Evaluation of physiochemical and biomedical properties of psyllium-poly(vinyl phosphonic acid-co-acrylamide)-cl-N,N-methylene bis acrylamide based hydrogels.

Present investigation deals with the synthesis of psyllium based copolymeric hydrogels and evaluation of their physiochemical and biomedical properties. These copolymers have been prepared by grafting of poly(vinyl phosphonic acid) (poly (VPA)) and poly(acrylamide) (poly(AAm)) onto psyllium in the presence of crosslinker N,N-methylene bis acrylamide (NNMBA). These copolymers [psyllium-poly(VPA-co-AAm)-cl-NNMBA] were characterized by field emission-scanning electron micrographs (FE-SEM), electron dispersion X-ray analysis (EDAX), Atomic force microscopy (AFM), Fourier transform infrared spectroscopy (FTIR), 13C-nuclear magnetic resonance (NMR), X-ray diffraction (XRD), and thermogravimetric analysis (TGA)- differential thermal analysis (DTG). FESEM, AFM and XRD demonstrated heterogeneous morphology with a rough surface and an amorphous nature. Diffusion of ornidazole occurred with a non-Fickian diffusion mechanism, and the release profile data was fitted in the Korsemeyer-Peppas kinetic model. Biochemical analysis of hydrogel properties confirmed the blood-compatible nature during blood-polymer interactions and revealed haemolysis value 3.95 ± 0.05 %. The hydrogels exhibited mucoadhesive character during biomembrane-polymer interactions and demonstrated detachment force = 99.0 ± 0.016 mN. During 2,2-diphenyl-1-picrylhydrazyl reagent (DPPH) assay, free radical scavenging was observed 37.83 ± 3.64 % which illustrated antioxidant properties of hydrogels. Physiological and biomedical properties revealed that these hydrogels could be explored for drug delivery uses.

Teprotumumab for Treatment of Pretibial Myxedema.

Pretibial myxedema (PTM), also called thyroid dermopathy, is a dreaded and potentially debilitating manifestation of thyroid disease, more commonly Graves' disease, which can occur at any time over the course of the disease. No substantial long-term therapies have been able to target the condition, and management has typically been supportive (eg, compression socks, weight loss), with courses of moderate-intensity steroids. Teprotumumab has been approved for the management of thyroid eye disease (TED), and it is believed that the 2 share a similar pathophysiology likely related to type 1 insulin-like growth factor receptor, which may explain why some patients have also experienced improvement in PTM. Here we present a patient who received 8 doses of teprotumumab for TED who, over the course of management and into follow-up, experienced significant improvement in her pretibial myxedema. The patient noted considerable improvement in quality of life and ability to perform daily activities. We present this case to consider further investigation into the utilization of teprotumumab for thyroid disease-related PTM in patients with impaired quality of life.

Single Serum Cortisol Value as a Prognostic Marker in Acute Ischemic Stroke.

BACKGROUND: Stroke is a major global burden with significant morbidity, mortality, and long-term disability. Acute ischemic stroke (AIS) is a stressful condition causing stimulation of the hypothalamic-pituitary-adrenal (HPA) axis resulting in numerous endocrinal alterations in the body. We evaluated the serum cortisol as a prognostic marker in AIS. METHODS: This was a prospective observational study comprising 100 cases suffering from AIS, and serum cortisol at the baseline was measured. Severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) during admission, and functional outcome was assessed at 1, 4, and 24 weeks using a modified Rankins score (mRS). Statistical analysis was performed to find the relationship between serum cortisol and the severity of stroke, outcome, and mortality at 1, 4, and 24 weeks of stroke. RESULTS: In our study, we found positive correlations between random blood sugar and serum cortisol (r = 0.273, p = 0.006); stroke severity (NIHSS) and serum cortisol (r = 0.785, p < 0.001); stroke outcome (mRS) at 1, 4, and 24 weeks; and serum cortisol (p < 0.001 and r = 0.676, 0.654, 0.650 for all three intervals, respectively). We also found higher serum cortisol among patients who died at 1, 4, and 24 weeks compared to those who survived with a p-value being <0.001 for all three intervals. CONCLUSIONS: A stress response causing an increase in serum cortisol occurs in AIS. This response is detrimental to the patient. The serum cortisol at baseline can be considered a marker of severity, short- and long-term prognosis, and mortality after AIS.

Outcomes of immediate dental implants in vascularised bone flaps for mandibular reconstruction.

BACKGROUND: The aim of this study is to assess the outcomes of immediate implant placement for dental rehabilitation following mandibular reconstruction with vascularised bone flaps in a single Australian tertiary cancer centre. METHODS: A retrospective analysis of patients who underwent immediate dental implant or delayed placement in vascularised bone flaps was performed. Primary outcome measures assessed included the number of implants placed, operative time, complication rates, time to radiotherapy initiation, dental rehabilitation rates and time to dental rehabilitation. RESULTS: In total, 187 dental implants were placed in 52 patients, of which 34 patients underwent immediate implant placement and 18 had delayed implant placement. There were no significant differences in the postoperative complication rate (32% immediate vs. 33% delayed, P = 0.89) or time to postoperative radiotherapy (median 42 days immediate vs. 47 days delayed, P = 0.24). Dental rehabilitation was achieved in 62% of the immediate cohort versus 78% of the delayed cohort. The time to be fitted with a dental prosthesis was significantly shorter in the immediate cohort (median 150 days immediate vs. 843 days delayed, P = 0.002). CONCLUSIONS: The placement of immediate dental implants at the time of primary reconstruction of the mandible is a safe procedure and facilitates timely dental rehabilitation.

Effect of Radiotherapy on Functional and Health-Related Quality of Life Outcomes after Jaw Reconstruction.

Long-term health-related quality of life (HRQOL) and functional outcomes following mandibular and maxillary reconstruction are lacking. To determine these outcomes, a cross-sectional study of patients with a history of cancer who underwent jaw reconstruction was undertaken. Participants were identified from a database of jaw reconstruction procedures at the Chris O'Brien Lifehouse (Sydney, Australia). Eligible patients had at least one month follow-up, were aged ≥18 years at surgery, and had history of malignancy. HRQOL was measured using the FACE-Q Head and Neck Cancer Module (FACE-Q H&N). Functional outcomes were measured using the FACE-Q H&N, MD Anderson Dysphagia Inventory (MDADI) and Speech Handicap Index (SHI). Ninety-seven questionnaires were completed (62% response rate). Mean age of respondents was 63.7 years, 61% were male, and 64% underwent radiotherapy. Treatment with radiotherapy was associated with worse outcomes across 10/14 FACE-Q H&N scales, three MDADI subscales and one composite score, and the SHI. Mean differences in scores between irradiated and non-irradiated patients exceeded clinically meaningful differences for the MDADI and SHI. Issues with oral competence, saliva, speaking, and swallowing worsened with increasing time since surgery. Younger patients reported greater concerns with appearance, smiling, speaking, and cancer worry. Women reported greater concerns regarding appearance and associated distress. History of radiotherapy substantially impacts HRQOL and function after jaw reconstruction. Age at surgery and gender were also predictors of outcomes and associated distress. Pre-treatment counselling of patients requiring jaw reconstruction may lead to improved survivorship for patients with head and neck cancer.

Patient specific implant with high condylar neck osteotomy for temporomandibular joint preservation in segmental mandibulectomy.

STUDY DESIGN: Letter to the Editor. OBJECTIVE: Disarticulation may be considered during segmental mandibulectomy where margins necessitate high condylar neck osteotomy. Although a number of techniques have been reported for reconstruction of the condyle, successful preservation of normal joint anatomy, where possible, should be considered as a superior alternative. This report demonstrates a safe and predictable approach to condylar head preservation with high condylar neck osteotomy. METHODS: We present two cases of native TMJ preservation with a very short salvageable condylar component utilising 3D-printed patient specific cutting guides and implants. RESULTS: The condyle preserving reconstructive technique described successfully preserves the capsule of the TMJ, and with careful execution can preserve the intra-articular components of the joint and their relationships to each other. Both patients have experienced excellent outcomes to date. CONCLUSIONS: As opposed to disarticulation reconstructions, this technique is more likely to achieve long-term normal occlusion, maintain normal alignment of reconstructed segments, and preserve condylar translation as opposed to simple hinging, in addition to avoiding the potential pitfalls of alternative techniques.

Health-related quality of life in maxillectomy patients undergoing dentoalveolar rehabilitation.

OBJECTIVES: Surgical resection of the maxilla impairs aesthetics, speech, swallowing, and mastication. Maxillary reconstruction is increasingly performed with virtual surgical planning (VSP) to enhance functional dental rehabilitation with a conventional denture or osseointegrated implants. The aim of this study was to determine whether dental status and VSP is associated with health-related quality of life (HRQOL) and function in patients who have undergone maxillectomy. MATERIALS AND METHODS: A cross-sectional study was conducted among patients who underwent free flap reconstruction or obturation of the maxilla between July 2009 and December 2020. The FACE-Q Head and Neck Cancer (FACE-Q) module, M.D. Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI) were used to evaluate HRQOL. RESULTS: Forty-three patients (response rate 59%) completed questionnaires and 48% underwent dental rehabilitation. In Okay Class II and III defects, adjusting for the effect of radiotherapy and time from surgery, there was a positive association between denture status and FACE-Q smiling (p = 0.020), eating (p = 0.012), smiling (p = 0.015), and MDADI global (p = 0.015), emotional (p = 0.027), functional (p = 0.028), and composite (p = 0.029) scores. VSP was associated with FACE-Q swallowing (p = 0.005), drooling (p = 0.030), eating (p = 0.008), smiling (p = 0.021), MDADI global (p = 0.017), emotional (p = 0.041), functional (p = 0.040), composite (p = 0.038), and SHI total scores (p = 0.042). CONCLUSIONS: Dentoalveolar rehabilitation and VSP were associated with higher HRQOL scores relating to eating and drinking, smiling, and speaking.

Synthesis and characterization of arabinoxylan-bis[2-(methacryloyloxy)ethyl] phosphate crosslinked copolymer network by high energy gamma radiation for use in controlled drug delivery applications.

Keeping in view the therapeutic important dietary fiber psyllium, herein this research report its potential has been explored for the formation of sterile hydrogel by high energy radiation induced copolymerization of arabinoxylan-poly bis[2-(methacryloyloxy)ethyl] phosphate (BMEP) for use as drug delivery carrier. The polymeric network structure was characterized by 13C NMR, FTIR, TGA/DTG and DSC, XRD and AFM techniques. Release profile of a drug cefuroxime and best fit kinetic model were determined. The blood -polymer interaction, mucosal-polymer adhesion, antioxidant and mechanical properties were also evaluated. The radiation dose influenced the crosslink density and the mesh size of the hydrogel network. Release profile of a drug cefuroxime followed non-Fickian diffusion and best fitted to first order kinetic model. The grafted product was sterile, porous, antioxidant and mucoadhesive in nature and could be explored for controlled and sustained GIT drug delivery applications.

Machine Learning-Based Analytical Systems: Food Forensics.

Despite a large amount of money being spent on both food analyses and control measures, various food-borne illnesses associated with pathogens, toxins, pesticides, adulterants, colorants, and other contaminants pose a serious threat to human health, and thus food safety draws considerable attention in the modern pace of the world. The presence of various biogenic amines in processed food have been frequently considered as the primary quality parameter in order to check food freshness and spoilage of protein-rich food. Various conventional detection methods for detecting hazardous analytes including microscopy, nucleic acid, and immunoassay-based techniques have been employed; however, recently, array-based sensing strategies are becoming popular for the development of a highly accurate and precise analytical method. Array-based sensing is majorly facilitated by the advancements in multivariate analytical techniques as well as machine learning-based approaches. These techniques allow one to solve the typical problem associated with the interpretation of the complex response patterns generated in array-based strategies. Consequently, the machine learning-based neural networks enable the fast, robust, and accurate detection of analytes using sensor arrays. Thus, for commercial applications, most of the focus has shifted toward the development of analytical methods based on electrical and chemical sensor arrays. Therefore, herein, we briefly highlight and review the recently reported array-based sensor systems supported by machine learning and multivariate analytics to monitor food safety and quality in the field of food forensics.

Characterization and Mapping of Spot Blotch in Triticum durum-Aegilops speltoides Introgression Lines Using SNP Markers.

Spot blotch (SB) of wheat is emerging as a major threat to successful wheat production in warm and humid areas of the world. SB, also called leaf blight, is caused by Bipolaris sorokiniana, and is responsible for high yield losses in Eastern Gangetic Plains Zone in India. More recently, SB is extending gradually toward cooler, traditional wheat-growing North-Western part of the country which is a major contributor to the national cereal basket. Deployment of resistant cultivars is considered as the most economical and ecologically sound measure to avoid losses due to this disease. In the present study, 89 backcross introgression lines (DSBILs) derived from Triticum durum (cv. PDW274-susceptible) × Aegilops speltoides (resistant) were evaluated against SB for four consecutive years, 2016-2020. Phenotypic evaluation of these lines showed a continuous variation in disease severity indicating that the resistance to SB is certainly quantitative in nature. Phenotypic data of DSBILs were further used for mapping QTLs using SNPs obtained by genotyping by sequencing. To identify QTLs stable across the environments, Best Linear Unbiased Estimates (BLUEs) and Predictions (BLUPs) were used for mapping QTLs based on stepwise regression-based Likelihood Ratio Test (RSTEP-LRT) for additive effect of markers and single marker analysis (SMA). Five QTLs, Q.Sb.pau-2A, Q.Sb.pau-2B, Q.Sb.pau-3B, Q.Sb.pau-5B, and Q.Sb.pau-6A, linked to SB resistance were mapped across chromosomes 2A, 2B, 3B, 5B, and 6A. Genes found adjacent to the SNP markers linked to these QTLs were literature mined to identify possible candidate genes by studying their role in plant pathogenesis. Further, highly resistant DSBIL (DSBIL-13) was selected to cross with a susceptible hexaploidy cultivar (HD3086) generating BC2F1 population. The QTL Q.Sb.pau-5B, linked to SNP S5B_703858864, was validated on this BC2F1 population and thus, may prove to be a potential diagnostic marker for SB resistance.

Coping With Craving and Withdrawal Due to Substance Use Disorders During the COVID-19 Lockdown.

OBJECTIVE: Substance use disorder (SUD) is a chronic remitting and relapsing disorder, and abrupt discontinuation of the substance due to nonavailability in the absence of treatment precipitates withdrawals and craving. The objective of this study was to assess the craving and withdrawal coping mechanisms used by patients with SUDs as a result of disruption in availability of substances and medications due to sudden lockdown in response to coronavirus disease 2019. METHODS: A survey was administered via telephone from June 25, 2020, to July 15, 2020, to patients who had previously attended the substance use clinic of a tertiary care teaching hospital in North India from January 1, 2020, to March 21, 2020 (up to the time of lockdown). Sociodemographic and clinical details were obtained from case record files. A 16-item questionnaire was developed to collect information on coping with craving and withdrawal symptoms. A total of 215 patients were registered in the substance use clinic during this period for the treatment of SUDs, and of those, 43 could not be contacted due to various reasons such as wrong contact numbers, patient expired (not related to substance withdrawal), or not willing to talk. The mean age of the subjects was 37.05 (SD = 13.22) years, and men outnumbered women. The remaining 172 patients were contacted via telephone, and responses were gathered regarding withdrawal symptoms and coping with craving. RESULTS: More than two-thirds of the patients were still maintaining abstinence from their primary substance of abuse during lockdown. A large number of patients (n = 41, 43.2%) reported difficulty in obtaining prescribed medication for detoxification without renewal of their prescription. More than 66% of patients reported that they were able to control their craving, and many kept themselves busy with household activities. CONCLUSIONS: The majority of patients who had completed the acute phase of withdrawals were able to maintain abstinence in the absence of renewal of prescribed medication and substance of abuse due to sudden disruption in supply. The patients were able to use certain strategies to control their craving.

Maxillofacial reconstruction with prefabricated prelaminated osseous free flaps.

BACKGROUND: The prefabricated fibula flap is an advanced method of occlusal-based reconstruction that combines placement of osseointegrated dental implants with prelamination, using a split skin graft on the fibula, weeks prior to the definitive reconstruction. This approach is resource intensive but has several advantages including eliminating the delay from reconstruction to dental rehabilitation. METHODS: A retrospective cohort study of all prefabricated fibula flaps used for mandible and maxillary reconstruction from 2012 to 2020 was performed. Outcome measures were implant survival, implant utilization and functional dental rehabilitation. RESULTS: A total of 17 prefabricated fibula flaps were performed including two analogue and 15 digital plans. There were nine maxillary and eight mandibular reconstructions, of which 11 were primary and seven were secondary. There were no free flap failures. A total of 65 implants were placed (average 3.8, median 3 implants). There was one implant failure at 6 years giving a 1.5% failure rate. There was 91% implant utilization and 94% functional dental rehabilitation. CONCLUSION: The prefabricated fibula flap provides outstanding dental rehabilitation in well-selected patients.

Pleural and Mediastinal Lipomatosis with Subpleural Fat as a Mimicker of Pleural Effusion- A Rare Case Report.

Subpleural and mediastinal lipomatosis are benign intrathoracic conditions discovered incidentally on plain chest radiographs. However, diagnosis is usually made by Computed Tomography (CT). A case of both mediastinal and pleural lipomatosis associated with use of steroids in a 58-year-old male patient presented with complaints of breathlessness and dry cough is discussed in this case report. Intially, pleural effusion and bilateral upper lobe patchy opacities were suspected as a cause of breathlessness on the basis of chest x-ray findings. For which, CT scan of chest was advised.

Imaging Evaluation of Enhancement Patterns of Flat Gall Bladder Wall Thickening and Its Correlation with Clinical and Histopathological Findings.

INTRODUCTION: Gall bladder Wall Thickening (GWT) is caused by wide spectrum of diseases. Initially Ultrasound (USG) was used as imaging modality for screening of acute abdomen because of its high sensitivity and real time character. Now, Computed Tomography (CT) is used because of its high temporal and spatial resolution. AIM: Evaluation of GWT and its enhancement patterns on contrast enhanced CT scan in a bid to differentiate benign from malignant causes and to correlate the imaging features with clinical and histopathological findings. MATERIALS AND METHODS: It was a hospital based prospective study in which USG was done as an initial modality for screening and Multi Detector Computed Tomography (MDCT) scan was done later on for detailed evaluation of enhancement patterns of GWT. The study cases were then divided into five CT patterns according to enhancement patterns. The diagnostic performance of MDCT was compared with histopathological and serological findings. Relevant history, clinical examination and routine investigations were done. RESULTS: The one layered pattern with a heterogeneously enhancing thick layered pattern (Type 1) was significantly associated with gall bladder cancer (p<0.001). The sensitivity and specificity of Type 1 enhancement pattern on CT for predicting the Gall Bladder (GB) malignancy were 90.476% and 97.43% respectively. The positive and negative predictive values were 95% and 95%, respectively. Focal wall thickening, irregular margin character and hepatic infiltration by GWT and lymphadenopathy were other findings that predict malignancy (p-value<0.05). CONCLUSION: MDCT enhancement patterns of a thickened GB wall and associated findings were helpful in differentiating malignant GWT from benign GWT.

Colour Doppler Evaluation of Extracranial Carotid Artery in Patients Presenting with Acute Ischemic Stroke and Correlation with Various Risk Factors.

INTRODUCTION: Stroke is defined as an abrupt onset of neurologic deficit due to vascular cause. It is one of the leading causes of mortality and morbidity all over the world making early diagnosis and treatment inevitable. Lesions of extra cranial carotid arteries are implicated in majority of cases of acute ischemic stroke. Carotid Doppler is a non-invasive imaging technique, with sensitivity approaching that of angiography. Computed Tomography (CT) plays a major role to assess the site and nature of the lesion in patients with acute ischemic stroke. AIM: To evaluate the role of carotid Doppler sonography in patients presenting with acute ischemic stroke and find association between carotid artery stenosis and risk factors such as diabetes mellitus, hypertension, hyperlipidemia, smoking and age. MATERIALS AND METHODS: The present study was conducted on 50 patients. CT scan was done to diagnose acute ischemic stroke in patients who presented to emergency medicine with symptoms of acute ischemic stroke. Retrospectively CIMT and plaque characterization were done by gray scale ultrasound. Site and severity of stenosis were assessed on colour Doppler. All these findings were correlated with clinical presentation and risk factors. The collected data was statistically analyzed and multivariant logistic regression (R-value) test of significance was applied by using SPSS 16.0 version software. RESULTS: On carotid Doppler, ICA/CCA PSV ratio was good predictor of stenosis and ratio above three indicates significant stenosis (>60%). Carotid bulb was most common location of plaque formation. Hypertension and diabetes were the most prevalent risk factors for cerebral ischemic stroke. Out of total 50 patients, 32 had hypertension (64%) and 22 had diabetes (44%). Hypertension and hyperlipidemia showed maximum mean R-values (0.275 and 0.048 respectively) and positive correlation with stenosis and increased CIMT in acute ischemic stroke patients. CONCLUSION: The present study highlights the importance of Doppler sonography in acute ischemic stroke patients through surveillance of atherosclerosis.

Incidence of Lettuce mosaic virus in lettuce and its detection by polyclonal antibodies produced against recombinant coat protein expressed in Escherichia coli.

Lettuce mosaic virus (LMV), a member of the genus Potyvirus of family Potyviridae, causes mosaic disease in lettuce has recently been identified in India. The virus is seed borne and secondary infection occurs through aphids. To ensure virus freedom in seeds it is important to develop diagnostic tools, for serological methods the production of polyclonal antibodies is a prerequisite. The coat protein (CP) gene of LMV was amplified, cloned and expressed using pET-28a vector in Escherichia coli BL21DE3 competent cells. The LMV CP was expressed as a fusion protein containing a fragment of the E. coli His tag. The LMV CP/His protein reacted positively with a commercial antiserum against LMV in an immunoblot assay. Polyclonal antibodies purified from serum of rabbits immunized with the fusion protein gave positive results when LMV infected lettuce (Lactuca sativa) was tested at 1:1000 dilution in PTA-ELISA. These were used for specific detection of LMV in screening lettuce accessions. The efficacy of the raised polyclonal antiserum was high and it can be utilized in quarantine and clean seed production.

A novel approach to the management of a central giant cell granuloma with denosumab: A case report and review of current treatments.

PURPOSE: To describe the efficacy of denosumab in the treatment of an aggressive giant cell granuloma of the mandible. METHODS: Denosumab was administered to a patient with a large aggressive giant cell granuloma of the mandible resistant to standard medical therapy. The effectiveness and response was measured on the basis of patient symptoms and radiological parameters. RESULTS: A significant reduction in patient symptoms was reported in association with tumour regression on follow up radiographs. CONCLUSION: This report demonstrates potential use of denosumab in aggressive giant cell granulomas of the jaws that have been resistant to medical therapy.

Historical changes in the severity of dementia and accompanying neuropsychiatric symptoms in persons presenting for evaluation in a multiracial urban dementia center.

OBJECTIVE: We examine historical changes from 1992 to 2008 in the severity of dementia and accompanying neuropsychiatric symptoms among persons presenting for evaluation and treatment at a multiracial urban dementia center. METHODS: We reviewed intakes of white (n=197) and black (n=568) patients seen at a dementia center in New York City. Intakes were divided into 3 time categories: period 1 (1992 to 1996), period 2 (1997 to 2002), and period 3 (2003 to 2008). Diagnoses included the following: Alzheimer disease (73%), vascular dementia (13%), mixed dementia (9%), mild cognitive impairment (2%), and other dementias (4%). RESULTS: Over the 3 assessment periods, persons increasingly presented at an earlier stage of illness with significantly higher levels of cognition and functioning, and a declining prevalence of psychotic symptoms and agitation. Blacks had a more advanced stage of illness, lower cognitive scores, and a greater prevalence of psychotic symptoms than whites in period 1, but not during the other time periods. There were no racial differences in functioning, agitation, or depression. CONCLUSION: Over the period 1992 to 2008, patients were increasingly more likely to present with early stages of dementia and fewer symptoms of psychoses and agitation, and racial differences in illness severity and neuropsychiatric symptoms disappeared. If our sample reflects trends in the United States, then it suggests that more persons will be in care for longer periods of time, previous research findings derived from dementia centers must be considered historically specific, and clinicians must be prepared to work with persons with milder forms of neurocognitive disorders.