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   Table of Contents - Current issue
July-December 2019
Volume 10 | Issue 2
Page Nos. 103-219

Online since Thursday, July 18, 2019

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Association of Vitamin D with vascular inflammation p. 103
Arun H.S Kumar
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Marine pigmented bacteria: A prospective source of antibacterial compounds Highly accessed article p. 104
Chatragadda Ramesh, Nambali Valsalan Vinithkumar, Ramalingam Kirubagaran
Antimicrobial properties of several nonpigmented bacteria isolated from the marine environment have been well understood. However, marine bacteria with distinct asset of pigmentation have not been studied intensively and explored unlike nonpigmented bacteria. Recently, several studies have found multidrug-resistant microbes against various diseases. Therefore, search for alternative novel and natural bioactive compounds is in demand at current research. Furthermore, the application of synthetic colorants in the food industry has several harmful effects; thus, exploring pigments from natural environments is important to substitute synthetic colorants. This review emphasizes marine pigmented bacteria as a potential alternative source of natural compounds as well as natural colorants. The antibacterial potential of marine bacterial pigmented compounds reported from the year 2000 to hitherto is detailed cogitatively in this review, along with the best-known paradigms of pigments such as prodigiosin and violacein. In parenthesis, some other important applications of well-studied prodigiosin and violacein pigment molecules are highlighted briefly.
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Identifying salivary transcriptome signatures for periodontal diagnosis Highly accessed article p. 114
KJ Nisha, Presanthila Janam, K Harshakumar
Periodontal disease is one of the most prevalent diseases in the human population worldwide. It is the major cause of tooth loss in adults above 40 years. Advanced forms are characterized by inflammation that extends deep into the tissues of the periodontium, a process that eventually causes the loss of the supporting connective tissue and the alveolar bone leading to tooth loss. Application of salivary biomarkers for periodontal diagnostics is promising and could facilitate the diagnosis and treatment in a clinical practice by dental practitioners. The salivary transcriptome offers the combined advantages of high-throughput marker discovery in a noninvasive biofluid with very high patient compliance. Identifying alterations in salivary transcriptomic signatures using microarray or sequencing technologies will help to find novel biomarkers in periodontitis. This narrative review intends to provide a highlight on the potential application of salivary transcriptomics in periodontal diagnosis.
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Current concepts and an update on the surgical management of metastasis to the sacral spine p. 119
Evelyn P Murphy, Rebecca F Lyons, Mark Curtin, Sudarshan Munigangaiah, John McCabe, Aiden Devitt
This review article endeavors to provide an update on the current concepts pertaining to the presentation, investigation, and management of sacral metastases. A review of the English language literature from 1995 to 2015 was undertaken. PubMed electronic database, SCOPUS, EMBASE, Medline OVID, and Cochrane database were searched to identify relevant studies using the terms “sacral metastases” and “metastatic sacral tumours.” Sacral metastasis can present in a variety of ways. Pain in the sacral region can be associated with neurology and mechanical instability. Multidisciplinary involvement is crucial to thoroughly work up the patient. This involves a variety of imaging modalities. Radiotherapy is often used as the first-line treatment. Surgical intervention is based on tumor location, infiltration of surrounding structures, expected outcomes based on primary malignancy, and pelvic stability. Adjuvant cryosurgery and radiosurgery have demonstrated promising results. This is a challenging entity to appropriately diagnose and treat. An appreciation of the disease stage, the clinical burden, and the implications for the individual patient are necessary to deliver patient-centered care.
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Microhardness of coronal dentin adjacent to resin-modified glass ionomer and compomer in Class V restorations p. 127
Prakash Lokhande, TM Mangala
Aims: The objective of this in vitro study was to compare the microhardness values of coronal dentin adjacent to resin-modified glass-ionomer cement (RMGIC) and compomer. Materials and Methods: Standardized Class V preparation was performed for 30 extracted human permanent molars affected by Class V caries. The samples were divided into three groups as follows: specimens before restoration (Group 1) (n = 10), samples restored using RMGIC (Group 2) (n = 10), and specimens treated with compomer (Group 3) (n = 10). Dentinal discs with 2-mm diameter were obtained after embedment into acrylic resin. Vickers microhardness measurements were performed using a digital microhardness tester (Zwick/Roell) immediately after the 10th, 20th, and 30th day by applying a load of 25 g for 15 s at a distance of 100, 200, and 300 μm from the cavity floor. Statistical Analysis Used: One-way analysis of variance and post hoc Tukey tests (P < 0.05) were conducted for all groups of specimens. Results: Group II demonstrated higher microhardness values as compared to those obtained for Group I and Group III. Conclusion: The results of the present study showed that the microhardness of the dentin adjacent to RMGIC was higher than that of the dentin adjacent to the compomer.
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Phytochemical screening and evaluation of cytotoxic activity of Calotropis gigantea leaf extract on MCF7, HeLa, and A549 cancer cell lines p. 131
Bindu Damodaran, Prashantha Nagaraja, Vivek Jain, MP Manuja Viraj Wimalasiri, GM Sankolli, G Vinoth Kumar, Venkataraman Prabhu
Background: Cancer is mostly managed by surgical removal, chemotherapy, and radiotherapy. However, there are side effects associated with these methods. Alternatively, herbal medicines are becoming popular for cancer treatment. Calotropis gigantea is a widely used plant in the traditional medical system. However, there are no reports on its potential in cancer management. Therefore, we aimed to examine the phytochemical composition and cytotoxic activity of C. gigantea methanolic leaf extract against three different cancer cell lines: HeLa (cervical), MCF7 (breast), and A549 (lung). Materials and Methods: The methanolic extract of C. gigantea leaf was used to determine the presence of phytoconstituents using standard methods such as thin-layer chromatography, high-performance liquid chromatography, and liquid chromatography–mass spectrometry. HeLa, MCF7, and A549 cell lines were treated with C. gigantea methanolic leaf extract at different concentrations (0, 100, 200, 300, and 400 μg/mL). Camptothecin and cisplatin were used as reference drugs for growth inhibition studies. Results: The phytoconstituents of methanolic leaf extract of C. gigantea included alkaloids, steroids, terpenoids, flavonoids, tannins, and phenols. The extract exhibited cytotoxicity against HeLa (IC50= 117.92 μg/mL), MCF7 (IC50= 43.65 μg/mL), and A549 (IC50= 27.32 μg/mL) cancer cell lines in vitro. Conclusion: Our results indicated that C. gigantea exhibited cytotoxicity against cervical, breast, and lung cancer cell lines in vitro, and thus, the crude extract can be a potential candidate for cancer treatment.
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A swift travel to stormy shore: Burden and distress experience by caregivers availing neuro-rehabilitation services p. 139
Bergai Parthsarathy Nirmala, Janardhana Navaneetham
Background: Persons with neurological conditions predominantly receive their care from informal caregivers in India. The day-to-day caring of these persons requires tireless effort, energy, and empathy, and can often impact the quality of life of caregivers. In this study, we assess the impact of caregiving on the quality of life of informal caregivers. Materials and Methods: Fifty caregivers of patients with neuro-rehabilitation needs admitted in the neuro-rehabilitation ward of our hospital were recruited for this study. A descriptive research design, burden assessment schedule, and a self-reporting questionnaire were used to assess the distress level. The data collected were analyzed using descriptive, parametric, and nonparametric statistics. Results: Of the 50 caregivers recruited, 32 were female and 28 were male. The caregivers in our cohort were predominantly over 40 years of age. Thirty caregivers were from nuclear family and 36 families had below poverty line card. Majority of the caregivers reported physical and mental health burden due to their caregiving role. This was followed by need for external support to facilitate their caregiving role. Overall, the burden perceived by the caregivers ranged from moderate to severe. Conclusion: The caregivers come from diverse backgrounds, but nonetheless, they experienced significant physical and emotional burden while caring for the ill person at home. Providing adequate training and socioeconomic support to the caregivers may be helpful in reducing their burden.
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Demographic and clinical profile of patients infected with dengue virus serotypes 1, 2, and 3 in North Karnataka p. 144
Pramod Sidram Manthalkar, Basawaraj V Peerapur
Introduction: Dengue fever is a mosquito-borne disease caused by flavivirus and has clinical presentation varying from being asymptomatic to severe complications (dengue shock syndrome and dengue hemorrhagic fever) depending on the serotype of the virus involved. Cross-protective immunity between the serotypes is lacking, hence the severity of the disease is more if multiple infections occur with two different serotypes. Hence, data on the demographic-specific prevalence of virus serotypes are vital to optimal clinical measures. Aim: The present study aimed to identify the dengue virus serotypes prevalent in the North Karnataka region of India in correlation to the clinical presentation of the disease. Materials and Methods: A prospective study was carried out in a Teaching hospital of North Karnataka, India, from June 2012 to March 2016. One thousand serum samples were tested for NS 1 antigen aIgM and IgG antibodies by enzyme-linked immunosorbent assay (ELISA) method. Samples positive for NS-1 was subjected to reverse transcription polymerase chain reaction (RT-PCR) for the detection of serotypes. Results: Of the 1000 serum sample test 462 serum samples were positive for dengue virus antigen or antibodies. Two hundred and forty-five patients (53.03%) were male and 217 patients (46.96%) were female. Age group of16-–30 years was more affected followed by 31–45 years, over 45 years, and 0–15 years of age group. Maximum number of cases were observed in Bidar city followed by Humnabad, Aurad, Bhalki, and Basavakalyan regions. Malaise was a predominant symptom in dengue virus serotype-3 (DENV-3) (P < 0.05), while headache (P < 0.001), and retro-orbital pain (<0.05) were predominant symptoms in DENV-2. GI symptoms (nausea, abdominal pain, and diarrhea) were significantly common in DENV-2 (P < 0.001). Hepatomegaly was frequently observed in DENV-2 (17.02%), (P < 0.05). A total of 462 samples were positive for either NS-1, IgM, or IgG or in combination. Viral RNA was extracted from 119 samples positive for NS-1 antigen by ELISA. Of the 119 samples tested for serotyping by RT-PCR, 38 belonged to dengue serotype-1 (DENV-1), 46 were of dengue serotype 2 (DENV-2) and 35 belonged to dengue serotype 3 (DENV-3). A change in the earlier serotype 1 and 2 from 2011 to 2013 to the present serotype DENV-2 and DENV-3 was observed and constant presence of DENV-2 in circulation was recorded. Conclusion: Dengue virus serotype 1, 2, and 3 were prevalent in our study population, and severe clinical manifestations were observed in patients suffering from dengue virus serotype 2 and 3.
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The improvement of pain behavior and sciatic nerves morphology in mice model of painful diabetic neuropathy upon administration of ginger (Zingiber officinale Roscoe.) extract and its pungent compound, 6-shogaol p. 149
Fifteen Aprila Fajrin, Arief Nurrochmad, Agung Endro Nugroho, Rina Susilowati
Background: 6-Shogaol is one of the bioactive compounds from ginger (Zingiber officinale Roscoe.) that had been widely used in many diseases. This research was aim to investigate the effect of ginger extract and its pungent compound, 6-shogaol on pain behavior and sciatic nerve morphology in mice model of painful diabetic neuropathy. Materials and Methods: Seventy-two male BALB/c mice were divided into nine groups. Diabetes was induced by single intraperitoneal injection of streptozotocin (STZ) 110 mg/kg body weight (BW). The mice were considered diabetic when the serum glucose level was at least 200 mg/dL. Thermal and mechanical hyperalgesia was measured using tail-flick latency and Randall–Selitto test once a week. Daily oral administration of 6-shogaol doses 5, 10, and 15 mg/kg BW, ginger extract doses 100, 200, and 400 mg/kg BW, or gabapentin dose 100 mg/kg BW was started at week 4. Diabetic mice without treatment and mice without STZ induction were used as controls. At week 7, the mice were euthanized, and paraffin sections of 1% osmium tetroxide-stained sciatic nerve samples were observed. Results: Ginger extract and 6-shogaol, but not gabapentin, produced dose-dependent lowering blood glucose effect. However, the mean of serum glucose level was not <200 mg/dL. After 4 weeks of hyperglycemia, the diabetic groups showed signs of hyperalgesia. The ginger extract, 6-shogaol, and gabapentin administration attenuated the hyperalgesic effect. The microstructure of sciatic nerves in diabetic mice that received ginger extract and 6-shogaol was less damaged compared to the diabetic control group. Conclusion: From this research, ginger extract and its pungent compound, 6-shogaol, showed anti-hyperalgesic and neuroprotective effects.
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Antioxidant and cytotoxic potential of leaf extracts of Costus igneus p. 157
Waseem Iqbal Khanday, Nazir Ahmad Wani, Balaji Paulraj
Background: Costus igneus leaves are traditionally used to treat diabetes and this plant is commonly known as insulin plant. Hypothesis: The purpose of this study was to evaluate the antioxidant and cytotoxic potential of different leaf extracts of C. igneus. Materials and Methods: The antioxidant potential of various leaf extracts of C. igneus was established by ferric reducing antioxidant power (FRAP) assay, 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) assay, metal-chelating activity, phosphomolybdenum assay, superoxide radical scavenging activity, 2,2-diphenylpicrylhydrazyl (DPPH) assay, reducing power assay, and cytotoxic activity by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay on breast cancer cell line Michigan Cancer Foundation (MCF-7). Results: In FRAP assay, acetone extract showed higher activity of 276.31 mmol Fe (II) E/mg extract. In ABTS assay, hexane extract showed the highest scavenging activity of 12878.893 μM Trolox equivalent antioxidant capacity (TEAC)/g extract. Hot water extract registered higher metal ion-chelating ability with 2.94 mg ethylenediaminetetraacetic acid equivalent/g extract. Hexane extract has recorded the highest total antioxidant capacity of 65.00 mg AAE/mg in phosphomolybdenum assay. Superoxide radical scavenging activity was found maximum in acetone extract with 41.11%. In DPPH assay, acetone extract recorded total free radical scavenging capacity with IC50 value of 40.70 μg/ml. Hexane extract has recorded significant highest reducing power at concentration 100 μg/μl with maximum optical density of 0.177. Acetone extract of C. igneus leaf extract at concentration of 150 μg/ml showed the highest cytotoxic activity on cancer cell line with cell viability of 65.51%. Conclusion: The present study explored that C. igneus shows efficient antioxidant activity as well as cytotoxic activity and could act as safe and cost-effective with potential biological applications.
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Chemical composition, antioxidant, and cytotoxic potential of Nannochloropsis species extracts p. 167
Princely Ebenezer Gnanakani, Perumal Santhanam, Kilari Eswar Kumar, Magharla Dasaratha Dhanaraju
Context: Screening of natural biomolecules from microalgae. Background: The microalgae were recognized for their biological and pharmacological importance of active natural products with high antioxidant and antiproliferative profile. In the preliminary screening, three species Nannochloropsis sp. (NC) (green algae), Amphora sp. (diatom), and Nostoc sp. (blue-green algae) were tested and Nannochloropsis was selected based on their scavenging properties. Objective: The objective of the study is to explore the biological information of microalgal species where the clinical investigation is still quite limited. Materials and Methods: The phytochemical screening of selected NC. primarily comprises saponins, terpenoids, flavonoids, and phenols which were confirmed by high-performance thin-layer chromatography, Fourier transform infrared, and gas chromatography–mass spectra analysis. Results: The ethyl acetate extract Nannochloropsis hexane (EAENH) fraction showed 40.61 mg GAE/g, 68.77 mg QE/g, 5.73 mg/g, and 57.38 mg CHL/g for total phenolic, flavonoid, carotenoid, and sterol content, respectively. Moreover, antioxidant activities were evaluated for the extract showing high flavonoid and phenolic contents after partial purification with hexane. The half inhibitory concentration (IC50) values for EAENH was found to be 13.9, 21.22, and 14.58 μg/mL for 1,1-diphenyl-2-picrylhydrazyl radical, hydrogen peroxide, and reducing power assays, respectively. The antiproliferative activity of EAENH on human non-small lung cancer cell line (A549) IC50 value was 175 μg/mL using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Conclusion: The present study confirmed that the bioactive components present in the EAENH were accountable for excellent antioxidant and cytotoxic properties.
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Pattern of antimicrobial usage in neonatal septicemia at neonatal intensive care unit of a tertiary care hospital in Kolkata p. 178
Manisha Das, Nandita Pal, Sanat Kumar Dolui, Supriyo Choudhury
Introduction: Antimicrobials are the mainstay treatment in neonatal septicemia (NS). National treatment guidelines for antimicrobial use in infectious diseases issued by the Government of India has paved the way for rationalizing antibiotic use, but it needs tailoring according to the prevalent local microbiota and individual patient's needs. A periodic surveillance of the microbial etiology and antibiotic use patterns in NS may be useful in rational selection of empirical antimicrobial therapy. Aims and Objectives: We observed the utilization pattern of antimicrobials and quantified the same in neonates admitted to neonatal intensive care unit (NICU) with septicemia along with the prospective follow-up of the clinical response to individual regimen. Materials and Methods: This hospital-based prospective observational study was conducted from January 2017 to June 2017 on 102 consecutive cases of NS admitted to NICU. Data regarding demographic parameters, antimicrobials used, and outcome were collected through a predesigned case record form. Antimicrobial usage was quantified as days of therapy (DOT) per 1000 patient days. Results: Common antimicrobials used in descending order of DOT were amikacin, colistin, and meropenem. Ampicillin, cefotaxime, and gentamicin were rarely found suitable for use based on the reported antibiograms. Piperacillin-tazobactam + amikacin regimen was the most commonly used empirical regimen. The case fatality rate was 4% in our study sample. Conclusion: Ampicillin, cefotaxime, and gentamicin had limited effectiveness in the majority of cases. Although there is a need of alignment with national treatment guidelines in NS, yet, the concurrent scope of periodic survey and research must be available for changeover to evidence-based local individualization of empirical antimicrobial therapy wherever required.
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Clinical experience using neodymium-doped yttrium aluminum garnet laser in cutaneous vascular malformations among Indian patients p. 184
Jayanta Bain, Arindam Sarkar, Abhishek De, Biswajit Kumar Biswas, Masihon Murmu
Introduction: Cutaneous vascular anomalies are relatively common in clinical practice with varied clinical features and deformity. Various treatment modalities are used to manage this condition. Aims and Objectives: In this study, our aims were to evaluate the outcome of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser in this type of vascular malformations. Materials and Methods: This was a prospective study conducted in the Department of Plastic Surgery in our institute from January 2014 to December 2015 among the patients having cutaneous vascular malformations. Results: There were total 34 patients; 20 patients were females and 14 were males. Sixteen were adults (>18 years) and 11 patients were below 1 year of age. Among different types of lesions, 23 (67.7%) were vascular malformations and 11 (32.3%) were hemangiomas. Most of the lesions (58.7%) showed positive effect of laser treatment as it becomes flat. All (100%) hemangiomas, i.e., infantile hemangioma and pyogenic granuloma become flat. However, 41.3% lesions showed no significant change in height. Among them, 58.3% were venous malformations, 25% capillary malformations, and 16.7% capillary venous malformations. Skin color was not changed in color among 58.9% cases. About 58.9% cases showed no skin texture changes (atrophic/hypertrophic). Excellent-to-fair outcome was observed among 64.8% cases. Conclusion: Nd:YAG laser therapy on cutaneous hemangiomas and vascular malformations is a good therapeutic option among Indian patients.
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Lipoprotein(a) and high-sensitive C-reactive protein as risk factors of coronary heart disease p. 189
Debasis Debadatta Behera, Bratati Singh, Suresh Kumar Behera, Subhashree Ray, Kamal Lochan Das
Background: Atherosclerotic process is considered to be the product of several influences, and there is no selective agent responsible for it. Around 50% of coronary heart disease (CHD) cases lack traditional risk factors such as hypertension, diabetes mellitus, smoking, dyslipidemia, and obesity in Indian subcontinent. Hence, nontraditional risk factors are increasingly used to determine patients at risk. The Aim of the Study: The study aimed to assess the nontraditional risk factors such as lipoprotein(a) (Lp[a]) and high-sensitivity C-reactive protein (Hs-CRP) as potential biomarkers in CHD patients and to correlate these factors with disease severity. Materials and Methods: This cross-sectional study was undertaken in 50 CHD patients and 50 healthy controls. Lp(a) and Hs-CRP along with other biochemical parameters were assessed in these patients. Results and Conclusion: Hypertriglyceridemia and hypertension were present in 74% and 62% of cases, respectively. Fasting blood sugar, triglyceride, and high-density lipoproteins were significantly altered in cases in comparison to control. Lp(a) (50.85 ± 23.42 mg/dl vs. 17.10 ± 5.18 mg/dl) and Hs-CRP (2.932 ± 0.605 vs. 0.379 ± 0.202 mg/dl) levels were raised significantly in cases when compared with the control (P < 0.001). A significant positive correlation was observed between Lp(a) and Hs-CRP. Hence, in addition to conventional parameters, the estimation of Lp(a) and Hs-CRP can prove to be a valuable tool in risk assessment of population and management of the disease.
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The effect of asthma exercise on cortisol hormone and interleukin-5 in the Indonesian patients with persistent asthma p. 193
Rahmaya Nova Handayani, Faisal Yunus, Iris Rengganis, Ermita I Ilyas, Fariz Nurwidya
Background: Inflammatory respiratory tract involves the interaction of several mediators that will cause asthma symptoms. This study aimed to reveal the effect of asthma exercise on cortisol hormone and interleukin-5 (IL-5) in the Indonesian patients with persistent asthma. Methods: This is a pre and posttest-designed experimental study in the Prof. Dr. Margono Soekarjo Hospital at Purwokerto, Indonesia. The diagnosis of asthma was established according to the Global Initiative For Asthma 2017. IL-5 levels were determined from peripheral blood mononuclear cells, and cortisol hormone analysis was performed by enzyme-linked immunosorbent assay technique. All parameters were tested before and after performing asthma exercise 4 times/week in 8 weeks with a duration of 60 min. The Wilcoxon and Pearson tests were performed for the statistical analysis. Results: Asthma exercise significantly increased the cortisol hormone levels (P < 0.0001) and significantly reduced the IL-5 levels (P = 0.005). However, there was no significant correlation between cortisol hormone and IL-5 (r = −0.002, P = 0.989). Conclusions: Asthma exercise can increase the cortisol hormone levels and reduce pro-inflammatory IL-5. Asthma exercise should be provided as a nonpharmacologic treatment in patients with persistent asthma.
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Does serum Vitamin D status influence high-sensitivity c-reactive protein and gensini score in established coronary artery disease individuals p. 197
AP Shaheena, Poornima A Manjrekar, Vivian D'souza, Padmanabh Kamath, MS Rukmini, Vinod Chandran, Durgarao Yalla, Mukund P Srinivasan
Introduction: Over the years, the extraskeletal effects of Vitamin D (vit D) are gaining prominence. The role of vit D deficiency (VDD) in coronary artery disease (CAD) is conflicting. Hence, the present study was aimed to correlate serum vit D levels with high-sensitivity C-reactive protein (hs-CRP) and Gensini score in CAD individuals. Materials and Methods: This cross-sectional study was conducted on 70 angiographically proven CAD individuals aged between 35 and 55 years of both sexes who presented with a history of myocardial injury or ischemia for the first time. The angiographic findings were graded using Gensini score. Serum vit D and hs-CRP were estimated using enzyme-linked immunosorbent assay. Results: The average serum vit D level was 15 ng/mL, and the ratio of diabetes and nondiabetes individuals was 52:18. Among the 70 patients, 66% (n = 46) were deficient, 20% (n = 14) were insufficient, and 14% (n = 10) had normal vit D status. Although insignificant, vit D levels had negative correlation with Gensini score (r = −0.17, P = 0.14) and hs-CRP levels (r = −0.03, P = 0.77) which was not sustained after multivariate logistic regression. A significant negative correlation (r = −0.35, P = 0.01) was found between serum vit D status and duration of diabetes. Conclusion: VDD observed in diabetes individuals is inversely related to the duration of diabetes which incidentally is associated with CAD. Thus, screening for vit D status may be vital for the management of CAD particularly in diabetes individuals.
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Stress analysis in endodontically treated primary molar with and without stainless steel crown: A comparative finite element model study p. 202
K Sundeep Hegde, Reshma M Suvarna, Sham S Bhat
Background: Children at high risk exhibiting anterior tooth decay and/or molar caries may benefit by treatment with stainless steel crowns (SSCs) to protect the remaining at-risk tooth surfaces. The nonlinear finite element analysis (FEA) has become an increasingly powerful approach to predict stress and strain within structures in a realistic situation that cannot be solved by conventional linear static models. There are very few studies that have measured the stress in endodontically treated primary teeth, especially when restored with crowns. Hence, this study is done to analyze stress in endodontically treated primary molar without and with SSC using FEA. Methodology: A three-dimensional (3D) FEA model was generated using an intact normally extracted human maxillary deciduous second molar. The tooth was subjected to a computerized tomography (CT) scan, and a cross-section of the tooth was obtained at an equal interval of 0.5 mm, in Digital Imaging and Communication in Medicine (DICOM) format. The 3D geometrical model of the tooth was converted from CT DICOM as a 3D model. Two models were created: Model 1 – without SSC; Model 2 – with SSC. They were then subjected to an occlusal load (354 N, 179 N, 42 N, and 8 N) both vertically and horizontally. Results: With increased load, there is an increase in Von Mises stress and strain. The displacement patterns are well within the safe range for Model 2 as compared to Model 1. Conclusion: Endodontically treated tooth when not suitably restored with a SSC results in fracture of the underlying tooth structure. Finite element model can not only be used to evaluate stress but can also be used as a tool to educate patients regarding the importance of postendodontic restorations.
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Resveratrol nanoparticle pretreatment improved the oral bioavailability of bromocriptine: Involvement of liver and intestinal CYP3A enzyme inhibition p. 209
Prasad Neerati, Suresh Palle
Background: Resveratrol (RSV) is a polyphenol belonging to phytoalexin family and has been reported to show inhibitory effects on CYP3A4 enzymes. However, there has been no report about the pharmacokinetic interaction of bromocriptine (BRO) with RSV and RSV nanoparticles (NRSV) in rats. Hence, the present study was undertaken in an attempt to enhance the oral bioavailability of BRO when BRO was pretreated with RSV and NRSV. Materials and Methods: Antisolvent precipitation method is used to prepare NRSV under temperature control. The following methods were used in this study, i.e., in vitro assessment of CYP3A activity in liver and intestinal microsomes and in vitro noneverted sac method. To confirm the in vitro findings, an in vivo pharmacokinetic study was also performed. Results: The results indicate that RSV significantly (P < 0.05) inhibited the CYP3A activity in intestinal and liver microsomes. In noneverted sac study, the intestinal transport and Papp of BRO were more significant (P < 0.05) in NRSV as compared to RSV group. Further, in vivo study revealed that the increased levels of Cmax and AUC were comparatively higher in NRSV-pretreated group than RSV group. In addition, pretreatment with RSV and NRSV significantly (P < 0.05) decreased the mean appararant clearance (CL/F) of BRO. Conclusion: NRSV pretreatment significantly increased the intestinal absorption and bioavailability of BRO probably by the inhibition of CYP3A-mediated metabolism in rats. However, further studies are needed to confirm these interactions in humans.
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Cardiac metastasis of a uterine leiomyosarcoma p. 217
Joseph Ahoubim, Bryce Sarcar, Yazan Abdeen
Uterine leiomyosarcoma (ULMS) is a rare malignancy of the myometrial smooth muscle that accounts for 1%–2% of cancers arising in women of postmenopausal age. ULMS is associated with significant morbidity and mortality, largely due to its ability to metastasize. The most common sites of metastasis include the lungs, bone, and liver. However, in rare cases, ULMS can metastasize to the heart and should be considered in patients with concomitant cardiovascular symptoms and known history of ULMS or risk factors of ULMS. Here, we report a case of a 74-year-old female who was diagnosed with ULMS-derived cardiac metastasis. Currently available treatment plans for cardiac metastasis involve a combination of medications such as mesna, doxorubicin, ifosfamide, and dacarbazine; radiation to the cardiac muscle; and resection of the mass. Given the significant improvement in the 5-year survival rate of patients who are promptly and accurately diagnosed, physicians should consider the possibility of cardiac metastases when patients with a history of ULMS present with cardiac abnormalities.
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