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   Table of Contents - Current issue
July-December 2018
Volume 9 | Issue 2
Page Nos. 105-301

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Understanding the anatomy of inflammation for evidence-based localized targeting Highly accessed article p. 105
Arun H S. Kumar
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French Phase I clinical trial disaster: Issues, learning points, and potential safety measures Highly accessed article p. 106
Harmanjit Singh, Sudhir Chandra Sarangi, Yogendra Kumar Gupta
Phase I clinical trial is the first exposure of investigational medicinal product in humans and it sets the pillar for further clinical development. Substantial attention has been paid to the first in human clinical trials after TeGenero TGN1412 disaster in 2006 which led to serious toxicity including multi-organ failure in 6 healthy volunteers. Since then many recommendation and guidelines have been formulated for the safe and rational conduct of such trials. In January 2016, another catastrophe occurred in France during Phase I trial of BIA 10-2474, a fatty acid amide hydrolase inhibitor, which led to one death and caused serious neurological damage in few other healthy volunteers. This review will focus on potential issues in BIA 10-2474 trial, possible measures that should have been taken during trials to prevent this disaster and potential safety measures for the rational and safe conduct of Phase I trials.
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Use of intralipid in the management of recurrent implantation failure: An overview Highly accessed article p. 111
Lubna Khan, Viquar Fatima Qureshi, Tahira Jabeen, Shoeb Qureshi
Recurrent embryo implantation failure is a disorder with potentially dreadful physiological and psychological manifestations for those who are affected. Embryo implantation and formation of a functional placenta are processes that require a plethora of regulatory mechanisms involving both maternal and embryonic cells. In the ensuing overview, an attempt is made to understand (1) the pathophysiology of recurrent unexplained implantation failure (2) the available evidence for the two popular treatment modalities, i.e., intravenous immune globulin and intralipid, (3) the limitation of current available data, (4) the pathophysiology and immunomodulatory treatment options for recurrent implantation failure to address the pathological, psychological, and financial distress, and associated impact on couple's quality of life.
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Neuroprotective effect of agmatine in mouse spinal cord injury model: Modulation by imidazoline receptors p. 115
Madhura P Dixit, Manoj A Upadhya, Brijesh G Taksande, Prachi Raut, Milind J Umekar, Nandkishor R Kotagale
Objective: The involvement of imidazoline receptors in the effect of agmatine was studied in locomotor recovery following experimental SCI (ESCI) in mice. Methods: ESCI was induced in mice using compression method. Locomotor function score (0–10) was measured on day 14 following ESCI. Results: Agmatine (2.5, 5, and 10 mg/kg) treatment through intraperitoneal route for 14 days following ESCI, dose-dependently improved the motor function score. Clonidine (0.1 mg/kg; imidazoline I1 receptor agonist) or moxonidine (0.5 mg/kg; I2 receptor agonist) treatment 15 min before agmatine (2.5 mg/kg) daily for 14 days, following ESCI, significantly potentiated the effect of per se agmatine. On the other hand, 15 min before treatment of efaroxan (1 mg/kg; imidazoline I1 receptor antagonist) or idazoxan (3 mg/kg; imidazoline I2 receptor antagonist) significantly blocked the motor function score of agmatine (10 mg/kg). Conclusion: These data suggest that imidazoline receptors may modulate the locomotor recovery following ESCI in agmatine treated mice, perhaps through I1/I2 receptors.
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The effect of intra-renal administration of L-NAME on renal medullary and cortical blood flow of stroke-prone spontaneously hypertensive rats and wistar rats p. 121
Ahmad F Ahmeda
Background: Autocrine and paracrine factors produced within the kidney regulate the cortical and medullary blood perfusion (CBP and MBP, respectively), which include endothelins, prostaglandins, reactive oxygen species, and nitric oxide (NO). This study investigated the role of NO in regulating the CBP and MBP of a kidney in both stroke-prone spontaneously hypertensive rats (SHRSP) and Wistar rats. Materials and Methods: Groups (n = 10 for each) of male SHRSP and Wistar rats (250–300 g) were prepared for experiments. Two laser Doppler microprobes were inserted, 1.5 and 4.0 mm, into their kidneys to measure CBP and MBP before and after the intrarenal infusion of L-NAME, the NO synthase inhibitor at dose of 10 μg/kg/min. At the end of the experiments, the animals were killed with an anesthetic overdose. Data ± standard error of the mean were subjected to Student's t-test and significance taken at P < 0.05. Results: Interstitial infusion of L-NAME into the corticomedullary border (CMB) causes significant reduction in MBP in both SHRSP and Wistar rats by 18% ±5% and 12% ±4%, respectively. The magnitude of reduction is closely similar in both strains. Acute infusion of L-NAME into CMB has no effect on CBP but increases the blood pressure (BP) in both strains equally (P < 0.05). Conclusion: These results suggest that NO plays an important role in regulating the tone of medullary blood vessels in both hypertensive and normotensive states with similar extent. L-NAME can easily spread into the systemic circulation, which is evidenced by the increase of BP.
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Comparative evaluation of harada–Mori and agar plate culture for the identification of hookworm species under limited resources p. 127
T Shantikumar Singh, Nongmaithem Onila Chanu, Sudip Dutta
Background: Human hookworm infection has widespread socioeconomic and public health implications. Several coproculture techniques have been developed for morphological identification of hookworm larvae under limited resource availability. The objective of this study was to compare the performances of Harada–Mori culture (HMC), agar plate culture (APC), and modified APC (MAPC) of hookworm positive stool specimen for identification of hookworm species occurring in East Sikkim, India. Materials and Methods: This prospective cohort study was performed using 180 stool specimen collected from children who attended Central Referral Hospital and Sir Thodup Namgyal Memorial Hospital, with the complained of gastrointestinal symptoms. Blood samples were also collected to correlate with the complete blood count (CBC). The hookworm positive stool specimen evaluated by microscopy was subjected to HMC, APC, and MAPC techniques to harvest hookworm larvae. Stoll's dilution egg count for determining egg intensity and CBC were also performed for the children who were positive for hookworm's eggs in their stool sample. Results: This study observed a predominance of Necator americanus (75%) over Ancylostoma duodenale (25%). CBC results showed high packed cell volume values in 9/12, low hemoglobin 9/12, and high eosinophil count in all the positive children. Stoll's dilution egg count showed moderate infection in 66.6%, light and heavy infections in 16.7% of children's. APC method was superior to HMC and MAPC in culturing and identifying hookworm species. Conclusions: APC was observed to yield better results and was easier to perform in limited resource laboratory setting compare to MAPC or Harada–Mori culture techniques.
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Morphometric analysis of vascular foramina in Indian dry calcaneus and its clinical applications p. 132
Naina S Wakode, Santosh L Wakode, Babita Kujur
Introduction: The calcaneus is the largest tarsal bone of hindfoot and its fractures are most difficult to treat. The knowledge about the vascular foramina is important to understand the pathogenesis and its surgical management. Aim: The scope of the present study is to generate morphological data in the form of location, size, and numbers of vascular foramina of calcaneus, as well as the length of calcaneus, to generate foramina index and their frequency of distribution in the dry calcaneus. Materials and Methods: The present study consisted of 118 (59 right and 59 left) dried human calcaneus. The bones were macroscopically studied for vascular foramina with respect to its size, location, numbers, and foramina index were determined. The data collected were statistically analyzed. Results: A total of 3112 vascular foramina were found on the right and left calcaneus. Kruskal–Wallis test showed that there was a statistically significant difference in a total number of vascular foramina over different surfaces of calcaneus (P ≤ 0.00001). Mann–Whitney U-test done for post hoc analysis proved that the total number of the vascular foramina observed on the lateral surface was significantly greater than the vascular foramina detected over other surfaces. The lateral and medial surfaces were presented with maximum number of foramina while posterior surface showed least number of the vascular foramina. Conclusion: We believe that the present study has provided additional data on vascular foramina of calcaneus in the Indian population, which will be an anatomical guide to surgical interventions involving the calcaneus bone.
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An In silico method to study structure, function, and regulatory role alteration mediated by single-nucleotide polymorphisms in gallbladder cancer p. 137
Arpit Kumar Pradhan, Rudrarup Bose, Shyamasree Ghosh, Amitava Datta
Introduction: Gallbladder cancer (GBC) is a fatal malignancy of gallbladder and bile ductswhich shows delayed symptoms and sometimes can be asymptomatic, being fatal. Reported globally, for a very low survival rate, it suffers from the lack of early diagnostic and prognostic markers. Single nucleotide polymorphisms (SNPs) have been reported to be associated in different cancers. Methods: In this study using in silico methods, we report for the first time a combination of SNPs from the coding and noncoding region leading to alteration in GBC. Different pipelines were designed for the study of SNPs. Regulatory role alteration of Synonymous and non-coding SNPs were studied using RegulomeDB, DeepSEA analysis and funcPred. Structural alteration and energy parameters for non-synonymous SNPs were studied by Swiss-PDB, Chimera and Gromacs. Protein stability analysis was done using MutPred, mCSM and I-mutant. Results: As a result, three potential variants from the coding region rs1042838, rs11887534, and rs700519 associated with progesterone receptor, ATP binding cassette subfamily G member 8 (ABCG8), and cytochrome P450 19A1, respectively, were predicted to be potentially damaging SNPs in GBC leading to structure and function alteration. Three noncoding SNPs (rs2978974, rs4633 and rs2830) and 1 missense SNP(rs523349) were shown to be associated with damaging effect in GBC, and one of these SNPs (rs2978974) showed significant chromatin feature alteration. Conclusion: Our study strongly shows that SNPs both in the coding and noncoding region may be exploited as a combination of potential biomarkers in early diagnosis of GBC due to structure function alteration by nonsynonymous SNPs and regulatory role alteration by noncoding SNPs.
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Characterization of microflora composition and antimicrobial activity of algal extracts from italian thermal muds p. 150
Antonella Giorgio, Federica Carraturo, Francesco Aliberti, Salvatore De Bonis, Giovanni Libralato, Mario Morra, Marco Guida
Aim: Fine granular clay, the so-called “peloids,” allowed to ripen for several months in contact with mineral thermal water and the organic substances derived from metabolic activities, represents the basis of thermal mud therapy. A complex microalgal community (Cyanophyceae, Chlorophyceae and Bacillariophyceae) is responsible for the therapeutic effects of thermal muds. Biological components of peloids produce bioactives, possessing anti-inflammatory, antirheumatic and antioxidant properties; for this reason, such matrix is widely used in thermal spas. The research reports results of a preliminary study aimed to characterize the microflora biodiversity of mature and nonmature thermal mud. Algal components were further extracted in order to test the antimicrobial activity of produced bioactive compounds. Materials and Methods: Microscopic, microbiological and molecular techniques were employed (DNA extraction, polymerase chain reaction and sequencing). For antimicrobial activity of algal extracts, Kirby–Bauer disck method was employed. Results: Results show a significant microfloral diversity in samples and a great number of taxa belonging to widely diffused genera such as Leptolyngbya sp., Nostoc sp., Scenedesmus sp., Navicula sp., and Amphora sp. Microbial communities indicate an absolute prevalence of a nonpathogenic flora, mostly composed of Bacillaceae. Conclusion: The association between the microbial and algal composition and the different maturation stages of thermal clay could represent an essential tool to identify markers of proper ripening. This ensures the best product quality and its beneficial properties. The extension of the study, characterizing the components of mud at different ripening times, consents the standardization of ripening process. Antimicrobial activity assay represents a preliminary step for subsequent analysis for the isolation of single component, employing analytical chemistry techniques, characterizing and identifying bioactive compounds of interest.
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Community healthcare professional visits are important determinants of knowledge and practices regarding newborn care among mothers p. 159
Hanspria Sharma, Akhil D Goel, Mudita Gosain, Ritvik Amarchand, Suresh K Kapoor, Archna Kumar, Anand Krishnan
Objective: This study assessed the knowledge, practices, and factors related to essential newborn care among mothers in a rural community in northern part of India and test its association with accredited social health activists (ASHAs) visits during antenatal and postnatal care. Methods: The study represents the formative phase of the community intervention trial for reducing neonatal mortality implemented in Ballabgarh block of Faridabad district, Haryana, India. Mothers who delivered within 1–6 months in 2012 in rural Ballabgarh before the interview were interviewed at home for knowledge and practices (KP) related to cord care, breastfeeding, thermal care, baby handling, and healthcare seeking including danger signs and free ambulance services. A KP score of 14 was derived from these domains and a score above 9 was taken as adequate. A logistic regression was used to test the hypothesis that ASHA visits were related to the higher knowledge among mothers when adjusted for other confounders. Results: Of the 1298 mothers, 42.3% (39.7–45.1) did not apply anything on umbilicus; 8.7% (7.3–10.4) were kept in skin-to-skin contact; 65% (62.3–67.6) were exclusively breastfed for 1st month; and 29.7 (27.2–32.3) first bathed their baby within 3 days to. 41% (38.7–44.1) of mothers were rated to have adequate KP. The KP score was significantly less in mothers who delivered at home (adjusted odds ratio [AOR]: 1.78; 95% confidence interval [CI]: 1.22–2.59), or underwent cesarean section (AOR: 1.67; 95% CI: 1.12–2.53) or did not have contact with ASHA (AOR: 1.64; 95% CI: 1.17–2.29). Conclusion: There is a considerable KP gap in the community. Strengthening and scaling up of ASHA visits could prove to be beneficial for modifying high-risk newborn care norms and practices.
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Comparing the effect of coconut oil pulling practice with oil pulling using sesame oil in plaque-induced gingivitis: A prospective comparative interventional study p. 165
Sriram Kaliamoorthy, Ambiga Pazhani, Mahendirakumar Nagarajan, Alagappan Meyyappan, Sreeram Rayar, Semmia Mathivanan
Background: Oil pulling, pulling oil, or oil swishing is an ancient healing practice and was first developed in ayurvedic medicine. Coconut and sesame oil are regular constituents in Indian food and are easily available. They also economically cheaper compared to others such as avocado, black cumin seed, canola, cedar nut, and olive oil and have been shown to have numerous health benefits. Aim: The aim of this study is to compare the effect of oil pulling utilizing coconut and sesame oil in patients with plaque-induced gingivitis. Materials and Methods: The study participants were divided into three group, namely, Group A – 20 individuals with plaque-induced mild-to-moderate gingivitis used coconut oil for oil pulling, Group B – 20 individuals with plaque-induced mild-to-moderate gingivitis used sesame oil for oil pulling, and Group C – 20 individuals with plaque-induced gingivitis who were advised to practice routine toothbrushing alone. Modified gingival index (GI) score for each group was assessed using modified GI at preintervention stage and postintervention stage at the 7th, 15th, and 21st day. Results: Significant reduction in the severity of gingivitis was seen in Group A and Group B at the 7th, 14th, and 21st day. Reduction was more significant in Group A compared to Group B and Group C. Group C showed mild reduction in mean GI score. Conclusion: Oil pulling is an effective oral hygiene practice along with routine oral hygiene practice. Coconut oil is very effective compared to sesame oil in the reduction of severity of gingivitis.
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Evaluation of toxicity studies and anti-inflammatory activity of Terminalia Bellerica in carrageenan-induced paw edema in experimental rats p. 169
Prerna Chauhan, Surender Singh, YK Gupta, Uma Kumar
Background: In traditional Indian system of medicine, Terminalia bellerica (TB) is known to possess several medicinal properties. Preclinical studies addressing safety profile and anti-inflammatory activity of TB extract (TBE) in experimental animals are lacking. The objective of the present study was to evaluate the toxicity studies and anti-inflammatory potential of hydroalcoholic fruit extract of TB in Wistar albino rats. Methods: Acute and subacute oral toxicity studies of TBE were evaluated in Wistar albino rats. TBE was administered at doses of 2000 and 1000 mg/kg in acute and subacute toxicity studies, respectively. Anti-inflammatory activity of TBE was evaluated in carrageenan-induced paw edema model. For the evaluation of anti-inflammatory activity, animals were divided into five groups (Group 1 – control, Group 2 – indomethacin 3 mg/kg, Group 3 – TBE 100 mg/kg, Group 4 – TBE 200 mg/kg, Group 5 – TBE 400 mg/kg). Results: No mortality and signs of toxicity were observed in both acute and repeated dose toxicity studies after oral administration of TBE up to the dose level of 2000 mg/kg. TBE showed a significant anti-inflammatory activity in carrageenan-induced paw edema model at 1, 3, and 5 h. A significant inhibition (P < 0.01) of paw edema as compared to control group was observed at doses of 100, 200, and 400 mg/kg at 1, 3, and 5 h. TBE showed comparable efficacy to indomethacin at 200 mg/kg. Maximum percentage inhibition was observed with TBE 200 mg/kg at 3 h (57.6%). Conclusion: The results indicate that hydroalcoholic extract of TB fruit is safe and exhibits a significant anti-inflammatory activity in experimental rats.
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Analysis of antibiotic sensitivity profile of biofilm-forming uropathogenic Escherichia coli p. 175
Kulkarni Ramesh Sudheendra, Peerapur V Basavaraj
Introduction: Biofilms are group of microorganisms which are embedded within a self-produced matrix of extracellular polymeric substance which adhere to each other. They are found to be involved in a wide range of infections in the body like urinary tract infections (UTIs). Biofilms are considered to be highly resistant to antimicrobial agents. Escherichia coli (E. coli) is the most common organism causing both community as well as hospital acquired UTI leading to serious health issues. Objectives: This study was conducted to analyse the antibiotic sensitivity profile of biofilm forming Escherichia coli (E. coli) isolated from patients with suspected UTI attending a Teaching hospital of North Karnataka. Materials And Methods: 388 E. coli isolates recovered from1000 suspected cases of UTI were tested for susceptibility to fourteen different antibiotics. In vitro biofilm formation was detected by Tube adherence method, Congo red agar method and Tissue culture plate method. Results: 277 isolates (71.39%) produced biofilm in-vitro by all the three methods. Biofilm forming E. coli developed significantly higher degree of resistance towards antimicrobial drugs Ampicillin (87.36%), Cefuroxime (81.58%), Amoxicillin clavulanic acid (77.61%), Ciprofloxacin (71.48%) and Ceftriaxone (71.48%). They were sensitive to higher antibiotics like Imipenem, Piperacillin-tazobactam, Nitrofurantoin, and Amikacin. Conclusion: Detection of biofilm in E. coli and its resistance to commonly prescribed antibiotics in the clinical practice is essential in improving the efficacy of empirical treatment. This study revealed the prevalence and antimicrobial susceptibility pattern of biofilm forming E. coli which helps clinicians to treat UTI effectively.
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A comparative study of efficacy and safety of piroxicam and naproxen in the management of pain in osteoarthritis of the knee p. 180
Yaseen Mohammed, Sarala Narayana, HS Arun
Introduction: Osteoarthritis (OA) is a degenerative joint disease and cause for functional disability. OA is characterized by the insidious onset of pain and limited range of movements. Piroxicam and naproxen are used in OA, rheumatoid arthritis, acute gouty arthritis, migraine, dysmenorrhea, and postoperative pain. The aim of this study was to compare the efficacy and safety of these drugs in patients with OA of the knee. Materials and Methods: This was a randomized, open-label, comparative, parallel group study conducted in patients with OA of knee joints. They received either oral piroxicam 20 mg or naproxen 500 mg twice daily for 6 weeks. The pain was assessed using Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores at baseline, 2nd, 4th, and 6th week. Patient satisfaction score (PSS) and quality of life were assessed at follow-up. Adverse effects were assessed using the World Health Organization causality scale. Descriptive and inferential statistics were used. Results: A total of 110 patients were recruited, 47 males and 63 females, 100 completed the study (51 in Group P and 49 in Group N). Both piroxicam and naproxen significantly reduced VAS and WOMAC scores at the 2nd, 4th, and 6th week (P = 0.001) compared to baseline, but this was not significant between the groups. PSS was significantly (P = 0.03) high at 4th and 6th week when compared to week 2 with both medications, but between the medications, it was insignificant (P = 0.10). The adverse effects such as epigastric discomfort, nausea, and vomiting were observed with both the drugs, but it was more with naproxen. Conclusion: Piroxicam was as effective as naproxen in relieving pain and improving the range of movements with less adverse effects.
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Impact of polymorphisms of TP53 Arg72Pro, excision repair cross-complementing Protein 1 Asn118Asn (C118T) and deletion in Intron 2 of BIM in chronic myeloid leukemia patients on imatinib treatment p. 185
Sailaja Kagita, Sadasivudu Gundeti, Raghunadharao Digumarti
Background: Imatinib (IM) results in durable responses in a large number of patients with chronic myeloid leukemia (CML). However, a substantial number develops drug resistance. There could be several reasons for the heterogeneity of response. To survive genotoxic damage induced by IM, BCR-ABL1 can modulate DNA repair mechanisms, cell-cycle checkpoints, and Bcl-2 family members. Hence, we aimed to find out the impact of single-nucleotide polymorphisms mainly TP53Arg72Pro, excision repair cross-complementing protein 1 (ERCC1) Asn118Asn (C118T) and deletion in intron 2 of BIM genes in CML patients and their association with disease progression and treatment outcome. Materials and Methods: In the present study, 174 CML and 174 control samples were analyzed for polymorphisms of TP53Arg72Pro, ERCC1 C118T, and intron 2 deletion in BIM genes using polymerase chain reaction-restriction fragment length polymorphism method. Results: Genotyping of TP53Arg72Pro polymorphism showed a trend toward proline genotype/allele association with younger age (P = 0.031), advanced phase, high BCR-ABL1 expression levels and presence of tyrosine kinase domain (TKD) mutations compared to respective groups. Genotyping of ERCC1 C118T polymorphism showed a significant association of CT genotype and T allele with high BCR-ABL1 levels BIM deletion polymorphism was not observed in the present study (P = 0.030) and presence of TKD mutations (P = 0.013). The 72 proline allele and heterozygous 118CT genotype frequencies were significantly elevated in deceased patients compared to those on IM and other tyrosine kinase inhibitors treatment. Conclusion: our data suggested that proline genotype/allele of TP53Arg72Pro polymorphism possibly leading to inefficient apoptosis and 118CT genotype in ERCC1 gene with possibly less DNA repair efficiency might be responsible for the suboptimal responses to IM and poor survival in CML patients. Deletion in intron 2 of BIM gene was not observed in our study.
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Detection and genetic characterization of Giardia intestinalis in children with gastrointestinal symptoms by PCR RFLP in Sikkim, India p. 193
Nongmaithem Onila Chanu, T Shantikumar Singh, Sudip Dutta
Background: This study is aimed to detect Giardia and genetically characterize Giardia intestinalis among children in Sikkim, India. Materials and Methods: A total of 400 stool samples were collected from the children (<15 years) with gastrointestinal symptoms, who attended Central Referral Hospital and Sir Thodup Namgyal Memorial Hospital. Giardia cysts were detected by microscopy from the stool samples and were genetically characterized by polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) targeting glutamate dehydrogenase gene (gdh). Results: Giardia cysts were detected in 20/400 (5% incidence rate). Out of 20 samples, 13 (65%) were successfully assayed by PCR-RFLP. The PCR product of gdh gene was digested by BsPL1 and RsaI and isolated 53.7% of BIV, 38.5% of AII and B mixed, and 7.8% of BIII assemblages. There was no AI assemblage found in this study. Diarrhea and abdominal pain were the common complaints associated with giardiasis. Conclusions: PCR-RFLP targeting gdh gene locus is a reliable, easy, and cost-effective method to identify G. intestinalis and its assemblages. This is the first report on the prevalence and genetic variability of human giardiasis in symptomatic children in Sikkim, India.
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The clinical dental undergraduate's perception of stress origin in India: A cross-sectional study p. 197
Shivasakthy Manivasakan, Sethuraman K Raman, A Santha Devy, R Saravanakumar
Purpose: The current study aims to compare the stress level of the undergraduate clinical dental students' year wise in a dental college using modified dental environmental stress (DES) questionnaire and to identify the key contributing factors of stress for each year. Methods: Research hypothesis of the study is that the stress of the final year students will be more than others. The study followed cross-sectional observational study design. Total of 166 students (73 3rd years, 50 final years and 43 interns) from a private dental college in south India participated in the study. Modified DES Questionnaire was given in an electronic format and the data were collected. One way and two way ANOVA with post hoc analysis was used to calculate stress score. Results: The 3rd year students were significantly less stressed than their seniors. The final years and the interns had equal amounts of stress. The academic factors followed by patient and clinic responsibilities and professional identity were the key stress contributing factors for the final year students. Faculty relations and personal life issues were the least contributing factors for all the three batches. Conclusion: Revision of the redundant areas in curriculum, considerate changes in the clinical quota system, academic support system, guidance, and counseling for psychological well-being of the students are the need of the hour to decrease the stress in the clinical dental students.
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Cytotoxic activities of the dichloromethane extracts from Andrographis paniculata (Burm. f.) nees p. 201
Maria Carmen S. Tan, Glenn G Oyong, Chien-Chang Shen, Consolacion Y Ragasa
Introduction: Although diterpenes from Andrographis paniculata Burm.f. Nees have been found to have chemotherapeutic activity, a thorough investigation on the cytotoxic and anti-proliferative analyses on different cancer cell lines using these isolated constituents has not been achieved. Objectives: The primary objective of this study was to probe the cytotoxic capacity of the labdane diterpenoids andrographolide (1), 14-deoxyandrographolide (2), 14-deoxy-12-hydroxyandrographolide (3), and neoandrographolide (4) on mutant and wild type immortalized cell lines. Methods: Breast adenocarcinoma (MCF-7), colon carcinomas (HCT-116 and HT-29), small cell lung carcinoma (H69PR), human acute monocytic leukemia (THP-1), and wild type primary normal human dermal fibroblasts - neonatal cells (HDFn) were incubated with 1-4 and the degree of cytotoxicity was analyzed by employing the in vitro PrestoBlue® cell viability assay. Working solutions of 1-4 were prepared in complete cell culture medium to a final non-toxic DMSO concentration of 0.2%. The plates were incubated at 37°C with 5% CO2 in a 98% humidified incubator throughout the assay. Nonlinear regression and statistical analyses were done to extrapolate the half maximal inhibitory concentration, IC50. One-way ANOVA (P < 0.05) and multiple comparison, Tukey's post hoc test (P < 0.05), was used to compare different pairs of data sets. Results were considered significant at P < 0.05. Results: The highest cytotoxicity index was exhibited by the H69PR and 1 trials which displayed the lowest IC50 value of 3.66 μg/mL, followed by HT-29 treated with 2, HCT-116 and 1 trials, and H69PR treated with 4 (IC50 = 3.81, 3.82 and 4.19 μg/mL, respectively). Only 1 and 4 were detrimental towards MCF-7; while 1, 3, and 4 were degenerative against H69PR. Tukey's post hoc multiple comparison indicated no significant difference in the cytotoxicity of 1-4 on HCT-116 cells which afforded IC50 values ranging from 3.82 to 5.12 μg/mL. Evaluation of the two colon carcinoma cell lines showed that HCT-116 was categorically more susceptible to cellular damage caused by treatments with 1-4 than was HT-29. Cytotoxicity was not detected in THP-1 and HDFn cells (IC50 >100 μg/mL). Conclusion: Diterpenoids 1-4 isolated from the dichloromethane extract of the leaves of A. paniculata exhibited different cytotoxic activities against MCF-7, HCT-116, HT-29, H69PR. All constituents had comparable action on HCT-116 cells but were not found to be cytotoxic to normal HDFn cells and mutant THP-1 cells.
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Prevalence of oral habits among 4–13-Year-Old children in Central Kerala, India p. 207
S Anila, RS Dhanya, Archana A Thomas, TI Rejeesh, K Jeffy Cherry
Aim: The present study was conducted to determine the prevalence of harmful oral habits among 4–13-year-old children in relation to their age and gender, in a dental college hospital in Central Kerala, India. Methods: A retrospective survey was conducted in 1034 children (478 males and 556 females) aged between 4 and 13 years. The participants were checked for the prevalence of oral habits in relation to their age and gender. Information regarding oral habits was obtained with the help of a questionnaire and clinical evaluation using mouth mirror and water tests. Chi-square test was used in the statistical analysis. Results: Overall prevalence of oral habits was 72.7% in the study participants. Nearly 47.1% of the children had only one habit, whereas 19.1% had two habits and 5.5% had three or more habits. Mouth breathing was the most commonly reported oral habit (29.4%), followed by tongue thrusting (23.5%), nail biting (20%), thumb-sucking (17%), pencil biting (8.7%), bruxism (4.9%), and lip/cheek biting (4.5%). Nail biting was reported significantly more in females and bruxism significantly more in males. Prevalence of thumb-sucking was very high in younger children (4–8 years) compared to older children (9–13 years). Conclusion: The prevalence of oral habits among 4–13–year-old children is very high in Central Kerala, compared to children in other Indian populations. Since oral habits can be intercepted and prevented, creating awareness regarding the adverse outcomes of oral habits is highlighted.
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Local analgesic effect of pethidine infiltrated intrafascially after total abdominal hysterectomy: A randomized, double-blind study p. 211
Emmanouil Stamatakis, Konstantina Kalopita, Sophia Hadzilia, Charalamampos Theofanakis, Dimitrios Valsamidis
Objective: Surgical-site infiltration with local anesthetics is a key component of multimodal analgesia regimen for adequate postoperative pain management. This randomized, double-blind study was designed to evaluate the local analgesic efficacy of pethidine in patients undergoing total abdominal hysterectomy (TAH) through a Pfannenstiel incision. Materials and Methods: Patients were randomized into two groups. The first group received wound infiltration (WI) with 0.5 mg/kg pethidine, diluted in 15 ml normal saline, and injected in the fascial layer at the end of surgery, combined with a simultaneous intramuscular (IM) injection of 2.5 ml normal saline (WI group). The second group received WI with 15 ml normal saline combined with an IM injection of 0.5 mg/kg pethidine and diluted in 2.5 ml normal saline (IM group). All patients received general anesthesia following a standardized anesthetic protocol. Study end points were 24-h total morphine consumption and pain scores based on a visual analog scale (VAS) at rest and on coughing at 1, 3, 6, and 24 postoperative h, as well as sedation scores observed using a 0–10 numeric rating scale. Adverse effects from morphine uptake, such as nausea, vomiting, and the need for rescue antiemetics, were recorded as well. Results: Postoperative VAS assessments showed no statistically significant advantage between WI and IM method, while the total (24h) consumption of morphine was lower in the IM, compared to the WI group (27.2%). The latter demonstrated a consistently higher median sedation score at all assessed time points after the operation (P < 0.05); however, it was significantly different only at the 6 h time point. Conclusions: Local WI with pethidine after TAH did not reduce the total morphine consumption for the first 24 h postoperatively. Morphine consumption was lower in the IM group, compared to the WI group. Further studies are needed to assess the effectiveness of pethidine as a local anesthetic agent.
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The relationship between hemoglobin A1C levels and sputum conversion time in indonesian patients with new cases of pulmonary tuberculosis p. 217
Ratnawati , Dewi Wijaya, Ahmad Muslim Nazaruddin, Fariz Nurwidya, Erlina Burhan
Background: Hemoglobin A1c (HbA1c) is a glycated form of hemoglobin and is associated with increased susceptibility to tuberculosis (TB), severity, and resistance to therapy. We aimed to determine the impact of HbA1c levels on sputum conversion time among Indonesian patients with pulmonary TB under the intensive phase of TB treatment. Methods: This prospective cohort study was conducted in patients with new cases of pulmonary TB patients aged ≥15-year-old and had never been diagnosed with type 2 diabetes mellitus (T2DM). The exclusion criteria of this study are pulmonary TB accompanied by T2DM, pregnancy, or coinfected with human deficiency virus. Statistical analysis was performed using Fisher's exact test to find the relative risk of all variables. We also performed power analysis to check the sample sufficiency. Results: One hundred and twenty-three patients of new cases of pulmonary TB were included in this study; of which 63 females and 60 males. There were 12 patients who had HbA1c levels ≥47.5 mmol/mol. More than half (56.1%) of patients had smear-positive acid-fast bacilli and duration of sputum smear conversion time for more than 2 months was recorded in 11 patients (8.9%). There was a significant relationship between HbA1c levels >47.5 mmol/mol and sputum conversion time >2 months with a relative risk of 6.3 (1.9–39.6), value of P = 0.01. Conclusion: HbA1c levels played an important role toward sputum smear conversion time in patients with new cases of pulmonary TB, and therefore, HbA1c should be considered as an important factor for the outcome in patients receiving anti-TB drugs.
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Lung diffusion capacity disorder in indonesian patients with Type 2 diabetes mellitus and the related factors Highly accessed article p. 222
Haruyuki Dewi Faisal, Budhi Antariksa, Ratnawati , Rochsismandoko , Faisal Yunus, Fariz Nurwidya
Background: Type 2 diabetes mellitus (T2DM) is a disorder characterized by chronic hyperglycemia and causing both macro- and micro-vascular complications. Lung as a microvascular-contained organ may be affected by the T2DM microvascular complication that results in lung diffusion capacity disorder. Methods: This cross-sectional study involved adult T2DM patients, without overt lung disorder, terminal kidney failure, or cardiovascular disorder, and who were on an outpatient basis. Patients who were recruited through consecutive sampling underwent interview session, physical examination, laboratory test, spirometry, and diffusing capacity of the lungs for carbon monoxide (DLCO) test. Results: Decreasing DLCO value has a significant relation to the high level of glycated hemoglobin (HbA1c) (P < 0.05). Patients with HbA1c >6.5 have 21 times risk to have decreasing DLCO value compared to patients with HbA1c <6.5 (P < 0.05). Conclusion: Uncontrolled glycemic status significantly contributed in the decreasing lung diffusion capacity among patients with T2DM. This study implies the importance of controlling blood glucose as a measure to preserve the lung diffusion capacity.
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Awareness of risk factors, warning signs, and immediate management measures of noncommunicable diseases: A multihospital-based study p. 227
Nitin Joseph, R Srinath, Aditya Ramanathan, Ashutosh Kumar Gupta, P Nandan, Rimsha Afnan
Introduction: Noncommunicable diseases (NCDs) account for more than one-third of outpatient visits and inpatient admissions and more than half of the proportional mortality rate from all causes of death in India. The burden of modifiable risk factors of NCDs in India is increasing significantly over the past five decades. Therefore, the reason behind this and the preparedness of people to deal with it need to be ascertained. Objectives: The objective of this study was to assess the awareness of people regarding risk factors, warning signs, and immediate management practices in specific NCDs. Materials and Methods: This cross-sectional study was conducted among people in a government and private tertiary care hospital of Mangalore city in February 2016. Data were collected by interviewing each participant using a pretested validated structured interview schedule. Results: All the 400 enrolled participants had heard about heart attack, hypertension, and diabetes mellitus. However, only 250 (62.5%) had heard about stroke. Good awareness about heart attack was present among 62.5%, stroke among 57.6%, hypertension among 59%, and diabetes mellitus among 55.8% of participants. Multivariate analysis using ordinal logistic regression analysis found that good educational status and being vegetarian were significant predictors of good awareness level about heart attack. Similarly, these factors along with urban residential status were significant predictors of good awareness level about stroke. Age above 55 years was a significant predictor of good awareness level about diabetes mellitus. Conclusion: The various sociodemographic groups identified to have poor knowledge about NCDs in this study require targeted intervention during health educational campaigns.
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A clinico-epidemiological study of thalassemia cases in India p. 236
Nitin Joseph, Siddharth Pai, Shreejita Sengupta, Suchaita Bharadwaj, Saksham Dhawan, Kanishk Khare
Introduction: Thalassemia is the most common single-gene disorder in India. Hence, care of these patients becomes a priority issue. Objectives: This study was done to assess the clinical presentations and management practices in thalassemia. Materials and Methods: Case sheets of patients with thalassemia admitted over the past 10 years from 2005 to 2014 were examined and recorded in a validated pro forma. Results: Of the total 183 cases, 179 (97.8%) were of beta thalassemia major, 3 (1.6%) of beta thalassemia intermediate, and 1 (0.6%) of beta thalassemia minor category. The median age at diagnosis was 1 year. Hardly, one-fourth of the cases were diagnosed in the first 6 months. Majority of cases were under-fives 58 (31.7%) and were males 116 (63.4%). Fever was the most common presenting symptom 34 (18.6%). Pallor 179 (97.8%) followed by hepatomegaly 172 (94%) were the most common signs. Bone deformities were reported in 13 (7.1%) cases. Among the under-fives, more than one-third were underweight and more than half were stunted. The mean posttransfusion value of hemoglobin after 1 year of transfusion among cases was 10 ± 1.6 g percent. Iron chelation therapy using desferrioxamine was given to 51 (27.9%) cases. The mean age of starting this therapy was 11.1 ± 8.2 years. Splenectomy was done in 4 cases, all of them being cases of beta thalassemia major. The mean age while performing splenectomy was 10.7 ± 4.8 years. Lenticular opacity was present among greater proportion of thalassemia cases on treatment with desferrioxamine (P = 0.022). Conclusion: Several complications were identified among thalassemia cases. A multidisciplinary care approach is therefore required for solving these problems.
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Radioprotective potential of Asparagus racemosus root extract and isoprinosine against electron beam radiation-induced immunosupression and oxidative stress in swiss albino mice p. 242
KP Sharmila, B Satheesh Kumar Bhandary, Ronald Fernandes, N Suchetha Kumari, Vadisha S Bhat, K Jayaram Shetty, Jerish M Jose, Alex John Peter
Background: Radiotherapy is an important and the most common treatment modality for human cancers. Cancer radiotherapy is associated with unadorned side effects that results from normal tissue damage which is a major subject of concern. Radiation induces damage to living cells due generation of aqueous-free radicals. Therefore, there is a crucial need for the protection of normal cells surrounding the tumor from radiation injury; and hence, the identification of radiation-protecting agents is a chief goal for basic radiation biologists and oncologists. Aim: The aim of this present study was to assess the radioprotective potential of Asparagus racemosus root ethanolic extract (ARE), and isoprinosine (IPR) against electron beam radiation (EBR)-induced immunosuppression and oxidative stress in Swiss Albino mice. Materials and Methods: Swiss albino mice were used for the assessment of the radioprotective potential of ARE and IPR against EBR-induced immunosuppression and oxidative stress. Cytokine estimations, namely, interleukin-2, interferon-gamma, and tumor necrosis factor-alpha were performed in the liver homogenate using ELISA kits, and bone marrow cellularity was determined in the experimental animals. Results: The results of the present study demonstrated the radioprotective and immunostimulatory efficacy of ARE and IPR against EBR-induced cytokine and bone marrow cellularity alterations. Conclusion: The findings of our study demonstrate the potential of ARE and IPR in mitigating radiation-induced mortality by offering protection to mice against lethal dose of whole body EBR. The present study also demonstrates that ARE and IPR exert its radioprotection against EBR induced immunosuppression by regulating cytokines.
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Epidemiology of pediatric trauma at a tertiary hospital in Riyadh, Saudi Arabia p. 247
Abdulrhman Alnasser, Ahmad Othman, Osama Mobaireek, Nesrin Alharthy, Nawfal Aljerian, Heythem Al Zamel, Shoeb Qureshi, Mohammed Al-Mutairi
Objective: To evaluate the pattern of pediatric traumas at a tertiary hospital in Riyadh, Saudi Arabia, based on gender, age groups, mechanisms of injury, and anatomical regions. Methods: This retrospective observational study used the trauma registry of King Abdulaziz Medical City Trauma Center to review the data of all pediatric patients aged <14 years who were admitted to the hospital following trauma from January 2009 to April 2014. Demographic characteristics, date and time of admission, injury type and mechanism, body area involved, and the mortality rates were analyzed. Results: A total of 1762 patients were included, 68% of who were males. The most common mechanism of injury was blunt trauma (73%), followed by burns (17%) and penetrating injuries (10%). Road traffic injuries were the most common cause (50%) of blunt trauma, followed by fall (40%) and those caused by a physical object (10%). During the study, 305 patients with burns were treated with scalds accounting for the highest proportion (68%) of burn injuries. Sharp objects (79%) were the most frequent cause of penetrating injuries. A total of 50 mortality cases were recorded, which most commonly occurred among the school-aged group (40%) and male patients (78%). The leading cause of deaths among patients was blunt injury (92%). Conclusion: This study has shown the patterns of pediatric trauma injuries in a tertiary hospital in Riyadh, Saudi Arabia, illustrating the local variability across genders, age groups, injury types, and injury mechanisms. Such demographic data will be valuable for optimally resourcing health-care system locally.
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Failure to validate a prediction model for risk of complications in pediatric cancer patients with fever and neutropenia p. 252
Osama K Mobaireek, Nesrin A Al-Harthy, Abdulrhman M Alnasser, Jinan R Al-Rashoud, Mohammed H Hommady, Winnie Philip, Shoeb Qureshi
Objectives: The aim is to clinically validate prediction model for risk of complications in pediatric cancer patients with febrile neutropenia (FN). Materials and Methods: A risk prediction model for pediatric patients with FN is previously published (Hakim et al. model). In this retrospective, cross-sectional study, we validated the model's prediction of proven invasive infection and culture-negative sepsis on 108 patients, aged 14 years or younger, who developed FN in outpatient settings, and were admitted to King Abdulaziz Medical City in Riyadh, Saudi Arabia between January 1, 2006 and December 31, 2015. Patients' charts were reviewed, and the predicted versus observed outcomes were recorded. For the clinical prediction model validation, odds ratios, sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were calculated. Results: Patients' ages ranged from 4 months to 13.5 years (median: 5.7 years). Sixty-two percent of patients had acute lymphoblastic leukemia or lymphoma, 33% had solid tumors, and 5% had acute myeloid leukemia. Clinical complications were identified in 38% of patients including positive cultures in 7%. In our population, the model's sensitivity was 27%, specificity was 75%, PPV was 39%, and NPV was 63%. Univariate analysis showed no statistically significant correlation between outcome and gender, clinical appearance, temperature, absolute neutrophil count, or cancer classification. Conclusion: Risk of FN complications could not be reliably predicted in our population using the previously published risk prediction model (Hakim et al. model). Moreover, none of the clinical variables could reliably classify patients. Hence, clinical practice needs to treat all FN patients with caution of high-risk complications.
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Knowledge and attitude of male primary school teachers about attention deficit and hyperactivity disorder in Riyadh, Saudi Arabia p. 257
Hamzah Hassan Alfageer, Mohamed Dhafer Aldawodi, Sulaiman A Al Queflie, Nazish Masud, Nesrin A Al Harthy, Nawaf Alogayyel, Mohammed Alrabah, Shoeb Qureshi
Objective: We assessed the level and source of knowledge and attitude of male primary school teachers about attention-deficit and hyperactivity disorder (ADHD). Methods: A cross-sectional study was conducted from January to November 2016 involving Saudi male teachers currently working at 17 primary schools in Khashm-Alaan district, Saudi Arabia. A prevalidated, self-administered, structured questionnaire was used for data collection. Teachers' mean knowledge score was measured in the following three categories: insufficient, good, and very good. Results: Only 141 out of 182 teachers completed the questionnaire. Mean age of participants was 36.16 ± 6.6 years with teaching experience of 12 ± 6.2 years. Bachelor's degree was the highest qualification reported by 86% of participants. Seventy-two percent of the teachers had either very good (13%) or good (59%) knowledge about ADHD. Almost half of them reported multiple sources such as internet, social media, and television for obtaining information about ADHD. However, internet and social media alone were reported as a source of information by 13% and 11.4%, respectively. Those who attended any course on ADHD had significantly (P = 0.006) more knowledge about the disorder. Furthermore, those teachers having taught a child with ADHD had more knowledge about the disorder. A significant correlation between mean knowledge and attitude scores was observed. Conclusion: Two-third of the teachers had knowledge about ADHD. Those who had either attended a course or taught a child with the ADHD had significantly more knowledge about the disorder. Most of the teachers learned about the disorder from multiple sources.
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An In vitro evaluation of tensile bond strength of commercially available temporary soft liners to different types of denture base resins p. 263
Meghna Chauhan, IN Aparna, Kishore Ginjupalli, Sarala Kumari, PS Sandhya, Nirban Mitra
Introduction: Optimal bond between denture base and the soft liner is necessary as adhesion failure is the most common problem encountered clinically. Hence, this study evaluated the tensile bond strength of two commercially available temporary soft liners to different types of denture base resins. Materials and Methods: Prepared wax specimens were heat cured to get 16 samples of each type of denture base resin specimens (DPI, Trevalon, and Trevalon HI). A 3 mm section of acrylic denture base material from the center of each specimen was removed, and the two parts of the fragmented specimens were then repositioned into the aluminum die for the application of temporary soft liners (Group A, Viscogel and Group B, GC tissue conditioner). The specimens were tested for bond strength using universal testing machine and debonded surfaces were observed under a stereomicroscope for analysis of failure. Results: Viscogel showed the highest tensile bond strength with all three different types of denture base resins. Viscogel was significantly superior over GC tissue conditioner. Trevalon exhibited better bond strength results with both Viscogel and GC temporary soft liners as compared to other two types of denture base resins. Conclusion: Viscogel, a temporary soft liner, showed better bond strength compared to GC soft liner in bonding conventional and modified denture base resins.
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Correlation between urinary cotinine, exhaled carbon monoxide, and nicotine dependence among indonesian individuals in the national narcotics and illicit drug rehabilitation center p. 268
Gatut Priyonugroho, Jamal Zaini, Erlang Samoedro, Iman Firmansyah, Fariz Nurwidya, Budhi Antariksa, Sita Andarini, Agus Dwi Susanto
Background: Environmental tobacco smoking exposure increased the level of urine cotinine and exhaled carbon monoxide (COex). Evidence suggests that there is an association between nicotine dependence and COex. The purpose of this study is to elucidate the correlation between urinary cotinine, COex, and nicotine dependence among Indonesian individuals with a history of substance use undergoing rehabilitation program. Materials and Methods: This cross-sectional study recruited participants who undergone rehabilitation at rehabilitation unit in Lido, aged >18 years old, and current smokers. We investigated the cigarette and substance consumption, Fagerstrom test for nicotine dependence (FTND), Addiction Severity Index (ASI), level of urinary cotinine, and level of COex. The ASI was determined by a psychologist who was working for rehabilitation unit. Results: The 72 assessed participants were male and aged 18–44 years old (mean 29 ± 7.1). We found significant positive correlation between urinary cotinine and COex (Spearman r = 0.3473, P = 0.0028), age of smoking initiation and age of substance use initiation (Spearman r = 0.5660, P < 0.0001), FTND and ASI (Spearman r = 0.3107, P = 0.0079), COex and age (Spearman r = 0.3323 P = 0.0043), COex and years smoking (Spearman r = 0.3028, P = 0.0097), as well as negative significant correlation COex and ASI (Spearman r = −0.2743, P = 0.0197). Conclusion: There was a significant correlation between urinary cotinine and COex, age of smoking initiation and age of substance use initiation, FTND and ASI, COex and age, COex and years smoking, and between COex and ASI.
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Immediate replacement of nonrestorable molar with impacted third molar: An experimental study p. 273
Swapnil Uttamrao Shinde, Aashish Deshmukh, Mahesh Ravindra Khairnar
Background: Autogenous transplantation of impacted third molars in place of nonsalvageable first or second molars can prove to be a good option. Hence, the present study evaluated the replacement of maxillary or mandibular nonrestorable molars with immediate autotransplantation of impacted third molar. Materials and Methods: Forty-two impacted third molars having complete root formation were extracted and autotransplanted into the extraction socket of nonrestorable first or second molars on 42 participants in the age range of 22–50 years. Follow-up period for the study was of 1 year at regular intervals. Participants were analyzed for pain, tooth mobility, ankylosis, and root resorption at follow-up intervals. Data obtained were analyzed using SPSS software. Results: Out of the 42 participants, 9 participants required extraction of autotransplanted tooth due to resorption and Grade 2 mobility. One tooth showed ankylosis. Success rate of the autotransplantation was 78%. Conclusion: It was concluded that immediate autotransplantation is a successful and more economical tooth replacement option provided that proper case selection and procedure should be followed.
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Novel eco-friendly “One-Pot” facile strategy for production of the natural quercetin from the plant: A model study p. 278
Elena Vladimirovna Maksimenko, Anna Vladimirovna Lekar, Salima Salimovna Khizrieva, Sergey Nikolaevich Borisenko, Elena Vladimirovna Vetrova, Nikolay Ivanovich Borisenko, Vladimir Isaakovich Minkin
This work is aimed at the development of an “one-pot” technique for the production of the natural antioxidant quercetin (QR) from the buds of Sophora Japanese (Sophora japonica L.) using the subcritical water (SBW). For the first time, SBW that serves as a reactant and a solvent has been used to obtain QR in good yields starting from the buds of Sophora Japanese. High-performance liquid chromatography was used to determine the quantitative and qualitative compositions of the obtained products. For the first time, a new eco-friendly “one-pot” technique was proposed for production of QR from the buds of Sophora Japanese using SBW. This method of preparation of QR allows one to avoid the use of toxic organic solvents. The good yields of the targeted QR can be obtained for the period of time which is ten times shorter than needed by the traditional procedures.
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Epiploic appendagitis: A self-limiting cause of abdominal pain p. 282
Prabin Sharma, Tamta Chkhikvadze, Pranav Sharma
Epiploic appendagitis (EA) is a rare cause of acute to subacute lower quadrant abdominal pain. It has two subtypes: primary and secondary EA. Primary EA is characterized by inflammation of the epiploic appendages caused by torsion or thrombosis of the draining vein of the appendage whereas secondary EA often occurs in association with other inflammatory processes in the abdomen and pelvis. Due to its similarity to other causes of acute abdomen, patients with primary EA often undergo unnecessary treatment with antibiotics and surgical intervention. We present a case of a middle-aged female who was diagnosed with primary EA based on imaging studies and was successfully managed with conservative treatment.
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Collagenous gastritis: A case report and literature review p. 285
Prabin Sharma, Andrea Barbieri, Amir Masoud
Collagenous gastritis (CG) is a rare disease, which is characterized by subepithelial deposition of collagen in the gastric mucosa, surface epithelial injury, and a lamina propria inflammatory infiltrate. Approximately 100 cases of CG have been reported in the literature. We report another case of a young girl who presented to us with severe anemia and chronic diarrhea and was diagnosed with CG based on clinical features and endoscopic and pathologic findings. She was successfully managed with oral iron, sucralfate, and proton pump inhibitor therapy.
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Surgical correction of atresia ani et recti along with pervious urachus in sahiwal cow calves p. 288
Naresh K Singh, Amit Kumar, Priyaranjan Kumar
Congenital atresia of intestines in anus and rectum part is commonly reported in newborn calves. This case report discusses cases of atresia ani et recti and its surgical correction. A circular incision was made on the bulge of the anus and patency of opening was maintained by the application of interrupted sutures. The animal's defecation improved slowly.
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Thoracic endovascular aneurysm repair for coarctation of the aorta with dissecting aortic aneurysm: A rarity p. 291
Babu Reddy, HS Natraj Setty, BC Srinivas, Sandeep Shankar, Vijay Kumar, K Sathish, B Mahadevaswamy, Murali Krishna, CN Manjunath
Endovascular procedures aim to reduce the morbidity and mortality. Repair is indicated for aneurysms that are the source of pain and tenderness, which may indicate an impending rupture. The options for repair include traditional open aortic surgery or endovascular repair. Endograft has been used in patients with aortic dissection, noting the extremely complex nature of open surgical repair in these patients, while the results have been excellent. Aneurysm formation is a significant complication after therapy for Coarctation of aorta (CoA). Aneurysms develop after surgical as well as transcatheter repair procedures of CoA. We report a rare case of coarctation of the aorta with dissecting aortic aneurysm who presented with sudden onset of chest pain radiating to back and dyspnea for 3 days. He successfully underwent balloon dilatation of coarctation segment followed by aortic stent-graft implantation. Uneventful during procedure prompts recovery on follow-up.
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Unusual finding of molar tube embedded in the labial vestibule: A rare case of negligence p. 294
Rais Ahmed, Abdul Ahad, Ali Asger Nakib, Mohd Tariq
Cases of negligence in orthodontics are not as frequent as in other dental or medical specialties. However, sometimes we come across a case of negligence that cannot be ignored. Here, we present a very uncommon finding of a molar tube embedded in the labial vestibule, between mandibular central and lateral incisors, for more than a month. The uniqueness of this finding is that a molar tube, as the name suggests, is supposed to be bonded on molars and if it gets dislodged due to any reason, it should have been embedded near the respective molar. With this dilemma in mind, this case offers many things to learn from errors.
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Dermoscopy negates the need for biopsy in cases of confetti-like leukoderma and exogenous ochronosis p. 297
Nahla Shihab, Lis Surachmiati Suseno, Lili Legiawati, Irma Bernadette Simbolon Sitohang
Confetti-like leukoderma and exogenous ochronosis are two of the rarest side effects of a long-term use of hydroquinone (HQ). HQ is the first choice of topical bleaching agents used in the treatment of melasma. Confetti-like leukoderma is characterized as mottled depigmented spots, whereas exogenous ochronosis presents as gray-brown or blue-black hyperpigmentation. Both disorders are especially found in the area where HQ is applied. We report two cases of women with these two rare pigment disorders, who had a history of using HQ for more than 8 years. The dermoscopic examinations show dark-brown globular-like structures on a diffuse fine brown reticular patterns background, multiple guttate depigmented macules, and prominent telangiectasias which are characteristics for melasma, ochronosis, and confetti-like leukoderma. Both patients were advised to stop HQ and treated with sunscreen, 0.05% retinoic acid cream, 2% kojic acid cream, and 20%–35% glycolic acid chemical peel.
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Generic versus branded medicine p. 300
Khichar Purnaram Shubhakaran, Rekha Jakhar Khichar
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Erratum: Severe Abdominal Complaints after Technical Successful Endovascular Treatment of Chronic Splanchnic Ischemia p. 301

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