Miswak-Infused Glass Ionomer Cement: A Comparative In Vitro Analysis of Antibacterial Efficacy and Compressive Strength

BACKGROUND

Glass ionomer cement (GIC) restorations are commonly used in primary dentition, due to their aesthetic appeal, self-adhesive nature, and biocompatibility. However, the material's limited antibacterial activity and inadequate mechanical strength highlight the necessity for modifying the material.

AIM

The study aims to evaluate and compare the antimicrobial potency and compressive strength of GIC-incorporated Miswak extract with that of conventional GIC.

MATERIALS AND METHODS

After obtaining the Miswak extract, a modified GIC was formulated by combining the extract with the conventional GIC powder and liquid components, in three different ratios (Powder: Extract and Liquid), Group I (2:1:1), Group II (3:1:2), Group III (3:2:1), and the Group IV as control, which consist of unmodified/conventional GIC. To evaluate and compare the antibacterial efficacy of the modified and unmodified GIC, standard strains of Streptococcus mutans and Lactobacillus were utilized. For each group, the minimal inhibitory concentration (MIC) assay was tested. For the evaluation of compressive strength, cylindrical moulds were utilized in compliance with ISO 9917-1:2007 standards and tested using the universal testing machine (Instron, ElectroPuls®, Bangalore, IND). The highest force exerted at the point of specimen fracture was recorded to calculate the compressive strength values in MPa. The data obtained were analyzed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 24.0, Armonk, NY) software. The statistical analysis was conducted utilizing repeated measures of analysis of variance (ANOVA) to calculate the mean MIC values and compressive strength, with pairwise comparisons assessed using Tukey's post hoc test.

RESULTS

The results proved that the antimicrobial properties of Miswak containing GIC performed better against S. mutans and Lactobacillus with a statistically significant difference when compared with group IV (p<0.05), it has been found that an increase in the concentration of extract increased the antimicrobial potency. Significant results were obtained in compressive strength where Group II (41.49±3.6) and Group III (15.23±4.96) proved to be weaker than the control (62.69±2.58), while Group I showed no differences from the control group (p>0.05).

CONCLUSION

It can be concluded that Group I was found to be better in terms of both antimicrobial properties and compressive strength, where no significant difference in compressive strength was identified when comparing Group I with Group IV. Thus, the overall study depicts that a lesser concentration of extract can be the best option in terms of good antimicrobial properties without altering its strength. Hence, the Miswak containing GIC could be a promising restorative material; further studies should include considering intraoral variables such as masticatory stress, moisture levels and in-vivo tests of this combination.

A Comparative In Vitro Analysis of Antimicrobial Effectiveness and Compressive Resilience in Chirata and Terminalia arjuna Modified Glass Ionomer Cement

BACKGROUND

Glass ionomer cements are commonly utilized in dental restorations due to their biocompatibility, strong chemical bond with dental tissues, and ability to resist tooth decay. However, their effectiveness can be compromised by the presence of persistent cavity-causing microorganisms. Therefore, it is essential to consider incorporating antibacterial agents into these restorative materials. Swertia chirayita (S. chirayita) and Terminalia arjuna (T. arjuna) are well-known for their rich composition of phytochemicals that can potentially inhibit the growth of bacteria. Hence, the current research is focused on modifying glass ionomer cement with Chirayita and T. arjuna extracts to enhance its antibacterial properties.

AIM

This research aims to determine the antimicrobial efficacy and compressive strength of glass ionomer cement modified with Chirayita and T. arjuna extracts.

METHODOLOGY

Plant extracts were prepared from both Chirayita and T. arjuna. The powder and liquid components of conventional glass ionomer cement (GIC) were mixed, followed by adding these extracts at three different concentrations. To assess antimicrobial properties, typical strains of Streptococcus mutans and Lactobacillus were employed to test both the modified GIC and unmodified GIC (used as a control). For Chirayita and T. arjuna-modified GIC, minimum inhibitory concentration (MIC) assays were conducted at three different concentrations. MIC was assessed at various time intervals ranging from 1 to 4 hours for modified and unmodified groups. Moreover, compressive strength was measured using cylindrical molds. The highest force exerted at the point of specimen fracture was recorded to calculate the compressive strength values in megapascal (MPa).

RESULTS

The antimicrobial efficiency of Chirata and T. arjuna-modified GIC was evaluated using a MIC assay, indicating a statistically significant enhancement in antimicrobial potency against S. mutans and Lactobacillus within the modified groups in contrast to the control group (p<0.05). However, there were no notable changes in compressive strength when comparing the control group to the modified groups (p>0.05).

CONCLUSION

The antimicrobial effectiveness against S. mutans was observed to be greater in both T. arjuna and Chirayita-modified GIC. In the case of Lactobacillus, Chirayita-modified GIC exhibited more pronounced antimicrobial properties compared to T. arjuna. Importantly, both extracts did not alter the compressive strength of Conventional (unmodified) GIC. Hence, Chirayita-modified GIC appears to be a promising restorative material for combatting recurrent caries. Additional investigation is required to assess the material's stability over an extended period.

A qualitative systematic review of anonymous/unspecified living kidney and liver donors' perspectives

OBJECTIVES & BACKGROUND

Anonymous live organ donors or unspecified donors are individuals willing to be organ donors for any transplant recipient with whom they have no biological or antecedent emotional relationship. Despite excellent recipient outcomes and the potential to help address organ scarcity, controversy surrounds the unconditional act of gifting one's organs to an unrelated recipient. This qualitative systematic review provides insights into the first-hand experiences, motivations, and challenges that unspecified donors face.

METHODS

A systematic search was conducted on Medline, Embase, CINAHL, PsycINFO, and Web of Science database for qualitative literature regarding unspecified living donors' motivations and experiences in liver and kidney transplantation. An inductive thematic analysis was conducted to generate themes and supportive subthemes.

RESULTS

12 studies were included. The four major themes were (i) motivations, (ii) perception of risks, (iii) donor support, and (iv) benefits of donation. Unspecified donors demonstrated a deep sense of social responsibility but tended to underestimate health risks in favour of benefits for recipients. Despite the lack of emotional support from family and friends, the decision to donate was a resolute personal decision for donors. Majority benefitted emotionally and did not express regret.

CONCLUSION

This qualitative review bridges the gap in literature on unspecified living donor psychology and provides a comprehensive understanding of the decision-making matrix and experiences of donors.

A network meta-analysis of 12,116 individuals from randomized controlled trials in the treatment of depression after acute coronary syndrome

BACKGROUND

Post-acute coronary syndrome (ACS) depression is a common but not well understood complication experienced by ACS patients. Research on the effectiveness of various therapies remains limited. Hence, we sought to conduct a network meta-analysis to assess the efficacy of different interventions for post-ACS depression in improving patient outcomes.

METHODS AND FINDINGS

Three electronic databases were searched for randomised controlled trials describing different depression treatment modalities in post-ACS patients. Each article was screened based on inclusion criteria and relevant data were extracted. A bivariate analysis and a network meta-analysis was performed using risk ratios (RR) and standardized mean differences (SMD) for binary and continuous outcomes, respectively. A total of 30 articles were included in our analysis. Compared to standard care, psychosocial therapy was associated with the greatest reduction in depression scores (SMD:-1.21, 95% CI: -1.81 to -0.61, p<0.001), followed by cognitive behavioural therapy (CBT) (SMD: -0.75, 95% CI: -0.99 to -0.52, p<0.001), antidepressants (SMD: -0.73, 95% CI: -1.14 to -0.31, p<0.001), and lastly, combination therapy (SMD: -0.15, 95% CI: -0.28 to -0.03, p = 0.016). No treatment modalities was found to be more effective in reducing depression scores when compared to one another. Additional analysis showed that these treatment modalities did not have significant impact on the overall mortality, cardiac mortality and recurrent myocardial infarction.

CONCLUSION

This network meta-analysis found that the treatment effect of the various psychological modalities on depression severity were similar. Future trials on psychological interventions assessing clinical outcomes and improvement in adherence to ACS-specific interventions are needed.

Barriers and Facilitators to Engagement With a Weight Management Intervention in Asian Patients With Overweight or Obesity: A Systematic Review

OBJECTIVE

The obesity epidemic is a global health concern with Asian countries facing one of the most rapid rises in obesity rates. However, given the underwhelming long-term efficacy of weight loss strategies, especially in Asia, this review aimed to explore barriers and facilitators to weight management of patients with overweight and obesity in Asia.

METHODS

Medline, CINAHL, PsycINFO, and Web of Science were searched for articles discussing barriers and facilitators of treatment to obesity from the perspectives of both health care professionals (HCPs) and patients. Qualitative and mixed method studies from Asia were included. Key quotes were extracted, coded, and thematically analyzed according to the methodology of Thomas and Harden.

RESULTS

A total of 26 articles were included in this review. From patient perspectives, 3 main themes were identified: factors influencing poor eating behavior, inhibiting lifestyle modifications, and facilitating lifestyle modifications. Patients highlighted several barriers including the lack of social support, physiologic limitations to exercise, and low health literacy. Rigid sociocultural norms and lack of accessible health care services, exercise facilities, and healthy food exacerbated the barriers. Facilitators to lifestyle modifications consisted of strong support systems and high health literacy. HCPs agreed that low health literacy, lack of social support, and patient motivation impeded patients' weight loss attempts but were unaware of the other barriers they faced.

CONCLUSION

There are discrepancies between ideas of barriers and facilitators of HCPs and patients. A mixture of population level, primary care, and personal interventions are required to address this disparity, and enhanced health literacy can improve weight loss outcomes.

Living in the non-alcoholic fatty liver disease silent epidemic: a qualitative systematic review of patients' perspectives

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) affects one-fourth of the global population. Yet, the care of these patients is limited and awareness of NAFLD remains low in the general public. Investigations into the lives of these patients are often forgotten and traditional quantitative studies only paint part of the picture.

AIM

To assess the first-hand accounts of these individuals and their perspective on living with NAFLD.

METHODS

A systematic search was conducted on Medline, Embase, CINAHL, PsycINFO and Web of Science database for qualitative literature regarding patients' perspectives on NAFLD. An inductive thematic analysis was conducted to generate themes and supportive subthemes.

RESULTS

We incuded eight articles in the review. There were three major themes including the impact on the quality of life, knowledge and information, and attitudes and perceptions on care. The impact of the quality of life details the emotional and physical distress of NAFLD. Knowledge and information include the lack of sufficient communication between healthcare providers and patients with a distinct knowledge gap. Attitudes and perceptions on care extrapolate the current active participation of patients and needs of the patients and the future care that they desire.

CONCLUSION

This review synthesises first-hand accounts of individuals with NAFLD. With the growing burden of NAFLD, future public interventions must consider individual views for success to be found. The identified themes serve as a forefront for consideration for public policies. Ultimately, NAFLD is a multisystem disease, which must be managed by a multidisciplinary team.

Moving beyond the initial colonoscopy: a call for action

INTRODUCTION

The evolution of colorectal screening has made headway with continual efforts globally to increase screening rates for colonoscopy-naïve patients. However, little has been done to encourage repeat colonoscopies after the initial scope despite recommendations to repeat colonoscopy every 10 years, with the uptake rates of repeat colonoscopy remaining abysmal at 22%.

METHODS

Previously, a qualitative systematic review evaluated the barriers and facilitators patients faced in their decisions to undergo colonoscopy, analyzing articles from Medline, Embase, CINAHL, PsycINFO and Web of Science. Key findings from articles which highlighted factors influencing patients' decisions to return for repeat colonoscopies were summarized.

RESULTS

Three articles were identified in the search. Facilitators for repeat colonoscopy included patients' assurance garnered from fostered trust in the patient-provider relationship, their intrinsic motivations from fear of cancer and an innate appreciation for the significance of obtaining repeated colonoscopies. Procedural factors such as the option for procedural visualization, its comprehensiveness and the utilization of anesthesia were also crucial motivators. Barriers that patients highlighted comprised of cumbersome bowel preparation and potential complications.

DISCUSSION

Recently, minimal research has been conducted on the sentiments of healthcare providers and patients regarding repeat colonoscopy. The lack of emphasis from healthcare institutions on encouraging patients to repeat colonoscopy after 10 years prevents effective colorectal cancer screening. To proficiently alleviate the burden of colorectal cancer, patient counseling has to shift beyond explaining colonoscopy risks and complications to promoting regular follow-up scopes. This article thus calls for more studies to focus on evaluating the uptake of repeat colonoscopies.

Barriers and facilitators towards colonoscopy: a qualitative systematic review

OBJECTIVES

Colonoscopy is integral in the early detection of colorectal cancer (CRC), be it for screening, diagnostic or therapeutic intentions. Despite the presence of multiple screening modalities, colonoscopy remains integral in providing a definitive CRC diagnosis. However, uptake rates remain low worldwide with minimal understanding towards stakeholders' perspectives. This systematic review is the first to outline the barriers and facilitators faced by providers and patients in receiving colonoscopy specifically.

METHODS

Using PRISMA guidelines, our systematic review consolidates findings from Medline, Embase, CINAHL, PsycINFO and Web of Science Core collection. All perceptions of healthcare providers and screening participants aged 45 and above towards colonoscopy were included.

RESULTS

Forty-five articles were included in our review. Five major analytical themes were identified - procedural perceptions, personal experiences, thoughts and concerns, societal influences, doctor-patient relationship and healthcare system. The discrepancies in knowledge between patients and providers have evidently reduced in the present decade, potentially attributable to the rising influence of social media. The sharing of providers' personal experiences, involvement of patients' family in colonoscopy recommendations and propagation of patients' positive recounts were also more apparent in the past compared to the present decade, highlighting the need to reevaluate the balance between medical confidentiality and personal touch. Additionally, Asian patients were reportedly more apathetic towards CRC diagnosis due to their strong belief in destiny, a crucial association consistent with present studies.

CONCLUSION

This study highlights pertinent gaps in our healthcare system, providing crucial groundwork for interventions to be enacted in engendering higher colonoscopy uptake rates.

Comparative analysis of drought-responsive transcriptomes of sugarcane genotypes with differential tolerance to drought

Water stress causes considerable yield losses in sugarcane. To investigate differentially expressed genes under water stress, two sugarcane genotypes were subjected to three water-deficit levels (mild, moderate, and severe) and subsequent recovery and leaf transcriptome was generated using Illumina NextSeq sequencing. Among the differentially expressed genes, the tolerant genotype Co 06022 generated 2970 unigenes (p ≤ 0.05, functionally known, non-redundant DEGs) at 2-day stress, and there was a progressive decrease in the expressed genes as the stress period increased with 2109 unigenes at 6-day stress and 2307 unigenes at 10-day stress. There was considerable reduction at recovery with 1334 unigenes expressed at 10 days after recovery. However, in the susceptible genotype Co 8021, the number of unigenes expressed at 2 days was lower (2025) than the tolerant genotype and a further reduction was seen at 6-day stress (1552). During recovery, more differentially expressed genes were observed in the susceptible cultivar indicating that the cultivar has to activate more functions/processes to recover from the damage caused by stress. Comparison of DEGs between all stages of stress and recovery in both genotypes revealed that, the commonly up- and down-regulated genes across different stages were approximately double in the tolerant genotype. The most enriched gene ontology classes were heme binding, peroxidase activity and metal ion binding in the biological process and response to oxidative stress, hydrogen peroxide catabolic process and response to stress in the molecular function category. The cellular component was enriched with DEGs involved in extracellular region followed by integral component of membrane. The KEGG pathway analysis revealed important metabolic activities and functionally important genes involved in mitigating water-deficit stress in both the varieties. In addition, several unannotated genes in important pathways were detected and together may provide novel insights into water-deficit tolerance mechanisms in sugarcane. The reliability of the observed expression patterns was confirmed by qRT-PCR. The results of this study will help to identify useful genes for improving drought tolerance in sugarcane.

Picosecond difference-frequency-generation in orientation-patterned gallium phosphide

We report the generation of tunable high-repetition-rate picosecond radiation in the mid-infrared using the new quasi-phase-matched nonlinear material of orientation-patterned gallium phosphide (OP-GaP). The source is realized by single-pass difference-frequency-generation (DFG) between the output signal of a picosecond optical parametric oscillator (OPO) tunable across 1609-1637 nm with input pump pulses at 1064 nm in OP-GaP, resulting in tunable radiation across 3040-3132 nm. Using a 40-mm-long crystal, we have generated up to 57 mW of DFG average power at ~80 MHz repetition rate for a pump power of 5 W and signal power of 0.9 W, with >30 mW over >50% of the tuning range. The DFG source exhibits a passive power stability better than 3.2% rms over 1 hour in good spatial beam quality. To the best of our knowledge, this is the first picosecond frequency conversion source based on OP-GaP.

Ti:sapphire-pumped deep-infrared femtosecond optical parametric oscillator based on CdSiP2

We report on a femtosecond optical parametric oscillator (OPO) for the deep-infrared (deep-IR) based on the Kerr-lens-mode-locked Ti:sapphire laser as the pump source. By deploying a novel cascaded intracavity arrangement, comprising a femtosecond OPO based on the nonlinear crystal, CdSiP2, synchronously pumped internal to a MgO:PPLN femtosecond OPO, we have generated broadly tunable radiation across 5958-8117 nm using rapid static cavity delay tuning, with a maximum power of 64 μW at 6791 nm, limited by the absorption in mirror substrates as well as polarization-dependent intracavity losses. The deep-IR idler power exhibits excellent passive stability of better than 1.1% rms over 2 h, with a spectral bandwidth as large as ∼650 nm at ∼6800 nm. The demonstrated concept is generic and can be similarly deployed in other operating time scales and wavelength regions, also using different laser pump sources and nonlinear materials.

Yb-fiber-laser-based, 1.8 W average power, picosecond ultraviolet source at 266 nm

We report a compact, stable, high-power, picosecond ultraviolet (UV) source at 266 nm based on simple single-pass two-step fourth-harmonic generation (FHG) of a mode-locked Yb-fiber laser at 79.5 MHz in LiB3O5 (LBO) and β-BaB2O4. Using a 30-mm-long LBO crystal for single-pass second-harmonic generation, we achieve up to 9.1 W of average green power at 532 nm for 16.8 W of Yb-fiber power at a conversion efficiency of 54% in 16.2 ps pulses with a TEM00 spatial profile and passive power stability better than 0.5% rms over 16 h. The generated green radiation is then used for single-pass FHG into the UV, providing as much as 1.8 W of average power at 266 nm under the optimum focusing condition in the presence of spatial walk-off, at an overall FHG conversion efficiency of ∼11%. The generated UV output exhibits passive power stability better than 4.6% rms over 1.5 h and beam pointing stability better than 84 μrad over 1 h. The UV output beam has a circularity of >80% in high beam quality with the TEM00 mode profile. To the best of our knowledge, this is the first report of picosecond UV generation at 266 nm at megahertz repetition rates.

Preparation and characterization of pioglitazone cyclodextrin inclusion complexes

Pioglitazone, a class II Biopharmaceutical Classification System drug having poor water solubility and slow dissolution rate may have a negative impact on its subtherapeutic plasma drug levels leading to therapeutic failure. In order to improve its water solubility and thus dissolution, cyclodextrin complexation technique was followed. The phase solubility studies were carried using three different types of cyclodextrins viz., β, methyl-β and γ-cyclodextrins. The Gibbs free energy was calculated in order to determine ease of the complexation. Binary systems of pioglitazone with cyclodextrins were prepared by kneading method and spray drying method. The phase solubility profiles with all the three cyclodextrins were classified as A_L-type, indicating the formation of 1:1 stoichiometric inclusion complexes. The complexation capability of cyclodextrins with pioglitazone increased in the order of methyl-β > β > γ-cyclodextrin. The Gibbs free energy was found to be in the order γ > methyl-β > β cyclodextrin. Characterization of inclusion complexes was done by solubility studies, in vitro dissolution studies, Fourier transformation-infrared spectroscopy, scanning electron microscopy, differential scanning calorimetry and X-ray powder diffractometry studies. Inclusion complexes exhibited higher rates of dissolution than the corresponding physical mixtures and pure drug. Greater solubility was observed with spray-dried methyl-β cyclodextrin complexes (2.29 ± 0.001 mg/ml) in comparison to the kneaded methyl-β cyclodextrin complexes (1.584 ± 0.053 mg/ml) and pure drug (0.0714 ± 0.0018 mg/ml).

Evaluation of three fall-risk assessment tools in an acute care setting

AIM

This paper is a report of a study to evaluate the validity of three fall-risk assessment tools to identify patients at high risk for falls.

BACKGROUND

Patient falls make up 38% of all adverse events occurring in hospital settings, and may result in physical injury and undesirable emotional and financial outcomes. No single fall-risk assessment tool has been conclusively validated.

METHOD

The Morse Fall Scale, St Thomas Risk Assessment Tool in Falling Elderly Inpatients, and Hendrich II Fall Risk Model were validated in inter-rater reliability and validity studies in 2003. This included assessment of the probability of disagreement, kappa-values, sensitivity, specificity, positive predictive values and negative predictive values of the assessment tools with the associated 95% CI.

FINDINGS

One hundred and forty-four patients were recruited for the inter-rater reliability study. The probabilities of disagreement were between 2.8% and 9.7%, and 95% CI for all tools ranged from 1.1% to 15.7%. The kappa-values were all higher than 0.80. In the validity study, 5489 patients were recruited to observe 60 falls. The Morse Fall Scale at a cutoff score of 25 and Heindrich II Fall Risk Model at a cutoff score of 5 had strong sensitivity values of 88% and 70%, respectively. However, in comparison with the Morse Fall Scale (specificity = 48.3%), only the Heindrich II Fall Risk Model had a more acceptable level of specificity (61.5%).

CONCLUSION

The Heindrich II Fall Risk Model is potentially useful in identifying patients at high risk for falls in acute care facilities.

Carbamazepine--the commonest cause of toxic epidermal necrolysis and Stevens-Johnson syndrome: a study of 7 years

BACKGROUND

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are a group of severe life threatening drug reactions. The drugs commonly implicated as the cause of these drug reactions vary depending on host factors and the prescription pattern of drugs in that particular area.

AIM

The aim of the study was to find the drugs implicated as the cause of SJS/TEN in the patients admitted in the dermatology ward at the Medical College, Thrissur and to find the clinical outcome.

METHODS

It was a retrospective study of 7 years from 1997 to 2004. The case records of all patients with a clinical diagnosis of TEN or SJS were studied in detail regarding the drugs implicated as the cause, the management and the clinical outcome.

RESULTS

During the study period, 41 patients in the age group ranging from 12 to 72 years were treated as inpatients, of which 20 were males and 21 were females. The commonest drug implicated as the cause of SJS/TEN was carbamazepine (44%). The indication for carbamazepine was control of pain in more than 50% of the cases. Presence of a major systemic disease before the onset of SJS/TEN was associated with a bad prognosis.

CONCLUSION

The increased use of carbamazepine, especially for control of pain, may be the reason for the increased incidence of SJS/TEN due to the same drug. Awareness about the drugs implicated in life threatening drug reactions will help physicians in preventing them by judicious use of the drugs.

Bone marrow necrosis in paediatric patients

Necrosis of bone marrow is a very rare condition with a prevalence ranging from 0.15 to 7 percent. It is mostly not compatible with life. We diagnosed four cases of necrotic marrow out of 830 bone marrow aspirations done in last five years of time. All were paediatric patients having peripheral pancytopenia. Three out of four patients expired within one month of diagnosis.

Pharmacokinetic profile of a new matrix-type transdermal delivery system: diclofenac diethyl ammonium patch

A transdermal delivery system containing the anti-inflammatory analgesic diclofenac diethyl ammonium in an ethyl hexyl acrylate and vinyl acetate pressure-sensitive adhesive system was developed for percutaneous absorption. These patches were subjected to in vitro permeation and permeation enhancement studies through rat skin using a specially designed diffusion cell. Further, the work deals with percutaneous absorption studies carried out on both animals and human volunteers. The pharmacokinetic parameters calculated from the blood levels of the drug reveal a profile typical of a sustained-release formulation, with the ability to maintain adequate plasma levels for 24 hr (i.e., up to the next application). (Area under the curve [AUC]: 4.356 +/- 1.3 mcg/ml.hr in animals and 0.442 +/- 0.053 mcg/ml.hr in humans; Tmax was 8 hr in both the cases, whereas Cmax was 0.288 +/- 0.088 mcg/ml in animals and 0.034 +/- .008 mcg/ml in human volunteers.) The amount of the drug bioavailable for targeting the sites of action is lower than via the oral route, but the absorbed dose appears to be adequate for therapeutic use, particularly because of the absence of side effects.

Pregnancy and congenital heart disease--maternal and fetal outcome

Two hundred and seventy five pregnancies in patients with congenital heart disease during 1980-1996 were analyzed retrospectively. Maternal and perinatal outcome was compared in 251 pregnancies of women with acyanotic and 24 pregnancies of women with cyanotic heart disease. Congenital heart disease was diagnosed during the index pregnancy in 26.1% of patients and the majority (88.4%) were in NYHA classes 1 and 2. Atrial septal defect (27.7%) was the most common lesion in women with acyanotic heart disease and the majority with cyanotic heart disease had Eisenmenger syndrome, 13 of 21 (61.9%). Sixty pregnancies occurred in patients with surgically corrected lesions (acyanotic, 56; cyanotic, 4). The incidences of abortions (8.3%), stillbirths (13.6%) and small for gestational age (SGA) (36.4%) were higher in cyanotic heart disease compared to acyanotic heart disease (stillbirth, 0.8%; SGA, 6.9%). There was a statistically significant difference in mean maternal age, mean gestational age and mean birth-weight in the surgically corrected and noncorrected lesions in both acyanotic and cyanotic heart disease. There was 1 maternal death in a woman with Eisenmenger syndrome.

Toxic epidermal necrolysis--a retrospective study

BACKGROUND

Toxic epidermal necrolysis (TEN) is a severe, idiosyncratic, exfoliative disease of the skin and mucous membranes. The treatment of this condition is controversial. High-dose corticosteroid therapy has been the most commonly advocated treatment, but, more recently, this has changed to a no-steroid protocol. These conflicting treatments prompted us to evaluate retrospectively our protocol.

METHODS

The patients admitted to the hospital from 1989 to 1995 with a clinical diagnosis of TEN were included in the study. These patients were given systemic steroids, prophylactic antibiotic, and supportive measures.

RESULTS

The patients belonged to both sexes with an average age of 34 years. The average area of involvement was 85.62%. All the patients made an uneventful recovery without any evidence of sepsis.

CONCLUSIONS

Treatment with systemic steroids is useful in the management of TEN, and there is no need for a burn care center.

Quantitative ultrasonographic evaluation of the carotid arteries in hypertension

Current treatment goals for hypertension include the prevention of end-organ injuries. Hypertension is certainly among the major contributors to atherogenesis, and many antihypertensive drugs seem to have wall-protecting properties. It is critical to identify, test, and implement non-invasive methods for the screening of the population in order to detect early wall abnormalities and to monitor the long-term effects of different antihypertensive treatments. Among these methods, B-mode ultrasound examination of carotid arteries has shown great potential in evaluating treatments that may prevent hypertension-related wall injuries.

Behavioral neurobiology of inverse agonist FG 7142 induced anxiety syndrome in rats

1. Neurobehavioral survey of inverse agonist FG 7142 was performed employing a novel anxiety paradigm namely FR-2 Two-Way crossover in a shuttle box. 2. FG syndrome was found to be similar to learned helplessness following shock treatment. Significant increase in mean latency to escape was observed from 0 to 25th trial. Effect of FG 7142 on the behavioral and neurological profile did not deviate significantly from controls. However, a general increase in arousal, darting and sideway movement (weaving) of the head were noted. 3. Drugs with specificity at benzodiazepine (BDZ) receptor site were employed as pretreatments in order to study their influence on FG 7142 induced anxiety syndrome. Diazepam and ZK 91296, significantly blocked the inverse agonist response. Head weaving as well as darting movements were completely abolished although rats demonstrated arousal and vigilance. 4. A dose dependent inhibition of FG response was observed with RO 15-1788, a specific BDZ receptor blocker. ZK 93423 at low doses (1 mg/kg) failed to reverse the escape deficit induced by FG. Higher doses of ZK 93423 could not be tested as significant sedation and ataxia were noted. 5. It is suggested that a careful combination of a BDZ agonist and inverse agonist may be beneficial in the treatment of generalised anxiety disorders.

Effect of Foeniculum vulgare Mill. seed extract on the genital organs of male and female rats

Following the oral administration of acetone extract of Foeniculum vulgare (fennel) seeds for 15 days is male rats, total protein concentration was found to be significantly decreased in testes and vas deferens and increased in seminal vesicles and prostate gland. There was a decrease in activities of acid and alkaline phosphatase in all these regions, except that alkaline phosphatase was unchanged in vasa. In female rats, oral administration of the extract for 10 days led to vaginal cornification and oestrus cycle. While moderate doses caused increase in weight of mammary glands, higher doses increased the weight of oviduct, endometrium, myometrium, cervix and vagina also. The results confirm the oestrogenic activity of the seed extract.

Effect of foeniculum vulgare seed extract on mammary glands and oviducts of ovariectomised rats

The effect of acetone extracts of Foeniculum vulgare Mill., seeds at different dose levels (50/ug, 150/ug and 250/ug/100gm body wt.) on mammary glands and oviducts of castrated rats was investigated. The extract was found to increase nucleic acids and protein concentration as well as the organ weights in both the tissues. The medium and high doses were very effective. The results confirm the estrogenic nature of the seed extract.

Pilomatrixoma of Male Breast

Pilomatrixoma is an uncommon tumour,of the skin and is characterised by transition of b@philic ceffs into shadow ceus. The, present cas6" described here because of certain unusual features namely origin from the male breast, production of hair within the tumour and associaion with mfiltr ductcarcinomaafin of the breast.