Enhancing bone tissue engineering using iron nanoparticles and magnetic fields: A focus on cytomechanics and angiogenesis in the chicken egg chorioallantoic membrane model.

AIM: To evaluate the potential of iron nanoparticles (FeNPs) in conjunction with magnetic fields (MFs) to enhance osteoblast cytomechanics, promote cell homing, bone development activity, and antibacterial capabilities, and to assess their in vivo angiogenic viability using the chicken egg chorioallantoic membrane (CAM) model. SETTINGS AND DESIGN: Experimental study conducted in a laboratory setting to investigate the effects of FeNPs and MFs on osteoblast cells and angiogenesis using a custom titanium (Ti) substrate coated with FeNPs. MATERIALS AND METHODS: A custom titanium (Ti) was coated with FeNPs. Evaluations were conducted to analyze the antibacterial properties, cell adhesion, durability, physical characteristics, and nanoparticle absorption associated with FeNPs. Cell physical characteristics were assessed using protein markers, and microscopy, CAM model, was used to quantify blood vessel formation and morphology to assess the FeNP-coated Ti's angiogenic potential. This in vivo study provided critical insights into tissue response and regenerative properties for biomedical applications. STATISTICAL ANALYSIS: Statistical analysis was performed using appropriate tests to compare experimental groups and controls. Significance was determined at P < 0.05. RESULTS: FeNPs and MFs notably improved osteoblast cell mechanical properties facilitated the growth and formation of new blood vessels and bone tissue and promoted cell migration to targeted sites. In the group treated with FeNPs and exposed to MFs, there was a significant increase in vessel percentage area (76.03%) compared to control groups (58.11%), along with enhanced mineralization and robust antibacterial effects (P < 0.05). CONCLUSION: The study highlights the promising potential of FeNPs in fostering the growth of new blood vessels, promoting the formation of bone tissue, and facilitating targeted cell migration. These findings underscore the importance of further investigating the mechanical traits of FeNPs, as they could significantly advance the development of effective bone tissue engineering techniques, ultimately enhancing clinical outcomes in the field.

Chronic Abdominal Discomfort Syndrome (CADS): Defining and Discussing a Novel Diagnosis.

In this article, we propose a new diagnostic paradigm known as Chronic Abdominal Discomfort Syndrome (CADS). Patient's presentation centers around chronic abdominal pain not explained by acute pathology with or without accompanying dyspepsia, bloating, nausea and vomiting among other symptoms. The pathophysiology is noted to be neurogenic, possibly stemming from visceral sympathetic nerves or abdominal wall afferent nerves. Diagnosis is supported by signs or symptoms traversing clinical, diagnostic and functional criteria. Included is a tool which can assist clinicians in diagnosing patients with CADS per those domains. We hope to facilitate primary care physicians' and gastroenterologists' utilization of our criteria to provide guidance for selecting which patients may benefit from further interventions or evaluation by a pain physician. The pain physician may then offer interventions to provide the patient with relief.

Comparative Growth Outcomes in Very Low Birth Weight Infants: Evaluating Different Feeding Strategies.

OBJECTIVES: To assess the growth pattern of preterm, very low birth weight (VLBW) appropriate for gestational age (AGA) infants on three different feeding regimens. METHODS: This prospective open label three-arm parallel randomized controlled trial was conducted at neonatal intensive care unit, Kasturba Hospital, Manipal. One hundred twenty VLBW (weight between 1000-1500 g and gestational age 28-32 wk) preterm AGA infants admitted from April 2021 through September 2022 were included. Three feeding regimens were compared: Expressed breast milk (EBM); EBM supplemented with Human milk fortifier (HMF); EBM supplemented with Preterm formula feed (PTF). Primary outcome measure was assessing the growth parameters such as weight, length, head circumference on three different feeding regimens at birth 2, 3, 4, 5 and 6 wk/discharge. Secondary outcomes included incidence of co-morbidities and cost-effectiveness. RESULTS: Of 112 infants analyzed, Group 2 supplemented with HMF showed superior growth outcomes by 6th wk/discharge of intervention, with mean weight of 2053±251 g, mean length of 44.6±1.9 cm, and mean head circumference of 32.9±1.4 cm. However, infants in Group 3, supplemented with PTF, registered mean weight of 1968±203 g, mean length of 43.6±2.0 cm, and mean head circumference of 32.0±1.6 cm. Infants exclusively on EBM presented with mean weight of 1873±256 g, mean length of 43.0±2.0 cm and mean head circumference of 31.4±1.6 cm. CONCLUSIONS: Addition of 1 g of HMF to 25 ml of EBM in neonates weighing 1000-1500 g showed better weight gain and head circumference at 6 wk/discharge, which was statistically significant. However, no significant differences in these parameters were observed at postnatal or 2, 3, 4, and 5 wk.

Low levels of CD26 on certain cellular subtypes of donor harvest is associated with better clinical outcomes post allogeneic stem cell transplantation through regulation of NF-κB pathway and pro-inflammatory cytokines.

BACKGROUND: We had previously reported significant association of immunoectoenzyme CD26 expression on donor harvest with acute Graft-versus-Host-Disease (aGVHD) in allogeneic stem cell transplantation (ASCT) patients. The current study was aimed at analysing CD26 signaling pathway molecules and understanding their impact on immune reconstitution and clinical outcomes post-ASCT. SUBJECTS AND METHODOLOGY: The study cohort included 26 transplant donors/patients who underwent reduced intensity (n = 21), myeloablative (n = 4) and non-myeloablative (n = 1) ASCT for hematological malignancies. Donors were matched related donors (n = 19) and haploidentical donors (n = 7). Surface expression of CD26, CD73 and ADA, and various immune cell subtypes were assessed by multicolour-flow cytometry. Soluble CD26 (sCD26) and cytokine levels were measured in plasma samples by ELISA and Multiplex Luminex assay, respectively. Immune cells from healthy individuals were stimulated with phytohemagglutinin (PHA) in the presence or absence of CD26 inhibitor. Effect of CD26 inhibition on NF-κB localization in PHA stimulated cells was analysed by immunofluorescence and confocal microscopy. Pro-inflammatory cytokines from the culture supernatants were detected with Cytometric bead array flow cytometry. Association of all measured markers with clinical outcomes was evaluated using appropriate statistical tests. RESULTS: CD26 surface expression on PBSC donor harvest cells showed increased risk of chronic GVHD (cGVHD, p = 0.055). Amongst the various immune cell subtypes, decreased B cells in harvest showed significant association with aGVHD (p = 0.022) whereas increased myeloid dendritic cells and CD3+T cells at Day100 in peripheral blood of transplant recipients correlated with cGVHD (p = 0.046) and aGVHD (p = 0.035), respectively. Further, high sCD26 in transplant recipients at Day100 exhibited association with reduced event-free survival (EFS) (p = 0.011). Higher CD26 expression on more & less mature NK cells, naïve & post-switched memory B cells and Treg cells in the donor harvest (p < 0.05) led to lower EFS in transplant recipients. Mechanistically, CD26 inhibitor caused dose-dependent reduction in CD26 enzyme activity and in pro-inflammatory cytokine production in post mitogen-stimulated T cell cultures. CONCLUSION: Our study has implicated that lower CD26 expression on immune cell subtypes of the donor stem cell harvest is associated with reduced risk of GVHD and better survival. The underlying mechanism was found to be through NF-κB pathway and pro-inflammatory cytokines. Based on these observations, chemically designed or natural resources-based CD26 inhibitors can be explored further in clinical trials for improving ASCT outcomes.

An In Vitro Evaluation of Morinda citrifolia and Ocimum sanctum as Potential Storage Media to Maintain Cell Viability for Avulsed Teeth Using Collagenase Dispase Assay.

Aim This study aimed to evaluate the protective effects of Ocimum sanctum extract and Morinda citrifolia juice on human periodontal ligament (PDL) cells after the reimplantation of avulsed teeth using a collagenase-dispase test. Materials and methods Sixty-five human premolars, all of which would eventually need to be extracted, were split into three experimental groups: one treated with Hanks Balanced Salt Solution, another with Morinda citrifolia juice and Ocimum sanctum extract, and two control groups (positive and negative). There were 10 teeth in each control group and 15 teeth each were used in the experimental groups, with the first 30 minutes spent dry before being submerged in one of three experimental media for 45 minutes, followed by 30 minutes of treatment with collagenase and dispase II. The cells' vitality was measured by the trypsin dye exclusion technique. To determine how many PDL cells were still alive, An optical microscope and a hemocytometer were used. The data were analyzed using Kruskal-Wallis one-way ANOVA and Mann-Whitney U tests. Results The percentage of viable PDL cells was greatest in Morinda citrifolia juice (85.18%), followed by HBSS (84.3%), and finally by Ocimum sanctum extract (68.04%). There was no significant difference in the number of viable PDL cells in Morinda citrifolia juice and HBSS. Conclusion The results of this research suggest that Morinda citrifolia juice has potential as a storage medium and as an alternative to HBSS, within the study's constraints, considering its availability as well as economic feasibility.

The effect of external magnetic field on osteogenic and antimicrobial behaviour of surface-functionalized custom titanium chamber with iron nanoparticles. A preliminary research.

PURPOSE: The controlled responsive characteristics of iron nanoparticles (FeNp) in magnetic fields make them an attractive prospect in this field. In the presence of a magnetic field, FeNp can significantly impact cell behaviour, leading to breakthroughs in nanotechnology. AIM/HYPOTHESIS: The aim is to determine the possible applications of iron nano particles (FeNp), and induced magnetic exposure role in osteoconduction and antibacterial activity. MATERIALS AND METHODS: The custom-grade IV titanium (Ti)hollow chamber is fabricated, surface treated with FeNp. Each titanium chamber contained neodymium, iron, and boron magnet disc, and the effect of FeNp on osteoblast-like cells (MG63) was evaluated in terms of cell attachment and survivability, morphological characteristics, particle absorption, and antibacterial properties. The effects of cellular uptake of FeNp and their responses to subcellular thrust were studied using fluorescent microscopy. MTT was used to determine cell viability, and von Kossa histochemical staining was used to determine matrix mineralization. RESULTS: In the magnetized Ti chambers group, osteogenic activity and mineralization were considerably greater than in the control groups (p 0.05). With a p value of 0.027, the S. aureus and E. coli were resistant to the antibacterial properties of the FeNp modified titanium custom Ti chamber (MIC: 0.03135 mg/mL and 0.02915 mg/mL, respectively). CONCLUSION: The one-of-a-kind, in vitro, conveniently modelled, limited sample study sheds light on the effect of surface-functionalized titanium custom Ti chamber with FeNp on MG63. The use of magnetized FeNp-surfaced implants for long-term strategic bone tissue engineering and bacteriostatic implants.

Safety, toxicity and pharmacokinetic assessment of oral Withaferin-A in mice.

Withaferin-A (WA) is the principle component of Withania somnifera (Ashwagandha). It has several biological activities including anti-cancer, anti-diabetic, neuroprotective, hepatoprotective and immune-modulatory properties. The acute and sub-acute toxicity of oral WA was investigated in mice. In the acute toxicity study, up to 2000 mg/kg of WA was well tolerated without any signs of toxicity or death. In the sub-acute toxicity study, mice were orally administered 10, 70 and 500 mg/kg of WA respectively, daily for 28 days. Upon physiological, serum chemistry, hematology and histopathogical examination, no features suggestive of drug-induced toxicity were observed at any dose levels, thereby confirming the No-Observed Adverse Effect Level (NOAEL) to be at least 500 mg/kg. Furthermore, the oral bioavailability of WA was evaluated using single intravenous and oral doses of 10 mg/kg and 70 mg/kg respectively using sparse sampling strategy. Bioanalysis was carried out using a validated LC-MS/MS method. The AUC of WA was found to be 3996.9 ± 557.6 ng/mL*h and 141.7 ± 16.8 ng/mL*h for the intravenous and oral routes of administration respectively. The oral bioavailability was determined to be 1.8%. To conclude, WA was found to be extremely safe even at high doses, with a low oral bioavailability.

A study to explore the appropriateness of dosing regimen of vancomycin in critically ill patients in a tertiary care unit of India.

Introduction: Vancomycin is used in proven or suspected MRSA and MRE infections. An AUC/MIC ratio of ≥400 is the current accepted critical PK/PD"efficacy" target of vancomycin activity. The present study was conducted to ascertain the appropriateness of practice of current dosage regimen of vancomycin (1 g BD) based on population pharmacokinetic approach. Methods: A single-center prospective study with the ICU setting of a tertiary care center was conducted. A total of 15 adult patients with sepsis treated with vancomycin were included over 15 months from May 2019 to July 2020. Blood samples were obtained at 5, 10, and 30 minutes and thereafter at 2 and 6 hours following the completion of the vancomycin infusion. The data obtained from HPLC estimation was analyzed using a population pharmacokinetic approach with NLME, Phoenix 8.3.2.166. The pharmacokinetic model was based on covariates such as bodyweight and urinary creatinine clearance to predict drug concentrations. Results: A total of 83 vancomycin blood samples were analyzed. The mean AUC0-last and AUC0-∞ in patients who improved and died were (AUC(0-last)=293 (152.97); AUC(0-∞)=535.14 (353.67) and (AUC(0-last)=137.19 (51.37); AUC(0-∞)=582.12 (1036.09) respectively, the difference between the two outcome groups was not statistically significant (p=0.104). The pharmacokinetic model was best described by a two-compartment linear model. The goodness-of-fit plots showed that the final covariate pharmacokinetic model (having bodyweight and urinary creatinine clearance) adequately described the observed vancomycin concentrations. Conclusions: Based on the finding of the study it was concluded that 1 g BD dosing of vancomycin is inappropriate. Including covariates such as urinary creatinine clearance and weight in the pharmacokinetic model helped predict drug concentrations more accurately. However, further studies are required to demonstrate efficacy regarding applying this strategy.

Comparative Assessment of Perceived Pain in Children During Palatal Anesthesia Using Two Injection Techniques: An In Vivo Study.

Background: Computer-controlled local anesthetic delivery (CCLAD) is an approach that uses a constant and slow flow of delivering the anesthetic solution into the tissues, which is capable of alleviating pain and discomfort in children. Aim: Assessment of perceived pain in children during palatal anesthesia using Wand technique and conventional technique. Materials and Methods: A total of 30 children requiring bilateral palatal anesthesia were included in the study in a split-half design. The children were asked to indicate their intensity of pain response on a visual analog scale (VAS) after administration of anesthesia by the Wand technique and the conventional technique. Statistical Analysis: The data were analyzed using Statistical Package for the Social Sciences (SPSS) 16.0. Mann-Whitney U test compared the mean VAS scores between the two groups. Statistical significance was defined as a P value of less than 0.05. Results: The mean VAS scores using the Wand technique and the conventional technique were 3.87 ± 1.99 and 4.20 ± 1.44, respectively (P = 0.332). Females had lesser VAS scores compared to males (P = 0.008). Conclusion: Females readily accepted the Wand technique compared to males, although there was no substantial difference between the two injection procedures.

Propofol's Efficacy and Outcomes on Anxious Children's Behavior in the Course of Dental Therapy: An Interventional Trial.

Introduction: Tranquility therapies have recently been more popular as a means of reducing anxiety amongst children in the course of painful diagnostic and therapeutic procedures. As a result, a variety of techniques (oral tranquility, intravenous (IV) tranquility) have been developed to assist practitioners in order to deal with such instances. The goal of this trial was to see how effective propofol could be in calming anxious youngsters during the course of dental therapy. The interventional investigation was undertaken at the Hazaribag College of Dental Sciences and Hospital in Jharkhand. Materials and Methods: To assess the outcomes of intravenous propofol on their performance in the course of therapy, 40 children within the age group of 3-6 years pursuing good physical health but uncooperative in nature (negative or definitely negative, bestowing to Frankel's performance scale) were comprised in the study. The performance rating scale was utilized to assess their performance throughout the therapy (BRS). In addition, the point of tranquility was assessed beforehand. Mann-Whitney U test was utilized to equate male and female points of performance along with gradations of drowsiness. The P value for significance was fixed at 0.05. Results: All participants' performance and point of tranquility in the course of therapy were promising, and therapy was accomplished for everyone. Mann-Whitney U test revealed no statistically significant differences in point of performance, or gradation of drowsiness amid males and females. Pearson's correlation coefficient revealed a strong positive association of therapy time with awakening time. Conclusion: Intravenous propofol deep tranquility in the presence of an anesthesiologist was found to be beneficial in restraining nervous and recalcitrant youngsters in the course of dental therapy.

A Look at Commonly Utilized Serotonin Noradrenaline Reuptake Inhibitors (SNRIs) in Chronic Pain.

Purpose of Review: Chronic pain continues to be one of the leading healthcare cost burdens in the United States and is typically defined as ongoing pain, lasting longer than six months. Various treatment options exist for chronic pain, including physical therapy, medical management, pain psychology, and interventional therapies. Pain medications have been the mainstay of treatment for chronic pain conditions with an increasing use of membrane stabilizers and antidepressants to treat neuropathic pain conditions. Specifically, serotonin noradrenaline reuptake inhibitors (SNRIs) have been used to treat a range of pain conditions expanding from everyday use for depressive disorders. Recent Findings: SNRIs, including duloxetine, venlafaxine, and milnacipran, have demonstrated efficacy in reducing pain in musculoskeletal pain (chronic low back pain and osteoarthritis), fibromyalgia, and neuropathic pain conditions (peripheral diabetic neuropathy). Summary: The article describes the function, role, and use of SNRIs to treat chronic and neuropathic pain by altering the noradrenergic descending inhibitory pathways.

Role of Distraction Osteogenesis in the Management of Postankylotic Deformity.

INTRODUCTION: Distraction osteogenesis (DO) has evolved in maxillofacial surgery and gained popularity due to the limitations of orthognathic surgery in gross asymmetry cases. PURPOSE: The primary aim of the paper was to determine if the use of DO for the management of severe deformities of the mandible secondary to temporomandibular joint ankylosis can achieve optimal results, with or without genioplasty, based on cephalometric norms. The secondary aim of this study was to evaluate the complications associated with DO in this group of patients. MATERIALS AND METHODS: Six patients with postankylotic deformity were included. Both internal and external devices were used for an average mandibular corpus lengthening of 15 mm with adjunctive procedure genioplasty. RESULTS: All patients had excellent outcome in terms of profile, functional occlusion, and mouth opening without deviation. Two patients had primary genioplasty showed excellent compliance and 2 as secondary at the time of device removal. Complications noted were, difficulty in vector control during distraction, paresthesia, occlusal discrepancy, scarring, and relapse of 2 to 3 mm. Preorthodontics and postorthodontics were done in all patients to settle the occlusion, which was stable after 2-year follow-up. CONCLUSIONS: Case series shows such gross deformities pose a greater challenge due to undergrowth, gross midline shift, and discrepancy between soft and hard tissue growth pattern and the desired results can be achieved by precise planning. Genioplasty at the time of device placement has definitive positive effect on patient compliance. Though orthognathic surgery has a definitive role in minor deformity, whereas in gross deformities DO with precise planning using 3-dimensional model and vector controlled technique offers excellent outcome.

Knowledge, Attitude, and Practice of Parents toward Their Children's Oral Health and its Influence on the Dental Caries Status of 5-10-year-old Schoolchildren in Nashik, Maharashtra: A Cross-sectional Study.

Aim: The aim of the present study is to assess the knowledge, attitude, and practices of parents toward their children's oral health and its influence on the dental caries status of 5-10 years old schoolchildren in Nashik, Maharashtra. Materials and methods: A cross-sectional questionnaire-based study was conducted among parents of 5-10 years old school children who visited our hospital. A total of 504 children and their parents were included in the study. Clinical examination of children was done using DMFT and deft index. A self-designed questionnaire was given to the parents to assess their knowledge, attitude and practices toward their children's oral health. Statistical analysis was performed using EPI INFO version 6.04. ANOVA test was used to test the association between dental caries status and KAP. p -value < 0.05 was considered to be statistically significant. Results: The mean DMFT was 1.6 ± 1.5 and mean deft was 6.6 ± 3.4. Majority of the parents (64.9%) showed fair knowledge, attitude, and practices. There was no significant difference between mean DMFT/deft and parental KAP. Conclusion: Overall the parents in the present study had reasonable KAP about oral health of their children. Deficient areas of oral health awareness include importance of milk teeth and their treatment, regular dental visits, and dietary practices. Clinical significance: Oral health awareness programs should be directed toward parents and should emphasize on topics such as importance of milk teeth and their treatment, regular dental visits, and dietary practices. How to cite this article: Patil AN, Karkare S, Jadhav HS, et al. Knowledge, Attitude, and Practice of Parents toward Their Children's Oral Health and its Influence on the Dental Caries Status of 5-10-year-old School-children in Nashik, Maharashtra: A Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(S-2):S126-S130.

Role of ADME gene polymorphisms on imatinib disposition: results from a population pharmacokinetic study in chronic myeloid leukaemia.

PURPOSE: Imatinib is a substrate of CYP3A4, ABCB1 and ABCG2, and is known to have wide variability in pharmacokinetics (PK). At the same time, a clear relationship between drug levels and response also exists for imatinib in chronic myeloid leukaemia (CML). Therefore, pharmacogenetic-based dosing of imatinib is an attractive proposition. This study aims to characterize the population pharmacokinetics of imatinib in order to identify significant covariates including pharmacogenetic variants. METHODS: Forty-nine patients with CML were enrolled in the study after being on imatinib for at least 4 consecutive weeks. Steady-state pharmacokinetic sampling was performed either in a sparse (4 samples each, n = 44) or intensive manner (9 samples each, n = 5). An additional pharmacogenetic sample was also collected from all patients. Plasma imatinib levels were estimated using a validated HPLC method. Pharmacogenetic variants were identified using the PharmacoScan array platform. Population pharmacokinetic analysis was carried out using NONMEM v7.2. Seven SNPs within CYP3A4, ABCB1 and ABCG2 genes were evaluated for covariate effect on the clearance of imatinib. RESULTS: Imatinib PK was well characterized using a one-compartment model with zero-order absorption. The clearance and volume of distribution were found to be 10.2 L/h and 389 L respectively. Only SNP rs1128503 of the ABCB1 gene had a small but insignificant effect on imatinib clearance, with a 25% reduction in clearance observed in patients carrying the polymorphism. Twenty-three out of forty-nine patients (47%) carried the polymorphic allele, of whom 17 were heterozygous and six were homozygous. CONCLUSION: Our study conclusively proves that genetic polymorphisms in the CYP3A4 and ABC family of transporters do not have any role in the personalized dosing of imatinib in CML.

Feasibility of therapeutic drug monitoring of sunitinib and its implications on response and toxicity in patients with metastatic renal cell cancer.

PURPOSE: Sunitinib is an oral tyrosine kinase inhibitor approved for the treatment of metastatic renal cell carcinoma (mRCC). High variability in pharmacokinetics coupled with a proven exposure-effect relationship makes sunitinib an ideal candidate for therapeutic drug monitoring (TDM). The feasibility of TDM of sunitinib in patients with mRCC was evaluated in this prospective observational study in a real-world scenario. METHODS: Seventy patients with mRCC treated with sunitinib at a fixed dose of 50 mg per day were enrolled in the study. Total trough plasma level (TTL) of sunitinib (sunitinib and its active metabolite, SU12662), was measured between days 14/15 of cycle 1. The discriminatory potential of TTL of sunitinib for the prediction of responders and occurrence of grade ≥ 3 toxicity was determined using receiver operating characteristic (ROC) curve. RESULTS: The median TTL of sunitinib was 76 ng/mL. Forty six out of 70 patients were evaluable for response, whereas 60 out of 70 patients were evaluable for toxicity. Threshold concentrations obtained from ROC analysis showed that TTL of 60.75 ng/mL and 82.3 ng/mL was discriminatory for response and occurrence of grade ≥ 3 toxicity respectively. 31/34 (91.7%) patients having TTL ≥ 60.75 ng/mL responded to treatment, while only 5/12 (41.6%) responded when TTL was < 60.75 ng/mL (P = 0.001). On the other hand, the incidence of grade ≥ 3 toxicity was 9/24 (37.7%) in patients with TTL ≥ 82.3 ng/mL compared to 4/36 (11.1%) in patients with TTL < 82.3 ng/mL (P = 0.024). CONCLUSION: The TTL range of 60.75-82.3 ng/mL was found to be optimal in terms of safety and efficacy. More than 50% of patients in our cohort attained TTL of sunitinib outside the optimal range, thus demonstrating the feasibility of TDM to improve safety and efficacy of sunitinib in mRCC.

Spindle-cell sarcoma of the heart: A case report of a rare cause of cardiac mass.

Spindle cell sarcoma of heart are the least reported primary cardiac tumours. We present a case of a 60-year-old man reported to us following successful resuscitation after cardiac arrest. This patient presented with symptoms of dyspnoea on exertion. The echocardiography showed features of cardiac tamponade. CT scan chest+ Abdomen + Pelvis confirmed echocardiography findings, and showed significant pericardial effusion with early cardiac tamponade. Patient continued to suffer dyspnoea even after pericardiocentesis and was unstable in the intensive care unit, hence he was shifted to operating room for re-exploration. The mass was excised in a piecemeal without instituting cardiopulmonary bypass. The total weight of the mass was approximately 500gms. The macroscopic examination of the specimen revealed a cystic mass with solid grey brown tissue. Following surgical debulking, chest X -ray in Intensive Care Unit showed improvement. The patient visited the outpatient clinic after 15 days of surgery. 2-D echocardiography revealed minimal pericardial effusion and patient was comfortable.

Trichotillomania in childhood: A case series.

Trichotillomania is a psychodermatological disorder characterized by an uncontrollable urge to pull one's own hair. It is often associated with depression and obsessive-compulsive disorder. We report five cases, a young male and four females, who presented with an increased desire to pluck out their hair, leading to large patches of baldness. Despite distinct forms of presentations and different comorbidities, the management more or less remained the same.

Use of Ketamine Infusions for Treatment of Complex Regional Pain Syndrome: A Systematic Review.

This systematic review aims to review clinical studies on the use of ketamine infusion for patients with treatment-resistant complex regional pain syndrome (CRPS). The following systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021228470). Studies for the systematic review were identified through three databases: PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Reviews. Inclusion criteria for studies consisted of randomized clinical trials or cohort studies that conducted trials on the use of ketamine infusion for pain relief in patients with CRPS. Exclusion criteria for studies included any studies that were systematic reviews, meta-analyses, case reports, literature reviews, or animal studies. In the included studies, the primary outcome of interest was the post-drug administration pain score. In this systematic review, 14 studies met the inclusion criteria and were reviewed. In these studies, the dosage of ketamine infusion used ranged from 0.15 mg/kg to 7 mg/kg with the primary indication being the treatment of CRPS. In 13 of the studies, ketamine infusion resulted in a decrease in pain scores and relief of symptoms. Patients who received ketamine infusion for treatment-resistant CRPS self-reported adequate pain relief with treatment. This suggests that ketamine infusion may be a useful form of treatment for patients with no significant pain relief with other conservative measures. Future large-scale studies, including randomized double-blind placebo-controlled trials on the use of ketamine infusion for CRPS, must be conducted in a large-scale population to further assess the effectiveness of ketamine infusion in these populations.

Simultaneous analysis of urinary total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, N'-nitrosonornicotine, and cotinine by liquid chromatography-tandem mass-spectrometry.

Biomarkers of exposure to harmful tobacco constituents are key tools for identifying individuals at risk and developing interventions and tobacco control measures. However, tobacco biomarker studies are scarce in many parts of the world with high prevalence of tobacco use. Our goal was to establish a robust method for simultaneous analysis of urinary total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), N'-nitrosonornicotine (NNN), and cotinine at the Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) in Mumbai, India. These biomarkers are validated measures of exposure to the carcinogenic tobacco nitrosamines 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and NNN and the addictive alkaloid nicotine, respectively. The established method is characterized by excellent accuracy, linearity, and precision, and was successfully applied to the analysis of 15 smokeless tobacco (SLT) users and 15 non-users of tobacco recruited in Mumbai. This is the first report of establishment of such procedure in a laboratory in India, which offers the first in-country capacity for research on tobacco carcinogenesis in Indian SLT users.