Thoracolumbar fracture-dislocation in a two-year-old female child following child abuse: A case report and literature review

Child abuse is a matter of serious concern that can often result in devastating injuries. Incidence of spinal injuries from child abuse has been reported in <1-3 % of spinal injury cases. In the present study, a case of thoracolumbar translational injury (AO type C) is presented following an incidence of child abuse in a 2-year-old female. After successful management with operative fixation, the child showed a remarkable recovery in her neurological function with ambulatory power.

Telerehabilitation is as effective as outpatient visits in the management of early osteoarthritis knee and mechanical low backache

PURPOSE

Teleconsultation services can be used to overcome the barriers imposed by the Covid-19 pandemic in providing basic orthopaedic rehabilitation services. Aim of the study is to compare the effectiveness of rehabilitation provided via outpatient and teleconsultation in patients with mechanical low backache (LBA) and early osteoarthritis (OA) of the knee joint utilizing Patient-Reported Outcome Measures. The satisfaction level of patients receiving teleconsultation will also be assessed.

METHODOLOGY

This study was a hospital-based prospective observational study. The study's participants were divided into two groups (Outpatient and Teleconsultation, respectively), and each group was further divided into two subgroups of 100 participants each (Knee-pain subgroup 1; LBA subgroup 2). SF-12 questionnaire, visual analogue scale (VAS) score for pain, and functional outcome scores (KOOS score for knee pain and the modified Oswestry Disability Index-MODI for LBA) were assessed at initial presentation and 6 months follow-up. Participants' satisfaction for teleconsultation service was assessed at final follow-up by 5 points Likert scale (5, very satisfied; 1, very dissatisfied).

RESULTS

Mean consultation time was significantly longer in the outpatient group (p < 0.001). No statistically significant difference in the VAS score, KOOS score (58.0 ± 7.6 vs. 57.8 ± 9.2; p = 0.893), and MODI Score (24.7 ± 13.3 vs. 27.4 ± 12.4; p = 0.128) between the corresponding subgroups of the two groups at final follow-up. Eighty-seven percentage of the participants were satisfied (Likert score ≥ 4) with the teleconsultation services.

CONCLUSION

Teleconsultation is equally effective to that as face-to-face outpatient consultation in the rehabilitation of patients with early OA knee and mechanical LBA.

LEVEL OF STUDY

Level 2, Prospective comparative study.

A Prospective Comparative Study of 3-Stitch Mesh Hernioplasty with Conventional Lichtenstein Repair

Background

Hernioplasty, in which a mesh is used to strengthen a weakness or defect in the inguinal wall, has replaced simple tissue repair. As it is associated with low recurrence, it is considered the gold standard and is one of the most common general surgical procedures. The ideal repair should be rapid, safe and simple to do, requires minimal dissection to create sufficient space, be cost-effective and be accompanied by a brief hospital stay, reduced pain, and fewer recurrences. The aim of the present study was to compare the efficacy of 3-stitch mesh fixation with that of traditional Lichtenstein mesh fixation of inguinal hernia repair.

Materials and Methods

Between July 2018 and December 2019, 59 cases of primary, uncomplicated inguinal hernias were surgically treated. Both the classical Lichtenstein technique (group A, n = 30) and the Lichtenstein technique with the three-stitch fixation method (group B, n = 29) were used on patients with inguinal hernias. Between the two groups, the mean operative times, post-surgical pain scores, average hospital stays and postoperative complications including recurrence rates were compared.

Results

With a P-value of 0.001, the 3-point fixation group (group B) took 3.41 ± 0.58 min less time to fix the mesh than the Lichtenstein group (group A, 5.52 ± 0.59 min). The pain after surgery was much less for participants who had 3-point mesh fixation than for those who had conventional mesh fixation in the early (1, 3, 7 and 15 days after surgery) and late (1 month and 3 months) postoperative periods, with a P-value of 0.0001. When compared to the classical mesh fixation group, the 3-point mesh fixation group had less urinary retention, seroma and swelling. Both groups had the same number of other complications.

Conclusions

The three-point hernioplasty is a simple procedure that is easier to adopt, less time-consuming, causes less trauma and has a lower risk of postoperative discomfort including chronic groin pain.

Arid/semi-arid flora as a treasure trove of bioactives and bioenergy: the case for underutilized desert legumes towards environmental sustainability

As the spectre of climate change gains in strength with each passing moment, many of our mundane food crops like rice face the heat, leading to uncertain yields and unforeseen disease outbreaks. Subsequently, mankind is forced to look for alternative food choices that should primarily come from indigenous plants that are less demanding in terms of usage of water and application of chemical-based fertilizers/pesticides. There are plants growing in the wild in the arid and semi-arid zones of Rajasthan, India, that can come to the rescue, with an added potential for development into valuable functional foods-i.e., not only as source of carbohydrates, proteins, and micro-nutrients but also that of health benefiting nutraceuticals (like antioxidant flavonoids) and relevant enzymes. The other parts (non-edible) of these plants have often also been traditionally validated via diverse ethnomedicinal practices; these could also be useful bioenergy sources. Keeping in mind the broader aim of looking at future functional foods that are also required to be environmentally sustainable, the current report: (a) reviews the extant literature on underutilized legumes from arid/semi-arid zones, (b) discusses current status with respect to biological activities present therein, and (c) suggests pertinent research questions and solution paths in the domains of bioactives, bioenergy, and sustainable environment.

Nature-inspired Enzyme engineering and sustainable catalysis: biochemical clues from the world of plants and extremophiles

The use of enzymes to accelerate chemical reactions for the synthesis of industrially important products is rapidly gaining popularity. Biocatalysis is an environment-friendly approach as it not only uses non-toxic, biodegradable, and renewable raw materials but also helps to reduce waste generation. In this context, enzymes from organisms living in extreme conditions (extremozymes) have been studied extensively and used in industries (food and pharmaceutical), agriculture, and molecular biology, as they are adapted to catalyze reactions withstanding harsh environmental conditions. Enzyme engineering plays a key role in integrating the structure-function insights from reference enzymes and their utilization for developing improvised catalysts. It helps to transform the enzymes to enhance their activity, stability, substrates-specificity, and substrate-versatility by suitably modifying enzyme structure, thereby creating new variants of the enzyme with improved physical and chemical properties. Here, we have illustrated the relatively less-tapped potentials of plant enzymes in general and their sub-class of extremozymes for industrial applications. Plants are exposed to a wide range of abiotic and biotic stresses due to their sessile nature, for which they have developed various mechanisms, including the production of stress-response enzymes. While extremozymes from microorganisms have been extensively studied, there are clear indications that plants and algae also produce extremophilic enzymes as their survival strategy, which may find industrial applications. Typical plant enzymes, such as ascorbate peroxidase, papain, carbonic anhydrase, glycoside hydrolases and others have been examined in this review with respect to their stress-tolerant features and further improvement via enzyme engineering. Some rare instances of plant-derived enzymes that point to greater exploration for industrial use have also been presented here. The overall implication is to utilize biochemical clues from the plant-based enzymes for robust, efficient, and substrate/reaction conditions-versatile scaffolds or reference leads for enzyme engineering.

Targeting lipid-sensing nuclear receptors PPAR (α, γ, β/δ): HTVS and molecular docking/dynamics analysis of pharmacological ligands as potential pan-PPAR agonists

The global prevalence of obesity-related systemic disorders, including non-alcoholic fatty liver disease (NAFLD), and cancers are rapidly rising. Several of these disorders involve peroxisome proliferator-activated receptors (PPARs) as one of the key cell signaling pathways. PPARs are nuclear receptors that play a central role in lipid metabolism and glucose homeostasis. They can activate or suppress the genes responsible for inflammation, adipogenesis, and energy balance, making them promising therapeutic targets for treating metabolic disorders. In this study, an attempt has been made to screen novel PPAR pan-agonists from the ZINC database targeting the three PPAR family of receptors (α, γ, β/δ), using molecular docking and molecular dynamics (MD) simulations. The top scoring five ligands with strong binding affinity against all the three PPAR isoforms were eprosartan, canagliflozin, pralatrexate, sacubitril, olaparib. The ADMET analysis was performed to assess the pharmacokinetic profile of the top 5 molecules. On the basis of ADMET analysis, the top ligand was subjected to MD simulations, and compared with lanifibranor (reference PPAR pan-agonist). Comparatively, the top-scoring ligand showed better protein-ligand complex (PLC) stability with all the PPARs (α, γ, β/δ). When experimentally tested in in vitro cell culture model of NAFLD, eprosartan showed dose dependent decrease in lipid accumulation and oxidative damage. These outcomes suggest potential PPAR pan-agonist molecules for further experimental validation and pharmacological development, towards treatment of PPAR-mediated metabolic disorders.

Nutraceutical and flavor profiles in underutilized desert legumes of India: gene editing strategies towards sustainable food development

Climate change has posed a challenge for food security all over the world in the form of fluctuating crop yields and novel disease outbreaks in plants. Human society's overdependence on a few food crops does not seem a wise precedence. There are numerous underutilized/orphan/neglected legumes growing in the Indian desert regions that can come to the rescue and act as balanced and sustainable sources of nutrients and health-benefitting nutraceuticals. However, challenges such as low plant yield, unidentified metabolic pathways and off-flavor in the food products derived from them prevent the realization of their full potential. Conventional breeding techniques are too slow to achieve the desired modifications and cater to the sharply rising demand for functional foods. The novel gene editing tools like CRISPR-Cas provide more precise tool to manipulate the target genes with or without introduction of foreign DNA and therefore, have better chances to be accepted by governments and societies. The current article reports some of the relevant 'gene editing' success stories with respect to nutraceutical and flavor profiles in the popular legumes. It highlights gaps and future potential, along with areas requiring caution, in underutilized edible legumes of the Indian (semi) arid regions like Prosopis cineraria, Acacia senegal and Cyamopsis tetragonoloba.

Friction reducing ability of a poly-l-lysine and dopamine modified hyaluronan coating for polycaprolactone cartilage resurfacing implants

Frictional properties of cartilage resurfacing implants should be sufficiently low to limit damaging of the opposing cartilage during articulation. The present study determines if native lubricious molecule proteoglycan 4 (PRG4) can adsorb onto a layer-by-layer bioinspired coating composed of poly-l-lysine (PLL) and dopamine modified hyaluronic acid (HADN) and thereby can reduce the friction between implant and articular cartilage. An ELISA was developed to quantify the amount of immobilized human recombinant (rh)PRG4 after exposure to the PLL-HADN coating. The effect on lubrication was evaluated by comparing the coefficient of friction (CoF) of bare polycaprolactone (PCL) disks to that of PLL-HADN coated PCL disks while articulated against cartilage using a ring-on-disk geometry and a lubricant solution consisting of native synovial fluid components including rhPRG4. The PLL-HADN coating effectively immobilized rhPRG4. The surface roughness of PCL disks significantly increased while the water contact angle significantly decreased after application of the coating. The average CoF measured during the first minute of bare PCL against cartilage exceeded twice the CoF of the PLL-HADN coated PCL against cartilage. After 60 min, the CoF reached equilibrium values which were still significantly higher for bare PCL compared to coated PCL. The present study demonstrated that PCL can effectively be coated with PLL-HADN. Additionally, this coating reduces the friction between PCL and cartilage when a PRG4-rich lubricant is used, similar to the lubricating surface of native cartilage. This makes PLL-HADN coating a promising application to improve the clinical success of PCL-based cartilage resurfacing implants.

Investigating the antioxidant activity enhancer effect of Cyamopsis tetragonoloba seed extract on phenolic phytochemicals

INTRODUCTION

Phenolic phytochemicals are known for antioxidant-mediated pharmacological effects in various diseases (diabetes, cancer, CVDs, obesity, inflammatory and neurodegenerative disorders). However, individual compounds may not exert the same biological potency as in combination with other phytochemicals. Cyamopsis tetragonoloba (Guar), an underutilized semi-arid legume which has been used as a traditional food in Rajasthan (India), is also a source of the important industrial product guar gum. However, studies on its biological activity, like antioxidant, are limited.

METHODS

We tested the effect of C. tetragonoloba seed extract to enhance the antioxidant activity of well-known dietary flavonoids (quercetin, kaempferol, luteolin, myricetin, and catechin) and non-flavonoid phenolics (caffeic acid, ellagic acid, taxifolin, epigallocatechin gallate (EGCG), and chlorogenic acid) using DPPH radical scavenging assay. The most synergistic combination was further validated for its cytoprotective and anti-lipid peroxidative effects in in vitro cell culture system, at different concentrations of the extract. LC-MS analysis of purified guar extract was also performed.

RESULTS AND DISCUSSION

In most cases, we observed synergy at lower concentrations of the seed extract (0.5-1 mg/ml). The extract concentration of 0.5 mg/ml enhanced the antioxidant activity of Epigallocatechin gallate (20 µg/ml) by 2.07-folds, implicating its potential to act as an antioxidant activity enhancer. This synergistic seed extract-EGCG combination diminished the oxidative stress nearly by double-fold when compared with individual phytochemical treatments in in vitro cell culture. LC-MS analysis of the purified guar extract revealed some previously unreported metabolites, including catechin hydrate, myricetin-3-galactoside, gossypetin-8-glucoside, and puerarin (daidzein-8-C-glucoside) which possibly explains its antioxidant enhancer effect. The outcomes of this study could be used for development of effective nutraceutical/dietary supplements.

Electronically Tunable Memristor Emulator Implemented Using a Single Active Element and Its Application in Adaptive Learning

In recent times, much-coveted memristor emulators have found their use in a variety of applications such as neuromorphic computing, analog computations, signal processing, etc. Thus, a 100 MHz flux-controlled memristor emulator is proposed in this research brief. The proposed memristor emulator is designed using a single differential voltage current conveyor (DVCC), three PMOS transistors, and one capacitor. Among three PMOS transistors, two transistors are used to implement an active resistor, and one transistor is used as the multiplier required for the necessary memristive behaviors. Through simple adjustment of the switch, the proposed emulator can be operated in incremental as well as decremental configurations. The simulations are performed using a 180 nm technology node to validate the proposed design and are experimentally verified using AD844AN and CD4007 ICs. The memristor states of the proposed emulator are perfectly retained even in the absence of external stimuli, thereby ascertaining the non-volatility behavior. The robustness of the design is further analyzed using the PVT and Monte Carlo simulations, which suggest that the circuit operation is not hindered by the mismatch and process variations. A simple neuromorphic adaptive learning circuit based on the proposed memristor is also designed as an application.

Effective Topical Psoralen Herbal Hydrogel Expending Capsaicin as a Penetration Enhancer

Background:

This research aims to prepare a hydrogel of psoralen and capsaicin extract for topical application using various gelling agents like Carbopol 940, HPMC, Pluronic 127, and Pectin to minimize the side effect of synthetic drugs in treating psoriasis. Natural, synthetic, and semi-synthetic polymers were utilized for the treatment of psoriasis provide a number of benefits, including improved skin permeability, particularly for psoralen, and improved drug stability with improved therapeutic concentration gradients across the skin. Psoriasis is a T cell-mediated autoimmune disease affecting 2-3 % worldwide.

Methods:

FTIR and HPLC confirm the extract identification. pH, spreadability, homogeneity, extrudability, phase separation, viscosity, drug content, and stability analysis are all tested on all prepared hydrogels. The releases of psoralen from all prepared formulations are studied in phosphate buffer pH 6.8 using dialysis membranes at 37oC.

Results:

The net results conclude that hydrogels made using Carbopol-940 and HPMC (A1, A3, B2, B3) are the most superior and reliable formulations in terms of physicochemical parameters and in vitro permeation studies, out of which 1% carbopol 940 formulations (A3) showed maximum %CDR of 87.96 % much higher compared to other concentration used. Fitting data of the best formulations (A1, A3, B2, B3) obtained from in vitro drug permeation studies showed the release best fitted to the Korsmeyer-Peppas model as indicated by higher R2 value. The optimum formulation (A3) has a higher R2 value, which is then compared with the marketed formulation for the release of psoralen (in vitro), showings that %CDR of A3 formulation (87.96%) is much higher than the %CDR of the marketed formulation (79.58%), due to the impact of capsaicin which acts as a penetration enhancer and therefore increases psoralen release from the hydrogel.

Conclusion:

As a result, the permeability issue with Psoralen for dermal drug administration has been overcome by using capsaicin as permeability enhancer.

Prospective randomized comparison of bone transport versus Masquelet technique in infected gap nonunion of tibia

AIM

The present prospective randomized study compared the bone transport technique (BT) and Masquelet technique (MT) in the treatment of infected gap non-union of the tibia.

PATIENTS AND METHODS

Total 25 patients with infected gap non-union of the tibia with bone gap upto 6 cm were randomised into BT group (group I, 13 patients) and MT (group II, 12 patients). The mean age was 31.77 years in group I and 39.67 years in group II. The mean intra-operative bone gap was 3.92 cm in group I and 3.79 cm in group II. Monolateral fixator was applied in nine patients each in both groups, while four and three fractures were stabilized with ring fixators in group I and II, respectively. Mean follow-up was 31.62 months and 30.42 months in group I and II, respectively. Bone and functional results were compared using the association for the study and application of the method of Ilizarov (ASAMI) criteria.

RESULTS

The average fixator period was 9.42 and 16.33 months in group I and II, respectively (p < 0.001). Union was achieved in 12 (92%) patients and 6 (50%) patients in group I and II, respectively. The functional results were excellent (eight and two), good (four and six), fair (zero and three) and poor (one and one) in group I and II respectively, (p 0.23). The Bone results were excellent, good and poor in nine, three and one patients in group I, and three, three and six patients in group II respectively, (p 0.109).

CONCLUSIONS

The functional and bone results were comparable but more reliable in bone transport than the Masquelet technique. The fixator duration and incidence of non-union were higher in MT group. Ilizarov bone transport technique should be preferred in infected non-union of the tibia with bone loss upto 6 cm.

An Investigation of Insulinotropic Potential of Herbal Plants for Management of Diabetes

The Insulinotropic hormone glucagon-like peptide-1, which has been proposed as a modern treatment for management of diabetes, is metabolized extremely with the aid of dipeptidyl peptidase-IV. Inhibitors on dipeptidyl peptidase-IV enhance the level of glucagon-like peptide-1, as have elevated glucose tolerance and improved insulin secretion. Recently, incretin-based treatments have end up a beneficial tool to treat diabetic patients, and distinctive research have focused on the identification of glucagon-like peptide-1 receptor agonists, which includes these of herbal origin. Aims: This study was aimed to explorations the effect of methanolic extract of plants to inhibit dipeptidyl peptidase-IV and comparing its inhibitory activities with Diprotin, as a reference standard additionally, this study focuses to the influences of glucagon-like peptide-1secretions which accelerated glucose tolerance and provocation of insulin biosynthesis and secretion on STC-1 cell line. Study Design: In-vitro model. Place and Duration of Study: Department of pharmacology, Karnataka College of pharmacy, Bangalore, India, between Jan 2022 to April 2022. Methodology: The test drug undertaking of different medicinal plants extract of management over diabetes right here we were the methanolic extraction of three plants; “Aegle marmelos, Moringa oleifera, then Syzygium cumini” have been tested in-vitro for dipeptidyl peptidase-IV inhibitory activity and have an impact on of incretin system like glucagon-like peptide-1. An in-vitro assay to measure glucagon-like peptide-1release from cultured murine EEC’s under fatty acid stimulation. dipeptidyl peptidase-IV is involved in the inactivation over glucagon-like peptide-1, a potent Insulinotropic peptide. Results: The current study underlines up to expectation the extracts inhibits the dipeptidyl peptidase-IV and enhances the glucagon-like peptide-1for diabetes. Results established so the extracts on Aegle marmelos, Moringa oleifera, and Syzygium cumini had dipeptidyl peptidase-IV inhibitory activity on 42.57μg/mL, 42.38/mL, and then 41.48μg/mL respectively. Diprotin A confirmed an IC50 virtue on 29.83μg/mL, as is used as positive controls. Similarly, the study additionally demonstrates that on a cellular level of Aegle marmelos, Syzygium cumini potentially stimulate glucagon-like peptide-1secretion, however Moringa oleifera indicate decent rises into glucagon-like peptide-1secretion. Conclusion: The outcomes assure the inhibitory impact about plants regarding dipeptidyl peptidase-IV, glucagon-like peptide-1secretion, and the main in conformity with stand a novel, efficient and fair strategy for the management on diabetes.

Meta-QTLs for multiple disease resistance involving three rusts in common wheat (Triticum aestivum L.)

In wheat, multiple disease resistance meta-QTLs (MDR-MQTLs) and underlying candidate genes for the three rusts were identified which may prove useful for development of resistant cultivars. Rust diseases in wheat are a major threat to global food security. Therefore, development of multiple disease-resistant cultivars (resistant to all three rusts) is a major goal in all wheat breeding programs worldwide. In the present study, meta-QTLs and candidate genes for multiple disease resistance (MDR) involving all three rusts were identified using 152 individual QTL mapping studies for resistance to leaf rust (LR), stem rust (SR), and yellow rust (YR). From these 152 studies, a total of 1,146 QTLs for resistance to three rusts were retrieved, which included 368 QTLs for LR, 291 QTLs for SR, and 487 QTLs for YR. Of these 1,146 QTLs, only 718 QTLs could be projected onto the consensus map saturated with 2, 34,619 markers. Meta-analysis of the projected QTLs resulted in the identification of 86 MQTLs, which included 71 MDR-MQTLs. Ten of these MDR-MQTLs were referred to as the 'Breeders' MQTLs'. Seventy-eight of the 86 MQTLs could also be anchored to the physical map of the wheat genome, and 54 MQTLs were validated by marker-trait associations identified during earlier genome-wide association studies. Twenty MQTLs (including 17 MDR-MQTLs) identified in the present study were co-localized with 44 known R genes. In silico expression analysis allowed identification of several differentially expressed candidate genes (DECGs) encoding proteins carrying different domains including the following: NBS-LRR, WRKY domains, F-box domains, sugar transporters, transferases, etc. The introgression of these MDR loci into high-yielding cultivars should prove useful for developing high yielding cultivars with resistance to all the three rusts.

Outcome of monolateral rail fixator in infected nonunion of femur diaphysis developing after intramedullary fixation

INTRODUCTION

Consensus is lacking regarding management of posttraumatic infected diaphyseal nonunions of femur following intramedullary nailing. Present study reports outcomes of single stage standardised treatment protocol using monolateral rail external fixator/limb reconstruction system in this type of infected diaphyseal femoral nonunions.

METHODS

This retrospective study included 26 patients with mean age of 31.7 years having posttraumatic infected diaphyseal femoral nonunions following intramedullary nailing and managed with radical debridement and monolateral rail fixator. The results were assessed by Association for the Study and Application of the Method of Ilizarov criteria.

RESULTS

Mean intraoperative bone gap was 4.34 (range, 2-7) cm. Mean gain in bone length was 4.04 (range, 0-7) cm. Fracture united primarily in 22 cases and after freshening of edges, fixator adjustment and fibular grafting in three more patients. Infection persisted in one patient. Most common complications were superficial pin tract infection (15 patients) and loss of more than 30° knee flexion (13 patients). The bone results were excellent, good, and poor in 15, 9, and 2 patients, respectively. The functional results were excellent, good, fair, and poor in 11,13,1 and 1 patient, respectively.

CONCLUSION

Single stage procedure including radical debridement, acute docking, distraction osteogenesis at corticotomy site and stabilization with monolateral rail fixator reliably achieves good to excellent bone and functional results, union and eradication of infection in majority of infected nonunions of femoral diaphysis developing after intramedullary fixation. We recommend acute docking in bone gap ≤ 5 cm.

Thermal Study of 155 mm Gun Barrel

Thermal analysis of 155 Gun barrel is an important aspect of designing the gun barrel and deciding the maximum firing rate. The performance of any artillery depends upon the thermal behaviour of the gun barrel among various factors, and its availability for continuous firing depends on the maximum bore temperature and cook-off time of the barrel. In this paper, the effect of maximum bore temperature, cook-off, active cooling is reviewed. Heat transfer to the gun barrel surface is calculated using analytical analysis with given ammunition parameters. Analytical and finite element analysis of maximum bore temperature and cook-off time is also included. Finite element analysis of external Jacket water cooling of the barrel shows that the gun can fire continuously at three rounds per minute without reaching cook-off temperature.

Artificial Intelligence in Pharmacovigilance and COVID-19

The history of pharmacovigilance started back 169 years ago with the death of a 15- year-old girl, Hannah greener. However, the Thalidomide incident of 1961 brought a sharp change in the pharmacovigilance process, with adverse drug reaction reporting being systematic, spontaneous, and regulated timely. Therefore, continuous monitoring of marketed drugs was essential to ensure the safety of public health. Any observed adverse drug reaction detected by signals was to be reported by the health profession. Moreover, signal detection became the primary goal of pharmacovigilance based on reported cases. Among various methods used for signal detection, the Spontaneous Reporting System was most widely preferred; although, it had the limitation of "under- reporting". Gradually, the World Health Organization collaborating centre and "Uppsala Monitoring Centre" were established in 1978 for international monitoring of drugs. The centre was responsible for operating various databases like vigiflow, vigibase, vigilyze, and vigiaccess. Recently, huge data could be generated through spontaneous reporting linked with computational methods, such as Bayesian Framework, E-Synthesis. Furthermore, drug safety surveillance at an early stage prior to the official alerts or regulatory changes was made possible through social media. In addition, India created a National Pharmacovigilance Program, and Schedule Y of the Drug and Cosmetic Act 1945 was reviewed and amended in 2005. The collaboration of Information Technology and Pharmaceutical Company can further enhance the awareness regarding artificial intelligence in pharmacovigilance, which was in its infancy until 2017. Artificial intelligence helps improve the quality and accuracy of information much quickly.

Clinical Profile and Prevalence of H Pylori, Iga-Ttg, and Spectrum of Duodenal Abnormalities in Non Ulcer Dyspepsia

The Rome IV criterion for a diagnosis of NUD is chronic or recurrent epigastric pain within the last 3 months and an onset of symptoms at least 6 months prior to presentation. The term functional Dyspepsia and idiopathic dyspepsia are often used as well. Symptoms include ulcer-like dyspepsia; gastroparetic-like (nausea, early satiety, and post-prandial pain), and undifferentiated. Pathogenesis of NUD is not completely known yet. Several mechanisms have been proposed to be responsible for these symptoms. Although there is strong evidence of an association between H. pylori infection and NUD, Celiac Disease and NUD. Being a tropical country, the prevalence of infections is parasitic cause. Dyspepsia is likely to be more in India. However, the present data from India as scares in literature. Hence the present study was planned to decipher the clinical profile, prevalence of H. pylori, IgA tTG, spectrum of duodenal biopsy abnormalities in NUD patients.

MATERIAL

This Descriptive Observational study was carried out in the Gastro Enterology center in GOI research institute from August 2020 to March 2021. Initially, 200 dyspepsia patients were selected. 50 patients were excluded due to various reasons. Finally, 150 patients who met the Rome 4 criteria for NUD/Functional Dyspepsia were recruited. The inclusion criteria were patients above 18 years of age, dyspepsia for &gt;/- 6 months, and no evidence of underlying malignancy, pan gastritis, previous gastric ulcers, and pancreatitis. The patients underwent routine blood investigations like haemogram and biochemistry, Rapid Urease Test (RUT), Upper Gastro-Intestinal Endoscopy, Duodenal Biopsy, and Serum IgA-tTG antibody.

OBSERVATION

The mean age was 46.3 yrs. +/- 14.12 yrs, of which 49.3% were females and 50.70% were males. The prevalence of Epigastric Pain Syndrome (EPS) was found in 37.3%, Post Prandial Distress Syndrome (PDS) in 30.7%, and 32% had both EPS+PDS. 38% of the NUD patients were positive on Rapid Urease Test (RUT) suggesting H. pylori infection. 88.7% of NUD patients were IgA-tTG antibody negative and 11.3% serologically positive. The Duodenal biopsy was normal in 48% of patients, 21.3% had mild inflammation/duodenitis, 8% chronic duodenitis and 22.7% had various grades of Celiac Disease (as per Marsh Grading). These 22.7% showing evidence of Celiac Disease on histopathological examination showed Marsh Grade 1 in 12.7%, Grade-2 in 2%, Grade 3A in 6.7%, and Grade 3B in 1.3%. Only 17.6% of biopsy positive had IgA-tTG antibody positivity but only 4% of total cases were positive for both biopsy and IgA-tTG antibody (p-value 0.05). Eosinophilic infiltration in duodenum common in NUD patients. It was observed that 17.33% (26/150) NUD patients had duodenal eosinophilia. Further, look for the association of duodenal eosinophilia with various diseases. 33.33% (19/57) H. pylori patients had duodenal eosinophilia with p-value &lt; 0.001. It was also observed that 7.52% (7/93) others like normal individual, Chronic duodenitis, mild inflammation/ duodenitis had Duodenal eosinophilia.

CONCLUSION

The prevalence of H. pylori and IgA-tTG antibodies in non-ulcer dyspepsia patients was 38% and 11.3% respectively. The spectrum of Duodenum biopsy abnormalities in NUD patients included mild inflammation/ duodenitis, Chronic duodenitis, and Celiac Disease. 22.7% of NUD patients had various degrees of celiac disease morphology on D2 biopsy and only 17.6% of these biopsy positive patients were positive for IgA-tTG. Only 4% of total NUD patients were positive for both biopsy and IgA-tTG antibody labeled as Celiac Disease (CeD). There is a significant association between H. pylori and duodenal eosinophilia.

Desert legume Prosopis cineraria as a novel source of antioxidant flavonoids / isoflavonoids: Biochemical characterization of edible pods for potential functional food development

Flavonoids and isoflavonoids in foods are attracting attention as they are significant antioxidant and phytoestrogenic compounds that are beneficial for human health. In this study, the edible pods of the underutilized desert legume Prosopis cineraria from Rajasthan, India were used to extract flavonoids. The pods from semi-arid zone showed the highest flavonoid content (432 mg Rutin hydrate/gm). UV spectrophotometric analysis was also done to characterize flavonoids. The flavonoids and isoflavonoids were further purified from semi-arid zone plants using column chromatography with Amberlite XAD7HP and Sephadex LH-20. LC-MS analysis revealed the presence of medicinally valuable antioxidant flavonoids and isoflavonoids in the pods, viz. vitexin, puerarin, phloridzin, and daidzein. It was seen that the flavonoids/isoflavonoids are present in the selected legume in different forms i.e. pure aglycone, C-glycoside as well as O-glycoside. This finding makes P. cineraria an attractive source candidate for extraction of these nutraceuticals with a potential for development into functional food.

•

Phytochemical studies were carried out on Prosopis cineraria, Indian desert's edible legume.

•

Pods from P. cineraria growing in the semi-arid zone showed maximum flavonoid content.

•

The flavonoids were purified using Amberlite XAD7HP and Sephadex LH-20 chromatography.

•

LC-MS indicated flavonoids (vitexin, phloridzin) and isoflavonoids (puerarin, daidzein).

•

The study highlights the potential of P. cineraria pods as novel antioxidant-rich functional food.

Anti-Type I Diabetic Activity of the Methanolic Extract of Aegle marmelos on Streptozotocin Induced Rat Model

Aegle marmelos, generally acknowledged as Bael, is being ancient in Ayurveda for the therapy of a number of disorders. All the components on it tree along with stem, bark, root, leaves, fruit and seeds at all stages of maturity have medicinal virtues and have been recorded in Ethno-medicine. Aims: The present investigation study the Anti-Type I diabetic activity of the methanolic extract of Aegle marmelos on STZ induced rat model. Study Design: In-vivo study in rat model Place and Duration of Study: Department of Pharmacology, Karnataka college of Pharmacy, Bangalore, India, between Jan 2021 to Dec 2021. Methodology: Extracted Aegle marmelos was to be evaluated the toxicity as per the OECD guidelines and biochemical, hematological and gross pathological analysis has been assessed. Type I Diabetes has been induced in Wistar rats through STZ 65mg/kg/b.w. I.P. During the experiment, Rat’s BW and FBS level were monitored. At the end of study, animals among all groups namely Group I: Normal control, Group II: STZ 65mg/kg, Group III: STZ + Insulin 4Ukg/b.w., Group IV: Aegle marmelos 250mg/kg and Group V: Aegle marmelos 500mg/kg were sacrificed and biochemical parameters like Lipid profile, C-Peptide, HbA1c, Serum insulin, pancreatic insulin, and histology of pancreas had been observed. Aegle marmelos was also screened for pro-inflammatory cytokines viz., IL-1β, IL-6 and TNF-α were assessed by ELISA test. Furthermore, Antioxidant Enzyme like SOD, CAT, LPO and GSH were performed. Results: The observed extract Aegle marmelos was shown safe in the toxicity data; B.W, Lipid Profile, RFT, LFT, hematological parameters were shown in the limit range and the vital organ tissue histology were not shown any anatomical and structural abnormalities. The findings of the other parameters have been shown significant impact in vivo to manage the diabetic markers like weight gain, blood glucose, lipid profile, C-Peptide, HbA1c, secretion of insulin, and pancreatic insulin. Diabetic pancreas of rats confirmed fall of beta cell density and disruption of normal architecture. But treated group were found to restore the mass of beta cells. Mediator of inflammatory cytokines like increased in STZ group and was inhibited by test chemicals. Elevated oxidative enzymes also have been seen to control upon the treatment with Aegle marmelos. Conclusion: All this findings and phytoconstituents present within the extract should be the possible chemical substances concerned in the prevention of diabetes.

Evaluation of functional outcome and comparison of three different surgical modalities for management of intertrochanteric fractures in elderly population

INTRODUCTION

The purpose of this study was to compare the role of the various surgical modalities ie, Hemiarthroplasty (HA), Dynamic Hip Screw (DHS), Cephalo-medullary nail (CMN) in the management of intertrochanteric fractures in elder patients with comparison of the results and assessment of the complications encountered with each method.

METHODS

Total 105 adult patients having intertrochanteric fractures managed during July 2013 to December 2018 at tertiary trauma care centre and followed for minimum 12 months were included in the study. Patients were divided into three groups. Primary hemiarthroplasty was done in 35 patients (group A) while DHS and PFN was done in 35 patients each in group B and group C respectively. Functional evaluation was done using Modified Harris Hip score (HHS) at different intervals while ambulatory function was measured using the Parker Mobility Score.

RESULTS

The mean age of patients was 72.14±2.9 years. Mean operative time and blood loss in group A was significantly higher than the other two groups. Hemiarthroplasty group could ambulate earlier than DHS/PFN group. Mean HHS at final follow up was 85.40±7 in group A while in group B and group C these values were 76.36±16.45 and 86.85±10.52 respectively. HHS was significantly higher (P, 0.01) in hemiarthroplasty group in comparison to DHS group. Post-operative complications were comparable in all the groups.

CONCLUSION

We support the use of hemiarthroplasty for unstable intertrochanteric fracture in elderly patients with lesser failure rates, early mobilization and better functional outcomes. Early mobilization and less hospital stay should be the goal of every surgical procedure in the elder population.

Physical Characterization and In Vitro Evaluation of Dissolution Rate from Cefpodoxime Proxetil Loaded Self Solidifying Solid SNEDDS

BACKGROUND

Cefpodoxime Proxetil (CPD) is a broad-spectrum cephalosporin indicated in respiratory and urinary tract infections. CPD is a BCS class IV drug with pH-dependent solubility and has poor bioavailability. This study investigated the challenges of developing ternary components based on solid SNEDDS of CPD for in vitro dissolution rate enhancement and self-solidifying behaviour.

METHODS

Tween 80, Transcutol and PEG6000 were employed as surfactants, solvents and solidifiers for a base of ternary components to develop self-solidifying solid SNEDDS, respectively. Ternary phase diagrams were used to characterize solidifying behaviour of ternary components in different proportions. S-SNEDDS formulations were drawn on the solidification areas available in the phase diagram and characterized for IR, XRD, DSC and in vitro drug release in various pH media.

RESULTS

Ternary components for the preparation of self-solidifying solid SNEDDS were selected based on drug solubility. FTIR and DSC characterization studies ruled out any drug interaction between CPD and components chosen to prepare S-SNEDDS. CPD was transformed from a crystalline into an amorphous state in ternary dispersions as revealed from XRD data. Optimized formulation (S-S 1) demonstrated more than 95% of drug release irrespective of the pH environments of the medium. Calculation of dissolution efficiency and similarity factors indicate that S SNEDDS resulted in a higher drug dissolution rate over binary dispersion (p<0.01). The stability studies showed that the S SNEDDS were stable in performances and CPD assay.

CONCLUSION

The present investigation provides an alternative approach for enhancing the CPD dissolution rate using self-solidifying solid SNEDDS exhibited solidification behaviour at ambient temperature conditions and drug loading, which could be exploited over conventional dosage form.

Conceptualizing a novel Hybrid Decontamination System (HDS) based on UV/H2O2 treatment for the enhanced decontamination and reuse of N95 FFRs

The ongoing Pandemic of COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has severely stressed the worldwide healthcare system and has created dangerous shortages of personal protective equipment (PPE) including N95 filtering facepiece respirators (FFRs). Even though suppliers struggled to meet global demand for N95 masks at an unprecedented level, a shortage of FFR appears as a significant factor in the transmission of the disease to frontline workers. CDC, USA has mentioned that FFR decontamination and reuse may be necessary during times of shortage to ensure guaranteed availability. Hence present stressed condition faced by the healthcare sector seeks for an affordable decontamination strategy that can be replicated easily broadening the utility of FFR decontamination across a range of healthcare settings. After reviewing available literature on the various disinfection techniques that may be used for the decontamination of FFRs, a first of its kind, portable Hybrid Decontamination System/procedure has been conceptualized and designed. This system combines the disinfecting properties of both vaporous hydrogen peroxide (VHP) and ultra-violet C irradiation (UV C) to ensure maximum decontamination of N95 respirators. The instrument will be equipped with a hydrogen peroxide chamber and UV light source. Sterilization of the FFRs will be done through treatment with VHP followed by UV light treatment. The proposed system will allow the user to completely sterilize the FFRs in a time-efficient manner.

Comparative evaluation and analysis of outcomes in non-idiopathic and idiopathic clubfeet with Ponseti method at a tertiary care centre of a developing country

BACKGROUND

Idiopathic clubfoot (congenital talipes equinovarus, CTEV) is being managed worldwide by Ponseti method with high success rates, while for non-idiopathic clubfoot surgical interventions is being widely used with variable results. This study evaluated the effectiveness of Ponseti method in non-idiopathic clubfoot and compared the results with idiopathic clubfoot.

METHODS

The paper evaluated the epidemiological incidence and demographic profile of non-idiopathic clubfoot in a tertiary centre of developing country. A total of 108 subjects with 85 having idiopathic (group I;125 feet) and 23 having non-idiopathic variety (group II;34 feet) were managed with Ponseti method and were followed for a mean duration of 38.33 (12-62) and 36.27 months (12-58) in group I and II respectively. The most common associations were meningomyelocele (MMC/spina bifida,5), arthrogryposis multiplex congenita (AMC,4), developmental dysplasia of hip (DDH,3) and Down's syndrome and amniotic band syndrome (2 each).

RESULTS

Primary correction was achieved in both the groups in 98% and 87% in group I and II respectively, while recurrences of at least one deformity was observed in 11 (9%) and 12 (40%) feet in group I and II respectively. Favourable outcomes were noticed in 22 (65%) feet in non-idiopathic group and 12 feet (35%) underwent extensive soft tissue release as compared to 3 feet (2.4%) in idiopathic variety.

CONCLUSION

Deformities improved significantly in non-idiopathic clubfeet with Ponseti methods although complete correction was not possible. Extensive surgical interventions were reduced in up to 35% feet in non-idiopathic variety and hence, it is recommended as primary treatment for all variety of clubfeet, irrespective of their etiology.

Intraosseous Lipoma of the Calcaneum

Lipomas are benign lesions of adipose tissue, which commonly affect the soft tissues but are rarely found in the musculoskeletal system. Intraosseous lipomas are rare benign tumors and even rarer in calcaneum, only to be found incidentally in the majority of cases. We report a case of a 45-year-old male patient who presented to the outpatient department with complaints of bilateral heel pain, which was initially treated conservatively as the presentation was similar to plantar fasciitis. On further follow-up, a plain radiograph of the ankles was taken, which showed a lytic lesion of the calcaneum with mild sclerotic margins on the right side with normal left foot radiographs. On magnetic resonance imaging, the lytic lesion demonstrated hyperintense signals on T1-weighted sagittal images, characteristic of fatty tissue, which helped us in arriving at the diagnosis of an intraosseous lipoma. The patient was treated by conservative means with physiotherapy, which relieved the pain, and on serial follow-ups, the lesion was found non-progressive on successive radiological evaluation. The differential diagnosis of such an entity includes plantar fasciitis, tumors such as an aneurysmal bone cyst, bone infarct, etc. With the increasing use of magnetic resonance imaging and computed tomography scans, physicians should be aware of the possibility of an intraosseous lipoma of the calcaneum, which should be ruled out during evaluation. Although possible, malignant pathology or aggressive transformation of such lesions is very rare; however, the lesion should be evaluated adequately and managed by surgical means in cases non-responsive to various conservative modalities.

Comparative analysis of antioxidant and antiproliferative activities of crude and purified flavonoid enriched fractions of pods/seeds of two desert legumes Prosopis cineraria and Cyamopsis tetragonoloba

Cyamopsis tetragonoloba and Prosopis cineraria are two legumes of the semi-arid region of Indian subcontinent which are unexplored with respect to their medicinal potential. Moreover, there is considerable lack in the comparative analysis of the biological properties of crude and enriched fractions obtained from the pods and seeds. Therefore, this study aims in investigating the effect of purification on the antioxidant and anticancerous activities of the extracts from the two legumes. This is the first study to purify an enriched methanolic fraction using Amberlite XAD7HP column chromatography followed by analysis using Thin Layer Chromatography. This matrix provided an economic and time efficient isolation of flavonoids and isoflavonoids from the seeds and pods of the above mentioned legumes. In addition, antioxidant activity carried out using DPPH assay showed that purification process did not contributed to enhanced antioxidant potential. However, inverse results were obtained during anticancerous activity assay on Huh-7 cell lines.

Straightplasty, a Limb Salvage Procedure in Malignant and Aggressive Bone Tumors of Lower Extremities: A Retrospective Analysis

Introduction The management of malignant bone tumors of lower extremities involves various modalities, which depend not only on local and systemic affection but are also affected by psychosocial factors. The purpose of this study was to evaluate functional and psychosocial outcomes in patients with non-salvageable lower limbs having malignant or aggressive benign bone tumors of distal thighs, who were treated with a technique called straightplasty. Material and methods We enrolled 20 patients of non-salvageable primary malignant or aggressive benign bone tumors around the knee. Out of these, 15 patients were followed and evaluated in view of functional and clinical outcomes having a minimum of 22 months of final follow-up. Results A total of 15 patients (8 males, 7 females) having a non-salvageable lower limb with a mean age of 20.53 years (range, 12 to 45 years), who were managed with straightplasty and followed for a mean duration of 31.73 months (range 22 to 72 months) were evaluated clinico-radiologically, and the functional outcomes were measured by Enneking' s method. The surgical procedure is simple and better in terms of functional outcomes than other procedures described in the literature, while it is observed as psychosocially more acceptable in developing nations, especially in the Indian context. Most of the parameters are comparable to rotationplasty and above-knee amputation, whereas it is less technically demanding and satisfying due to the straight limb rather than the rotated leg in rotationplasty. Conclusion We recommend straightplasty as an alternative to rotationplasty or above-knee amputation in patients having malignant or aggressive benign tumors around the knee joint and where limb salvage procedures are not feasible.

Optimization and Characterization of Brimonidine Tartrate Nanoparticles-loaded In Situ Gel for the Treatment of Glaucoma

Purposes: The present study aimed to develop brimonidine tartrate loaded poly(lactic-co-glycolic acid) acid vitamin E-tocopheryl polyethylene glycol 1000 succinate (BRT-PLGA-TPGS) nanoparticles in thermosensitivein situ gel to improve mucoadhensive properties and drug holding capacity for the better management of glaucoma.Methods: Nanoparticles was optimized by means of Box-Behnken Design (BBD). The formulations were prepared using various concentration of PLGA (0.1-0.4% w/v) and TPGS (0.3-0.5% w/v). The analytical data of fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC) and transmission electron microscopy (TEM) depicted the drug excipients compatibility and confirmed the nanoparticles. Nanoparticles incorporated gel was evaluated for transcorneal permeability, gelation time, gelling temperature, and rheological studies. In addition, in vitro, transcorneal permeation drug release studies and intraocular pressure (IOP) for optimized gel was also performed. Biocompatibility of formulations was investigated in rabbit model.Results: The drug loaded nanoparticles exhibited 115.72 ± 4.18 nm, 0.190 ± 0.02, -11.80 ± 2.24 mV and 74.85 ± 6.54% of mean size, polydispersity index (PDI), zeta potential and entrapment efficiency (% EE), respectively. As compared to marketed eye drop, the sustained and continuous release BRT release from Poloxamer-based in situ gel was 85.31 ± 3.51% till 24 h. The transcorneal steady-state flux (136.32 μg cm^-2 h^-1) of optimized in situ gel was approximately 3.5 times higher than marketed formulation (38.60 μg cm^-2 h^-1) flux at 4 h. The optimized formulation produces 3 fold greater influences on percentage reduction of IOP (34.46 ± 4.21%) than the marketed formulation (12.24 ± 2.90%) till 8 h.Conclusion: The incorporation of optimized BRT-PLGA-TPGS nanoparticles into a thermosensitivein situ gel matrix to improve precorneal residence time without causing eye irritation and also serve the sustained release of BRT through cornea for effective management of glaucoma.

Diaphyseal aneurysmal bone cysts (ABCs) of long bones in extremities: Analysis of surgical management and comparison with metaphyseal lesions

INTRODUCTION

Aneurysmal bone cysts (ABCs) are benign lesions of long bone metaphysis affecting mostly medullary region in younger age below 20 years of life. These may be originated rarely either in the cortex or in the superficial regions of diaphysis. The study highlighted the differences of diaphyseal lesions from the usual metaphyseal ones in view of their clinical, radiological and biological behavior and also discussed their management in brief.

MATERIAL AND METHODS

We reviewed a total of 84 aneurysmal bone cysts over the past fourteen years (2004-2017) and evaluated their surgical outcomes retrospectively. Total ten lesions were diaphyseal cortical in location (group I), while 74 lesions were conventional metaphyseal type (group II).

RESULTS

We observed that cortical ABCs were occurred commonly in diaphysis of femur, humerus, tibia and radius while presentation was at an older age than metaphyseal type. Radiographically these were eccentric lesion and more prone for pathological fractures than conventional type. These are differentiated radiographically from other benign lesions but also mimicking malignant conditions including low grade surface osteosarcoma and telangiectatic osteosarcoma while resemble similar to these on histopathological examination (HPE).

CONCLUSION

Biological behavior of cortical lesions does not differ significantly than conventional type but these are more prone for pathological fractures so these eccentric cortical ABC lesions should be treated with adequate internal fixation along with curettage and bone grafting. Although incidence of cortical or surface variety of ABCs is rare but surgeons might evaluate its severity in view of aggressive benign or malignant lesions of diaphysis.

Chemical and mechanical influence of root canal irrigation on biofilm removal from lateral morphological features of simulated root canals, dentine discs and dentinal tubules

Aim

To investigate the anti‐biofilm efficacy of irrigation using a simulated root canal model, the chemical effect of irrigants against biofilms grown on dentine discs and their impact on biofilm viscoelasticity, the efficacy of the irrigants in decontaminating infected dentinal tubules and the capacity of bacteria to regrow.

Methodology

Biofilm removal, viscoelastic analysis of remaining biofilms and bacterial viability were evaluated using a simulated root canal model with lateral morphological features, dentine discs and a dentinal tubule model, respectively. Experiments were conducted using a two‐phase irrigation protocol. Phase 1: a modified salt solution (RISA) and sodium hypochlorite (NaOCl) were used at a low flow rate to evaluate the chemical action of the irrigants. Ultrasonic activation (US) of a chemically inert solution (buffer) was used to evaluate the mechanical efficacy of irrigation. Phase 2: a final irrigation with buffer at a high flow rate was performed for all groups. Optical coherence tomography (OCT), low load compression testing (LLCT) and confocal scanning laser microscopy analysis were used in the different models. One‐way analysis of variance (anova) was performed for the OCT and LLCT analysis, whilst Kruskal–Wallis and Wilcoxon ranked tests for the dentinal tubule model.

Results

US and high flow rate removed significantly more biofilm from the artificial lateral canal. For biofilm removal from the artificial isthmus, no significant differences were found between the groups. Within‐group analysis revealed significant differences between the steps of the experiment, with the exception of NaOCl. For the dentine discs, no significant differences regarding biofilm removal and viscoelasticity were detected. In the dentinal tubule model, NaOCl exhibited the greatest anti‐biofilm efficacy.

Conclusions

The mechanical effect of irrigation is important for biofilm removal. An extra high flow irrigation rate resulted in greater biofilm removal than US in the artificial isthmus. The mechanical effect of US seemed to be more effective when the surface contact biofilm–irrigant was small. After the irrigation procedures, the remaining biofilm could survive after a 5‐day period. RISA and NaOCl seemed to alter post‐treatment remaining biofilms.

Biofilm removal from a simulated isthmus and lateral canal during syringe irrigation at various flow rates: a combined experimental and Computational Fluid Dynamics approach

Aim

(i) To quantify biofilm removal from a simulated isthmus and a lateral canal in an artificial root canal system during syringe irrigation with NaOCl at different concentrations and delivered at various flow rates (ii) to examine whether biofilm removal is further improved by a final high‐flow‐rate rinse with an inert irrigant following irrigation with NaOCl. (iii) to simulate the irrigant flow in these areas using a computer model (iv) to examine whether the irrigant velocity calculated by the computer model is correlated to biofilm removal.

Methodology

Ninety‐six artificial root canals with either a simulated isthmus or lateral canal were used. A dual‐species in vitro biofilm was formed in these areas using a Constant Depth Film Fermenter. NaOCl at various concentrations (2, 5 and 10%) or adhesion buffer (control) was delivered for 30 s by a syringe and an open‐ended needle at 0.033, 0.083, or 0.166 mL s⁻¹ or passively deposited in the main root canal (phase 1). All specimens were subsequently rinsed for 30 s with adhesion buffer at 0.166 mL s⁻¹ (phase 2). The biofilm was scanned by Optical Coherence Tomography to determine the percentage of the remaining biofilm. Results were analysed by two 3‐way mixed‐design ANOVAs (α = 0.05). A Computational Fluid Dynamics model was used to simulate the irrigant flow inside the artificial root canal system.

Results

The flow rate during phase 1 and additional irrigation during phase 2 had a significant effect on the percentage of the remaining biofilm in the isthmus (P = 0.004 and P < 0.001). Additional irrigation during phase 2 also affected the remaining biofilm in the lateral canal significantly (P ≤ 0.007) but only when preceded by irrigation at medium or high flow rate during phase 1. The effect of NaOCl concentration was not significant (P > 0.05). Irrigant velocity in the isthmus and lateral canal increased with increasing flow rate and it was substantially correlated to biofilm removal from those areas.

Conclusions

The irrigant flow rate affected biofilm removal in vitro more than NaOCl concentration. Irrigant velocity predicted by the computer model corresponded with the pattern of biofilm removal from the simulated isthmus and lateral canal.

Genome-wide analysis of H3K4me3 and H3K27me3 modifications due to Lr28 for leaf rust resistance in bread wheat (Triticum aestivum)

Present study revealed a complex relationship among histone H3 methylation (examined using H3K4/K27me3 marks), cytosine DNA methylation and differential gene expression during Lr28 mediated leaf rust resistance in wheat. During the present study, genome-wide histone modifications were examined in a pair of near isogenic lines (NILs) (with and without Lr28 in the background of cv. HD2329). The two histone marks used included H3K4me3 (an activation mark) and H3K27me3 (a repression mark). The results were compared with levels of expression (using RNA-seq) and DNA methylation (MeDIP) data obtained using the same pair of NILs. Some of the salient features of the present study include the following: (i) large scale differential binding sites (DBS) were available for only H3K4me3 in the susceptible cultivar, but for both H3K4me3 and H3K27me3 in its resistant NIL; (ii) DBSs for H3K27me3 mark were more abundant (> 80%) in intergenic regions, whereas DBSs for H3K4me3 were distributed in all genomic regions including exons, introns, intergenic, TTS (transcription termination sites) and promoters; (iii) fourteen (14) genes associated with DBSs showed co-localization for both the marks; (iv) only a small fraction (7% for H3K4me3 and 12% for H3K27me3) of genes associated with DBSs matched with the levels of gene expression inferred from RNA-seq data; (v) validation studies using qRT-PCR were conducted on 26 selected representative genes; results for only 11 genes could be validated. The proteins encoded by important genes involved in promoting infection included domains generally carried by R gene proteins such as Mlo like protein, protein kinases and purple acid phosphatase. Similarly, proteins encoded by genes involved in resistance included those carrying domains for lectin kinase, R gene, aspartyl protease, etc. Overall, the results suggest a very complex network of downstream genes that are expressed during compatible and incompatible interactions; some of the genes identified during the present study may be used in future validation studies involving RNAi/overexpression approaches.

The influence of time and irrigant refreshment on biofilm removal from lateral morphological features of simulated root canals

Aim

To evaluate the effect of irrigant refreshment and exposure time of a 2% sodium hypochlorite solution (NaOCl) on biofilm removal from simulated lateral root canal spaces using two different flow rates.

Methodology

A dual‐species biofilm was formed by a Constant Depth Film Fermenter (CDFF) for 96 h in plug inserts with anatomical features resembling an isthmus or lateral canal‐like structures. The inserts were placed in a root canal model facing the main canal. NaOCl 2% and demineralized water (control group) were used as irrigant solutions. Both substances were applied at a flow rate of 0.05 and 0.1 mL s⁻¹. The samples were divided into three groups with zero, one or two refreshments in a total exposure time of 15 min. A three‐way analysis of variance (anova) was performed to investigate the interaction amongst the independent variables and the effect of consecutive irrigant refreshment on percentage of biofilm removal. A Tukey post hoc test was used to evaluate the effect of each independent variable on percentage biofilm removal in the absence of statistically significant interactions.

Results

For the lateral canal, NaOCl removed significantly more biofilm irrespective of the number of refreshments and exposure time (P = 0.005). There was no significant effect in biofilm removal between the consecutive irrigant refreshments measured in the same biofilm. For the isthmus, NaOCl removed significantly more biofilm irrespective of the number of refreshments and exposure time; both NaOCl and a high flow rate removed significantly more biofilm when the exposure time was analysed (P = 0.018 and P = 0.029, respectively). Evaluating the effect of consecutive irrigant refreshment on the same biofilm, 2% NaOCl, 0.1 mL s⁻¹ flow rate and one or two refreshments removed significant more biofilm (P = 0.04, 0.034 and 0.003, <0.001, respectively).

Conclusions

In this model, refreshment did not improve biofilm removal from simulated lateral root canal spaces. NaOCl removed more biofilm from the lateral canal‐ and isthmus‐like structure. A higher flow rate removed significantly more biofilm from the isthmus‐like structure. There was always remaining biofilm left after the irrigation procedures.

Human lung extracellular matrix hydrogels resemble the stiffness and viscoelasticity of native lung tissue

Chronic lung diseases such as idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD) are associated with changes in extracellular matrix (ECM) composition and abundance affecting the mechanical properties of the lung. This study aimed to generate ECM hydrogels from control, severe COPD [Global Initiative for Chronic Obstructive Lung Disease (GOLD) IV], and fibrotic human lung tissue and evaluate whether their stiffness and viscoelastic properties were reflective of native tissue. For hydrogel generation, control, COPD GOLD IV, and fibrotic human lung tissues were decellularized, lyophilized, ground into powder, porcine pepsin solubilized, buffered with PBS, and gelled at 37°C. Rheological properties from tissues and hydrogels were assessed with a low-load compression tester measuring the stiffness and viscoelastic properties in terms of a generalized Maxwell model representing phases of viscoelastic relaxation. The ECM hydrogels had a greater stress relaxation than tissues. ECM hydrogels required three Maxwell elements with slightly faster relaxation times (τ) than that of native tissue, which required four elements. The relative importance (R_i) of the first Maxwell element contributed the most in ECM hydrogels, whereas for tissue the contribution was spread over all four elements. IPF tissue had a longer-lasting fourth element with a higher R_i than the other tissues, and IPF ECM hydrogels did require a fourth Maxwell element, in contrast to all other ECM hydrogels. This study shows that hydrogels composed of native human lung ECM can be generated. Stiffness of ECM hydrogels resembled that of whole tissue, while viscoelasticity differed.

Cardiovascular complications and its relationship with functional outcomes in Guillain-Barré syndrome

BACKGROUND

Guillain-Barré syndrome (GBS) is a monophasic disease characterized by acute polyradiculoneuropathy.

AIM

This study investigated cardiovascular complications in patients with GBS and their relationship with outcomes.

DESIGN AND METHODS

We included 96 patients, who were diagnosed with GBS according to Brighton case definitions. All enrolled patients were evaluated according to a predetermined algorithm, which included nerve conduction studies, cerebrospinal fluid analysis, electrocardiography, 2D echo, cardiac markers and autonomic function testing.

RESULTS

We enrolled a total of 96 patients. The mean age of patients was 35.75 ± 17.66 years. Furthermore, 54.2% of patients developed cardiovascular complications, of which changes in electrocardiography (ECG) findings (50%), hypertension (28.12%), labile hypertension (12.5), tachycardia (26.04), bradycardia (13.54%) and a fluctuating heart rate (HR) (11.46) were common. Other cardiovascular complications seen in GBS patients were increased pro-BNP (26.04%), raised troponin T levels (3.12%), acute coronary syndrome (2.08%), heart failure (2.08%) and abnormal 2D echo findings (8.33%). The results of the univariate analysis revealed that a history of preceding infection, a Medical Research Council sum score, neck muscle weakness, facial nerve involvement, bulbar involvement, respiratory failure, cardiovascular complications, autonomic dysfunction, acute motor sensory axonal neuropathy subtype and baseline Hughes score were significantly (P < 0.005) associated with poor outcomes. However, none of these factors were found to be independently associated with poor outcomes in the multivariate analysis.

CONCLUSION

A considerable number of patients with GBS developed cardiovascular complications and it needs attention.

Role of Vascular Ultrasound in Cases of Lower Limb Hyperpigmentation

Background

Hyperpigmentation remains an important finding in cases of venous insufficiency and peripheral arterial disease (PAD) among the vascular causes.

Aims

This study aimed at finding the presence of arterial and/or venous insufficiency in patients of lower leg hyperpigmentation by using vascular ultrasound (US).

Materials and Methods

Fifty patients of lower leg pigmentation were included in the study. The detailed history, general physical examination, and laboratory investigations were done. Color Doppler ultrasonography was performed to check for venous insufficiency/PADs. Qualitative variables were correlated using chi-square test/Fisher's exact test. P < 0.05 was considered statistically significant.

Results

The mean age of the patients was 44.32 ± 14.16 years. Four patterns of skin changes were seen - reticulate macular, diffuse macular, lipodermatosclerosis and ulcer. Thirty-five (70%) patients had no visible varicose vein while 15 (30%) had visible varicose vein. In patients with visible varicose vein, color Doppler showed signs of venous insufficiency in all patients, but in cases of no visible varicose vein, color Doppler showed signs of venous insufficiency in 19 (54.28%) patients and showed no signs of venous insufficiency in others (P = 0.78). Only 1 (2%) patient showed atherosclerotic changes in both anterior tibial arteries.

Conclusion

All patients with lower leg pigmentation with or without visible varicose vein should undergo vascular US to rule out any venous insufficiency.

Brucellosis in India: results of a collaborative workshop to define One Health priorities

Brucellosis is an important zoonosis worldwide. In livestock, it frequently causes chronic disease with reproductive failures that contribute to production losses, and in humans, it causes an often-chronic febrile illness that is frequently underdiagnosed in many low- and middle-income countries, including India. India has one of the largest ruminant populations in the world, and brucellosis is endemic in the country in both humans and animals. In November 2017, the International Livestock Research Institute invited experts from government, national research institutes, universities, and different international organizations to a one-day meeting to set priorities towards a "One Health" control strategy for brucellosis in India. Using a risk prioritization exercise followed by discussions, the meeting agreed on the following priorities: collaboration (transboundary and transdisciplinary); collection of more epidemiological evidence in humans, cattle, and in small ruminants (which have been neglected in past research); Economic impact studies, including cost effectiveness of control programmes; livestock vaccination, including national facilities for securing vaccines for the cattle population; management of infected animals (with the ban on bovine slaughter, alternatives such as sanctuaries must be explored); laboratory capacities and diagnostics (quality must be assured and better rapid tests developed); and increased awareness, making farmers, health workers, and the general public more aware of risks of brucellosis and zoonoses in general. Overall, the meeting participants agreed that brucellosis control will be challenging in India, but with collaboration to address the priority areas listed here, it could be possible.

Chemical efficacy of several NaOCl concentrations on biofilms of different architecture: new insights on NaOCl working mechanisms

AIM

To investigate the anti-biofilm efficacy and working mechanism of several NaOCl concentrations on dual-species biofilms of different architecture as well as the changes induced on the architecture of the remaining biofilms.

METHODOLOGY

Streptococcus oralis J22 and Actinomyces naeslundii T14V-J1 were co-cultured under different growth conditions on saliva-coated hydroxyapatite discs. A constant-depth film fermenter (CDFF) was used to grow steady-state, four-day mature biofilms (dense architecture). Biofilms were grown under static conditions for 4 days within a confined space (less dense architecture). Twenty microlitres of buffer, 2-, 5-, and 10% NaOCl were applied statically on the biofilms for 60 s. Biofilm disruption and dissolution, as well as bubble formation, were evaluated with optical coherence tomography (OCT). The viscoelastic profile of the biofilms post-treatment was assessed with low load compression testing (LLCT). The bacteria/extracellular polysaccharide (EPS) content of the biofilms was examined through confocal laser scanning microscopy (CLSM). OCT, LLCT and CLSM data were analysed through one-way analysis of variance (ANOVA) and Tukey's HSD post-hoc test. Linear regression analysis was performed to test the correlation between bubble formation and NaOCl concentration. The level of significance was set at a < 0.05.

RESULTS

The experimental hypothesis according to which enhanced biofilm disruption, dissolution and bubble formation were anticipated with increasing NaOCl concentration was generally confirmed in both biofilm types. Distinct differences between the two biofilm types were noted with regard to NaOCl anti-biofilm efficiency as well as the effect that the several NaOCl concentrations had on the viscoelasticity profile and the bacteria/EPS content. Along with the bubble generation patterns observed, these led to the formulation of a concentration and biofilm structure-dependent theory of biofilm removal.

CONCLUSIONS

Biofilm architecture seems to be an additional determining factor of the penetration capacity of NaOCl, and consequently of its anti-biofilm efficiency.

Purification and characterization of an isoflavones conjugate hydrolyzing β-glucosidase (ICHG) from Cyamopsis tetragonoloba (guar)

A β-glucosidase with high specific activity towards isoflavone glycosidic conjugates was purified from seeds of Guar (Cyamopsis tetragonoloba) by ammonium sulphate precipitation followed by size exclusion and ion exchange chromatography. The pH and temperature optima of the purified Isoflavones conjugate hydrolyzing β-glucosidase (ICHG) were found to be pH 4.5 and 37 °C, respectively. The enzyme was relatively stable at higher temperatures. Effect of different divalent metal ions was studied and it was found that Cobalt and Mercury ions completely inhibited the enzyme activity. K_m and V_max of the purified isoflavones conjugates hydrolyzing β-glucosidases (ICHG) was 0.86 mM and 6.6 IU/mg respectively. The enzyme was most likely a trimer (approximate Mr 150 kDa) with potential subunits of 50 kDa. The purified enzyme showed activity against isoflavone conjugate glycosides viz daidzin and genistin but was inactive towards other flavonoid conjugates. The product conversion was confirmed by HPTLC and HRMS analysis. The MALDI-TOF analysis of the ICHG showed a score greater than 78 with 20 matches in MASCOT software. The five resultant peptides obtained had highest similarity in sequence with β-glucosidase from Cicer arietinum. The β-glucosidase from the C. arietinum has also been reported to exhibit the isoflavone conjugate hydrolyzing properties thus confirming the nature of the enzyme purified from the Guar seeds.

•

A specific Isoflavones conjugate hydrolyzing β-glucosidase (ICHG) from Cyamopsis tetragonoloba (guar) was purified and characterized for the first time.

•

The purified enzyme is characterized as a trimer with a molecular weight of 150 kDa

•

The isolated enzyme can be further used in the bioengineering of the edible pods for the human consumption.

Study of interleukin-6 and interleukin-8 levels in patients with neurological manifestations of dengue

Context:

Pro-inflammatory markers play a key role in the pathogenesis of various Flavivirus infection.

Aim:

In this study, we evaluated the role of these markers in neurological manifestations of dengue.

Settings and Designs:

Consecutive dengue cases with different neurological manifestations who presented between August 2012 and July 2014 were studied in hospital-based case–control study.

Materials and Methods:

Interleukin (IL-6) and IL-8 level were measured in serum and cerebrospinal fluid (CSF) of dengue cases with different neurological manifestations and also in age- and sex-matched controls. Level was analyzed with various parameters and outcomes.

Statistical Analysis:

Statistical analysis was done using SPSS version 16.0 by applying appropriate statistical methods. P < 0.05 considered statistically significant.

Results:

Out of the 40 enrolled cases of dengue with neurological manifestations, 29 had central nervous system and 11 had peripheral nervous system (CNS/PNS) manifestations. In CNS group, both IL-6 and IL-8 (CSF and serum) were significantly elevated (P < 0.001), whereas CSF IL-6 (P = 0.008), serum IL-6 (P = 0.001), and serum IL-8 (P = 0.005) were significantly elevated in PNS group. CSF IL-6, serum IL-6, and IL-8 were significantly elevated in poor outcome patients in CNS group (P < 0.05). CSF IL-6 and IL-8 were significantly elevated in CSF dengue positive cases as compared to CSF negative patients (P < 0.05). Cytokine level was not significantly correlated with neuroimaging abnormality in CNS group. Nine patients died and the remainder recovered.

Conclusion:

Elevated level of IL-6 and IL-8 is associated with different neurological manifestations and poor outcome, but whether they are contributing to neuropathogenesis or simply a correlate of severe disease remains to be determined.

Ophthalmological manifestation in patients of tuberculous meningitis

BACKGROUND

Vision impairment, blindness in particular is a devastating complication in patients with tuberculous meningitis. However, information regarding ophthalmological manifestation and its impact on vision is sparse in the literature. This study evaluated the spectrum of ophthalmological manifestations in tuberculous meningitis, including retinal nerve fiber layer thickness assessment by optic coherence tomography and its correlation with visual and clinical outcome.

METHODS

This was a prospective observational study done from October 2015 to March 2017. Consecutive patients of tuberculous meningitis, diagnosed as per consensus case definition were included in the study. The patients were divided into two categories: uncomplicated and complicated tuberculous meningitis. Clinical evaluation, cerebrospinal fluid examination and contrast enhanced MRI of brain was done. Detailed ophthalmological evaluation including optic coherence tomography was done in all patients. All the patients were followed for 6 months. The primary outcome was blindness or low vision after 6 months. The secondary outcome was death or severe disability after 6 months. It was defined as modified Barthel index (MBI) ≤ 12 at 6 months (including disability plus death). Appropriate statistical analysis was done.

RESULTS

Out of 101 patients of tuberculous meningitis, 47 patients of TBM belonged to uncomplicated category, while 54 patients were of complicated group. The visual impairment was present in 24 out of 101 (23.76%) patients out of which 20 (19.8%) patients had low vision while 4 (3.96%) had blindness. The visual impairment was more evident in complicated group, low vision 0.03 (1.2-31.5). The most common abnormality on fundus examination was papilledema (22.8%). The complicated group had more incidence <0.0001 (19.6-48). Optic atrophy was found in three patients while choroid tubercles were found in eight patients (all complicated TBM group). RNFL thinning was noted in 10 patients in both the eyes. On univariate analysis, presence of diplopia at baseline, impairment of color vision at baseline, visual impairment at baseline, cranial nerve VIth involvement, optic atrophy and papilledema at baseline, RNFL thinning, abnormal VEP and baseline MBI were associated with poor visual outcome. On multivariate analysis, none of the factors were found to be independently associated with poor visual outcome. On univariate analysis, many factors including baseline MRC staging, altered sensorium, seizure, hemiparesis, basal exudates, infarcts, optochiasmaticarachnoiditis, visual impairment at baseline were found to be associated with poor clinical outcome at 6 months. On multivariate analysis, presence of seizure (P = 0.047, odds ratio = 78.59, 95% confidence interval (1.07-578.72)) was the only factor found to be independently associated with poor outcome.

CONCLUSION

Wide spectrum of ophthalmological manifestation was observed in patients of tuberculous meningitis. The visual impairment was more evident in complicated tuberculous meningitis. Ophthalmological findings like optic atrophy, papilledema and RNFL thinning were associated with poor visual outcome on univariate but not multivariate analysis. Visual impairment at baseline, among other factors was associated with poor clinical outcome on univariate analysis, whereas seizure was the only factor independently associated with poor outcome on multivariate analysis.

Influence of doping ion, capping agent and pH on the fluorescence properties of zinc sulfide quantum dots: Sensing of Cu2+ and Hg2+ ions and their biocompatibility with cancer and fungal cells

Herein, a facile one-pot synthetic method was explored for the fabrication of glutathione capped Mn²⁺ doped‑zinc sulphide quantum dots (GSH-Mn²⁺-ZnS QDs) for both fluorescent detection of Cu²⁺ and Hg²⁺ ions and for fluorescence imaging of two cancer (RIN5F and MDAMB231) and fungal (Rhizopus oryzae) cells. Particularly, doping of Mn²⁺ into ZnS QDs nanocrystal structure resulted a great improvement in the fluorescence properties of ZnS QDs. The emission peak of undoped ZnS QDs was found at 447 nm, which is due to the large number of surface defects in the ZnS QDs nanostructures. Under identical conditions, there is a good linear relationship between the quenching of fluorescence intensity and analytes (Cu²⁺ and Hg²⁺ ions) concentration in the range of 0.005 to 0.2 mM and of 0.025 to 0.4 mM for Cu²⁺ and Hg²⁺ ions, respectively. The GSH-Mn²⁺-ZnS QDs exhibit least cytotoxicity against RIN5F and MDAMB231 cells, demonstrating the multifunctional applications in sensing of metal ions and biocompatibility towards cancer (RIN5F and MDAMB231) and fungal (Rhizopus oryzae) cells.