associated with total fracture (odds ratio: 0.575; 95% confidence interval: 0.346 to 0.955, p = 0.0324). CONCLUSIONS: The use of spironolactone is inversely associated with fractures in men with CHF.