Comparison of the anaesthetic efficacy of different volumes of 4% articaine (1.8 and 3.6 mL) as supplemental buccal infiltration after failed inferior alveolar nerve block

AIM

To compare the anaesthetic efficacy of different volumes (1.8 mL vs. 3.6 mL) of 4% articaine with 1 : 100 000 epinephrine injected as buccal infiltrations after a failed inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis.

METHODOLOGY

Two hundred and thirty-four adult patients, diagnosed with irreversible pulpitis in a mandibular tooth, participated in this multicentre, randomized double-blinded trial. Patients received IANB with 1.8 mL of 4% articaine with 1 : 100 000 epinephrine. Pain during treatment was recorded using the Heft-Parker visual analogue scale (HP VAS). The primary outcome measure, and the definition of 'success', was the ability to undertake pulp chamber access and canal instrumentation with no or mild pain (HP VAS score <55 mm). Patients who experienced 'moderate-to-severe' pain (HP VAS score ≥ 55 mm) were randomly allocated into two groups and received buccal infiltrations with either 1.8 mL or 3.6 mL of 4% articaine with 1 : 100 000 epinephrine. Root canal treatment was re-initiated after 10 min. Success was again defined as no pain or weak/mild pain during endodontic access preparation and instrumentation. Statistical analysis was performed using Mann-Whitney U and chi-square tests.

RESULTS

The initial IANB of 4% articaine gave an overall success rate of 37%. The success rate of supplementary buccal infiltration with 1.8 and 3.6 mL volumes was 62% and 64%, respectively. The difference between the success rates of the two volumes was not statistically significant.

CONCLUSIONS

Increasing the volume of 4% articaine with 1 : 100 000 epinephrine from 1.8 to 3.6 mL, given as supplementary buccal infiltrations after a failed primary IANB with 1.8 mL of 4% articaine with 1 : 100 000, did not improve the anaesthetic success rates in patients with symptomatic irreversible pulpitis.

Anti-dsDNA negative and anti-Ro positive lupus nephritis: a report of a rare case

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease, characterized by an autoantibody response to various nuclear and cytoplasmic antigens. Renal disease in SLE occurs in 40-75% of patients, most often within five years of onset of disease, and is one of the strongest predictors of a poor outcome. A hallmark of glomerular involvement in lupus nephritis is the presence of autoantibodies against double-stranded DNA (dsDNA). Its level usually correlates with disease activity. Our patient presented with a rash resembling malar rash and features of nephrotic syndrome. On investigating, patient was found to have pancytopenia, raised erythrocyte sedimentation rate and depressed serum C3 levels with positivity of antinuclear antibodies and anti- Ro antibodies. However, most of the markers of lupus nephritis including anti dsDNA antibody were negative. Renal biopsy showed features of lupus nephritis (class-IV). Differential item functioning studies showed a full house immunoflourescence staining pattern characteristic of lupus nephritis. Association of Anti-Ro antibody alone with lupus nephritis is less known in literature. Negativity of anti-dsDNA antibody, which is usually considered to be diagnostic of lupus nephritis, poses a diagnostic dilemma short of renal biopsy. Till date only very few cases of non-drug induced lupus nephritis with negative dsDNA antibodies have been reported. In this report we wish to highlight a case of lupus nephritis which was negative for its specific anti dsDNA antibodies and with possible role of anti-Ro antibodies in the pathogenesis of lupus nephritis although the underlying mechanism is incompletely understood.

A rare case report showing direct association between hepatitis B and bulbar palsy

Bulbar Palsy is B/L impairment of function of cranial N. 9, 10, 11, 12 at lower motor neuron level either at nuclear or fascicular level in medulla or B/L lesion of lower cranial N. outside brainstem. We present case of viral hepatitis who initially presented with classical signs and symptoms of hepatitis B followed by characteristic features of bulbar palsy in form of difficulty in swallowing and slurring of speech reduced gag reflex, weak palatal movement. Other causes for bulbar palsy were excluded and indirect laryngoscopy confirmed presence of bulbar palsy. Patient had no previous neurological abnormality, there are many studies in the past for association of hepatitis B and bulbar palsy but no one confirmed about a direct association between hepatitis B and bulbar palsy. To best of knowledge this is the first case report which shows direct association between hepatitis B and bulbar palsy.

Purification and characterization of pectin lyase secreted by Aspergillus flavus MTCC 10938

An indigenously isolated fungal strain Aspergillus flavus MTCC 10938 was subjected to pectin lyase (PNL) production under submerged fermentation conditions. The enzyme was purified to homogeneity from the culture filtrate of the fungus involving concentration by ultrafiltration, anion exchange chromatography on DEAE cellulose and gel filtration chromatography on Sephadex G-100. The purified PNL gave a single protein band in SDS-PAGE analysis with a relative molecular mass corresponding to 50 kDa. Using citrus pectin as the substrate the K(m) and k(cat) values of the enzyme lyase were obtained as 1.7 mg/mL and 66 s(-1), respectively. The optimum pH of the purified PNL from A. flavus MTCC 10938 was 8.0 and up to 90% of its activity retained in the pH range from 3.0 to 11.0 after 24 h incubation. The optimum temperature of the purified enzyme was revealed at 55 degrees C and it was completely stable up to 40 degrees C when exposed for 30 min. The purified A. flavus MTCC 10938 PNL showed efficient retting of Crotalaria juncea fibres.

Isolation and characterization of plant growth promoting traits of a rhizobacteria: Pantoea agglomerans lma2

The use of microbial technology in agriculture is expanding quickly with the identification of new bacterial strains which are more effective in promoting the growth of plants. The rhizobacteria that promote the growth of plants can have a positive effect on the productivity of crops especially when subjected to salt stress. A nitrogen-fixing bacterium was isolated from the wheat rhizosphere of an arid region. The strain was identified on the basis of tests API20E and 16S rRNA sequencing, as Pantoea agglomerans lma2. This strain degraded several carbon sources: sugars (fructose, ribose, dextrin, salicin...), lipids (lecithin, tributyrin and tween 80), proteins (gelatin, casein), grew on KCN and could grow from pH 4 to 8 and had an optimum at pH 7. The growth temperature showed a maximum at 30 degrees C and the bacteria could tolerate from 4 to 41 degrees C and the growth rate was higher when the NaCl concentration was between 100 and 300 mM. The performance of activities enhancing the growth of plants of P. agglomerans lma2 was significantly better in the presence of salt. Rates of Indole Acetic Acid (IAA), siderophores production and solubilization of phosphate increased between 100 and 400 mM NaCl compared to the control without salt. The maximum values were saved to 300 mM for the production of siderophores (18.32%) and solubilization of phosphate (1061.49 microg mL(-1)) and 100 mM for the production of IAA (161 microg mL(-1)). A significant correlation existed between these three activities. These results showed that P. agglomerans lma2 with its Plant Growth Promoting Rhizobacteria (PGPR) and halophilic properties could constitute a good fertilizer in arid and saline zone.

Measurements of aperture and beam lifetime using movable beam scrapers in Indus-2 electron storage ring

In this paper, the measurements of vertical and horizontal aperture which are available for stable beam motion in Indus-2 at beam energy 2.5 GeV using movable beam scrapers are presented. These beam scrapers are installed in one of the long straight sections in the ring. With the movement of beam scrapers towards the beam centre, the beam lifetime is measured. The beam lifetime data obtained from the movement of vertical and horizontal beam scrapers are analyzed. The contribution of beam loss due to beam-gas scattering (vacuum lifetime) and electron-electron scattering within a beam bunch (Touschek lifetime) is separated from the measured beam lifetime at different positions of the beam scrapers. Vertical and horizontal beam sizes at scrapers location are estimated from the scraper movement towards the beam centre in quantum lifetime limit and their values closely agree with measured value obtained using X-ray diagnostic beamline.

Thyroid storm presenting as congestive heart failure and protein-S deficiency-induced biventricular and internal jugular venous thrombii

The thyroid storm is a medical emergency characterized by decompensation of one or more organ systems. Associated cardiac involvement carries poor prognosis. Early recognition and appropriate management of life-threatening thyrotoxicosis is vital to prevent the high morbidity and mortality that may accompany this disorder. We report a young lady presenting with thyroid storm presenting as acute heart failure with biventricular and bilateral internal jugular venous thrombi. In addition, she also had thyrotoxicosis-induced transient protein-S deficiency which recovered following remission.

Chronic idiopathic urticaria and thyroid autoimmunity: perplexing association

Background:

Autologous serum skin test (ASST) is the most commonly used laboratory test to differentiate chronic autoimmune urticaria patients from chronic idiopathic urticaria patients without autoantibodies. Thyroid autoimmunity is the original paradigm for autoimmune disease in general and many previous studies show increased prevalence of thyroid autoantibodies and deranged thyroid hormone profile in chronic idiopathic urticaria patients.

Aim:

To find the association between thyroid autoimmunity and chronic autoimmune urticaria, if any.

Materials and Methods:

The chronic idiopathic urticaria patients were divided into two subgroups based on autologous serum skin test. Thyroid autoantibodies were estimated in 40 patients each of ASST positive and ASST negative groups. Further, thyroid hormone profile was done in cases with significant titers of thyroid autoantibodies. Forty patients, who had never suffered from urticaria, represented the control group.

Results:

The prevalence of thyroid autoantibodies did not differ significantly among the ASST positive (20%) and ASST negative patients (15%). The control group had low prevalence of these autoantibodies (5%).

Conclusion:

The almost equal prevalence of thyroid autoantibodies in two subgroups of chronic idiopathic urticaria patients suggests possibly the same etiopathogenesis of the two subgroups. The two subgroups probably form a continuum, or even may be the same entity.

Risk Factors for Acute Respiratory Infections in Hospitalized Under Five Children in Central Nepal

Introduction: Acute respiratory infection is a leading cause of morbidity and mortality in under 5 children in developing countries. There are various modifiable risk factors associated with Acute Respiratory Tract Infection (ARI). Hence, identification of associated risk factors for ARI may be helpful to reduce the burden of disease. The aims of this study were to study the risk factors for ARI in under five hospitalized children and to correlate risk factors with ARI related morbidity. It was a hospital- based prospective study. Materials and Methods: Children of less than 5 years admitted in ward with diagnosis of ARI were enrolled in the study as cases. Control included children under 5 years of age attending to Well Baby Clinic, Immunization Clinic and siblings or relatives under 5 years who came with patients in the Paediatric outpatient department of the same institution during the same period. Various risk factors, demographic and clinical data of each child were recorded in a pre-designed proforma of both groups. Results: A total of 200 cases and 200 controls were enrolled. The various risk factors associated with ARI on stepwise logistic regression were male gender, rural residency, overcrowding, history of ARI in any family member within two weeks and undernutrition. The statistically insignificant risk factors were infancy, economic status, illiterate parents, cooking fuel other than LPG, low birth weight, prematurity, lack of exclusive breast feeding, vitamin A deficiency and incomplete immunization. Conclusion: The various risk factors for ARI identified in this study were male gender, rural residency, overcrowding, history of ARI in any family member within two weeks and undernutrition. DOI: http://dx.doi.org/10.3126/jnps.v33i1.7358 J Nepal Paediatr Soc. 2013;33(1):39-44

A novel Osmium-based compound targets the mitochondria and triggers ROS-dependent apoptosis in colon carcinoma

Engagement of the mitochondrial-death amplification pathway is an essential component in chemotherapeutic execution of cancer cells. Therefore, identification of mitochondria-targeting agents has become an attractive avenue for novel drug discovery. Here, we report the anticancer activity of a novel Osmium-based organometallic compound (hereafter named Os) on different colorectal carcinoma cell lines. HCT116 cell line was highly sensitive to Os and displayed characteristic features of autophagy and apoptosis; however, inhibition of autophagy did not rescue cell death unlike the pan-caspase inhibitor z-VAD-fmk. Furthermore, Os significantly altered mitochondrial morphology, disrupted electron transport flux, decreased mitochondrial transmembrane potential and ATP levels, and triggered a significant increase in reactive oxygen species (ROS) production. Interestingly, the sensitivity of cell lines to Os was linked to its ability to induce mitochondrial ROS production (HCT116 and RKO) as HT29 and SW620 cell lines that failed to show an increase in ROS were resistant to the death-inducing activity of Os. Finally, intra-peritoneal injections of Os significantly inhibited tumor formation in a murine model of HCT116 carcinogenesis, and pretreatment with Os significantly enhanced tumor cell sensitivity to cisplatin and doxorubicin. These data highlight the mitochondria-targeting activity of this novel compound with potent anticancer effect in vitro and in vivo, which could have potential implications for strategic therapeutic drug design.

Worm infestation among the school children of Dhankuta District

Intestinal parasitic infections (IPI) cause serious public health problem in Nepal. They are more prevalent in the poor segments of the population with low household income, poor handling of personal and environmental sanitation, overcrowding and limited access to clean water. The objective of the study is to assess knowledge and practice about worm infestation and to find out the relation of knowledge and practice with the selected variables. A cross-sectional study was conducted in 200 students of Grade 9 and 10 in Government and private schools of Dhankuta. The chi-square test was used to measure the association of knowledge and practice about worm infestation. The knowledge regarding risk factors of worm infestation due to unhygienic pig farming practices is significantly higher in female (66.4%) than male (44.8%). All the risk factors were found to be significantly higher in knowledge among the private school as compared to Government school. Regarding Fathers occupation, unemployed (100.0%) believe it is due to poor personal hygiene and very less of labor (50%) which is significantly associated. Regarding Mother Group, students never eat raw meat and vender food whose mothers have skilled worker. The school going students of Dhankuta were aware of the knowledge regarding the worm infestation but had less knowledge among the school children of Government as compared to private.

Isolated exon 8 deletion in type 1 spinal muscular atrophy with bilateral optic atrophy: unusual genetic mutation leading to unusual manifestation?

Proximal spinal muscular atrophy (SMA) or type 1 SMA is a fatal autosomal recessive disorder usually caused by homozygous deletion of exons 7 and 8 in the survivor motor neuron (SMN) gene. Additional deletion of the neuronal apotosis inhibitory protein (NAIP) gene exacerbates the clinical severity. Isolated exon 8 deletion has been reported in a single case series of SMA types 2 and 3 and never with SMA type 1. While extraocular muscles are typically spared, there are a few case reports documenting associated external ophthalmoplegia. Optic atrophy is a hitherto unreported association of SMA. We report a 10-month-old male infant with SMA type 1 with optic atrophy due to isolated deletion of exon 8 of the SMN gene with intact exon 7 and NAIP gene.

Health-care seeking among people with cough of 2 weeks or more in India. Is passive TB case finding sufficient?

SETTING

Thirty districts of India.

OBJECTIVES

To estimate 1) the proportion of people with cough of ≥2 weeks, 2) those who did not seek care from a health care provider for cough, and 3) their characteristics.

METHODOLOGY

A cross-sectional community-based survey in which 4562 people (aged ≥18 years) were interviewed.

RESULTS

Of the 4562 individuals interviewed, 437 (9.5%, 95%CI 7.2-11.8) had cough ≥2 weeks; this was more frequent in those >55 years of age (14%) and in those from districts in eastern (12%) and northern (11%) states of India. Of those with cough, 300 (69%, 95%CI 60-77) had not sought care from any health care provider. Not seeking care was more frequent in people residing in rural areas (73%) compared with urban areas (53%), and in the districts of eastern (82%) and northern (74%) states compared to districts from the southern (46%) and western (54%) states.

CONCLUSIONS

Nearly a tenth of those interviewed aged ≥18 years had cough of ≥2 weeks. About two thirds, especially those from rural areas, had not visited a health care provider for the cough. This finding has huge implications for India's current mostly passive case-finding strategy for detecting and controlling tuberculosis.

Polyelectrolyte coated polymeric nanoparticles for controlled release of docetaxel

Polyelectrolyte coatings are effective means of minimizing the rate of release of small molecules from a nanoparticle system. The current investigation aim at developing biodegradable drug delivery carriers composed of three types of polymers viz poly(lactide-co-glycolic) acid [PLGA], poly(lactide-co-glycolic) acid-polyethylene imine [PLGA-PEI] and poly lactic acid [PLA]. The PLGA and PLGA-PEI nanoparticles were in the size range approximately 150 nm while PLA nanoparticles were approximately 80 nm in size respectively. The nanoparticles were found to encapsulate 66%, 62% and 65% of the hydrophobic drug, Docetaxel (DOCE) respectively. "Layer by Layer (LbL)" self assembly technique was then performed to coat these particles with polyelectrolyte thin films (PEs). DLS studies showed hydrodynamic diameter of 330 nm, 350 nm and 310 nm for the coated PLGA, PLGA-PEI and PLA nanoparticles respectively, while SEM and TEM studies demonstrated that after coating the particle sizes were approximately 200 nm for all the three nanoparticles. In vitro drug release studies demonstrated that at the end of 24 hours, about 83%, 90% and 88% of drug was released from uncoated PLA, PLGA-PEI and PLGA nanoparticles respectively. Using LbL coating, the same amount of the drug was found to be released in a sustained way for up to 7 days for PLGA and up to 6 days for PLGA-PEI and PLA nanoparticles. In vitro cytocompatibility studies were carried out with each system and the cell viability at end of 48 hours was found to be in the range of 70% to 100%. Current approach of sustained drug delivery can help in improving the therapeutic efficiency of the breast cancer drug, DOCE.

Esthetics with prosthetics in case of maxillary canine transposition: a clinical report

Transposition is a dental anomaly manifested by a positional interchange of two permanent teeth. The maxillary permanent canine usually transposes with the first premolar and occasionally with the lateral incisor. These are mainly genetically governed and are treated orthodontically if complete segment of tooth is present; in case of missing teeth, participation of cosmetic dentist is must. The present case report describes a situation where left canine to lateral incisor complete transposition was present along with a missing left central incisor. Esthetic rehabilitation of the "smile zone" was the major concern. Scrupulous treatment planning to esthetically contour transposed teeth according to their normal positions, i.e., transposed left canine to lateral incisor and transposed left lateral incisor to canine with replacement of missing tooth, was a challenge.

First Report of a Natural Infection of Stevia rebaudiana by a Group 16SrXXIV Phytoplasma in India

Stevia rebaudiana Bertoni (Asteraceae) is one of the most important commercial crops in the world (4). It is known to produce glycosides that are as much as 300 times sweeter than sucrose and do not affect blood sugar levels. Unlike artificial sweeteners like saccharin, they are noncarcinogenic and safe for diabetics. An unknown disease emerged during the summers of 2007 to 2009 in a field of S. rebaudiana at CIMAP Lucknow, India, where more than 20% of the plants exhibited symptoms typical of phytoplasma infection including leaf yellowing, reduced size of leaves, shoot proliferation, flower bud deficiency, as well as bushy and stunted growth. Some of these plants were potted and kept in a glasshouse for investigation. Affected plants in the field expressed a quick decline consisting of growth cessation, bronzing of mature leaves, wilting, and death, resulting in a significant reduction in biomass and quality. Typical phytoplasma-like (pleomorphic) bodies ranging from 450 to 900 nm were observed in the phloem cells of infected plants by transmission electron microscopy (1). These bodies were always found in diseased plants, but not in asymptomatic ones. No other microorganisms were noted. Total DNA was extracted from symptomatic as well as asymptomatic plants by a CTAB method. PCR was carried out with the universal phytoplasma primers P1/P6 (P1, 5'-AAGAGTTTGATCCTGGCTCAGGATT-3'; P6, 5'-CGGTAGGGATACCTTGTTACGACTTA-3') (2) followed by nested primers R16F2n/R16R2 (R16F2n, 5'-GAAACGACTGCTAAGACTGG-3'; R16R2, 5'-TGACGGGCGGTGTGTACAAACCCCG-3') targeting the 16S rRNA gene sequence (3). The P1/P6 and R16F2n/R16R2 primers produced the expected 1.5- and 1.2-kb amplicons, respectively, from the symptomatic plants and not from the asymptomatic ones. Seventeen symptomatic and eight asymptomatic samples were analyzed through PCR. Nested PCR products were ligated into the plasmid vector using the TOPO TA Cloning Kit (Invitrogen, Carlsbad, CA). Transformation and selection of recombinant clones was carried out according to the manufacturer's recommended protocol. The sequence obtained from the final PCR product was deposited in the GenBank database (No. JF970603). It was analyzed through the iPhyClassifier ( http://plantpathology.ba.ars.usda.gov/cgi-bin/resource/iphyclassifier.cgi ) online tool and found to share 98.2% similarity with that of the 'Sorghum bunchy shoot phytoplasma' reference strain (GenBank No. AF509322) that belongs to 16SrXXIV-A subgroup. The virtual restriction fragment length polymorphism pattern of the S. rebaudiana phytoplasma 16S rRNA gene sequence showed maximum similarity to the reference pattern of AF509322 (similarity coefficient of 0.85). Although a number of phytoplasmas have been detected on a wide range of plants in India, little is known about the leafhopper that presumably transmits them to S. rebaudiana and other medicinal crops. Infections by diverse phytoplasma strains/species underscore the need for phytoplasma-free planting stock and intensification of research efforts to reduce ecological and economic impacts of these phytoplasmas. To our knowledge, this is the first report of a natural infection of S. rebaudiana by a group of 16SrXXIV-A phytoplasma. References: (1) P. V. Ajayakumar et al. Aust. Plant Dis. Notes 2:67, 2007. (2) S. Deng and C. Hiruki. J. Microbiol. Methods 14:53, 1991. (3) D. E. Gundersen and I. M. Lee. Phytopathol. Mediterr. 35:144, 1996. (4) S. M. Savita et al. J. Hum. Ecol. 15:261, 2004.

Cranial nerve palsies in typhoid fever: report of three cases

Neurological manifestations of enteric fever are well known. However, isolated cranial nerve palsies are rare. A 4-year-old boy and two girls aged 5 and 11 years with culture-proven typhoid fever are described, two of whom developed palatal palsy and the other sixth cranial nerve palsy. Following treatment, there was complete resolution of the cranial nerve palsies within 5-7 weeks. While palatal palsy is reported rarely, isolated sixth cranial nerve palsy associated with typhoid has not been reported previously.