Catalytic Ozonation of Reactive Black 5 in Aqueous Solution Using Iron-Loaded Dead Leaf Ash for Wastewater Remediation

In the current study, iron-loaded dead leaf ash (Fe-DLA) was used as a novel catalyst in the heterogeneous catalytic ozonation process (HCOP) for textile wastewater containing Reactive Black 5 (RB-5). The research demonstrates a significant boost in removal efficiency, reaching 98.76% with 1.0 g/min O3 and 0.5 g/L catalyst dose, by investigating key variables such as pH, ozone and catalyst doses, initial concentration, and the presence of scavengers in 1 L wastewater. The addition of tert-butyl alcohol (TBA) reduced RB-5 elimination, indicating the involvement of OH radicals. Catalyst reusability decreased slightly (2.05% in the second run; 4.35% in the third), which was attributed to iron leaching. A comparison of single ozonation (Fe-DLA) adsorption and catalytic ozonation processes (Fe-DLA/O3) revealed that the combined process improved dye degradation by 25%, with removal rates ranking as Fe-DLA adsorption O3 Fe-DLA/O3, with an impressive 76.44% COD removal. These results strongly support RB-5 removal using Fe-DLA and HCOP at a basic pH, highlighting the catalyst's utility in practical wastewater treatment.

Frequency, distribution and determinants of Helicobacter pylori infection in adults and adolescents with gastric symptoms: cross-sectional epidemiological inquiry in district Haripur, Pakistan

Abstract Helicobacter pylori (HP) is a vital element in the etiology of peptic ulcers and gastric cancer. This research aimed to determine the frequency, distribution, and determinants of HP infection in adults and adolescents with gastric symptoms in district Haripur, Khyber Pakhtunkhwa, Pakistan. This cross-sectional study was performed from June 2018 to June 2020 at the Medical Laboratory Technology Department, The University of Haripur, Pakistan. Presence of HP was a research variable, while sex, age groups, education status, overcrowding, dining habits, milk intake, drinking water source and animal contact were grouping variables. Immuno-chromatographic technique (ICT) was used to for serological detection of HP antibodies. All variables were represented by frequency and percentage with 95%CI. Prevalence of HP and its distribution by eight socio-demographic variables was testified by the chi-square goodness-of-fit test while association was testified by chi-square test of association. Out of total 1160 cases, 557 (48%) were positive for HP. Population prevalence was higher in men, in the age group 20-40 years, illiterate, family size ≤ 10 persons, taking restaurant food, using tetra pack, using municipal water, and having animal contact. The observed prevalence of HP was similar to its expected prevalence in the population. The observed distribution of HP in the sample was different from its expected distribution in population by eight socio-demographic variables. Presence of HP was associated with all eight socio-demographic variables besides age groups.

Graphene-grafted bimetallic MOF membranes for hazardous & toxic contaminants treatment

Development of membrane with improved carbon dioxide (CO2) gas separation capability is a significant challenge. However, the fabrication of membrane that efficiently separate and purification CO2-containing gases has been the focus of global attention. Cellulose Acetate (CA) has robust reinforcing characteristics when incorporated within a suitable polymer matrix. This work focus on the synthesis of novel mixed matrix membranes (MMMs) by introducing Graphene-grafted bimetallic MOFs in Cellulose Acetate polymer. The graphene-grafted bimetallic MOF (GG-BM MOFs) was prepared by a hydrothermal technique. Whereas, the solution casting approach used to fabricate membranes. The 1-5 wt% of GG-BM MOFs incorporated into the CA matrix. The mechanical, hydrophilicity and adsorption characteristics of fabricated MMMs were investigated. The crystallinity of MMM enhanced after the addition of GG-BM MOFs. In addition, the mechanical characteristics of MMMs were improved with the incorporation of GG-BM MOFs inside the polymer matrix. Maximum stress and strain was obtained for 2 wt% MMM (36.4 N/mm2 and 11% respectively). The CO2 adsorption performance was evaluated at 10 bar and 45 °C. The FTIR results represent insignificant bond shifting with the addition GG-BM MOFs at these conditions. The overall results showed that MMMs containing 2 wt% GG-BM MOFs have good adsorption properties for CO2 i.e 3.15 wt% of CO2. The MMMs have shown a decrease in the mechanical properties and CO2 adsorption at the higher GG-BM MOFs loading due to the presence of agglomeration which was confirmed through SEM. Thus, the addition of GG-BM MOFs in the CA matrix positively altered the physicochemical characteristics of the resulting MMMs, which could assist them in achieving remarkable CO2 adsorption at 2 wt%.

Influence of mechanical debridement with adjunct probiotic therapy on clinical status and salivary cortisol levels in patients with periodontal inflammation

OBJECTIVE

The null hypothesis is that there is no difference in periodontal parameters and salivary cortisol levels (CL) among patients with periodontal inflammatory conditions (PIC) who receive non-surgical mechanical debridement (NSMD) with or without adjunct probiotic therapy (PT). The aim of this study was to assess the influence of NSMD with and without adjunct PT on clinical status and whole salivary CL in patients with PIC.

PATIENTS AND METHODS

Participants were randomly divided into four groups: Group-1: NSMD alone (n=19); Group-2: NSMD + PT (n=18); Group-3: PT + oral hygiene instructions (OHI) (n=17); and Group-4: PT alone (n=18). Lactobacillus rhamnosus SP1 (2×107 colony-forming units/day) was used for PT. Plaque and gingival indices (PI and GI), probing depth (PD) and clinical attachment loss (AL) were assessed, and whole salivary CL was assessed at baseline and at 6-week follow-up. Marginal bone levels were assessed at baseline and demographic data was collected using a questionnaire. Sample-size estimation was performed, and statistical significance was determined at p<0.05.

RESULTS

At follow-up, PI (p<0.01), GI (p<0.01), and PD (p<0.01) were significantly higher in PT + OHI and PT alone groups compared with individuals who underwent NSMD + PT and NSMD alone. At baseline and follow-up, there was no significant difference in CL in all groups. There was no statistically significant correlation between age, gender, PI, PD, GI, clinical AL, salivary flow rate, education status and salivary CL in all groups at baseline and follow-up.

CONCLUSIONS

NSMD continues to be the "gold standard" and most reliable treatment strategy for managing PIC. It is imperative to reach a consensus regarding the duration, dosage, and frequency of PT that would yield optimal results for managing PIC.

A Novel Energy-Efficient Reservation System for Edge Computing in 6G Vehicular Ad Hoc Network

The roadside unit (RSU) is one of the fundamental components in a vehicular ad hoc network (VANET), where a vehicle communicates in infrastructure mode. The RSU has multiple functions, including the sharing of emergency messages and the updating of vehicles about the traffic situation. Deploying and managing a static RSU (sRSU) requires considerable capital and operating expenditures (CAPEX and OPEX), leading to RSUs that are sparsely distributed, continuous handovers amongst RSUs, and, more importantly, frequent RSU interruptions. At present, researchers remain focused on multiple parameters in the sRSU to improve the vehicle-to-infrastructure (V2I) communication; however, in this research, the mobile RSU (mRSU), an emerging concept for sixth-generation (6G) edge computing vehicular ad hoc networks (VANETs), is proposed to improve the connectivity and efficiency of communication among V2I. In addition to this, the mRSU can serve as a computing resource for edge computing applications. This paper proposes a novel energy-efficient reservation technique for edge computing in 6G VANETs that provides an energy-efficient, reservation-based, cost-effective solution by introducing the concept of the mRSU. The simulation outcomes demonstrate that the mRSU exhibits superior performance compared to the sRSU in multiple aspects. The mRSU surpasses the sRSU with a packet delivery ratio improvement of 7.7%, a throughput increase of 5.1%, a reduction in end-to-end delay by 4.4%, and a decrease in hop count by 8.7%. The results are generated across diverse propagation models, employing realistic urban scenarios with varying packet sizes and numbers of vehicles. However, it is important to note that the enhanced performance parameters and improved connectivity with more nodes lead to a significant increase in energy consumption by 2%.

Factors leading to delayed and challenging presentation of benign breast lumps in young females

Background and Objective

A delayed presentation of benign breast diseases may lead to a therapeutic challenge when they enlarge enormously or become multiple. Aim of this study was to evaluate the factors leading to delayed presentation of benign breast lumps.

Methods

This cross-sectional study was conducted at Madinah Teaching Hospital and Allied Hospital, Faisalabad from January 2019 to October 2021. One hundred and forty five female patients were selected by non-probability purposive sampling. Patients with large size (>5cm) or multiple benign breast lumps were included. An interview was conducted using structured questionnaire translated in Urdu. Factors leading to delayed presentation and social impact scale for stigma were evaluated.

Results

Patients had a mean age of 26.52 ± 6.90 years. The average delay of seeking medical care was 8.48 ± 8.41 months. Factors leading to delayed presentation were; lack of knowledge n=112 (77.2%) and parda (religious issues) n=112 (77.2%), followed by poverty n=109 (75.2%), and fear of cancer n=90 (62.1%). All the sub-scales of stigma, i.e., social rejection, financial insecurity, internalized shame and social isolation were high in late presenters, though, only financial insecurity was significantly high in late presenters (p=0.03).

Conclusion

Lack of awareness, socioeconomic factors and disease related stigma were the main factors related to delayed presentation in young females with benign breast diseases. Addressing these factors may improve timely diagnosis and management of delayed and challenging cases.

Efficacy of adjunct subgingival minocycline delivery for treatment of peri-implantitis in moderate cigarette smokers

OBJECTIVE

Localized subgingival minocycline hydrochloride (MH) delivery as an adjuvant to with non-surgical mechanical debridement (NSMD) is useful for the treatment of periodontitis; however, there are no trials that have assessed the efficacy of subgingival MH delivery with NSMD for the treatment of peri-implantitis in cigarette-smokers and non-smokers. This randomized controlled trial assessed the efficacy of subgingival MH delivery with NSMD for the treatment of peri-implantitis in cigarette-smokers.

PATIENTS AND METHODS

Self-reported current cigarette-smokers and non-smokers with peri-implantitis were encompassed. These individuals were subdivided into 2-subgroups. Patients in test- and control groups received NSMD with and without a single delivery of subgingival MH. Modified-gingival-index (mGI), modified-plaque-index (mPI), probing-depth (PD) and crestal-bone-loss (CBL) were measured at baseline and at 6-months' follow-up. Demographic-data was also collected. Level of significance was set at p<0.01.

RESULTS

Twenty-four cigarette-smokers and 24 non-smokers with peri-implantitis were included. There was a significant reduction in mPI (p<0.01), mGI (p<0.01), PD (p<0.01) at 6-months among patients with and without type-2 DM in test- and control-groups. There was no significant difference in peri-implant mPI, PD and mGI, patients with and without type-2 diabetes in test- and control-groups at 6-months of follow-up. There was no significant difference in CBL in all patients at 6-months of follow-up.

CONCLUSIONS

A single application of subgingival MH delivery is as effective as NSMD alone for the treatment of peri-implantitis in cigarette-smokers and non-smokers.

Anti-nociceptive efficacy of essential oil-based extracts for the management of orofacial pain: a systematic review of available evidence

OBJECTIVE

Experimental studies have shown that essential oil (EO)-based extracts derived from medicinal plants exhibit antinociceptive activity. The aim of the present systematic review was to assess the anti-nociceptive efficacy of EO-based extracts for the management of orofacial pain (OFP).

MATERIALS AND METHODS

To address the focused question "Are EO-based formulations effective for the management of OFP disorders?", indexed databases were searched without time and language restrictions using the preferred reporting items for systematic reviews and meta-analysis guidelines. Risk of bias (ROB) was assessed.

RESULTS

Eight studies were included and processed for data extraction. Two studies were clinical (one in adults and one in children) and 6 were performed in rodents. Results from one clinical study showed that inhalation of EO-extracts does not affect subjective toothache scores; and results from the study on children reported that inhalation of lavender oil reduces anxiety and pain during and after tooth extraction. Results from all experimental studies showed that administration of EO-extracts reduces orofacial nociceptive behavior. The ROB was high in 50% and 83.3% of the clinical and experimental studies, respectively.

CONCLUSIONS

The anti-nociceptive efficacy of EO-extracts for the management of OFP remains debatable. Further well-designed and power-adjusted randomized clinical trials are needed in this regard.

O07 Managing relapsing and refractory lupus nephritis in juvenile systemic lupus erythematosus: a case report

Case report - Introduction

Juvenile-onset systemic lupus erythematosus (jSLE) is a rare systemic autoimmune-disease affecting children, with an incidence between 0.5 and 6 per 100,000.

A 20-year-old female with known jSLE was diagnosed six years ago, age 14, following multiple attendances to A&E with non-specific symptoms. She was initially discharged with simple analgesia but later admitted to the paediatric ward with severe central chest pain. Investigations confirmed pleuro-pericardial effusion and positive lupus antibodies.

She subsequently had recurrent flares with predominantly renal involvement. She remained symptomatic despite multiple combined immunosuppressive agents including biological therapies. Unfortunately, her kidney-functions deteriorated, requiring close monitoring in the Advanced Kidney-Care Clinic.

Case report - Case description

A 14-year-old female who was otherwise fit and healthy with no family history of autoimmune conditions presented to the Emergency department with constant throbbing limb-pain and recurrent episodes of chest pains.

Immunological investigations revealed positive anti-nuclear antibodies (ANA), anti-double-stranded(ds)-DNA antibodies, C1Q-antibody and lupus inhibitor on two repeat tests. Echocardiogram showed pleuro-pericardial effusion and due to the high risk of cardiac tamponade, she was transferred to a tertiary centre for further management. She had intravenous steroid with good resolution of symptoms, and subsequently received maintenance therapy of azathioprine and hydroxychloroquine. She stayed in remission for approximately one year before her clinical condition worsened. She started to develop active inflammatory arthritis and serositis, with increasing anti-dsDNA titres, reducing complement levels, worsening anaemia and a positive direct antiglobulin test. Oral corticosteroids were recommenced and azathioprine was switched to mycophenolate-mofetil.

She subsequently had recurrent flares; predominantly renal involvement and worsening proteinuria. This did not improve with repeat courses of antibiotics given for presumed urinary tract infections (UTIs), prompting renal biopsy which confirmed active renal lupus (combined Class III and V lupus nephritis). Rituximab and tacrolimus were initiated but rituximab was withheld after the first dose due to severe, widespread desquamating rash, mucosal ulceration and fever, biopsy-proven and drug-induced. Short-term remission after 1 dose of rituximab and then renal relapse with repeat renal biopsy showed class 5 lupus nephritis. Intravenous cyclophosphamide with Euro-lupus regimen was given.  5 months after discontinuation of cyclophosphamide her renal disease relapsed again with rising anti-dsDNA, ESR and proteinuria to &gt; 6g/l, despite mycophenolate. Repeat and extended course of cyclophosphamide was restarted. Combination MMF and tacrolimus did not maintain control of disease and renal function continued to decline. Belimumab IV-monthly was added in combination and proteinuria halved, with stabilisation of renal function, although now with eGFR 25ml/min. The most recent biopsy shows chronic damage. SLEDAI-improved from 22 to 10.

Case report - Discussion

In children, adolescent females are predominantly affected as observed in this case. The peak age of onset is around 12 years, often with more severe disease presentation than lupus in adults; with a higher incidence of major organ involvement and aggressive disease course with a higher chance of developing complications. 

She developed uncontrolled hypertension and nephrotic syndrome requiring treatment with multiple antihypertensive agents and thrombosis prevention with DOACs. The patient was offered but refused anaemia treatment with erythropoietin. She received infection prevention treatment (PCP prophylaxis) and GnRH agonist injections to preserve ovarian function while on cyclophosphamide.

Later, she developed iatrogenic cushingoid syndrome and severe facial acne. Poor compliance, commonly seen in this age group, possibly contributed to the poor outcomes.  Other medication-related complications included retinal hydroxychloroquine toxicity that led to dose reduction. Allergy to rituximab (Mabthera) prevented its further use; given the severity of reaction concerns, other biosimilar humanized anti-CD20 antibodies were considered, but difficult to obtain; deteriorating renal function with predominantly damaged kidneys and class V nephritis on biopsy and aiming to control immunology along with other active symptoms (arthritis, serositis–pleurisy, systemic symptoms, anaemia) options were limited. There was increasing evidence to use belimumab plus tacrolimus +/- Mycophenolate-Mofetil to maintain remission. Belimumab was used after a repeat course of cyclophosphamide for this patient, after discussion with tertiary renal centres.

During the course of her illness, she had progressively deteriorating renal function, which prompted discussion for renal replacement therapy or renal transplant. Considering that this was affecting her at such a young age, she was advised to keep an up-to-date vaccination status. Her worsening condition as well as its associated complications related to treatment and polypharmacy have significantly affected her mental health and quality of life in many ways, including suffering from depression and fatigue. Frequent hospital visits for investigations and treatment also hampered her education. This emphasizes the importance of social, family, and educational support for patients with this condition.

In conclusion, despite a multidisciplinary approach and access to specialist services severe relapsing course of SLE and multiple diseases and treatment-related complications developed with co-morbidity, leading to life-changing organ damage and impact on quality of life.

Case report - Key learning points

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To conclude, jSLE is a challenging disease that is both difficult to diagnose and to treat. Clinicians should be aware of the greater risk of systemic complications in children with SLE.

P25 Early onset congenital sarcoidosis: Challenges in the management of recurrent severe bilateral uveitis and inflammatory arthritis

Case report - Introduction

We report a rare case of 20-year-old male diagnosed with congenital sarcoidosis (Blau Syndrome) presenting with a triad of skin rash, arthritis and bilateral uveitis.

He has had recurrent flares of sight-threatening bilateral uveitis, as well as persistent arthritis, which has continued despite treatment with multiple immunosuppressive agents and corticosteroids. The best control has been achieved with combination of methotrexate and infliximab which he has returned to; however, complications of frequent infections has necessitated breaks in treatment.

Case report - Case description

A 4-year-old male presented with inflammatory skin rash which was biopsied and diagnosed as sarcoid lesion. He developed bilateral blurring of vision and diagnosed with uveitis, which was treated with topical and oral steroids. He then experienced multiple joint pains with synovitis. His father had been diagnosed from a young age with sarcoidosis. Other possible causes were ruled out.

From early childhood, our patient was treated with methotrexate, then methotrexate and azathioprine for recurrent uveitis, but required long-term oral prednisolone. He started infliximab with methotrexate in adolescence with good response and weaned his steroids. However, uveitis flared when infliximab was stopped for appendicectomy, requiring rescue with oral and intraocular steroids.

Further flares with cystoid macular oedema secondary to sarcoid uveitis and arthritis flares required high-dose steroids, contributing to iatrogenic cushingoid syndrome. Beta-haemolytic streptococcal infection led to guttate psoriasis, after which he had more persistent polyarticular inflammation and tenosynovitis. Antibodies were detected against infliximab although clinically uveitis continued to respond. Adalimumab caused site injection reactions. MDT discussions recommenced higher dose infliximab. Long-standing nausea after methotrexate, oral or subcutaneous, despite folic acid and anti-emetics, became intolerable. Transfer of care to another rheumatology centre focused on trying to control his arthritis. Leflunomide and then mycophenolate-mofetil replaced methotrexate. Infliximab was then switched to tofacitinib (developed severe headache) and then baricitinib. Joint symptoms improved on baricitinib, and nausea reduced with mycophenolate; however, his uveitis flared severely again requiring further high-dose oral and intraocular steroid rescue. Further MDT and patient discussion resulted in restarting methotrexate 20mg weekly (enduring nausea) and infliximab 5mg/kg monthly. Uveitis settled and arthritis control remained stable over the last 12 months with reduction in prednisolone to 5mg daily. Recurrent infections with recent pilonidal sinus continue to cause treatment interruptions.

Case report - Discussion

Sarcoidosis is a chronic, idiopathic multisystem, granulomatous disorder rarely occurring in children. Early onset sarcoidosis/Blau syndrome (familial) is distinct, presenting in children around age 4 years and characterised by the triad of skin, joint and eye manifestations without the pulmonary involvement seen in adults. Children with Blau syndrome can develop severe complications such as blindness, growth retardation, heart involvement, renal failure and death.

Our patient was diagnosed with Blau syndrome based on the symptom triad and NOD2 gene mutation positive. He had recurrent flares of severe uveitis and difficult to manage joint disease involving his wrists/hands, shoulders, knees, ankles with tenosynovitis. He required shoulder decompression, knee-meniscal surgery and plastic-surgery to finger tendons. With early treatment he has grown well and preserved visual acuity (6/9 in both eyes), with no other organ involvement.

He works full-time. He has suffered from depression and struggled with body image issues, particularly from cushingoid changes. Difficult patient choices balanced medication side effects and control of eye/joint inflammation. He endures nausea after weekly methotrexate and some ongoing joint symptoms to enable his uveitis-responsive treatment to be prioritised.

Recurrent infections interrupted use of the most efficacious immunosuppressive therapy (infliximab and methotrexate). Jak Inhibitors provided some benefit for joint symptoms but did not control his uveitis. Different mechanisms seem to be important in the perpetuation of his uveitis and arthritis given the differential responses to treatment. Other treatment options such as anti-IL1 therapy were considered; however, limited data for eye inflammation results in patient continuing on his current therapy.

Multi-disciplinary care/co-ordination is essential in managing this complex, rare condition to balance optimisation of his medications to treat his most organ threatening and debilitating symptoms.

Genetic studies have enabled confirmation of the familial basis of his condition and autosomal dominant inheritance risk.

Case report - Key learning points

Catalytic ozonation for the removal of reactive black 5 (RB-5) dye using zeolites modified with CuMn2O4/gC3N4 in a synergic electro flocculation-catalytic ozonation process

This study aims to investigate the decolourization efficiency of reactive black 5 (RB-5) dye by using CuMn₂O₄/gC₃N₄ coated zeolites (zeolite 4A) for the first time in a hybrid electro-flocculation-catalytic ozonation process. A comparison between various treatment options such as electro-flocculation, electro-flocculation in the presence of a catalyst, and catalytic ozonation in combination with electro-flocculation was explored. Moreover, the effect of different factors such as pH, time, catalyst dose, ozone dose, radical scavenger, and voltage has been studied in each treatment option mentioned earlier. The results indicated that the best treatment option was found to be catalytic ozonation in combination with electro-flocculation with removal efficiency (RE) of 90.31% at pH 10 after 30 min of the treatment process. The hydroxyl radical scavenger effect indicated that the synergistic catalytic process follows a radical mechanism. It is therefore concluded that CuMn₂O₄/gC₃N₄-zeolite catalysts in synergic electro-flocculation-catalytic ozonation process may be effectively used for the treatment of textile wastewaters.

Removal of toluene as a toxic VOC from methane gas using a non-thermal plasma dielectric barrier discharge reactor

Methane is the main component of biogas, which could be used as a renewable energy source for electricity, source of heat, and biofuel production after upgrading from biogas. It also contains toxic compounds which cause environmental and human health problems. Therefore, in this work, the removal of a toxic compound (toluene) from methane gas was studied using a dielectric barrier discharge (DBD) reactor. It was observed that the removal of the toxic compound could be achieved from methane carrier gas using a dielectric barrier discharge reactor, and it depends on plasma input power. The maximum removal of the toxic compound was 85.9% at 40 W and 2.86 s. The major gaseous products were H₂ and lower hydrocarbons (LHC) and the yield of these products also increases with input power. In the current study, the yield of gaseous products depends on the decomposition of toxic compounds and methane, because the decomposition of methane also produces H₂ and lower hydrocarbons. The percentage yield of H₂ increases from 0.43-4.74%. Similarly, the yield of LHC increases from 0.56-7.54% under the same reaction conditions. Hence, input power promoted the decomposition of the toxic compound and enhanced the yield of gaseous products.

AB0853 IGG4-RELATED DISEASE CAUSING OCULAR NERVE PALSIES AND ORBITAL APEX SYNDROME: CASE REPORT AND LITERATURE REVIEW

Background:

IgG4-Related Disease (IgG4-RD) is a systemic immune-mediated fibroinflammatory condition. The epidemiology is not well defined: it usually affects adults from middle-age onwards, predominantly male. Both B and T-cells are central in IgG4-RD pathogenesis, as demonstrated by the efficacy of B-cell depletion therapy.IgG4-RD can affect multiple organs including the central and peripheral nervous system, producing a constellation of clinical symptoms and signs, depending on the organ structures involved.

IgG4-related orbital disease is relatively rare can implicate all extra-ocular muscles, structures emerging from the Orbital apex, optic canal, or superior and inferior orbital fissure. Depending on the structures involved, it can produce different or sometimes subtle clinical presentations, posing diagnostic challenge. There were case reports of IgG4-related ophthalmic disease misdiagnosed as intraocular tumour.

Objectives:

IgG4-RD is increasingly recognised as an entity affecting the head and neck region. However, it rarely involves skull base and presents with orbital apex syndrome. In this current case report, we describe an interesting case of IgG-related orbital disease presenting with ocular nerve palsies and orbital apex syndrome.

Methods:

Case report.

Results:

A 36-year-old gentleman with cocaine and alcohol misuse presented with a 2-month history of left sided headache, diplopia, recurrent ear infections, otalgia and hearing loss. Initial imaging suggested left otomastoiditis and intravenous antibiotics were commenced. Contralateral partial third nerve palsy with pupil sparing was elicited. 2 months later, there was worsening right eye ptosis, proptosis, right relative afferent pupillary defect, reduced visual acuity and colour vision as well as a near-complete ophthalmoplegia. Subsequent imaging showed worsening soft tissue swelling centred on the upper left parapharyngeal and masticator space, with multiple perineural enhancement and lateral extension to right orbital apex and orbital fissures. Blood tests only revealed raised IgG4 subclass. Infectious aetiology was excluded. Left nasal mass biopsy performed showed no fungal organism or malignancy. There were lymphoplasmacytic proliferation but no storiform fibrosis or obliterative phlebitis. IgG4 immunostaining on two assessable fields revealed 22 and 17 positive plasma cells respectively, and an IgG4: IgG ratio of <10%, and 50% in the other. Significant improvement was seen clinically and radiologically with antibiotics and a tapering regime of oral Prednisolone. Patient was commenced on Azathioprine as long term immunosuppression.

Conclusion:

A high degree of clinical suspicion is necessary to diagnose IgG4-RD when presenting with orbital apex syndrome and ocular nerve palsies,IgG4-RD can mimic mastoiditis of infectious aetiology. Other differentials may include cocaine-induced midline destructive lesions and granulomatosis with polyangiitis. The diagnosis can be supported by elevated serum IgG, elevated IgG index and pathognomonic histopathological findings. . The diagnosis of IgG4-related orbital disease should be deliberated on by a multidisciplinary group, with every effort being made to exclude an infectious aetiology, before embarking on immunosuppressive therapy.Primary treatment is with steroids. However, immunotherapy using azathioprine can be utilised in recurrent disease or patients with steroid intolerance.

References:

[1]Goto H, Ueda S. Immunoglobulin G4-related ophthalmic disease involving the sclera misdiagnosed as intraocular tumor: report of one case. OculOncolPathol. 2016;2(4):285–8.

[2]Ohyama K, Koike H, Iijima M, et al. IgG4-related neuropathy: a case report. JAMA Neurol. 2013;70(4):502–5.

[3]AbdelRazek MA, Venna N, Stone JH. IgG4-related disease of the central and peripheral nervous systems. Lancet Neurol. 2018;17(2):183–92.

[4]Kamekura R, Takahashi H, Ichimiya S. New insights into IgG4-related disease: emerging new CD4+ T-cell subsets. Curr Opin Rheumatol. 2019;31(1):9–15.

Disclosure of Interests:

None declared

152 The Relationship Between 25(OH) Vitamin D and Bone Mineral Density (BMD) in Patients 65 Years and Older with Prior Fragility Fractures

Introduction

25(OH) vitamin D [25(OH) D] levels are known to influence skeletal health as well as muscle function. Some studies suggest a positive association between 25(OH) D levels and BMD at various skeletal sites in men but not in women. These findings were mostly observed in younger (less than 50 year old) cohorts. Evidence for this association in older patients with prior fragility fractures is lacking. Aim: To assess the correlation of 25(OH) D levels with T-scores at the neck of femur, hip and spine in patients 65 years and older with prior fragility fractures and the effect of gender on the correlation.

Methods

A retrospective, cross-sectional analysis of patients 65 and older with previous fragility fractures in patients attending a fracture prevention service. Data was extracted from the electronic records. SPSS 26 statistical software was used for statistical analysis. Pearson correlation coefficient was used to calculate correlation and regression coefficient for gender.

Results

151 patients were included; 26 males and 126 females. Mean age was 76.2 and 74.1 years respectively. In the males there was good positive, statistically significant correlation between the 25(OH) D and T-scores at the neck of femur (r = 0.415; p &lt; 0.05) and hip (r = 0.413; p &lt; 0.05), but correlation with T-score of the spine was not statistically significant (r = 0.349; p = 0.103). In the females there was no statistically significant correlation between 25(OH) D and T-scores at the neck of femur, hip or spine (r = 0.163; p = 0.077), (r = 0.096; p = 0.299) and (r = 0.114; p = 0.217) respectively.

Conclusion

In males, 65 years and older, with prior fragility fracture, there is a positive significant correlation between 25(OH) D and BMD at the neck of femur and hip whereas there is no significant correlation in females.

A study on the influence of pH changes during catalytic ozonation process on alumina, zeolites and activated carbons for the decolorization of Reactive Red-241

The current study focuses on a prime effect of pH changes in the catalytic ozonation process (COP) by using three main classes of catalysts such as zeolites (alumina-silicates), alumina (metal oxides), and activated carbons for decolorization of Reactive Red 241 (RR-241). The role of pH changes, point of zero charges and the effect of catalyst dose on pH change was studied. The results reveal that the overall removal efficiency of RR-241 in the case of COPs was the highest compared with single ozonation process (at pH = 7 the efficiency was 80, 65 65.5 and 60% for AC/O₃, Al₂O₃/O₃, Zeolite/O₃ and O₃ respectively). At initial acidic pH 4, the highest pH variations in COPs and ozonation processes were observed. Moreover, the pH changes were not found to be significant near the point of zero charges of materials (pH_pzc = 6.8, 8.4 and 8.8 for zeolite, activated carbons and Al₂O₃, respectively. The COP in the presence of activated carbon shows the highest removal efficiency (82%) at pH 7. The material dose effect indicates that increasing the amount of catalyst (from 1 gm to 2 gm) significantly leads to a change in the pH of the solution. Results reveal the prominent effect and significance of pH changes on the efficiency of COP to determine true catalytic efficiency.

Influence of mini-screw implant-assisted intrusion on orthodontically induced inflammatory root resorption: a systematic review

AIM

To systematically review indexed literature related to the influence of mini-screw implant (MSI)-assisted intrusion on orthodontically induced inflammatory root resorption (OIIRR).

METHODS

Indexed databases were searched without time and language restrictions using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were: (a) original studies; (b) patients/subjects undergoing MSI-assisted intrusion; and (c) tomographic and/or histological assessment of OIIRR. Letters to the Editor, commentaries, case reports/series, reviews, and studies based on two-dimensional radiographic assessment of OIIRR were excluded. For experimental and clinical studies, the risk of bias assessment was performed using the Systematic Review Centre for Laboratory animal Experimentation risk of bias tool and the Risk of Bias in Non-randomized Studies of Interventions guidelines, respectively.

RESULTS

The initial search yielded 453 studies, out of which 6 (3 clinical and 3 on animal-models) were included. The clinical studies were performed on males and females with a mean age ranging between 16.07 and 25.5 years. Duration of the clinical studies ranged from 3.8 to 9 months. The animal studies were performed on mini-pigs, rats, and dogs. The mean age in the studies on rats and mini-pigs was 2.76 and 18 months, respectively. In the study on canine models, mean age was not reported. In all studies, MSI-assisted intrusion was shown to cause OIIRR. Power analysis was performed in one study. All studies had a moderate risk of bias.

CONCLUSIONS

MSI-assisted intrusion is a risk factor for OIIRR; however, from a clinical perspective, further well-designed and power-adjusted studies are needed.

Treatment of leachate through constructed wetlands using Typha angustifolia in combination with catalytic ozonation on Fe-zeolite A

Leachate control and management is a major challenge faced during solid waste management as it may pollute surface and groundwaters. In the current research, constructed wetlands (CWs) vegetated with Typha angustifolia plant in combination with catalytic ozonation by ferrous (Fe)-coated zeolite A was studied for the treatment of leachate. The CWs treatment with 9 days detention reduced the chemical oxygen demand (COD) and biochemical oxygen demand (BOD) up to 75.81% and 69.84%, respectively. Moreover, total suspended solids (TSS), total dissolved solids (TDS), and total kjeldahl nitrogen (TKN) removal of 91.16%, 33.33%, and 25.22% were achieved, respectively. The Fe-coated zeolite A catalytic ozonation further reduced the COD up to 90.7%. Comparison of the processes showed the effective performance of the combined process (CW/O₃/Fe-zeolite) with 97.76% COD reduction of leachate. It is, therefore, concluded that the studied combined process (CW/O₃/Fe-zeolite A) was more efficient as compared with single ozonation and CW alone, hence it can be implied for the leachate treatment in real conditions.

Elimination of basic blue 9 by electrocoagulation coupled with pelletized natural dead leaves (Sapindus mukorossi) biosorption

Elimination of basic blue 9 (BB-9), a cationic textile dye, by electrocoagulation coupled with biosorption exploiting pelletized natural dead leaves (PNDL) of Sapindus mukorossi, an economic alternative biosorbent, was investigated. The experimental runs were conducted in a laboratory-scale hybrid reactor loaded with Al electrodes, aeration spargers and PNDL packed twin suspended buckets. The pelletized adsorbents offer key advantages of good mechanical stability, lesser clogging risk, and easy disengagement as compared to powdered adsorbents. The parameters of current density, pH, PNDL dose, and initial dye concentration were studied for the decolorization and COD removal efficiency. The experimental results revealed that up to 99.9% decolorization and 90.01% COD removal efficiency achieved after 8 min at optimum condition of current density (j)=20.27 mA/cm², pH = 9, PNDL dose = 6 g/L, and initial dye concentration = 50 mg/L. The BB-9 elimination followed the first-order kinetics with K₁=0.318 min^-1 and R²=0.997. The results revealed the potential of PNDL as a feasible biosorbent with the effective performance of the coupled process.

Degradation of safranin by heterogeneous Fenton processes using peanut shell ash based catalyst

Today, dyes are one of the major problematic pollutants in the environment and are broadly used in several industrial sectors. In the current research work, decolorization of safranin (basic dye) from aqueous solution was investigated using iron-impregnated peanut shell ash (Fe-PSA) as a catalyst in the UV-assisted heterogeneous Fenton process (Fe-PSA/H₂O₂/UV). The effect of parameters such as H₂O₂ concentration, catalyst dose, pH, initial dye concentration, temperature, and agitation speed was studied. The maximum decolorization of safranin was achieved at optimum parametric values of reagent dose = 8 mM, catalyst dose = 0.5 g, pH = 3, initial concentration of safranin = 50 ppm, temperature = 25 °C, and agitation speed = 200 rpm. The results revealed the efficient performance of Fe-PSA as catalyst in the Fe-PSA/H₂O₂/UV process for safranin treatment.

Knowledge of Medical Practitioners about Periodontal Diseases and Its Impact on Overall Health: A Cross-sectional Study

INTRODUCTION

Periodontal disease is defined as an inflammation of the gums that may result in loss of the tissues holding the teeth in its place. The signs and symptoms include red and/or swollen gums, bleeding gums, halitosis or in severe cases, loosening of teeth. Periodontal diseases act as a risk factor for several health conditions including diabetes and cardiovascular diseases and it can even result in adverse pregnancy outcomes. Therefore, in this study, we aim to assess the knowledge of medical practitioners regarding periodontal diseases and its impact on overall health.

METHODS

We conducted a cross-sectional, questionnaire-based study that included 100 medical practitioners working in the Combined Military Hospital Lahore, Pakistan.

RESULTS

In our study, 83.0% participants knew the definition of periodontal disease; 7.0% of the participants responded that they take their patient's periodontal history; 26.0% screened their patients for gums related problems while 87.0% reported that they are comfortable in performing an oral examination. 80.0% of the participants agreed that periodontal disease can be a risk factor for diabetes; 73.0% said they believe that it can lead to adverse pregnancy outcomes; 62.0% thought that it can result in cardiovascular diseases.

CONCLUSION

Most of the participants in our study had a considerable amount of knowledge about periodontal diseases. However, it is important to stress the value of taking a detailed periodontal history and screening patients for periodontal problems.

Influence of involuntary cigarette smoke inhalation on osseointegration: a systematic review and meta-analysis of preclinical studies

There are no studies that have systematically reviewed the influence of involuntary cigarette smoke inhalation (ICSI) on the stability of implants. The aim of the present study was to perform a systematic review and meta-analysis of preclinical studies that assessed the influence of involuntary cigarette smoke inhalation ICSI on osseointegration. Indexed databases (PubMed, Google-Scholar, Scopus, EMBASE, and Web of Knowledge) were searched till September 2017. Titles and abstracts of studies identified using the above-described protocol were independently screened by 2 authors. Full-texts of studies judged by title and abstract to be relevant were independently evaluated for the stated eligibility criteria. Nine studies were included. Six studies showed that ICSI compromised bone area contact around implants. In 4 studies, peri-implant bone mineral density was significantly higher in the control group than among subjects exposed to ICSI. For the effects of ICSI on the osseointegration of dental implants, significant differences could be observed for bone-to-implant contact for test subjects in cancellous (Z=-4.08, p<0.001) and cortical bone (Z=-4.31, p<0.001) respectively. ICSI may negatively influence osseointegration of dental implants. It is imperative to educate patients about the negative effects of passive smoking on dental and systemic health.

Does incorporating collagen and chondroitin sulfate matrix in implant surfaces enhance osseointegration? A systematic review and meta-analysis

Implant surface modification has been used to improve osseointegration. However, evidence regarding improved new bone formation (NBF) and osseointegration with the use of collagen-chondroitin sulfate (CS) matrix coated implants remains unclear. The aim of this study was to assess the efficacy of collagen-CS matrix coating on the osseointegration of implants. The focused question was "Does the incorporation of collagen-CS matrix in implant surfaces influence osseointegration?" To answer the question, indexed databases were searched up to July 2017 using various combinations of the key words "collagen", "chondroitin sulfate", "osseointegration", and "implants". The initial literature search identified 497 articles, of which 18 reporting experimental studies fulfilled the inclusion criteria. Thirteen of the studies included (72%) reported that implants coated with a collagen-CS matrix presented higher NBF, bone-to-implant contact, and/or bone volume density. The strength of this observation was supported by meta-analysis results. Nevertheless, the results should be interpreted with caution due to the lack of standardization regarding the dosage formulation of collagen-CS, short-term follow-up, and lack of assessment of confounders. On experimental grounds, the incorporation of collagen-CS matrix into implant surfaces appears to promote osseointegration. From a clinical perspective, the results from animal models support phase I studies in healthy humans.

Influence of implant location in patients with and without type 2 diabetes mellitus: 2-year follow-up

The aim of the present cross-sectional retrospective 2-year follow-up clinical study was to assess the influence of implant location on clinical and radiographic parameters around dental implants placed in patients with and without type 2 diabetes mellitus (T2DM). Twenty-seven patients with T2DM and 25 non-diabetic controls were included. Implants were classified into three zones according to their location: (1) anterior zone: implant/s replacing anterior teeth, (2) middle zone: implant/s replacing premolars, and (3) posterior zone: implant/s replacing molars. Peri-implant bleeding on probing (BOP), probing depth (PD), and crestal bone loss (CBL) were measured. P-values less than 0.05 were considered statistically significant. The mean age of patients with T2DM was 42.5 years and that of non-diabetic controls was 40.6 years. The mean fasting blood glucose levels of patients with and without T2DM were 74.5mg/dl (66-80mg/dl) and 82.5mg/dl (79-88.1mg/dl), respectively. The mean duration of T2DM was 4.3 years. There was no significant difference in BOP, PD, or CBL around implants placed in any of the zones in the jaws of patients with and without T2DM. There is no influence of implant location on clinical and radiographic parameters around dental implants placed in patients with and without T2DM.

Oral Candida carriage and species prevalence in denture stomatitis patients with and without diabetes

The objective of this study was to assess the oral Candida carriage and species prevalence in denture stomatitis (DS) patients with and without diabetes mellitus (DM). To address the focused question “In patients receiving dentures, how does having diabetes compared to no diabetes influences the carriage and species prevalence of oral Candida?” Indexed databases were explored without time or language restrictions up to and including February 2017. Nine studies were included. In these studies, the number of diabetics ranged between 14 patients and 405 individuals with mean ages ranging between 33 years and 66.4 years. In five studies, the percentage of hyperglycemic patients in the diabetic group ranged from 14.3% to 100%. In one study, all diabetic patients were normoglycemic. Seven studies reported Candida-associated DS to be significantly higher among diabetics than non-diabetics. Candida albicans was the most prevalent species isolated among diabetics and non-diabetics with DS. Denture-wearers with DM are more susceptible to Candida-associated DS as compared to non-diabetics.

Recent updates on electronic cigarette aerosol and inhaled nicotine effects on periodontal and pulmonary tissues

E-cigarette-derived inhaled nicotine may contribute to the pathogenesis of periodontal and pulmonary diseases in particular via lung inflammation, injurious, and dysregulated repair responses. Nicotine is shown to have antiproliferative properties and affects fibroblasts in vitro, which may interfere in tissue myofibroblast differentiation in e-cig users. This will affect the ability to heal wounds by decreasing wound contraction. In periodontics, direct exposure to e-vapor has been shown to produce harmful effects in periodontal ligament and gingival fibroblasts in culture. This is due to the generation of reactive oxygen species/aldehydes/carbonyls from e-cig aerosol, leading to protein carbonylation of extracellular matrix and DNA adducts/damage. A limited number of studies regarding the effects of e-cig in oral and lung health are available. However, no reports are available to directly link the deleterious effects on e-cigs, inhaled nicotine, and flavorings aerosol on periodontal and pulmonary health in particular to identify the risk of oral diseases by e-cigarettes and nicotine aerosols. This mini-review summarizes the recent perspectives on e-cigarettes including inhaled nicotine effects on several pathophysiological events, such as oxidative stress, DNA damage, innate host response, inflammation, cellular senescence, profibrogenic and dysregulated repair, leading to lung remodeling, oral submucous fibrosis, and periodontal diseases.

Role of diode lasers in oro-facial pain management

With the increasing use of low level laser therapy (LLLT) in clinical dentistry, the aim of the present study was to assess the effectiveness of diode lasers in the management of orofacial pain. Indexed databases were searched without language and time restrictions up to and including July 2016 using different combinations of the following key words: oral, low level laser therapy, dental, pain, diode lasers, discomfort and analgesia. From the literature reviewed it is evident that LLLT is effective compared to traditional procedures in the management of oro-facial pain associated to soft tissue and hard tissue conditions such as premalignant lesions, gingival conditions and dental extractions. However, it remains to be determined which particular wavelength will produce the more favorable and predictable outcome in terms of pain reduction. It is highly recommended that further randomized control trials with well-defined control groups should be performed to determine the precise wavelengths of the diode lasers for the management of oro-facial pain. Within the limits of the present review, it is concluded that diode lasers therapy is more effective in the management of oro-facial pain compared to traditional procedures.

A randomised controlled trial assessing the efficacy of co-phenylcaine nasal spray in flexible transnasal pharyngolaryngoscopy

INTRODUCTION The aim of this study was to assess whether using co-phenylcaine nasal spray before flexible transnasal pharyngolaryngoscopy results in reduced pain and discomfort during the procedure. METHODS This was a randomised controlled trial. Eighty-four patients were randomised to receive either co-phenylcaine nasal spray or placebo nasal spray before performing transnasal flexible pharyngolaryngoscopy. Patient reported outcome measures included pain, discomfort, unpleasantness and willingness to repeat the procedure while clinician reported outcome measures comprised ease of examination and quality of view obtained during the procedure. RESULTS There was no statistically significant difference in scores for pain, discomfort, unpleasantness and willingness to repeat the procedure between the co-phenylcaine and placebo groups. On the other hand, ease of examination scores were significantly better for the co-phenylcaine group than for the placebo group. CONCLUSIONS The majority of patients do not find flexible pharyngolaryngoscopy unpleasant or painful with or without topical nasal anaesthesia. However, the spray does appear to help the examiner in completing a satisfactory assessment.

Parametric optimization of rice bran oil extraction using response surface methodology

Use of bran oil in various edible and nonedible industries is very common. In this research work, efficient and optimized methodology for the recovery of rice bran oil has been investigated. The present statistical study includes parametric optimization, based on experimental results of rice bran oil extraction. In this study, three solvents, acetone, ethanol and solvent mixture (SM) [acetone: ethanol (1:1 v/v)] were employed in extraction investigations. Response surface methodology (RSM), an optimization technique, was exploited for this purpose. A five level central composite design (CCD) consisting four operating parameter, like temperature, stirring rate, solvent-bran ratio and contact time were examined to optimize rice bran oil extraction. Experimental results showed that oil recovery can be enhanced from 71% to 82% when temperature, solvent-bran ratio, stirring rate and contact time were kept at 55°C, 6:1, 180 rpm and 45 minutes, respectively while fixing the pH of the mixture at 7.1.

Dental extraction as a risk factor for bisphosphonate related osteonecrosis of the jaw in cancer patients: an update

Osteonecrosis of the jaw (ONJ) is a complication related to the use of bisphosphonates (BPs). Patients receiving BPs for the treatment of malignancies are at an increased risk of developing bisphosphonate-related ONJ (BRONJ) as compared to patients receiving BPs for the treatment of other disorders such as osteoporosis. Additionally, tooth extractions have been suggested to increase the risk of BRONJ in individuals taking BPs.

OBJECTIVE

To review the role of dental extraction as a risk factor for BRONJ in cancer patients.

MATERIALS AND METHODS

Databases were searched from January 1999 up to and including July 2012 using various combinations of the following keywords: "bisphosphonate", "osteonecrosis of the jaw", "cancer", "oral" and "dental extraction".

RESULTS

Twenty two studies were included. Eighteen studies assessed the relationship between BRONJ and dental extractions in cancer patients, reporting the overall prevalence of BRONJ following extraction in this group as 3.25 +/- 2.23%. Four studies did not report a correlation between BRONJ and extractions, and recommended protocols to avoid the complication.

CONCLUSION

There is a plausible relationship between dental extractions and the development of BRONJ in cancer patients. Written informed consent must be obtained prior to dental procedures in patients at risk for developing BRONJ.