Musculoskeletal pain affecting undergraduate nursing students: A cross sectional study on the prevalence and the associated factors

BACKGROUND

Musculoskeletal pain conditions (MSP) affect not only professional nurses but nursing students too. Long standing pain conditions affecting young individuals in their productive years can impact their work efficiency and can have economic impacts. Effective interventions to decrease the effect of MSP conditions are essential for a healthy professional nursing force which form the backbone of the healthcare system.

PURPOSE

We conducted this study with an aim to estimate the prevalence and patterns of MSP conditions in undergraduate nursing students. Additionally, we attempted to evaluate the associated factors and identify the predictors of MSP conditions in them.

METHODS

This cross-sectional study was conducted using a web-based electronic questionnaire on nursing students at a tertiary level teaching hospital. The questionnaire prepared on Kobo Toolbox was circulated among the students of each class by their class representative using WhatsApp and e-mail. Two reminders were sent at 24-hour intervals. The data were analysed to identify the prevalence of MSP and evaluate the probable associated factors.

RESULTS

One hundred and seventy-nine out of 255 (70.2 %) participants responded and 173 consented for participation. Around 53.2 % participants had suffered from MSP in the past year. A total of 43.9 % of the participants had previously suffered from musculoskeletal pain even earlier than the past one-year in question. Those in their 2nd academic year had higher odds of suffering from MSP. Factors related to self-study after the formal teachings at the school/ college of nursing like the place, duration, and posture, and the pattern of usage of electronic devices like smartphones and laptop computers had no significant association with the MSP conditions. Lack of physical exercise, attending clinical placements, and the factors related to such placements like duration and frequency of placements, and the duration of breaks during any placement were noted to have an influence on MSP.

CONCLUSION

More than 50 % students reported to be affected by MSP over a year. Association with factors like inadequate physical activity, and strenuous clinical placements identified in this study indicate that modifications in the nursing curriculum are required. Encouraging physical activity on one hand, while minimising exhaustive, and taxing clinical placements might be the way forward for improving the musculoskeletal health of aspiring nurses.

Burden, maternal risk factors, and fetal outcomes in twin pregnancies: a retrospective observational study

Background: Twin pregnancies present significant challenges for obstetricians worldwide. Although they account for a relatively small percentage of global births, their occurrence varies across different regions. The increasing utilization of assisted reproduction techniques and the advancing maternal age contribute to the growing incidence of twin pregnancies. As a result, it is essential to understand the implications and risks associated with multiple gestations. The objective was to determine the burden of twin pregnancies, identify maternal risk factors, assess fetal outcomes, and explore potential associations between these factors. Methods: Data were collected from hospital records, including information on maternal age, parity, method of conception, gestational age, pregestational body mass index (BMI), and family history. Maternal and fetal complications, mode of delivery, and high-risk conditions in the fetuses were documented. Statistical analysis was performed using the Fisher-exact test. Results: The study included 78 twin pregnancies. The majority of women (78.2%) fell within the age range of 21-30 years. The majority of women (70.5%) had a normal pregestational BMI. Preterm births occurred in 24.3% of twin pregnancies. Hypertensive disorders (24.0%) and foetal malpresentation (38.0%) were common indications for cesarean section. Fetal complications included intrauterine growth restriction (11.5%), birth weight discordance (25.0%), early neonatal deaths (14.7%), and low APGAR scores (16.0%). Conclusions: Twin pregnancies present challenges due to the increased risks of maternal complications, preterm birth, and adverse fetal outcomes. The study emphasizes the need for careful management and monitoring of twin pregnancies to improve outcomes.

ASSESSEMENT OF CARDIOVASCULAR RISK FACTORS AND BMI AMONG PROFESSIONAL COMMERCIAL DRIVERS IN SAGAR DISTRICT OF CENTRAL INDIA: A CROSSECTIONAL STUDY

Introduction : The commercial professional drivers are at risk of developing diabetes, hypertension and obesity due to the nature of their work as they tend to go early, work for many hours , have irregular dietary habits and sleep pattern and sedentary lifestyle.The study sought to determine the known risk factors in order to better clarify the burden of this health issue in Sagar district of Central India. A crossectional descriptive and analytical study was conducte Method : d among 496 commercial professional drivers and blood sugar, blood pressure and height and weight was measured . The life style related risk factors were assessed using semistructured questionnaire and also dietary pattern was assessed. The student T test and Chisquare test were used for statistical analysis. The youngest person was 22 Results: years old and oldest was 66. The mean age was 39.55±12.53 years. The mean number of years for which they were in job was 17.5 ± 9.62 and they worked for a mean duration of 13.56 ± 2.87 hours. The other risk factors found was alcohol intake and smoking,irregular dietary pattern, lack of physical activity and sleep. There is a need for intervention to promote a heal Conclusion: thy life style and curb the prevalence of diabetes, hypertension and overweight to improve the health of drivers and safety of passenger

Changes in the Status of Spastic Diplegic Children in Terms of Gross Motor Function Classification System and Functional Mobility Scale Following Surgical Intervention: A Single Centre Experience

Introduction Most centers in low- to mid-income countries (LMICs) lack facilities for a comprehensive instrumented gait analysis (IGA) which is often considered the preferred method for assessment of the functional results of surgery in children with spastic diplegia. We aimed to study if there were any changes in the Gross Motor Function Classification System (GMFCS) levels and Functional Mobility Scale (FMS) scores after surgery and whether they can be used as an indirect indicator of change in the functional status of a child. Methods This prospective study was conducted at the Pediatric Orthopedic unit of a teaching hospital on spastic diplegic children requiring surgical intervention. GMFCS levels and FMS scores were recorded before the surgery and at each follow-up visit, with the latest record being two years post-surgery. The change in the scores was indicated as an improvement, deterioration, or no change from the baseline and compared to the score of the preceding visit. In addition, it was examined whether the age at surgery had any effect on the temporal change in the scores. Results A total of 25 children were included for analysis after excluding those who failed to fulfill the predefined inclusion and exclusion criteria. Both the GMFCS levels and FMS scores improved from the third month to one-year post-surgery, after which a few patients had a worsening of their scores at the two years follow-up visit. The age at which surgery was performed had no significant effect on the pattern of change in the scores. Most children sought consultations with the physical therapy department only when they visited the surgical team for follow-up. Conclusion This study shows that surgical interventions do improve the functional outcomes in children with spastic CP when assessed using FMS scores while maintaining an undeteriorated GMFCS level in most children. While a peak improvement can be expected one year after surgery in most patients, possible of worsening from baseline scores do exist, and the parents must be informed of the same. Any decision for surgery must involve the parents, and the usefulness of postoperative physical therapy must be impressed upon them before the surgery and during each follow-up visit too.

IS COVID 19 PANDEMIC ADDING MORE OF DIABETIC POPULATION: A STUDY IN CENTRAL INDIA

Background– COVID 19 is associated with high prevalence of diabetes along with other comorbidities which also increase the severity and mortality risk in COVID 19 disease. Recently many studies have shown the association between COVID 19 and new onset diabetes. This study was done with objectives1.To nd out the incidence of new onset of hyperglycemia/diabetes in COVID 19 patients and 2.To develop screening policy for detection of new onset hyperglycemia in COVID-19 patients. Materials And Methods- This study is a hospital based observational cross sectional and prospective, cohort study conducted in the COVID ICU of Dedicated COVID Hospital, Bundelkhand Government Medical College, Sagar (M.P.) India, a teaching tertiary care centre. Out of 1562 COVID 19 positive patients admitted with moderate to severe pneumonia from JULY 2020 to JANUARY 2021, 487 patients were hyperglycemic at the time of admission. Patients were categorized into two subgroups: 1.Patients with previously conrmed diabetes or Prediabetes and 2.Hyperglycemia with no existing diabetes. Patients in this later subgroup were our follow up subjects for this study; their blood sugar level was monitored regularly during their stay in hospital & a correlation of COVID 19 and hyperglycemia was observed. In present study Incidence of newResults- onset hyperglycemia was 16.8%; 262 out of 1562. Of all 1562 patients admitted in hospital, 660 (44.7%) were found to be hyperglycemic. Among 660 patients, 436 (66.06%) patients were already known diabetic or pre-diabetic and 262 (16.8) were with newly onset hyperglycemia. 15 out of 262 (5.7%) patients were expired during their disease course, 157(60%) remained hyperglycemic while 90 (34.3) had attained normoglycemia without anti-diabetic drugs. COVID 19 disease is causative factor for new onset hyperglycemia /new onsetConclusion- diabetes.

AB0042 OPTIMAL CONDITIONS FOR THE DETECTION OF INFLAMMASOME ACTIVATION IN CD14+ CD16- MONOCYTES FROM HUMAN BLOOD BY FLOW CYTOMETRY

Background

The inflammasome activation is linked to the aggregation of the adaptor protein ASC into a multimeric structure, known as the ASC speck. The aggregation of cytosolic ASC into ASC specks is therefore used as a readout parameter for inflammasome activity. The direct detection of ASC speck formation on a single cell basis through flow cytometry, can analyze inflammasome activated cells. This allows the investigation of inflammasome activity in a clinical setting.

Objectives

Investigating the optimal conditions for a reliable identification of inflammasome activated ASC speck positive cells ex vivo using flow cytometry.

Methods

Freshly donated blood from five different healthy donors was used for all experiments. The choice of anticoagulant, storage time and storage temperature were examined. PBMCs were isolated from blood collecting tubes with ethylenediaminetetraacetic acid (EDTA) or lithium heparin (LH). PBMCs were also isolated from LH blood stored at 4 °C, room temperature (RT), 37 °C and after different storage times. After isolation, PBMCs were fixed immediately and stained for flow cytometric analysis. ASC speck positive CD14+ CD16- monocytes and THP-1 cells can be generated through incubation with nigericin in PBS.

Results

We adapted a method for flow cytometric analysis of ASC specks, with was previously described by Sester et al. [1]. As expected, we observed ASC speck formation after inflammasome activation, in CD14+ CD16-monocytes through a decrease in ASC fluorescent pulse width and an increase in ASC fluorescent pulse area. Monocytes in PBMCs collected from tubes with EDTA compared with LH showed significantly higher numbers of unspecific ASC speck positive cells. Blood storage at RT for 24 h can lead to an unspecific ASC speck formation. Storage at 37 °C resulted in contamination of the PBMC interface with erythrocytes, while blood stored at 4 °C resulted in severe cell clumping. Since storing LH blood for 24 h at RT lead to unspecific ASC speck formation in CD14+ CD16- cells, but not monocytes from freshly isolated PBMCs, the determination of the time until unspecific ASC speck signals occur was investigated. A significant increase in ASC speck positive CD14+CD16- monocytes was detected after 4 h storage at RT compared to directly processed samples and the number of ASC speck positive monocytes further accumulated over time. The incubation with nigericin in PBS leads to a significant increase in ASC speck positive CD14+ CD16- monocytes and THP-1 cells compared to incubation in RPMI media.

Conclusion

The flow cytometric detection of ASC specks is adapted for practical clinical usability. To reduce background signals, LH- instead of EDTA blood collecting tubes are recommended. The LH blood should be processed within 2 h after blood collection and be stored at RT. To avoid nonspecific activation and formation of ASC specks, the PBMCs should be isolated directly after venipuncture and fixed immediately. It is also possible to freeze the PBMCs until further usage. However, this will cause some loss of ASC speck positive cells. With these settings, clinical samples can now be examined.

References

[1]Sester, D.P et al. A novel flow cytometric method to assess inflammasome formation. J. Immunol. 2015, 194, 455–462.

Acknowledgements

We thank all healthy donors who participated in this study. The authors thank Jana Gramenz (University Medicine Greifswald, Pediatric Rheumatology and Immunology, Greifswald, Germany) for excellent technical assistance.

Disclosure of Interests

None declared

Is COVID 19 Pandemic Adding More of Diabetic Population: A Study In Central India

ABSTRACT Background– COVID 19 is associated with high prevalence of diabetes along with other comorbidities which also increase the severity and mortality risk in COVID 19 disease. Recently many studies have shown the association between COVID 19 and new onset diabetes. This study was done with objectives1.To find out the incidence of new onset of hyperglycemia/diabetes in COVID 19 patients and 2.To develop screening policy for detection of new onset hyperglycemia in COVID-19 patients Materials and methods- This study is a hospital based observational cross sectional and prospective, cohort study conducted in the COVID ICU of Dedicated COVID Hospital, Bundelkhand Government Medical College, Sagar (M.P.) India, a teaching tertiary care centre. Out of 1562 COVID 19 positive patients admitted with moderate to severe pneumonia from JULY 2020 to JANUARY 2021, 487 patients were hyperglycemic at the time of admission. Patients were categorized into two subgroups: 1.Patients with previously confirmed diabetes or Prediabetes and 2.Hyperglycemia with no existing diabetes. Patients in this later subgroup were our follow up subjects for this study; their blood sugar level was monitored regularly during their stay in hospital & a correlation of COVID 19 and hyperglycemia was observed. Results- In present study Incidence of new onset hyperglycemia was 16.8%; 262 out of 1562. Of all 1562 patients admitted in hospital, 660 (44.7%) were found to be hyperglycemic. Among 660 patients, 436 (66.06%) patients were already known diabetic or pre-diabetic and 262 (16.8) were with newly onset hyperglycemia. 15 out of 262 (5.7%) patients were expired during their disease course, 157(60%) remained hyperglycemic while 90 (34.3) had attained normoglycemia without anti-diabetic drugs. Conclusion- COVID 19 disease is causative factor for new onset hyperglycemia /new onset diabetes

Neck pain among undergraduate medical students in a premier institute of central India: A cross-sectional study of prevalence and associated factors

Context:

Competitive exams conducted for undergraduate and postgraduate medical courses in India are tough. The undergraduate course is additionally taxing to the students’ health. Lack of physical activity, the stress of studies, and universal adoption of different gadgets make the undergraduate medical students prone to develop musculoskeletal pain-related issues.

Aims:

This study aimed to evaluate the prevalence of neck pain and the associated factors including gadget use among undergraduate medical students of a premier medical college in central India.

Settings and Design:

All undergraduate medical students including the interns of our institute were enrolled for this cross-sectional study.

Methods and Materials:

A self-explanatory internet-based questionnaire prepared using Kobo Toolbox was circulated via WhatsApp and email by the class representative of each batch of students. The responses obtained were analyzed using Statistical Package for the Social Sciences (SPSS).

Statistical Analysis Used:

Proportions and means were calculated. Chi-square test and univariable logistic regression analysis were used.

Results:

Three hundred thirty-one valid responses out of 423 responses were analyzed. In total, 58.3% of 331 students suffered from neck pain within the last one year. Students in the 3^rd and 4^th year had 2.9 times higher odds of current neck pain in comparison to 1^st-year students. History of neck pain before joining the course was associated with a higher risk of having current neck pain. Self-perceived aggravation of pain from gadget use had significantly higher odds of contributing to the current episode of neck pain.

Conclusions:

Neck pain is not uncommon among undergraduate medical students. History of previous neck pain including that during schooling makes a student prone for the current episode of pain. Academic stress, smartphone and laptop use tend to aggravate the pain in those who have neck pain.

Systems approach for assessment of maternal deaths in Rajasthan: A feasibility study

Background

High maternal mortality in the state like Rajasthan, which is at second rank in terms of high Maternal Mortality Ratio (MMR) in India, require concentrated efforts in this direction The objectives of this study were to assess the magnitude and trend of maternal death and underlying factors contributing to maternal deaths in Rajasthan and to identify barriers and challenges in reporting maternal deaths in Rajasthan.

Methods

Data related to maternal deaths, cause of deaths and live births were retrieved from official Government sources and MMR was calculated. To find out the underlying factors contributing to maternal deaths, Verbal Autopsies were conducted through household surveys. In-depth interviews of health care staff were conducted to carry out the 'SWOT' analysis in order to identify the barriers in reporting maternal deaths. Data was analysed using SPSS version 23.

Results

A total of 7185 maternal deaths were reported from Rajasthan in last five years. The mean age of mothers was 25.18±4.98 years. Haemorrhage were reported as most common cause of maternal death (17%) followed by Severe hypertension or fits (8%) and obstructed labour (2%). The median duration of hospital stay was 23 hours (IQR=7.5-70). Maximum deaths were reported during post-partum period (61%), while around one fourth of the deaths happened during delivery.

Conclusions

The discrepancies were observed in the reporting of number and causes of maternal deaths. The trend and forecasted figures were quite different from the published National and State level reports in this regard.

Key messages

need to streamline and strengthen the Maternal Deaths Surveillance and Response to track the number of deaths and get the exact information about the underlying factors contributing to them. Effective strategies can be developed to reduce the Maternal Deaths in the State.

Evaluation of Sealing Ability of Three Root Canal Sealers: An In Vitro Study

AIM

To evaluate the sealing ability of three different types of sealers using confocal laser microscopy.

MATERIALS AND METHODS

Sixty extracted single-root premolars were selected and divided into three groups (20 teeth in each group) according to the type of sealer used, namely, mineral trioxide aggregate (MTA) Fillapex, AH Plus, and Bio C Sealer. Root canal preparation and obturation were done in all the samples. Roots was dissected transversely in apical plane. Percentage of gap from region to canal circumference was calculated using a confocal laser microscope. Samples were subjected to statistical analysis.

RESULTS

High dye penetration was seen with AH Plus compared to MTA Fillapex and least with Bio C Sealer. The AH Plus is the best sealer with respect to seal ability of all the three.

CONCLUSION

This study helps to appraise the sealing ability of the different types of sealers using confocal laser microscopy which is useful for the success of root canal treatment.

CLINICAL SIGNIFICANCE

As sealer has to seal voids, foramina, and canals, it should have good penetration for the success of root canal treatment.

Evaluation of Eruption Pattern and Caries Occurrence among Children Affected with Fluorosis

AIM

The aim of this study was to evaluate eruption pattern and occurrence of caries in children affected with fluorosis.

MATERIALS AND METHODS

One hundred and fifty subjects (75 each with/without fluorosis) with age group of 7-8 years were selected. Dental fluorosis assessed on the buccal surfaces of the permanent incisors and molars and scored using the Thylstrup and Fejerskov index. The tooth were scored as emerged when at least one cusp of the tooth was visible in the mouth. Caries attack rate in primary and permanent teeth were estimated using DMFS and defs index in fluorosis patient. The findings were subjected to statistical analysis. The data were analyzed using Student "t" test and ANOVA "F" test.

RESULTS

There was statistically highly significant difference found in the incidence of occlusal, mesioproximal, and distoproximal caries between fluorotic and nonfluorotic patients (p < 0.001). The result of present study showed a nonsignificant association between fluoride exposure parameter and median emergence ages of permanent incisors and molar teeth. On the other hand, caries occurrence shows a significant association with fluorosis.

CONCLUSION

In this study, a significant positive correlation exists in the prevalence of caries and fluorosis. It is concluded that occlusal and proximal caries are less pronounced in fluorosis patients.

CLINICAL SIGNIFICANCE

Dental caries is a public health problem. In this study, we study the fluoride effect since the predominant cariostatic effect of fluoride is beneficial in extensive caries reduction without a concomitant risk of dental fluorosis. How to cite this article: Trivedi S, Trivedi A, Banda NR, et al. Evaluation of Eruption Pattern and Caries Occurrence among Children Affected with Fluorosis. J Contemp Dent Pract 2019;20(10):1217-1222.

Correlation of Blood Glucose Levels, Salivary Glucose Levels and Oral Colony Forming Units of Candida albicans in Type 2 Diabetes Mellitus Patients

AIM

The study aims to correlate salivary glucose, blood glucose levels and oral colony forming units of Candida albicans and to evaluate whether saliva can be used as noninvasive means to measure glycemic status in type II diabetics without the need for the invasive procedure.

MATERIALS AND METHODS

The study included 100 type II diabetic patients (group I) of both genders with age 40 years and above and100 healthy patients (group II), age and sex matched with the study group. Group I includes uncontrolled and controlled diabetics as groups IA and IB, respectively. Salivary glucose measurement was done using the enzymatic colorimetric method and blood glucose levels measured by doing venepuncture and centrifuged. The oral candidal carriage was calculated by incubation in Sabouraud's dextrose agar supplemented with chloramphenicol and incubated aerobically for 48 hours. To compare the mean values Z test was applied. To determine the relationship between two variables Pearson's correlation coefficient was used.

RESULTS

The salivary glucose levels showed a significant correlation with blood glucose levels. The salivary candida carriage was higher in uncontrolled as compared to controlled diabetics and healthy individuals.

CONCLUSION

Positive correlation was obtained between salivary glucose and blood glucose in diabetics and candidal carriage has a positive correlation with blood glucose levels. This salivary glucose and blood glucose levels correlation confirms its use to find glycemic status in diabetic patients.

CLINICAL SIGNIFICANCE

The positive correlation of salivary glucose with blood glucose shows that it can be utilized as a noninvasive tool for monitoring glycemic status in diabetic patients.

Effect of homoeopathic treatment on filariasis

A single blind follow-up study was undertaken to assess the effect of homeopathic treatment on microfilarial clearance and frequency of filarial fevers in an endemic village, India, State of Orissa. Homoeopathic treatment effectively reduced the frequency of filarial fevers by 20 per cent (P<0.05) among amicrofilaraemic cases, with a higher reduction in cases with genital involvement (36%) and mastitis (57%). However, among symptomatic microfilaraemia cases, the frequency of filarial fever (attack) had doubled (p<0.05) following treatment. There was no additional effect on microfilaria clearance in asymptomatic carriers.

Homœopathic treatment of filariasis

A single-blind study was conducted to assess the effect of homœopathic treatment on cases of bancroftian filariasis. Based on the predominant symptom, the filariasis cases were grouped as adenitis, genitalia involvement, lymphoedema and mastitis. Effect of treatment with homœopathic drugs were assessed by comparing with groups treated with placebo. Filiariasis cases treated with homœopathic medicines showed a better improved/not improved ratio (2.0) compared with cases treated with placebo (0.46). The results indicate that the improvements derived from homœopathic medicines are statistically highly significant (p<0.001).

Evaluation of Effect of Connector Designs in Implant Tooth-supported Fixed Partial Denture: A Two-dimensional Finite Element Analysis

AIM

The aim of this study was to evaluate the effect of connector designs on scale and distribution pattern of the stress generated in the supporting bone of implant tooth-supported three-unit fixed partial denture in distal extension situation.

MATERIALS AND METHODS

Three-unit fixed partial denture geometric models with implant abutment in second molar, pontic in first molar, and second premolar as mesial abutment in distal extension situations were evaluated using a two-dimensional (2D) finite element analysis. Three models were designed and constructed with mesial and distal rigid connectors, mesial nonrigid connector, and distal nonrigid connector respectively, using the software ANSYS, version 10.0 (University Intermediate). The models were analyzed to determine the maximum equivalent von Mises stress at five critical zones (maximum value) under static axial loading (240 N) after meshing and assigning the material properties.

RESULTS

The maximum stress concentration values at mesial and distal alveolar crest of the implant-supporting bone were 60.59 and 68.57 MPa, respectively, in Model No 1. The high equivalent von Mises stress concentration values at the mesial and distal alveolar crest of the implant-supporting bone were 1.65 and 0.747 MPa with 0.1 mm vertical movement and 7.88 and 9.34 MPa with 0.5 mm vertical movement of the connector respectively, in Model No 2. The high equivalent von Mises stress concentration values at mesial and distal alveolar crest of the implant-supporting bone were 10.45 and 3.43 MPa with 0.1 mm vertical movement and 4.50 and 5.71 MPa with 0.5 mm vertical movement of the connector respectively, in Model No 3.

CONCLUSION

In the supporting bone around the implant in Model No 1, the maximum von Mises stress concentrations were displayed in the crestal zones. In the supporting bone around the implant abutment, the von Mises stress concentrations were minimal toward the apical third zone in all the models. The stress concentrations were minimal in the supporting bone around the implant and the natural tooth in the models with nonrigid connector.

CLINICAL SIGNIFICANCE

When implant is used as distal abutment in three-unit implant tooth-supported fixed partial denture with pontic at first molar in distal extension situation, it is recommended to place the nonrigid connector in the mesial side of the distal implant abutment.

Retained Intra-uterine Foetal Bones Resulting in Secondary Infertility: A Case Report

Termination of pregnancy (abortion) is a reasonably safe procedure when properly performed. However, even after being performed with due precautions, complications may occur. Retention of fetal products following a mid-trimester abortion is a rare complication of abortion which can then result in secondary infertility. We are here presenting the case of a young woman who underwent an abortion in the 15th week of gestation due to anencephaly in the fetus and who then failed to conceive for the next five years. Transvaginal ultrasonographic examination suggested the presence of bone-like structures in the uterine cavity which were removed hysteroscopically. The patient was able to conceive after the hysteroscopic removal of bony fragments. Retained bony fragments from a previous mid-trimester abortion should thus be kept in the list of differentials of secondary infertility.

Comparative Evaluation of Fracture Strength of Different Types of Composite Core Build-up Materials: An in vitro Study

AIM

The aim of the study was to evaluate the fracture strength of three types of composite core build-up materials. The objectives were to study and evaluate the fracture strength and type of fracture in composite core build-up in restoration of endodonti-cally treated teeth with or without a prefabricated metallic post.

MATERIALS AND METHODS

A total of 60 freshly extracted mandibular premolars free of caries, cracks, or fractures were end-odontically treated and restored with composite core build-up with prefabricated metallic posts cemented with resin luting cement (group I) and without a post (group II). This was followed by a core build-up of 10 teeth each with three different types of composite materials: Hybrid composite, nanocomposite, and ormocer respectively. The samples were mounted on polyvinyl chloride block and then loaded in the universal load frame at 90° to the long axis of tooth. The fracture strength of the samples was directly obtained from the load indicator attached to the universal load frame.

RESULTS

Analysis of variance (ANOVA) test revealed that teeth restored with post exhibited highest fracture strength (1552.32 N) and teeth restored without post exhibited lowest fracture strength (232.20 N). Bonferroni's test revealed that values for hybrid composite (Z-100, 3M ESPE) with post, nanocomposite (Z-350, 3M ESPE) with post, ormocer composite (Admira-VOCO) with post, and nanocomposite (Z-350, 3M ESPE) without post were not significantly different from each other.

CONCLUSION

Teeth restored with post and core using hybrid composite yielded the highest values for fracture strength. Teeth restored with ormocer core without post exhibited the lowest values. Teeth restored with nanocomposite core without post exhibited strength that was comparable with hybrid composite core but higher than that of ormocer.

CLINICAL SIGNIFICANCE

Mutilated endodontically treated teeth can be prosthetically rehabilitated successfully by using adhesive composite core build-up along with post to meet anatomical, functional, and esthetic demands.

Actinomycotic osteomyelitis of palate masquerading periapical pathology: A rare case report

Osteomyelitis is an infection that is challenging to manage due to the poor vascularization of bone that favors the proliferation of microorganisms. We report a case of osteomyelitis occurring in endodontically treated teeth in the maxillary palatal region. Clinically and radiographically, it was initially diagnosed as osteomyelitis and was treated accordingly with antibiotics for 1 year with no reported healing. Later, biopsy was done and the findings were consistent with that of chronic osteomyelitis in association with infection by Actinomyces organisms. Thus, the case highlights the rare occurrence of actinomycotic osteomyelitis in maxilla and the importance of biopsy and histopathology which will help in correct diagnosis and rapid resolution through appropriate antibiotic therapy.

Syncytial Hepatitis of Tilapia ( Oreochromis niloticus L.) is Associated With Orthomyxovirus-Like Virions in Hepatocytes

Using transmission electron microscopy (TEM), the presented work expands on the ultrastructural findings of an earlier report on "syncytial hepatitis," a novel disease of tilapia (SHT). Briefly, TEM confirmed the presence of an orthomyxovirus-like virus within the diseased hepatocytes but not within the endothelium. This was supported by observing extracellular and intracellular (mostly intraendosomal), 60-100 nm round virions with a trilaminar capsid containing up to 7 electron-dense aggregates. Other patterns noted included enveloped or filamentous virions and virion-containing cytoplasmic membrane folds, suggestive of endocytosis. Patterns atypical for orthymyxovirus included the formation of syncytia and the presence of virions within the perinuclear cisternae (suspected to be the Golgi apparatus). The ultrastructural morphology of SHT-associated virions is similar to that previously reported for tilapia lake virus (TiLV). A genetic homology was investigated using the available reverse transcriptase polymerase chain reaction (RT-PCR) probes for TiLV and comparing clinically sick with clinically normal fish and negative controls. By RT-PCR analysis, viral nucleic acid was detected only in diseased fish. Taken together, these findings strongly suggest that a virus is causally associated with SHT, that this virus shares ultrastructural features with orthomyxoviruses, and it presents with partial genetic homology with TiLV (190 nucleotides).

Cation exchange synthesis of uniform PbSe/PbS core/shell tetra-pods and their use as near-infrared photodetectors

In this work we explore the preparation of complex-shaped semiconductor nanostructures composed of different materials via a cationic exchange process in which the cations of the original semiconductor nanostructure are replaced by cations of different metals with preservation of the shape and the anionic framework of the nanocrystals. Utilizing this cation exchange method, we synthesized two new tetrapods for the first time: Cu2-xSe/Cu2-xS and PbSe/PbS, both prepared from CdSe/CdS tetrapods as 'templates'. We also fabricated near-infrared (NIR) photodetectors with a very simple architecture comprising a PbSe/PbS tetrapod layer between two Au electrodes on a glass substrate. When illuminated by a NIR laser, these devices are capable of achieving a responsivity of 11.9 A W(-1) without the use of ligand-exchange processes, thermal annealing or hybrid device architecture. Transient absorption spectroscopy was carried out on these PbSe/PbS tetrapods, the results of which suggest that the branched morphology contributes in part to device performance. Investigation of the charge dynamics of the PbSe/PbS tetrapods revealed an extremely long-lived exciton recombination lifetime of ∼17 ms, which can result in enhanced photoconductive gain. Overall, these heterostructured tetrapods showcase simultaneously the importance of nanoparticle shape, band structure, and surface chemistry in the attainment of NIR photodetection.

Molecular mechanism of in vitro transformation of mammalian cells by chemical carcinogens

BHK21 clone 13 cells transformed by dimethylnitrosamine (DMN) or nitrosomethylurea (NMU) ("alkylating" chemical carcinogens) appear to be restricted by temperature in the expression of their transformed phenotype. When grown at 38.5 degrees C, they exhibit a transformed phenotype (clonal morphology and ability to plate in agar), when grown at 32 degrees C, their phenotype is normal. Conversion from the normal to the transformed phenotype and the reverse is possible by temperature shifts. Conversely of the BHK21 clone 13 cells, of the rat fibroblasts (R111) transformed by 4-nitroquinoline-N-oxide (NQN), some exhibit a transformed phenotype restricted by temperature while others are not restricted by temperature in the expression of transformation. A working hypothesis is proposed suggesting that the phenotype of cells transformed by chemical carcinogens may be determined by the nature of the chemical reaction with the cell DNA. "Alkylating" carcinogens cause prevalently point mutation in bacteria (of the base substitution kind); in the case of transformation of mammalian cells temperature-sensitive phenotypes will be obtained. "Frameshift" carcinogens cause frameshift mutation in bacteria and cells transformed by this class of carcinogens will exhibit a transformed phenotype unrestricted by temperature.

Prevalence of torus palatinus and torus mandibularis among Malay population

The aims of this study were to determine the prevalence, size, shape, and location of torus palatinus (TP) and torus mandibularis (TM), and to assess their sex-related and age-related differences in the Malay population. Sixty-five subjects were assessed for the presence of both tori at the School of Dental Sciences University Sains Malaysia. The prevalence of TP was 38–63% and that of TM was 1–10%. TP was frequently more common in females than males (90.9% versus 9.1%; P < 0.05) and was frequently found in medium sizes, spindle shaped, and was often located at the combined premolar to molar areas. The prevalence of TM was not significantly different in males and females (33.3% versus 66.7%; P = 0.523), occurred most commonly in bilateral multiple form, and was often located at the canine to premolar area.

Intraosseous acinic cell carcinoma

Acinic cell carcinoma is an uncommon low-grade malignant tumor of salivary glands. It was first described by Nasse in 1892, arising in parotid salivary gland. Salivary gland tumors are also known to develop within jaw bones, arising within the jaw as a primary central lesion, and are extremely rare with only a few cases reported. We present a rare case report of 65-year-old woman with intraosseous acinic cell carcinoma of left side of the mandible.

Genetic variety of bovine viral diarrhea virus 1 strains isolated from sheep and goats in India

Antigenic and genetic typing of pestiviruses isolated from Indian sheep and goats was carried out. Testing of 1777 sheep and 1026 goat blood samples collected between 2004 and 2008 resulted in isolation of twelve pestiviruses, seven from sheep and five from goats. All of them were antigenically typed as bovine viral diarrhea virus 1 (BVDV-1). Both the partial 5ʹ-UTR and entire non-structural autoprotease (Npro) gene of the pestiviruses were amplified by RT-PCR and sequenced. The phylogenetic analysis confirmed all twelve sheep and goat pestiviruses as BVDV-1 and they were further classified into two subtypes, BVDV-1b (seven) and BVDV-1c (five). This is for the first time that BVDV-1c was detected in sheep and goats. However, no association between the subtype and geographic area of origin was observed. Although closely related, BVDV-1b and BVDV-1c isolates of sheep and goats were placed in a different clade than previously reported Indian BVDV-1b/BVDV-1c isolates. This study confirmed widespread prevalence of BVDV-1 in Indian sheep and goats that has significance in the epidemiology of bovine viral diarrhea.

KEYWORDS

bovine viral diarrhea virus; BVDV-1; goat; Npro; genetic typing; sheep; 5ʹ-UTR.

Quercetin modulates Na(+)/K(+) ATPase and sodium hydrogen exchanger in type 2 diabetic erythrocytes

Quercetin has been reported to possess many important biological properties. We undertook in vitro studies to examine the effect of quercetin on erythrocyte Na(+)/K(+) ATPase and sodium hydrogen exchanger (NHE) activity in normal and type 2 diabetic subjects. A significant (p<0.02) increase in the activities of Na(+)/K(+) ATPase and a decrease (p< 0.01) in NHE were observed in type 2 diabetic subjects compared to normal. In vitro treatment with quercetin caused inhibition of both Na(+)/K(+) ATPase and NHE. The inhibitory effect of quercetin was concentration dependent. The effect of quercetin on Na(+)/K(+) ATPase and NHE may be explained due to a direct effect of this compound on plasma membrane leading to a change in membrane fluidity. The data obtained in this study may help to explain the anti—diabetic and anti—carcinogenic role of quercetin.

Laparoscopic vertical sleeve gastrectomy after open gastric banding in a patient with situs inversus totalis

While several equivalent alternatives are available in the bariatric algorithm, more recently the laparoscopic sleeve gastrectomy (SG) has been gaining traction as an effective means of weight loss in patients with morbid obesity. We present the case of a 39-year-old woman with situs inversus totalis, who was taken to the operating room for laparoscopic SG. The patient had previously undergone a failed open gastric banding procedure 20 months earlier. Awareness of the inherited condition before performing the operation allows for advanced planning and preparation. Subsequent modifications to the standard trocar placement help make the procedure more technically feasible. To our knowledge, this is the first published report of a laparoscopic SG after open gastric banding in a patient with situs inversus totalis. After encountering the initial disorientation, we believe experienced laparoscopic surgeons can perform this procedure successfully and safely.

Increased zymogen activity of thrombin-activatable fibrinolysis inhibitor prolongs clot lysis

BACKGROUND AND OBJECTIVES

Thrombin-activatable fibrinolysis inhibitor (TAFI) is a zymogen that can be activated by proteolytic cleavage into the active enzyme TAFIa. Hydrolysis of the C-terminal lysines on fibrin by TAFIa results in a down-regulation of fibrinolysis. Recent studies demonstrated that the zymogen also exerts an intrinsic enzymatic activity. Our objective was to identify and characterize zymogen-stimulatory nanobodies.

METHODS AND RESULTS

The screening of 24 nanobodies against TAFI revealed that two nanobodies (i.e. Vhh-TAFI-a51 and Vhh-TAFI-i103) were able to stimulate the zymogen activity 10- to 21-fold compared with the baseline zymogen activity of TAFI. The increase in catalytic efficiency can be attributed mainly to an increased catalytic rate, as no change in the K(M) -value was observed. The stability, the susceptibility towards PTCI and GEMSA and the kinetics of the stimulated zymogen activity differ significantly from those of TAFIa activity. Epitope mapping revealed that both Asp(75) and Thr(301) are major determinants in the binding of these nanobodies to TAFI. Localization of the epitope strongly suggests that this instability is as a result of a disruption of the stabilizing interactions between the activation peptide and the dynamic flap region (residues 296-350). In TAFI-depleted plasma reconstituted with a non-activatable variant of TAFI (TAFI-R92A), clot lysis could be prolonged by nanobody-induced stimulation of its zymogen activity as well as by increasing its concentration.

CONCLUSIONS

Increasing the zymogen activity of TAFI results in an antifibrinolytic effect.