Assessment of Knowledge, Attitude, and Practice of Pharmacovigilance and Materiovigilance among Oral Health Practitioners in India

Aim

This electronic survey was carried out to assess the knowledge, attitude, and practices among the oral health practitioners.

Methods

A questionnaire survey was conducted among undergraduates, graduated practitioners, and specialist practitioners. A Google Form that included a specified instruction format, informed consent with a clear description of the purpose of the study, and questions in different categories were sent through Whatsapp and email. Descriptive statistics were used to analyze responses. The association of knowledge and attitude with respect to oral health professionals was analyzed with the Chi-square test.

Results

The questionnaire was completed by 570 participants. Thirty percent of participants encountered ADR related to the drugs available in the market and 33.2% of participants encountered adverse reaction related to materials used in practice. ADR should be reported as soon as it is detected, according to this study about 12.1% of participants reported the ADRs, and this reporting is primarily for patient safety. Almost 66.8% of participants perceived that dental products can cause ADR owing to a lack of information about ADR and reporting procedures, or due to fear of legal concerns. Only about 9.5% of the participants had previously attended an ADR workshop.

Conclusion

Oral health practitioners have a general understanding of ADR; however, there is substantial evidence of underreporting and a lack of reporting system information. Organizing an orientation program and raising awareness about ADR reporting could help improve spontaneous reporting and better patient care.

Evaluation of the Impact of Different Instrumentation Techniques on the Incidence of Postoperative Pain in Patients Undergoing Root Canal Treatment

BACKGROUND

Postoperative pain is a common concern in root canal treatment, and the choice of instrumentation technique can significantly impact patient comfort. This study aimed to evaluate the impact of different instrumentation techniques on the incidence of postoperative pain in patients undergoing root canal treatment.

METHODS

A randomized controlled trial was conducted on 208 patients randomly assigned to four groups: step-back preparation, crown-down preparation, hybrid technique, and conventional instrumentation. Pain intensity was assessed using a verbal rating scale (VRS) at six, 12, 24, 48, and 72 hours postoperatively. Data were analyzed using appropriate statistical methods.

RESULTS

The mean pain scores and standard deviations (SDs) were calculated for each instrumentation technique at different time intervals. At six hours, the step-back preparation group reported a mean pain score of 2.3 (SD = 0.8), the crown-down preparation group had a score of 2.8 (SD = 0.9), the hybrid technique group had a score of 2.5 (SD = 0.7), and the conventional instrumentation group had a score of 3.1 (SD = 0.1). The differences in pain scores between the groups were statistically significant at all time intervals (p < 0.05).

CONCLUSION

The choice of instrumentation technique significantly influenced the incidence of postoperative pain in root canal treatment. The step-back preparation technique was associated with lower pain intensity than the crown-down preparation, hybrid technique, and conventional instrumentation. These findings highlight the importance of considering the instrumentation technique to optimize patient comfort during and after root canal treatment.

Organophosphorus-Catalyzed Borylative Ring-Opening of Vinylcyclopropanes: A Stereoselective Route to δ-Valerolactones

We report an operationally simple route to δ-valerolactones through an organophosphorus-catalyzed borylative ring-opening/allylation of vinylcyclopropanes providing δ-hydroxy esters stereoselectively. The δ-hydroxy esters were lactonized to obtain densely substituted δ-valerolactones. The present methodology exhibited enhanced functional group tolerance compared to the existing metal-mediated methods. A plausible mechanism for borylative ring-opening reaction has been suggested. ³¹P NMR studies indicated the involvement of a phosphonium zwitterionic species. The synthetic utility of the intermediate allyl boronates was demonstrated.

Incidence and Intensity of Pain Following Endodontic Treatment by Different Instrumentation Techniques in Teeth With Periapical Lesion

AIM AND OBJECTIVES

 This study was carried out to compare the effectiveness of hand and rotary instrumentation techniques on postoperative pain in asymptomatic necrotic premolars with periapical lesions and instrumented by a modified step-back technique using a K file, crown down by continuous rotary motion technique using ProTaper Universal (Dentsply Mailefer, Ballaigues, Switzerland), and with the reciprocation technique using WaveOne (Dentsply Sirona, Charlotte, NC, USA).

MATERIALS AND METHODS

 For this study, 66 premolars with single roots and canals were chosen. The procedure was completed in a single visit. Following access opening, the working length was initially determined using an apex locator and then confirmed after inserting K file #10 by radiograph. The canal was cleaned and shaped using a grouping system. After the master apical preparation, the canal was dried by paper point and obturated with gutta-percha and AH plus sealer, an epoxide-amine resin pulp canal sealer. In order to confirm the obturation, a radiograph was taken. After that, a permanent restoration material was used to seal the access cavity. Following that, patients to whom the visual analog scale (VAS) had already been explained were contacted by phone at six, 12, 24, and 48 hours.

RESULTS

 In this study, compared to a stainless steel instrumentation technique, WaveOne instrumentation caused more noticeable pain. The results of the current study showed that, on average, postoperative pain scores decreased over the course of the 12 to 48-hour period, reaching a minimum or a maximum at 48 hours (p<0.01).

CONCLUSION

 Postoperative pain was produced by all instrumentation methods used in the study. In comparison to ProTaper and WaveOne, instrumentation using the modified step-back technique with K files caused less pain, especially over the course of a 24-hour period.

Efficacy of ozone to eliminate endopathogenic microorganism in rootcanal biofilm

Objective:

Materials and Methods:

Conclusions:

The in vitro efficacy of neutral electrolysed water and povidone-iodine against CRS-associated biofilms

BACKGROUND

Despite best medical and surgical practice, some cases of chronic rhinosinusitis (CRS) can remain recalcitrant. Bacterial biofilms have been associated with the recalcitrance of sinonasal inflammation. Biofilms are highly resistant to commonly prescribed antibiotics. Accordingly, more effective antimicrobial treatment options are needed to treat refractory CRS. The aim of this study was to determine the in vitro efficacy of neutral electrolysed water (NEW) and povidone-iodine (PVI) against CRS-associated Staphylococcus aureus biofilms.

METHODS

Mature S. aureus biofilms were grown in a Centre for Disease Control (CDC) biofilm reactor. The antimicrobial activity of NEW, PVI and doxycycline was determined for both planktonic and biofilm cultures of a clinical S. aureus isolate using minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and minimum biofilm eradication concentration (MBEC) assays.

RESULTS

MICs and MBCs were determined for all antimicrobials. MBC values were similar to MICs for both antiseptics, but doxycycline MBCs were significantly higher than the associated MICs. Biofilms were highly resistant to NEW and doxycycline. The MBEC for doxycycline was between 500 and 1000 µg/mL. NEW was ineffective against biofilms and no MBEC could be determined. In contrast, a concentration of 10% of the commercial PVI solution (10 mg/mL PVI) led to effective eradication of mature biofilms.

CONCLUSION

In this study, only PVI showed promising antibiofilm activity at physiological concentrations. The in vivo efficacy of PVI warrants further investigation of its potential as a treatment for recalcitrant CRS.

Auto-reactivity against gut bacterial peptides in patients with late-onset diabetes

The depletion of gut mucosal barrier enables exposure of gut microbes/gut microbial products to the host mucosal immunity which may increase the risk of metabolic/inflammatory disorders. These immune responses can lead to the development of mild autoimmunity to metabolic peptides coming from gut bacteria and may result in metabolic diseases like late-onset diabetes (LOD). In the present study, we identified host sera cross-reactivity with gut bacterial peptides similar to host proteins. The interaction between diabetic sera and gut peptides was detected by enzyme-linked immunosorbent assay (ELISA) and results were confirmed using surface plasmon resonance (SPR). The ELISA assay showed a higher level of serum cross-reactivity in LOD patients as compared to non-diabetic controls against three peptides (P-5, P-9, and P-13). SPR analysis confirmed binding-affinity against P-5 and P-13. Also, a significant correlation was observed between inflammatory markers and P-5. This study demonstrates that gut health is important not only for intestinal diseases but also for several late-onset diseases, like, diabetes.

Pentalogy of Fallot: A case report and overview dental implications

Pentalogy of Fallot is a rare congenital cyanotic heart disease and a variant of tetralogy of Fallot, in which tetralogy of Fallot is associated additionally with an atrial septal defect. It is characterized by right to left intracardiac shunting of blood leading to decreased pulmonary blood flow resulting in the development of cyanotic episodes. The case report aims to present the dental management of an 8-year-old child with a repaired cardiac anomaly of pentalogy of Fallot. His medical condition was assessed and physician consent was sought for procedural intervention. All invasive procedures were planned under antibiotic prophylaxis to prevent bacteremia associated endocarditis. Elaborate chairside dental intervention was carried out beginning with preventive schedule, oral prophylaxis and topical fluoride application followed by interception of carious progression with multiple GIC restorations and extractions of retained and grossly decayed teeth. Patient was reviewed on follow-up visit and no pain, discomfort, or complications were reported. Based on the case report it can be concluded that the medical status in patients affected with Pentalogy of Fallot must be taken into consideration to plan dental treatment and precautions must be taken for prevention of stress induced cyanosis and bacterial endocarditis in such cases.

The sinonasal mycobiota in chronic rhinosinusitis and control patients

BACKGROUND

While bacterial associations with chronic rhinosinusitis (CRS) are increasingly well described, fewer studies have examined the fungal component of the sinonasal microbiota. Here we present a study of the sinonasal mycobiota in a cohort of 144 patients (106 patients with CRS and 38 controls).

METHODOLOGY

Fungal communities were characterised by analysis of mucosal swab samples of the left and right middle meatuses via ITS2 marker amplicon sequencing on the Illumina MiSeq platform. Fungal associations with previously published bacterial community and inflammatory cytokine and cell data for this cohort (collected at the same intra-operative time point) were also investigated.

RESULTS

Malassezia spp. were ubiquitous and often highly predominant. Season of sampling explained more of the variability in the data than any of the clinical parameters. The predominant Malassezia sp. was distinct in patients with cystic fibrosis compared to those without. However, distinctions in the mycobiota were not evident between any other patient groupings assessed, and few fungal-bacterial or fungal-inflammatory associations were observed.

CONCLUSIONS

This study confirms the prominent place of Malassezia spp. within the upper respiratory tract. Overall, few distinctions between patient groups were evident, and these data lend further support to the hypothesis that fungal community types may have no direct causative association with idiopathic CRS. Additional studies incorporating a broader array of inflammatory markers are required to assess whether these ubiquitous fungi nonetheless play an exacerbating role in some sensitive individuals.

Mechanical and Thermal Properties of Teak Wood Flour/Starch Filled High Density Polyethylene Composites

Teak wood flour (TWF) reinforced HDPE composites were prepared and characterized in terms of mechanical, morphological and thermal properties using 2% polyethylene grafted with maleic anhydride (PE-g-MAH) as compatibilizer. The composites were prepared by twin screw extrusion and samples were prepared by injection molding. Mechanical properties increased with the incorporation of TWF, Starch and PE-g-MAH. Tensile strength and Young's modulus increased by 96% and 207%, respectively for TWF (40%)-HDPE composite as compared to virgin matrix. Scanning electron microscopy revealed good interface between TWF and matrix. FT-IR spectra confirmed the esterification reaction and H-bond between anhydride group of PE-g-MAH and cellulose of TWF. The DSC results showed that the melting temperature increased from 129°C to 137°C while crystallization (%) decreased from 40.49% for HDPE to 34.77% for 40% TWF composites, respectively. The storage modulus increased for all the composites at low temperature. Glass transition temperature practically remained unaffected by filler loading.

Calcium ion incorporated hydrous iron(III) oxide: synthesis, characterization, and property exploitation towards water remediation from arsenite and fluoride

Calcium ion-incorporated hydrous iron(III) oxide (CIHIO) samples have been prepared aiming investigation of efficiency enhancement on arsenic and fluoride adsorption of hydrous iron(III) oxide (HIO). Characterization of the optimized product with various analytical tools confirms that CIHIO is microcrystalline and mesoporous (pore width, 26.97 Å; pore diameter, 27.742 Å with pore volume 0.18 cm³ g^-1) material. Increase of the BET surface area (> 60%) of CIHIO (269.61 m² g^-1) relative to HIO (165.6 m² g^-1) is noticeable. CIHIO particles are estimated to be ~ 50 nm from AFM and TEM analyses. Although the pH optimized for arsenite and fluoride adsorptions are different, the efficiencies of CIHIO towards their adsorption are very good at pH 6.5 (pH_zpc). The adsorption kinetics and equilibrium data of either tested species agree well, respectively, with pseudo-second order model and Langmuir monolayer adsorption phenomenon. Langmuir capacities (mg g^-1at 303 K) estimated are 29.07 and 25.57, respectively, for arsenite and fluoride. The spontaneity of adsorption reactions (ΔG⁰ = - 18.02 to - 20.12 kJ mol^-1 for arsenite; - 0.2523 to - 3.352 kJ mol^-1 for fluoride) are the consequence of entropy parameter. The phosphate ion (1 mM) compared to others influenced adversely the arsenite and/or fluoride adsorption reactions. CIHIO (2.0 g L^-1) is capable to abstract arsenite or fluoride above 90% from their solution (0 to 5.0 mg L^-1). Mechanism assessment revealed that the adsorption of arsenite occurs via chelation, while of fluoride occurs with ion-exchange.

Combinatorial Characterization of Saliva for Oral Precancer Diagnostics

Background: Saliva based diagnostic can play an important role in the translational research related to cancer diagnostics and treatment. It is easily available, noninvasive, low storage cost, has less contamination chances with simple collection procedure. Cancers related to tobacco use, including oral cancer account for about 30% of all cancers in males and females. Five years' survival rate remains the same even after decades of advancement of detection, prevention, and treatment of OSCC (oral squamous cell carcinoma) mainly due to late diagnosis of oral potentially malignant disorders (OPMDs). Aim: Combinatorial characterization of saliva, endorsing multidimensional spectroscopic signatures using suitably designed biochamber. Methods: Eighteen saliva samples (6 normal, 6 OSF [oral submucous fibrosis, a type of OPMD] and 6 confirmed OSCC) were collected from GNIDSR (Guru Nanak Institute of Dental Science and Research) Kolkata. Ethical approval was obtained for the study and all the participants were explained the objectives of the study and a written informed consent was obtained from them. Participant's demographic detail and clinical characteristics were also recorded. The participants were asked not to consume food 1 hour before sample collection and were suggested to rinse their mouth 30 minutes prior to saliva expectoration to minimize the contamination of food in saliva. Empty, sterile, graded tubes were used for this purpose. The subjects were asked not to clear nose or throat during the process of saliva expectoration to avoid forced phlegm from other part of the respiratory tract. The saliva samples were then immediately transferred to −20 degrees and later in −80 degrees for long storage. The electrical impedance (EI) of saliva was measured in custom made biochambers with copper electrodes. The EI was measured for the frequency sweep from 20 Hz to 2 MHz using an impedance analyzer. Apart from EI measurement, the corresponding samples were subjected to FTIR (Fourier-transform IR spectroscopy) analysis. SPSS and OMNIC software were used for the data analysis of EI and FTIR respectively. Results: [Table: see text][Table: see text][Table: see text][ Table A , B & C represents descriptive statistics, correlation matrix and component matrix respectively. The multivariate analysis of the FTIR data indicates the significant differences ( P < 0.005) among the different study groups such as normal, OSF and OSCC. The eigen values (normal 0.917, OSF 0.962, OSCC 0.975) from component matrix analysis also indicate the same. Conclusion: The spectroscopic characterization (EI and FTIR) of saliva was effective in evaluating normal and OPMD condition. This noninvasive paradigm can serve as a complimentary technique to the existing gold standard methods for the early detection of oral cancer.

Moving beyond descriptions of diversity: clinical and research implications of bacterial imbalance in chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a debilitating disease which affects 5-16% of the general population and involves long-term inflammation of the sinonasal cavity. While microbial involvement in the pathogenesis of CRS has long been suspected, the exact role of microbes remains unclear. Recent application of cultivation-independent, molecular methods has provided much new information, taking advantage of developments in both laboratory- and bioinformatics-based analyses. The aim of this mini-review is to present a variety of available bioinformatics approaches, such as data classification techniques and network analyses, with proven applications in other aspects of human microbiome health and disease research. The uses of molecular techniques in the clinical setting are still in its infancy, but these tools can further our understanding of microbial imbalance during chronic disease and help guide effective patient treatment. The mini-review emphasises ways in which CRS bacterial gene-targeted sequencing data can progress beyond descriptive summaries and toward unlocking the mechanisms by which bacterial communities can be markers for sinus health.

Toll-like receptor activation by sino-nasal mucus in chronic rhinosinusitis

BACKGROUND

The sino-nasal disease chronic rhinosinusitis (CRS) is primarily an inflammatory condition that manifests in several ways. However, the aetiology of this complex disease is poorly understood. The aim of this study was to explore the association between toll-like receptor (TLR) activation, host immune response and sino-nasal mucus in healthy and diseased patients.

METHODS

The activation of TLR2/1 and TLR4 by sino-nasal mucus from 26 CRS patients and 10 healthy controls was measured. In addition, 7 inflammatory cytokines, bacterial community composition and bacterial abundance within the sino-nasal mucus were measured using molecular and diagnostic tools.

RESULTS

TLR activity was observed in 9/36 samples, including 2 healthy controls. There was a strong, positive correlation between members of the Gammaproteobacteria (Haemophilus, Enterobacter, Pseudomonas) and TLR2/1 and TLR4 activity. Bacterial abundance and cytokine (tumour necrosis factor) abundance were also positively correlated with TLR activity.

CONCLUSIONS

These findings suggest that a small proportion (20-30%) of individuals in each sub-group are more predisposed to TLR activity, which may be related to bacterial composition, diversity and abundance in the sinuses.

The in vitro effect of xylitol on chronic rhinosinusitis biofilms

INTRODUCTION

Biofilms have been implicated in chronic rhinosinusitis (CRS) and may explain the limited efficacy of antibiotics. There is a need to find more effective, non-antibiotic based therapies for CRS. This study examines the effects of xylitol on CRS biofilms and planktonic bacteria.

METHODS

Crystal violet assay and spectrophotometry were used to quantify the effects of xylitol (5% and 10% solutions) against Staphylococcus epidermidis, Pseudomonas aeruginosa, and Staphylococcus aureus. The disruption of established biofilms, inhibition of biofilm formation and effects on planktonic bacteria growth were investigated and compared to saline and no treatment.

RESULTS

Xylitol 5% and 10% significantly reduced biofilm biomass (S. epidermidis), inhibited biofilm formation (S. aureus and P. aeruginosa) and reduced growth of planktonic bacteria (S. epidermidis, S. aureus, and P. aeruginosa). Xylitol 5% inhibited formation of S. epidermidis biofilms more effectively than xylitol 10%. Xylitol 10% reduced S. epidermidis planktonic bacteria more effectively than xylitol 5%. Saline, xylitol 5% and 10% disrupted established biofilms of S. aureus when compared with no treatment. No solution was effective against established P. aeruginosa biofilm.

CONCLUSIONS

Xylitol has variable activity against biofilms and planktonic bacteria in vitro and may have therapeutic efficacy in the management of CRS.

Tuned synthesis and characterizational insight into β-cyclodextrin amended hydrous iron-zirconium hybrid oxide: a promising scavenger of fluoride in aqueous solution

Fluoride adsorption on CHIZO takes place with H-bonding inside the core, thus forming an encapsulated moiety.

Feto-maternal Outcome Using New Screening Criteria of Serum TSH for Diagnosing Hypothyroidism in Pregnancy

INTRODUCTION

Evidence suggests that by using the classical non pregnant reference range for serum TSH (STSH), one might miss hypothyroidism in pregnancy. Therefore, upper normal cut off value of S TSH should be taken as <2.5 mIU/L in the first trimester and <3mIU/L in the second and third trimester. However, two Indian studies have reported higher trimester specific reference ranges in the Indian pregnant women.

OBJECTIVES

To assess the maternal and fetal outcomes using new screening criteria with upper S TSH cut off as >3mIU/L, for diagnosing hypothyroidism in pregnancy.

MATERIALS AND METHODS

This study was a cross sectional study, carried out in the Department of Obstetrics and Gynaecology of a tertiary care hospital, in collaboration with the Department of Endocrinology. Pregnant women with ≤ 20 weeks gestation, attending antenatal OPD from December 2010 to January 2012 were included in the study. On the basis of S TSH level, women were divided into Study Group with S TSH level between 3.1 to 6.2 mIU/L, (new range to be studied) and an equal number of age and parity matched Control Group with S TSH levels between 0.4 to 3 mIU/L. The maternal and fetal outcomes were compared between study and control groups.

RESULTS

During the study period, a total of 66 women had S TSH between 3.1-6.2 mIU/L. Maternal and fetal outcomes in both the groups were comparable. There was no difference in the mode of delivery between study and control groups.

CONCLUSION

The lower S TSH cut off recommended for diagnosing hypothyroidism in pregnancy may not be applicable to pregnant Indian women.

Al2O3 influence on structural, elastic, thermal properties of Yb(3+) doped Ba-La-tellurite glass: evidence of reduction in self-radiation trapping at 1μm emission

Ba-La-tellurite glasses doped with Yb(3+) ions have been prepared through melt quenching technique by modifying their composition with the inclusion of varied concentration of Al2O3 to elucidate its effects on glass structural, elastic, thermal properties and Yb(3+) ion NIR luminescence performance. The FTIR spectral analysis indicates Al2O3 addition is promoting the conversion of BOs from NBOs which have been generated during the process of depolymerisation of main glass forming TeO4 units. The elastic properties of the glass revealed an improved rigidity of the glass network on addition of Al2O3. In concurrence to this, differential thermal analysis showed an increase in glass transition temperature with improved thermal stability factor. Also, Yb(3+) fluorescence dynamics demonstrated that, Al2O3 inclusion helps in restraining the detrimental radiation trapping of ∼1μm emission.

Adsorption of fluoride on synthetic iron (III), zirconium(IV) and binary iron(III)-zirconium (IV) oxides: comparative assessment on pH effect and isotherm

Fluoride is an accumulative poison at high dose of intake for humans and animals. In the present study, the sorption of fluoride from aqueous solution has been investigated on synthetic hydrous ferric oxide (HFO), hydrous zirconium oxide (HZO) and hydrous zirconium(IV)-iron(III) oxide (HZFO) by batch mode experiments. Both HFO and HZFO were crystalline and HZO was amorphous in nature. The parametes studied were the effect of pH and sorption equilibriums. The results showed increase in fluoride-sorption with increasing pH from nearly 2.0 to 5.0, 4.6 and 6.8 for HFO, HZO and HZFO, respectively. Analysis of temperature dependent sorption data obtained at equilibrium solution pH 6.8 (+/- 0.2) has been described by the Langmuir, Freundlich, Temkin and Redlich-Peterson isotherm model equations. The present sorption data fit, in general, found very well with the Langmuir and Redlich-Peterson models; and the data fit for HZFO and HFO found to increase, but for HZO the data found to decrease with increasing temperature. The computed thermodynamic parameters such as deltaG0, delltaH0 and deltaS0 from the Langmuir equilibrium constant (b, L/Umg) values show that the fluoride-sorption on HZFO was more spontaneous and endothermic process compared to HFO. The deltaH0 value obtained for fluoride adsorption on HZO indicates exothermic nature.

A study of tubular potassium secretory capacity in older patients with hyperkalaemia

OBJECTIVES

Sustained hyperkalaemia usually indicates a defect in renal potassium (K+) excretion and can be due to severe impairment of glomerular filtration rate (GFR). The major determinants of renal K+ secretion were studied in hyperkalaemic and normokalaemic elderly subjects to probe the major determinants of hyperkalaemia in this setting.

DESIGN

The transtubular potassium gradient (TTKG) provides an index of tubular K+ secretion and normally rises in patients with significant hyperkalaemia. Both GFR(glomerular filtration rate) and TTKG were assessed at baseline and repeated after 3 hours following ingestion of 0.1mg of fludrocortisone in three groups.

SETTING

An acute general hospital in the West of Ireland.

PARTICIPANTS

23 subjects in total; 8 older patients with unexplained hyperkalaemia (OHK), 8 older patients with normokalaemia (ONK) and 9 young normokalaemic controls (YNK).

MEASUREMENTS

The GFR was either measured by 24 hour creatinine clearance estimation or calculated using the Cockroft and Gault formula.TTKG was calculated using a specific formula.

RESULTS

Mean baseline TTKG was similar in all three groups and consequently inappropriately low in hyperkalaemic subjects. Three hours post fludrocortisone, the TTKG had risen significantly from baseline levels in the young subjects only (from 7.5+/-0.09 to 11.6+/-1.1, p<0.05). No significant increase was noted in either older group at this timepoint.

CONCLUSIONS

The inappropriately low baseline TTKG in the OHK group as well as the absence of a response to fludrocortisone indicate tubular insensitivity to aldosterone. GFR values in both OHK (40.06+/-2.31) and ONK (55.58+/-6.1) groups were significantly lower than those in the YNK group (101.66+/-6.9). In aggregate, these findings indicate that older hyperkalaemic patients typically have both impairment of glomerular filtration and renal tubular K+ secretion and highlights the requirement for vigilance in elderly patients when using medications which interfere with tubular function.

Recurrent lymphocytic hypophysitis in a woman 27 years after subtotal adrenalectomy for hypercortisolism possibly of autoimmune origin

Lymphocytic hypophysitis commonly occurs in females in peripartum period but several unusual presentations have been reported. Here we report a rare case of recurrent lymphocytic hypophysitis in a woman who had subtotal adrenalectomy for hypercortisolism 27 years back. Polyglandular autoimmune endocrinopathy with an uncommon combination of Cushing's syndrome and recurrent hypophysitis is a strong possibility in this case. Treatment with steroids has been found to have beneficial effect.

Imaging in intersex disorders

BACKGROUND

Evaluation of the gonads and internal genital structures is an essential component for evaluation of patients presenting with ambiguous genitalia. Ultrasonography (US) and magnetic resonance imaging (MRI) are the two preferred modalities.

OBJECTIVE

To compare US and MRI in patients with intersex for localization of gonads and internal genitalia.

PATIENTS AND METHODS

Ten patients with proven intersex disorders were included in the study. Findings from US and MRI were corroborated by those from surgery/laparoscopy.

RESULTS

For evaluation of the gonads, MRI was found to be marginally more sensitive than US. For internal genital structures, both modalities were found to be equally sensitive and specific with no false positive results.

CONCLUSION

US still remains the modality of choice for screening patients with intersex disorders. MRI is helpful in cases with equivocal US findings.

A proteomic approach to understanding the development of multidrug-resistant Candida albicans strains

Resistance of the pathogenic yeast Candida albicans to the antifungal agent fluconazole is often caused by the overexpression of genes that encode multidrug efflux pumps ( CDR1, CDR2, or MDR1). We have undertaken a proteomic approach to gain further insight into the regulatory network controlling efflux pump expression and drug resistance in C. albicans. Three pairs of matched fluconazole-susceptible and resistant clinical C. albicans isolates, in which drug resistance correlated with stable activation of MDR1 or CDR1/2, were analyzed for differences in their protein expression profiles. In two independent, MDR1-overexpressing, strains, additional up-regulated proteins were identified, which are encoded by the YPR127 gene and several members of the IFD ( YPL088) gene family. All are putative aldo-keto reductases of unknown function. These proteins were not up-regulated in a fluconazole-resistant strain that overexpressed CDR1 and CDR2 but not MDR1, indicating that expression of the various efflux pumps of C. albicans is controlled by different regulatory networks. To investigate the possible role of YPR127 in the resistance phenotype of the clinical isolates, we constitutively overexpressed the gene in a C. albicans laboratory strain. In addition, the gene was deleted in a C. albicans laboratory strain and in one of the drug-resistant clinical isolates in which it was overexpressed. Neither forced overexpression nor deletion of YPR127 affected the susceptibility of the strains to drugs and other toxic substances, suggesting that the regulatory networks which control the expression of efflux pumps in C. albicans also control genes involved in cellular functions not related to drug resistance.

The epothilones, eleutherobins, and related types of molecules

Taxol is currently one of the most effective anticancer agents available. However, limitations due to multidrug-resistance (MDR) susceptibility and lack of aqueous solubility render it less than an ideal drug. These limitations, coupled with taxol's unique mechanism of tumor inhibition, involving the stabilization of microtubule assembly, have spurred the search for more effective chemotherapeutic agents. This review will discuss the chemistry and biology of some of the most promising new molecules with "taxol-like" activity. The extended family of microtubule-stabilizing agents now includes the epothilones, eleutherobins, discodermolide, laulimalide and WS9885B. The epothilones have emerged as one of the most exciting new candidates for detailed structure-activity-related studies. A review of our efforts in the synthetic and biological aspects of this research is presented, as are the latest developments reported from other laboratories in academia and the pharmaceutical industry. The synthesis and structure-activity studies of eleutherobins, as well as recent progress with discodermolide, laulimalide and WS9885B are also reviewed. An abundance of exciting advances in chemistry and biology have emerged from these studies, and it is hoped that it will ultimately result in the development of new and more effective chemotherapeutic agents in the fight against cancer.

Gastric toxicity and mucosal ulceration induced by oxygen-derived reactive species: protection by melatonin

Uncontrolled hydrochloric acid secretion and ulceration of the stomach mucosa due to various factors are serious global problems. Although the mechanism of acid secretion from the parietal cell is now well understood, the processes involved in gastric ulceration are still not clear. Among various causes of gastric ulceration, lesions caused by stress, alcohol consumption, Helicobacter pylori infection and due to use of nonsteroidal antiinflammatory drugs have been shown to be mediated largely through the generation of reactive oxygen species, especially the hydroxyl radical. A number of excellent drugs have proven useful in controlling hyperacidity and ulceration but their long-term use is associated with disturbing side-effects. Hence, the search is still on to find a compound possessing antisecretory, antiulcer and antioxidant properties which will serve as a therapeutic agent to reduce gastric hyperacidity and ulcers. This article describes the role of reactive oxygen species in gastric ulceration, drugs controlling them with their merits and demerits and, the role of melatonin, a pineal secretory product, in protecting against gastric lesions. In experimental studies, melatonin has been shown to be effective in reducing mucosal breakdown and ulcer formation in a wide variety of situations. Additionally, the low toxicity of melatonin supports further investigation of this molecule as a gastroprotective agent. Finally, we include a commentary on how melatonin research with respect to gastric pathophysiology can move forward with a view of eventually using this indole as a therapeutic agent to control gastric ulceration in humans.

Melatonin protects against stress-induced gastric lesions by scavenging the hydroxyl radical

The antiulcer effect of melatonin on gastric lesions caused by restraint-cold stress or by indomethacin (IMN) was studied with the intent of determining the mechanism of action of the indole. Melatonin dose-dependently prevents both stress and IMN-induced gastric damage with around 90% inhibition at a dose of 60 mg per kg BW. When compared with already-marketed antiulcer drugs, such as ranitidine and omeprazole, melatonin was found to be more effective than ranitidine but less effective than omeprazole in preventing stress ulcer. When compared with other antioxidants, melatonin was more potent than glutathione and essentially equipotent to alpha-tocopherol in blocking stress-induced ulcer. As stress-induced gastric lesions are mainly caused by oxidative damage due to hydroxyl radicals (*OH), the effect of melatonin in scavenging the *OH generated during stress conditions, as well as in an in vitro model system, was studied. The results indicate that melatonin at the dose of 60 mg per kg BW caused an 88% reduction of endogenous *OH during stress. Melatonin was also highly effective in scavenging *OH generated in vitro by a Cu2+-ascorbate system. In this case, melatonin at 100 microM reduced *OH by 80%. Melatonin was also found to be a more potent radical scavenger than benzoate, a known *OH scavenger. The results indicate that melatonin prevents stress-induced gastric lesions by scavenging the endogenous *OH. As it also protects against IMN-induced gastric damage, it probably also offers gastroprotection by maintaining endogenous prostaglandin levels.

Hypothalamic hamartoma as a cause of precocious puberty in neurofibromatosis type 1: patient report

Precocious puberty resulting from hypothalamic hamartoma is well known. Neurofibromatosis type 1 can also present with precocious puberty. However, hypothalamic hamartoma as the cause of precocious puberty in patients with neurofibromatosis type 1 has never been described in the literature. This rare occurrence of these two together in a patient with precocious puberty is reported.

Dexamethasone makes the gastric mucosa susceptible to ulceration by inhibiting prostaglandin synthetase and peroxidase--two important gastroprotective enzymes

The plausible mechanism by which dexamethasone makes the gastric mucosa susceptible to ulceration has been studied. As acid aggravates ulcer, the role of dexamethasone on acid secretion was first investigated. Dexamethasone stimulates both basal and drug (mercaptomethylimidazole)-induced gastric acid secretion by 100 and 50% respectively in male Wister rats 24 h after intramuscular administration at the dose of 1 mg/kg body wt. This stimulated acid secretion is 93% blocked by cimetidine indicating increased liberation of histamine in the process. Pretreatment of dexamethasone before 24 h produces ulcer in 30% of the pylorus- ligated rats and aggravates the ulcer index by 82% in both pylorus and esophagus ligated rats. The incidence of ulceration in the latter cases is also increased by 25%. As mucosal prostaglandin synthetase and peroxidase play an important role in gastroprotection through biosynthesis of prostaglandin and by scavenging endogenous H2O2 respectively, the effect of dexamethasone on the activities of these gastroprotective enzymes were studied. Prostaglandin synthetase and peroxidase activities of the mucosa are significantly inhibited by 87 and 83% respectively by 24-h pretreatment with dexamethasone. The results indicate that dexamethasone makes the mucosa prone to ulceration by inhibiting the activity of prostaglandin synthetase to block the gastroprotective action of prostaglandin and also by inhibiting the peroxidase, thereby elevating the endogenous H2O2 level to generate more reactive hydroxyl radical responsible for the mucosal damage.

Study of portal hypertension in children with special reference to sclerotherapy

Portal Hypertension (PH) is the commonest cause of upper gastrointestinal bleeding in children. Most Indian studies have highlighted extrahepatic portal venous obstruction (EHPVO) as the major cause of PH in children. As there is paucity of data from the eastern part of the country we decided to study the major causes of PH in children in this region and to ascertain the efficacy of sclerotherapy for its management. Fifty children aged 14 months to 10 years with PH were studied from April 1990 to April 1995. Thorough examination and relevant investigations showed non-cirrhotic portal fibrosis (NCPF) in 24 (48%), EHPVO in 18 (36%) and cirrhosis of liver in 8 (16%) children. Forty six children had hematemesis and melaena of whom endoscopic sclerotherapy (EST) was done in 45 cases. One child having type 2 gastric varices was referred for surgery. Following eradication of varices the patients were followed-up at 3 monthly intervals. Number of sittings of sclerotherapy required for obliteration of varices was 5.9 +/- 1.6. A variceal state was achieved in 35 (78%) cases and varices were reduced to Grade I in 6 cases (13%). Two cases underwent surgery for EST failure. One patient of cirrhosis died within two weeks of bleeding episode due to hepatic encephalpathy. Rebleeding (13%) and recurrences (13%) were noted during the follow-up period. Retrosternal discomfort (22%), dysphagia (22%), stricture (13%), oesophageal ulceration (13%) and fever (11%) were the complications noted but these could be managed conservatively. The present study highlights that NCPF is an important cause of PH in eastern India. EST is useful in controlling variceal bleeding in children irrespective of their aetiology.