AYUSH for COVID-19: Science or Superstition?

There is a lot of discussion on COVID-19 control strategies from the mainstream approaches, but it is also necessary to examine the contributions of the Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa Riga and Homeopathy (AYUSH) sector, which is now being brought into public health interventions nationally. Although the AYUSH sector had previously joined the management of dengue and chikungunya outbreaks in some Indian states, its participation has remained contentious and there is reluctance in mainstream public health discourses to seriously examine their interventions. This is a commentary on the efforts made by the Ministry of AYUSH, state AYUSH directorates, AYUSH research institutions, and public hospitals, based on official documents as well as official statements reported in the media, with the aim of bringing out concerns in the process of adapting traditional textual knowledge and practices to public health requirements of the current age.

Green synthesis and characterization of selenium nanoparticles and its augmented cytotoxicity with doxorubicin on cancer cells.

Green synthesis of selenium nanoparticles (SeNPs) was achieved by a simple biological procedure using the reducing power of fenugreek seed extract. This method is capable of producing SeNPs in a size range of about 50-150 nm, under ambient conditions. The synthesized nanoparticles can be separated easily from the aqueous sols by a high-speed centrifuge. These selenium nanoparticles were characterized by UV-Vis spectroscopy, scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and elemental analysis by X-ray fluorescence spectrometer (XRF). Nanocrystalline SeNPs were obtained without post-annealing treatment. FTIR spectrum confirms the presence of various functional groups in the plant extract, which may possibly influence the reduction process and stabilization of nanoparticles. The cytotoxicity of SeNPs was assayed against human breast-cancer cells (MCF-7). It was found that SeNPs are able to inhibit the cell growth by dose-dependent manner. In addition, combination of SeNPs and doxorubicin shows better anticancer effect than individual treatments.

Of informal practitioners of biomedicine. The interplay of medicine, economy and society in India.

Instead of diminishing with the spectacular advancement of medical expertise in the country , unqualified biomedical practice in India has been strengthened by the growth of the pharmaceutical production in the twenty first century. In public health discourse, the view that the informal health practitioners have to be punished and abolished has been countered by the recommendation that they could be trained and incorporated in primary health care where public health amenities are inadequate. The quality of care provided by the informal health care practitioners has also been subject to clinical assessment based on standardized patient vignettes. Based on a sociological approach, this paper examines the time line of chronically ill patients under lived conditions to arrive at an understanding of the role of informal health practitioners in long term treatment and highlights the setbacks. METHODS: This paper draws on 253 household surveys from two villages in Madhya Pradesh, in depth interviews with four unqualified practitioners in the area, twenty five unstructured interviews of chronic patients, twenty five structured interviews on the cases of untimely death and FGDs with health workers in 2021. CONCLUSION: Informal health care practitioners offer consultation cum dispensing of medicines and are the primary source of biomedical care in the remote study area without any public transport. But they are 'for profit' economic actors who are ill-equipped to handle chronic diseases. What sets them aside from the qualified private doctors in the town is their social obligation to balance their profit motive with the ethics of proximity and neighborly ties with the villagers amidst whom they reside. These features of the market and community place the informal health care practitioners at the cusp of economy and society and defy simple binaries that they are either crooks or assets.

Clinical utility, feasibility of home tonometry using iCare HOME by glaucoma patients.

Purpose: To determine agreement between diurnal variation testing (DVT) of intraocular pressure (IOP) with Goldmann applanation tonometer (GAT) and iCare HOME (IH) by an optometrist (OP) and home monitoring by participants (PT). Methods: Patients (18-80 years) with glaucoma and suspects were enrolled. IH IOP and GAT were taken by an OP at 2 h intervals from 8 AM to 4 PM on Day 1 and PT between 6 AM and 9 PM, for the next 2 days. IOP, date, and time were viewed via iCare LINK software. Results: In total,: 72.9. (: 51/70) PT trained were able to take reliable readings. One hundred two eyes (51 patients, age 53 ± 16 yrs) were analyzed. Correlation between optometrist (OP) and participants (PT) was strong and positive {IH OP-IH PT- r = 0.90, p-0.0001;IH PT-GAT- r = 0.79, p-0.0001}. Agreement by Bland Altman plots was limited {IH OP-IH PT mean 0.1 mmHg (95% LOA -5.3 to 5.5), IH PT-GAT 2.2 mmHg (-5.7 to 10.1)}. Intraclass correlation coefficient for IH OP-IH PT was 1.18 (95% CI 1.37-1.09). Intradevice {0.95 (95% CI 0.94-0.97)} and interrater repeatability {0.91 (0.79-0.96)} were good. 37% of eyes had a synchronous peak on GAT and IH during the day DVT. Conclusion: Home tonometry by iCare HOME is easy, feasible, but due to limited agreement cannot substitute GAT DVT.

Brassica nigra plays a remedy role in hepatic and renal damage.

CONTEXT: Black mustard [Brassica nigra (L.) Koch] of the Brassicaceae (Cruciferae) family is commonly used as a spice and a cheap source of antimicrobial agents for bacterial infections. OBJECTIVES: The present investigation was to demonstrate the protective effect of the methanol extract of B. nigra leaves against D-galactosamine (D-GalN)-induced hepatic and nephrotoxicity in Wistar rats. METHODS: Activity of the methanol extract of B. nigra at doses of 200 and 400 mg/kg b.wt. against D-GalN (500 mg/kg b.wt.) induced toxicity, with silymarin used as the standard. Histological damage, activities of serum marker enzyme, hematological changes, metabolites such as bilirubin, urea, uric acid, and creatinine levels, tissue thiobarbutric acid reactive substance, enzymic and non-enzymic antioxidants and inflammatory marker enzymes such as myeloperoxidase, cathepsin D, and acid phosphatase were assessed. RESULTS: The D-GalN-induced toxicity was evident from a significant increase (p < 0.001) in the serum and tissue inflammatory markers in toxic rats, when compared with the control (saline alone treated animals). The B. nigra pretreated groups (200 and 400 mg/kg b.wt.) showed significant (p < 0.001) reduction in the D-GalN-induced toxicity as obvious from biochemical parameters. Histopathological observations confirm the protective effect of B. nigra leaf extract by reduction in hepatic and renal tissue damage. Experimentals extract showed a similar effect as the standard. CONCLUSIONS: The crude methanol extract of B. nigra leaf lacks inherent toxicity and exhibits hepatic and nephroprotective effects against D-GalN-induced toxicity in Wistar rats.

Rice bran lysolecithin as a source of energy in broiler chicken diet.

1. Rice bran lysolecithin (RBL) was evaluated in broiler chicken diets. In the first experiment, RBL was included in diet at 0, 0·5, 2, 8 and 32 g/kg and fed to 250 broiler chickens from 0 to 42 d of age. In the second experiment, RBL was fed at 0, 25 and 50 g/kg diet to 405 day-old broiler chickens until 21 d of age, while during the finisher phase (22-35 d of age) chickens receiving each concentration of RBL were given all three concentrations of RBL in a 3 × 3 factorial manner. The diets were isocaloric. 2. Body weight, food consumption and food conversion efficiency were unaffected by feeding RBL, while the weight of pancreas increased at ≥2 g/kg of RBL in diet (experiment 1). In experiment 2, body weight was greater in the chickens receiving RBL at either 25 or 50 g/kg (21 d) and 50 g/kg (35 d of age). At 21 d of age, food consumption was greater at 25 or 50 g RBL/kg diet, while food conversion efficiency improved with 50 g RBL/kg diet. 3. Fat digestibility increased with RBL at 32 g/kg (experiment 1) and ≤25 g/kg (experiment 2). Rice bran lysolecithin increased ready to cook weight at 50 g/kg during starter phase and decreased abdominal fat at 25 and 50 g/kg during finisher phase (experiment 2). Liver and meat fat content were not affected. 4. It is concluded that lysolecithin from rice bran oil could be used as energy supplement in broiler chicken diet.

Identification, quantification of bioactive constituents, evaluation of antioxidant and in vivo acute toxicity property from the methanol extract of Vernonia cinerea leaf extract.

CONTEXT: Vernonia cinerea (L.) Less [Compositae (Asteraceae)] is used traditionally for several medical purposes such as inflammation, pain, fever, and cancer. OBJECTIVES: The present study identified the bioactive constituents in the methanol extract of Vernonia cinerea leaf and evaluated its antioxidant activity and acute toxicity. METHODS: The identification of phytochemicals was accomplished by GC-MS and the major antioxidant phenolic compounds in the extract were quantified by HPTLC analysis. To quantify the essential elements, atomic absorption spectrophotometeric analysis was carried out. Total phenol and flavonoid content was measured by Folin-Ciocalteau reagent and 2% aluminium chloride, respectively. RESULTS: GC-MS analysis identified the presence of 27 phytoconstituents. The predominant phenolic compound in the extract as quantified by HPTLC was gallic acid (1.92 mg/g) followed by rutin (0.705 mg/g), quercetin (0.173 mg/g), caffeic acid (0.082 mg/g) and ferulic acid (0.033 mg/g). The following elements were quantified: Fe (0.050 ppm), Mn (0.022 ppm), Co (0.0180 ppm), Pb (0.029 ppm), Hg (3.885 ppm) and Se (4.5240 ppm). The antioxidant activity of the extract increased with increasing concentration and the correlation (r²) for all in vitro assays were satisfactory. CONCLUSIONS: V. cinerea extract has significant (p < 0.05) antiradical activity. Hence, V. cinerea may have potential medicinal value and can be used in the formulation of pharmacological products for degenerative diseases.

Prospective cohort study of regenerative potential of non vital immature permanent maxillary central incisors using platelet rich fibrin scaffold.

Regenerative endodontic procedures have gained momentum as a treatment modality of young immature permanent teeth. Literature reports reveal that platelet-rich fibrin (PRF) stimulates growth factors and induces regeneration. This study was undertaken to assess the regenerative potential of non-vital immature permanent maxillary central incisors using PRF with a follow-up for 2 yrs. 19 patients in the age group of 9-25 yrs with immature, non-vital permanent maxillary central incisors (n = 23) with/without signs and/or symptoms of periapical pathosis and open apex were included in this study. In the first appointment, access opening, canal disinfection and triple antibiotic paste placement were done. In the subsequent visit, PRF was prepared and placed inside the canal. Access was sealed with Mineral trioxide aggregate plug and composite. The patient was reviewed up to 24 mths. The mean difference was statistically analyzed using Friedman test followed by Dunn post hoc test and adjusted by Bonferroni correction (p < 0.05). As per AAE guidelines, the primary and secondary goals were achieved. A significant (p < 0.001) gradual increase in the root length, thickness of dentinal walls and decrease in apical diameter were observed. Within the limitations of this study, PRF placement was clinically and radiographically effective in inducing regeneration of non-vital immature permanent teeth.

Comparison of intraocular pressure variability detected by day diurnal variation to that evoked by water drinking.

Purpose: To determine correlation and agreement between intraocular pressure (IOP) peak and fluctuations detected by day diurnal variation (day DVT) to that after the water-drinking test (WDT). Methods: Patients (18-80 years) with glaucoma, suspects, and ocular hypertension (OHT) were enrolled. IOP readings were taken on applanation tonometer, at 2-h intervals, from 8 AM to 3 PM (DVT). 3 PM IOP served as WDT baseline. Patients consumed water (10 mL/kg) in 5-15 min, at 3 PM, after they fluid fasted for 2 h. IOP was recorded every 15 min, from 3.30 to 4.30 PM. Results: A total of 200 eyes (100 patients) were included. 58.5% were established glaucoma, 32% suspects, 9.5% OHT. Correlation between mean and peak IOP by WDT and day DVT was strong and significant (r = 0.89, P < 0.00; r = 0.73, P < 0.00) while it was weak for fluctuation (r = 0.12, P < 0.07). Agreement on Bland and Altman plots was limited for mean IOP and poor for peak and fluctuations. Conclusion: An exaggerated WDT response may indicate a compromised outflow facility and warrant close patient monitoring but the WDT cannot substitute day DVT in our clinical practice.

Anti-Mullerian Hormone Levels in Indian Women Seeking Infertility Treatment: Are Indian Women Facing Early Ovarian Senescence?

BACKGROUND: Antimullerian hormone (AMH) is a key marker of ovarian reserve and predictor of response to fertility treatment. AIM: To understand the prevalence of low ovarian reserve in Indian women seeking infertility treatment, compare their AMH with age-matched fertile Indian controls and understand ethnic differences with Caucasian women. SETTING AND DESIGN: Retrospective observational study done as collaboration between our in vitro fertilization centre and a laboratory with Pan-India presence. MATERIALS AND METHODS: Women aged 20-44 years were selected as Group A (seeking infertility treatment n = 54,473), Group B (conceived naturally in the past; n = 283) and Group C (data of Caucasian women; n = 718). Serum AMH levels were measured and descriptive analysis done. STATISTICAL ANALYSIS: Descriptive statistics and Chi-square test. RESULTS: In Group A, 28.7%, 48.7% and 70.6% of women aged <30 years, 30-34 years and 35-39 years had serum AMH levels ≤2 ng/mL and the proportions were higher than Group B. The rate at which median AMH decreased was 1.1-2 times faster in Group B as compared to Group C. The decrease in median AMH across age groups in Group A was similar to Group B. CONCLUSIONS: Indian women in their late twenties and early thirties visiting fertility centers showed a worrisome trend of low AMH. Our study can be used as a reference for those women considering postponing pregnancy. It may be time to look at intangible cultural factors linked to social habits, ethnicity, diet, genetic predispositions, and environmental factors like endocrine disrupting chemicals contributing to premature ovarian senescence.

Double trouble with the disc - Hickam's dictum versus Occam's razor!

Differentiating glaucomatous and non-glaucomatous optic neuropathy can be challenging even to an experienced clinician and it is even more complex to identify early ophthalmic manifestation of neurological lesions when the optic nerve is already jeopardized by advanced glaucoma. This is a case of a patient with juvenile open-angle glaucoma with advanced glaucomatous cupping who developed an intracranial tuberculoma and subsequent obstructive hydrocephalus. Subtle edema identified in an almost totally damaged nerve, coupled with a history of headache and tinnitus, was the clinching factor prompting early treatment in the form of ventriculoperitoneal shunting and antituberculous therapy. Detailed history, systematic clinical exam, and appropriate imaging are imperative in reducing morbidity and sometimes mortality associated with these neurological conditions.

Effect of emotional regulation training on depression, anxiety and stress among the patients with alcohol dependence admitted in selected de-addiction centers at south India.

Background The purpose of the study was to assess the effect of emotional regulation training on depression, anxiety, and stress among patients with alcohol dependence. Depression, anxiety, and stress are very common negative emotions seen in the patients with alcohol dependence which leads to relapse of the condition. The emotional regulation could help the individuals to overcome the negative emotions. Methods The present study adopted a one-group pretest and posttest in a preexperimental design. A total of 30 patients with alcohol dependence in two de-addiction centers were recruited using a convenience sampling technique. In this study, the participant received the intervention of emotional regulation training for 13 days to overcome negative emotions. On the 14th-day posttest was conducted. Results There was a statistically significant difference found in the mean scores of depression, anxiety, and stress at p<0.001 level between the pre and posttest. There was no significant association found between the scores of depression, anxiety, stress, and any of the background variables of the patients with alcohol dependence throughout the pretest and posttest. Conclusions The study proved that emotional regulation training is an effective intervention in reducing negative emotions like depression, anxiety, and stress among patients with alcohol dependence.

Comparative evaluation of micron- and nano-sized intracanal medicaments on penetration and fracture resistance of root dentin - An in vitro study.

Intracanal medicaments play a vital role in disinfection of root canal system. The aim of this study was to evaluate intratubular penetration and fracture resistance of roots filled with micron- and nano-sized intracanal medicaments: calcium hydroxide (CH), nanocalcium hydroxide (NCH), chitosan (CS) and nanochitosan (NCS). Their antibacterial effect on E. faecalis was tested using agar diffusion method. NCH and NCS were prepared by precipitation method and ionic crosslinking respectively. NCH and NCS particles were spherical, with an average particle size of 102±11.3nm and 130±17.6nm respectively. The medicaments were filled in extracted human teeth. Depth of penetration of the medicaments into dentinal tubules at coronal (C), middle (M) and apical (A) thirds was measured. Fracture resistance of the teeth was evaluated after 1 week and 1-month intervals. NCH showed the highest depth of penetration (C ∼746.98µm, M ∼700.30µm, A ∼134.69µm). CS showed the highest fracture resistance, whereas no significant difference was found between other medicaments, at both the time intervals. NCH (8.07±0.06) and NCS (8.13±0.06) showed significantly higher zone of inhibition than CH (7.7±0.17) and CS (7.37±0.15). Under the conditions of this study, it can be concluded that NCH and NCS can be used as potential intracanal medicaments.

Size Dependent Uptake and Hemolytic Effect of Zinc Oxide Nanoparticles on Erythrocytes and Biomedical Potential of ZnO-Ferulic acid Conjugates.

Despite zinc oxide nanoparticles (ZnONPs) being increasingly used as carriers in biomedical fields due to their multifaceted properties and therapeutic importance, better understanding of the mechanisms and cellular consequences resulting from their interaction with cells and cellular components has been warranted. In the present study, we investigate the size-dependent interaction of ZnONPs on RBCs, and its impact on cell viability, DNA damage, ROS generation and morphological changes, employing cellular and analytical methods. Size, charge, stability and solubility were confirmed by DLS, zeta potential, ICP-AES and TEM analysis. Further ICP-AES, TEM, spectroscopic observations and cell based assays showed that ZnONPs exhibited a size dependent impact on RBCs and haemoglobin (Hb), particularly size <50 nm. Conversely, ferulic acid (FA) conjugates and serum albumin significantly reduced the adverse effects exhibited by ZnONPs. The extent of DNA damage and ROS generation is comparatively low in ZnONPs-FA than in ZnONPs alone treated cells. Thus our study documents a novel conceptualization delineating the influence of size on the material properties and therapeutic potential of nanoparticle.

Predicting the Magnitude of Functional and Structural Damage in Glaucoma From Monocular Pupillary Light Responses Using Automated Pupillography.

PURPOSE: To predict the magnitude of functional damage [mean deviation (MD) on visual field examination] and structural damage [retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness on spectral domain optical coherence tomography] in glaucoma from monocular pupillary light response measurements using automated pupillography. METHODS: In total, 59 subjects (118 eyes) with either a confirmed or suspected diagnosis of glaucoma underwent automated pupillography, along with visual fields and spectral domain optical coherence tomography examinations. Association between pupillary light response measurements of each eye [amplitude of constriction, latency of onset of constriction (Loc), latency of maximal constriction (Lmaxc), velocity of constriction and velocity of redilation] and corresponding MD, average RNFL, and average GCC measurements were evaluated using univariate and multivariate regression analysis after accounting for the multicollinearity. Goodness of fit of the multivariate models was evaluated using coefficient of determination (R). RESULTS: Multivariate regression models that contained Loc and Lmaxc showed the best association with MD (R of 0.30), average RNFL thickness (R=0.18) and average GCC thickness (R=0.26). The formula that best predicts the MD could be described as: MD=-14.06-0.15×Loc+0.06×Lmaxc. The formula that best predicts the average RNFL thickness could be described as: Average RNFL thickness=67.18-0.22×Loc+0.09×Lmaxc. CONCLUSIONS: Glaucomatous damage as estimated by MD, RNFL, and GCC thickness measurements were best predicted by the latency parameters (Loc and Lmaxc) of pupillography. Worsening of glaucomatous damage resulted in a delayed onset of pupillary constriction and a decreased Lmaxc.

Diagnostic ability of peripapillary vessel density measurements of optical coherence tomography angiography in primary open-angle and angle-closure glaucoma.

AIMS: To evaluate the diagnostic ability of peripapillary vessel density measurements on optical coherence tomography angiography (OCTA) in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG), and to compare these with peripapillary retinal nerve fibre layer (RNFL) thickness measurements. METHODS: In a cross-sectional study, 48 eyes of 33 healthy control subjects, 63 eyes of 39 patients with POAG and 49 eyes of 32 patients with PACG underwent OCTA (RTVue-XR, Optovue, Fremont, California, USA) and RNFL imaging with spectral domain OCT. Diagnostic abilities of vessel density and RNFL parameters were evaluated using area under receiver operating characteristic curves (AUC) and sensitivities at fixed specificities. RESULTS: AUCs of peripapillary vessel density ranged between 0.48 for the temporal sector and 0.88 for the inferotemporal sector in POAG. The same in PACG ranged between 0.57 and 0.86. Sensitivities at 95% specificity ranged from 13% to 70% in POAG, and from 10% to 67% in PACG. AUCs of peripapillary RNFL thickness ranged between 0.51 for the temporal sector and 0.91 for the inferonasal sector in POAG. The same in PACG ranged between 0.61 and 0.87. Sensitivities at 95% specificity ranged from 8% to 68% in POAG, and from 2% to 67% in PACG. AUCs of all peripapillary vessel density measurements were comparable (p>0.05) to the corresponding RNFL thickness measurements in both POAG and PACG. CONCLUSIONS: Diagnostic ability of peripapillary vessel density parameters of OCTA, especially the inferotemporal sector measurement, was good in POAG and PACG. Diagnostic abilities of vessel density measurements were comparable to RNFL measurements in both POAG and PACG.

Diagnostic Ability of Automated Pupillography in Glaucoma.

PURPOSE: To evaluate the diagnostic ability of automated pupillography measurements in glaucoma and study the effect of inter-eye asymmetry in glaucomatous damage on the diagnostic ability. METHODS: In an observational, cross-sectional study, 47 glaucoma patients and 42 control subjects underwent automated pupillography using a commercially available device. Diagnostic abilities of the pupillary response measurements were evaluated using area under receiver operating characteristic (ROC) curves (AUC) and sensitivities at fixed specificities. Influence of inter-eye asymmetry in glaucoma [inter-eye mean deviation (MD) difference on visual fields (VF)] on the diagnostic ability of pupillography parameters was evaluated by ROC regression approach. RESULTS: The AUCs of automated pupillography parameters ranged from 0.60 (amplitude score with peripheral blue stimulus) to 0.82 (amplitude score with full field white stimulus, Amp-FF-W). Sensitivity at 95% specificity ranged between 5% (amplitude score with full field blue stimulus) and 45% (amplitude score with full field green stimulus). Inter-eye MD difference significantly affected the diagnostic performance of automated pupillography parameters (p < 0.05). AUCs of Amp-FF-W at inter-eye MD difference of 0 dB, 5 dB, 10 dB and 15 dB were 0.71, 0.80, 0.87 and 0.93, respectively, according to the regression model. The corresponding sensitivities at 95% specificity were 20%, 34%, 50% and 66%, respectively. CONCLUSIONS: The diagnostic abilities of even the best automated pupillography parameters were only moderate in glaucoma. The performance of these pupillography measurements in detecting glaucoma significantly increased with greater inter-eye asymmetry in the glaucomatous damage.

Predicting the intereye asymmetry in functional and structural damage in glaucoma using automated pupillography.

PURPOSE: To predict the intereye asymmetry in functional (mean deviation, MD on visual field, VF) and structural (retinal nerve fibre layer, RNFL and ganglion cell complex, GCC thickness on spectral domain optical coherence tomography, SDOCT) measurements in glaucoma using the automated pupillography parameters. METHODS: Fifty-nine subjects with a diagnosis of either glaucoma or glaucoma suspect underwent automated pupillography along with VF and SDOCT examinations. Association between pupillography and the absolute intereye difference in MD, RNFL and GCC measurements was evaluated using regression analysis after accounting for the multicollinearity. RESULTS: Univariate regression analysis showed statistically significant associations (p < 0.05) between multiple pupillography parameters and the intereye difference in MD, RNFL and GCC thickness measurements. Multivariate regression with less strongly correlated parameters identified intereye difference in amplitude change (Ac) per cent to be the parameter that best predicted the intereye asymmetry in MD (Intereye asymmetry in MD = 2.20 + 1.33*intereye difference in Ac per cent, R2  = 0.36), RNFL thickness (3.38 + 3.55*intereye difference in Ac per cent, R2  = 0.49) and GCC thickness (4.49 + 2.06* intereye difference in Ac per cent, R2  = 0.41). Ability of intereye Ac per cent difference to predict intereye asymmetry in MD, RNFL and GCC thickness was better in patients with angle closure disease (R2  = 0.38, 0.79, 0.66, respectively) compared to those with open angles (R2  = 0.25, 0.15, 0.16, respectively). CONCLUSIONS: Intereye asymmetry in MD, RNFL and GCC thickness measurements was best predicted by the intereye difference in Ac per cent on automated pupillography. The predicting ability was better in patients with angle closure compared to those with open angles.

Evaluation of microshear bond strength and nanoleakage of etch-and-rinse and self-etch adhesives to dentin pretreated with silver diamine fluoride/potassium iodide: An in vitro study.

AIMS: The aim of this in vitro study was to comparatively evaluate the microshear bond strength (MSBS) of etch-and-rinse and self-etch (ER and SE) bonding systems to dentin pretreated with silver diamine fluoride/potassium iodide (SDF/KI) and nanoleakage at the resin-dentin interface using transmission electron microscope (TEM). SUBJECTS AND METHODS: Seventy-two dentin slabs of 3 mm thickness were prepared from extracted human permanent third molars and divided into four groups (n = 18) based on the dentin surface treatment as follows: (1) ER adhesive bonding without dentin pretreatment; (2) SDF/KI pretreatment of dentin followed by ER adhesive bonding; (3) SE adhesive bonding without dentin pretreatment; and (4) SDF/KI pretreatment of dentin followed by SE adhesive bonding. Resin composite was built on the dentin slabs to a height of 4 mm incrementally, and dentin-composite beams of approximately 1 mm 2 cross-sectional area were prepared. The beams were subjected to MSBS analysis, and the fractured surface was observed under scanning electron microscope to determine the mode of failure. The resin-dentin interface was examined under TEM for evaluation of nanoleakage. STATISTICAL ANALYSIS USED: One-way ANOVA followed by Tukey's post hoc multiple comparison tests. RESULTS: Pretreatment of dentin with SDF/KI increased the MSBS of ER and SE adhesives, though not statistically significant, except between Groups 2 and 3. In all the groups, the predominant mode of failure was adhesive followed by cohesive in resin, mixed and cohesive in dentin. TEM examination of resin-dentin interface showed that pretreatment with 38% SDF/KI reduced nanoleakage regardless of the type of bonding system used. CONCLUSIONS: Pretreatment of dentin with SDF/KI minimized nanoleakage at the resin-dentin interface without adversely affecting the bond strength of resin composite to dentin.

Discriminant Function of Optical Coherence Tomography Angiography to Determine Disease Severity in Glaucoma.

PURPOSE: To determine the discriminant function of optical coherence tomography angiography (OCTA) by disease severity in glaucoma. METHODS: In this prospective, observational cross-sectional study, all subjects underwent visual fields, retinal nerve fiber layer (RNFL) measurements, and OCTA imaging. Local fractal analysis was applied to OCTA images (radial peripapillary capillaries [RPC] layer). Vessel density en face and inside the disc and spacing between large and small vessels were quantified. Stepwise logistic regression was performed and a glaucoma severity score (range, 0-1: 0, normal; 1, severe glaucoma) was developed by using global and regional (superotemporal [ST], inferotemporal [IT], temporal, superonasal [SN], inferonasal, and nasal) vascular parameters. Glaucoma severity score was compared with visual field and RNFL indices. RESULTS: One hundred ninety-nine eyes (112 subjects) with glaucoma (28 eyes preperimetric; 83 early, 43 moderate, and 45 severe glaucoma) and 74 normal (54 subjects) eyes were enrolled. Preperimetric and glaucomatous eyes had significantly altered (P < 0.001) global vascular parameters as compared to normal; regionally, ST, then SN and IT sectors (in that order) showed more change in glaucomatous eyes. Vascular parameters showed better discriminant ability (area under the curve [AUC], sensitivity, and specificity of 0.70, 69.2%, and 72.9%, respectively) than structural parameters between normal and preperimetric glaucomatous eyes. Vascular parameters had comparable AUC (P > 0.05) to visual fields for perimetric glaucoma. Glaucoma severity score identified preperimetric glaucoma and early glaucoma better than did visual fields. CONCLUSIONS: Vascular parameters could be a useful adjunct tool to evaluate/diagnose glaucoma. Longitudinal studies are needed to determine their use in early detection and prognostication.