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Dental implants have become the preferred treatment option for missing teeth replacement due to their functional and restorative benefits. However, placing implants in the esthetic zone remains a challenge due to anatomical factors and the need for optimal emergence profile. The use of custom abutments and regenerative techniques in this case report resulted in a successful implant-supported restoration with excellent functional and aesthetic outcomes. The case highlights the importance of proper treatment planning and the use of advanced techniques in implant dentistry to achieve optimal results. Bangladesh Journal of Medical Science Vol.22 (Special Issue) 2023 p.100-105

Ten from molecular marker ISSRs, (Inter, - Simple, Sequence, Repeats.) were used to find genetic, diversity, genetic* relationship, and DNA* fingerprint* of nine Okra (Abelmoschus esculentus) genotypes. Primers varied among them in giving unique DNA fingerprints, primers (UBC-809, HB12, and HBS10) gave a unique fingerprint for one genotype of okra, while primers (844A, UBC808) give unique fingerprint for four genotypes. High genetic distance was (0.722) between Egypt and Hasnawia while low genetic distance was (0.074) between Hasnawia and Lahluba. Cluster analysis (Phylogenetic tree) grouped studied genotypes in to two main cluster, the first large one included six genotype(Mosulia , Houseagrl, Khnisiraa ,Hasnawia ,Lahluba and Batra) and other small one includes three genotype (Soutl,Egypt and Zasco seed).ISSR marker could reveal genetic relationship in studied genotypes according to their origin, thus it gave an excellent tool to breeding programs help breeders .

Facial musculature aids in orofacial functions and involves speech, mastication, deglutition. Orofacial myofunctional exercises are exercises which are associated with form and function of face and lip. This includes facial and tongue exercises such that it enhances proper tongue position, improved breathing, chewing and swallowing. Orofacial muscle exercises not only guide in management of deleterious oral habits but also improves the muscular tonicity and proper speech which leads to a congruous orofacial functioning. This article not only addresses oral cavity but also throws light over myofacial therapy that includes head and neck. It also facilitates proper nasal breathing, promotes post-operative healing by myofunctional exercise.

This article highlights a voltage instability when the bidirectional interlinking converter (BIC) of a hybrid ac–dc microgrid operates as a constant power load (CPL). The instability is attributed to the impedance interactions seen at the dc port of the BIC. The BIC is operated with two different controllers, viz., a PI controller and a model predictive controller (MPC). In order to avert the instability, prohibiting impedance interactions is proposed as a design objective while determining the bandwidth of the PI controller. However, since a flexible control over bandwidth is not available with MPC, an active damping technique is proposed to address the instability. The proposed technique works equally well for the PI controllers with fixed or predetermined bandwidths. An important feature of the proposed technique is that it does not interfere with the original objectives of the controllers, once the instability is addressed. The technique comprises only one tuning factor, which does not depend on the BIC's internal parameters. As a result, it can easily be implemented as a general stabilizing scheme in any BIC. The efficacy of the proposed technique is verified through simulations, frequency-domain impedance analyses as well as experiments on a laboratory prototype of the BIC.

Titanium is a commonly used inert bio-implant material within the medical and dental fields. Although the use of titanium is thought to be safe with a high success rate, in some cases, there are rare reports of problems caused by titanium. Even though various recent advancement in the implant has been implicated in this era, still titanium is gold stranded among dental implant materials. In most of these problematic reports, only individual reports are dominant and comprehensive reporting has not been performed. This comprehensive article has been prepared to review the toxicity of titanium and its alloy materials in the field of dentistry. Keywords: Allergy; implant toxicity; titanium implants; titanium particles; Yellow nail syndrome

Surgical Precision to restore both biologic and aesthetic demands of patients is most important in today’s periodontal practice. Technical skills of the clinician are challenged by the limited range of visual acuity. Periodontal microsurgery increases the efficiency of basic periodontal surgical procedures by improving normal vision through magnification along with advance lighting system. Incorporation of magnification in periodontal practice gives precise outcomes which are not achieved with traditional macro surgery in terms of improved visual acuity, ergonomic benefits, decreased patient morbidity, enhanced patient acceptance, rapid healing, passive wound closure and reduced tissue trauma.The aim of this review is to enlighten about periodontal microsurgery, its role in magnification, micro-surgical instrumentation, microsurgical suturing techniques, clinical advancement and application. Keywords: Ergonomics; magnification; microsurgery; precision; techniques

This study proposes a comprehensive power management scheme (CPMS) for the economical and smart operation of a photovoltaic (PV) battery based Hybrid Microgrid (HMG) system. The solar-PV, DC-loads and battery storage are interfaced to DC-bus of the HMG. The battery is integrated into the DC-bus using a bidirectional energy storage converter (BESC). The voltage and frequency of AC-bus are regulated by utility grid and bidirectional interlinking converter (BIC) during grid-connected and islanded modes of operation, respectively. The proposed CPMS obviates high-speed communication link between converters for maintaining the system stability during power disturbances. Therefore, the vulnerability to collapse due to communication link failure is eliminated, thereby enhancing system reliability. The operational performance of HMG is improved with the proposed CPMS by providing additional features (minimisation of operating cost of the HMG, enhancement in voltage regulation of the DC-bus etc.) using low-speed communication network. The proposed CPMS can also be extended to a larger HMG system by utilising the full bandwidth of the communication network. Further, the proposed CPMS enables HMG to seamlessly switch from grid-connected to islanded mode and vice-versa. Experimental results validating the efficacy of the proposed CPMS are presented.

The SCoT marker was able to shed light on the origin-specific genetic link between the genotypes under study, providing breeders with a valuable resource. Some Tomato (Lycopersicon esculentum Mill) genotypes were analyzed for their genetic diversity, genetic connection, and DNA fingerprint using ten molecular markers of the SCoT (Start Codon Targeted) type. Different SCoT primer combinations generated distinctive DNA fingerprints. The results demonstrate that polymorphism is most prevalent when using the primer SCoT30 (100 percent) and least prevalent when using the primer SCoT54 (50 percent) (33.3). This study found that the genetic distance between Bushra and Warda was the lowest (0.1111) and the genetic distance between Fouton and the Special Pack was the highest (0.55583), but that the distance between the two was the smallest (0.1111). (Special pack and Cherry tomato). Through the use of cluster analysis (a phylogenetic tree), the examined genotypes were divided into two distinct groups. The goals of this research were to use SCoT to catalog the variety of tomato genotypes and to discover the connections between the various molecular fingerprinting-based clustering methods.

A previously independent 83-year-old lady presents with acute confusion, decreased mobility, urinary retention, and constipation, having recently received a course of oral acyclovir for shingles. The patient was noted to have extensive bruising to her upper limbs, and blood tests showed raised inflammatory markers with low platelet count, although this remained above 75 × 109/L. Her confusion on a background of shingles raised the differential diagnosis of varicella-zoster virus (VZV) encephalitis. CT head and MRI brain showed no acute intracranial abnormality. Lumbar puncture yielded frankly haemorrhagic cerebrospinal fluid (CSF), but viral polymerase chain reaction (PCR) testing was negative for the varicella-zoster virus. She later developed further right shoulder pain and right lower limb weakness three days post-initial lumbar puncture. Repeat CT head was unremarkable. MRI spine showed extensive spinal subarachnoid haemorrhage, with possible cervical arteriovenous malformation and L5/S1 spinal nerve compression. The patient was managed conservatively with dexamethasone and inpatient physiotherapy support. She was discharged after a long hospital stay at a new mobility baseline requiring hoist transfers.

This paper proposes a novel ancillary feature in bidirectional interlinking converter (BIC) for enhancing the transient performance of an islanded hybrid ac–dc microgrid. The system under consideration includes an ac microgrid with a mix of inertial and non-inertial sources integrated with a dc microgrid through a BIC. The existing BlC control schemes do not judiciously utilize the inertial sources [like the synchronous generator (SG)] as short-term storage for enhancing the transient performance of the system. Since both the microgrids are interfaced through a BIC, this can be achieved by adaptively varying its output frequency during disturbance in the ac microgrid. In the proposed scheme, the BIC is operated as a virtual synchronous generator (VSG) and its output frequency is deliberately increased/decreased during the disturbance. The change in BIC output frequency results in circulating current between the BIC and the SG. Since the BIC voltage phasor leads/lags the SG voltage phasor, it results in the utilization of the inertia of SG as storage. It provides a cost-effective solution by reducing the dependence of the scheme on storage, thereby minimizing the storage requirement while maintaining the transient stability of the system. The proposed control strategy is validated through simulations and experiments.

Background/Aims Acquired hypocomplementemia occurs through immune complex-mediated diseases, as seen in systemic lupus erythematosus (SLE), idiopathic membranoproliferative glomerulonephritis (MPGN) and cryoglobulinemia. Infective causes are less common, although chronic bacterial and viral infections causing glomerulonephritis (GN) and vasculitis have been reported. Bacterial infections causing chronic osteomyelitis, endocarditis and visceral abscesses have all been implicated, whilst hepatitis B is the only virus known to cause severe GN/ vasculitis leading to low complement levels. Severe meningococcal disease is an established cause of acquired hypocomplementemia, typically associated with Nisseria Meningitidis. Parvovirus B19 is an infection exclusive to humans, usually manifesting as fifth disease, a mild illness characterised by a rash, fever and runny nose. Less common systemic effects include hydrops fetalis, thrombocytopenia, neutropenia, neurological sequalae (including encephalopathy, aseptic meningitis, neuropathy and neuralgic amyotrophy), myocarditis and hepatitis. Arthropathy is by far the most common manifestation in adults, affecting 60% of females and 30% of males. Methods The literature on Parvovirus B19 and hypocomplementemia is sparse, limited to case reports and comparative studies, the pathogenicity of which stems from glomerulonephritis, consequently resulting in low complement levels. We present a case series of 2 patients with Parvovirus B19 infection and acquired hypocomplementemia between 2016-2020. Results Patient A, a 26-year-old female, presented with a vasculitic rash on her legs and arthralgia affecting her hands and knees, refractory to oral prednisolone and hydroxychloroquine. She was found to have low complement levels (C3 0.61 g/l and C4 0.03 g/l), whilst ANA, ENA and ANCA testing was negative. She also had a negative rheumatoid factor and anti-CCP antibody, and a normal serum protein: creatinine (6 mg/mmol). Immunoglobulins were within normal range (IgG 8.7 g/l, IgA 0.80 g/l, IgM 2.41 g/l) and a serum protein electrophoresis was normal. Hepatitis and HIV serology was also negative. Patient B, a 34-year-old female, 9 weeks pregnant, presented with polyarthralgia, fever and a maculopapular rash, with normal inflammatory markers and a normal serum protein: creatinine (9 mg/mmol). Her complement was low (C3 0.57 g/l and C4 Conclusion We recommend that clinicians consider acute viral illness in patients presenting with vasculitis and hypocomplementemia. If diagnosis and treatment can be established early, patients can avoid the need for long term immunosuppression. Disclosure A. Gharatya: None. C. Nelson: None. S. Melath: None.

The etiological factors of periodontal diseases are the habitation of dysbiotic bacteria, absence of beneficial bacteria, and susceptibility of the host. Irresolute pattern in the periodontal diseases pathogenesis leads to the evolution of novel antimicrobial therapy.The objective of the study is to assess and compare the competency of locally delivered probiotic paste with chlorhexidine gel as a supplement to scaling and root planing (SRP) in chronic periodontitis patients.A split-mouth randomized controlled trial was designed on 10 systemically healthy participants having chronic periodontitis at three distinct quadrants with 5-6-mm pocket depth. The sites in each participant were randomly selected for Group A (negative control), Group B (positive control), and Group C (test). In Group A, only SRP, Group B - SRP + chlorhexidine local drug delivery (LDD), Group C - SRP + probiotic LDD were done, respectively. Gingival index (GI) and bleeding index (BI) were determined at baseline, 3It shows a significant reduction in GI, BI, PPD, and gain of CAL in probiotic LDD group.Nowadays, since microbes are rapidly developing resistance to antibiotics, the development of probiotics is a boon for the treatment of periodontal diseases. Diseases of the periodontium are not restricted to the oral cavity alone but also have strong systemic effects. Hence, probiotics give a natural and promising choice of therapy to establish both good oral and systemic health.

Background Fibroblast Ggrowth factor-23 (FGF-23) is a phosphate regulator primarily expressed by osteocytes. Excess FGF-23 leads to decreased hydroxylation of 25-hydroxyvitamin D and poor renal phosphate reabsorption. This leads to hypophosphataemia and represents a rare cause of osteomalacia, resulting in bone oedema and stress fractures. Methods A 57-year-old man with known skin psoriasis presented with a two-year history of left foot and ankle pain. On examination, he had chronic dactylitis of the left, big toe associated with skin psoriasis and nail pitting. Serum inflammatory markers were normal, and autoimmune screens for RF, anti-CCP and HLA-B27 were negative. Bilateral foot and ankle X-rays showed no bony abnormality. This was diagnosed as likely psoriatic arthritis and MRI showed talar bone oedema, felt to be related to the inflammatory arthritis. Symptoms settled well on non-steroidal anti-inflammatories. However, he presented two months later with focal distal tibial pain and swelling. There was no history of trauma. Repeat MRI showed proximal migration of bone oedema with stress fractures of the left posterior talus and distal tibial metaphysis. Results Blood tests showed low phosphate, elevated PTH, normal adjusted calcium, raised ALP and low 25-hydroxyvitamin D. DEXA scan confirmed osteoporosis of the hip. The patient was commenced on intravenous three-monthly pamidronate and colecalciferol (vitamin D3) supplements. Despite this, the patient continued to have migratory joint pain affecting the ankle, hip and sacroiliac joints. Methotrexate was prescribed to improve his psoriasis, but whilst his skin improved his legs remained painful. A repeat MRI showed new insufficiency fractures to the left talus and right neck of femur. Although taking colecalciferol supplementation, his serum phosphate remained low (0.5mmol/L). On further investigation, Myeloma screen and FDG PET were normal but he was noted to have an increased fractional urinary phosphate excretion indicating poor renal phosphate reabsorption. Serum FGF-23 assay was elevated at 131 mIU/L (normal Conclusion This case illustrates the need for thorough investigation of symptomatic, treatment-refractory hypophosphataemia. Although mild hypophosphatemia could indicate adult onset rickets, rarer causes such as FGF-23 secreting tumours should be considered. These tumours are notoriously difficult to locate; 68-Gallium DOTATATE PET may offer superior specificity to other imaging modalities, including FDG-PET, in detecting these mesenchymal tumours. FGF-23 decreases hydroxylation of vitamin D3 and renal phosphate reabsorption, and calcitriol alongside phosphate supplementation is advisable for symptomatic management until definitive treatment. Disclosures K. Fisher None. S. Melath None. S. Patel None.

Background Fibroblast growth factor-23 (FGF-23) is a phosphate regulator primarily expressed by osteocytes. Excess FGF-23 leads to decreased hydroxylation of 25-hydroxyvitamin D and poor renal phosphate reabsorption. This leads to hypophosphatemia and represents a rare cause of osteomalacia, resulting in bone oedema and stress fractures. Methods A 57-year-old man with known skin psoriasis presented with a two-year history of left foot and ankle pain. On examination, he had chronic dactylitis of the big toe and extra-articular features included skin psoriasis on the scalp, elbows, knees, and nail pitting. Serum inflammatory markers were normal, and autoimmune screens for RF, anti-CCP and HLA-B27 were negative. Bilateral foot and ankle X-rays showed no bony abnormality. This was diagnosed as likely psoriatic arthritis and MRI showed talar bone oedema, felt to be related to inflammatory arthritis. Symptoms settled well on non-steroidal anti-inflammatories. However, he presented with focal distal tibial swelling and pain, two months later. There was no history of trauma, Repeat MRI2 showed proximal migration of bone oedema with stress fractures of the left posterior talus and distal tibial metaphysis. Bloods tests showed low phosphate, elevated PTH, normal adjusted calcium, raised ALP and low 25-OH vitamin D. DEXA scan confirmed osteoporosis of the hip. The patient was commenced on bisphosphonate with 25-hydroxyvitamin D and phosphate supplementation. Despite this, the patient continued to have migratory joint pain affecting the ankle, hip and sacroiliac joints. Methotrexate was started for psoriasis and whilst his skin improved, his pain remained and further MRI showed left talar and right neck of femur insufficiency fractures. Results Although taking vitamin D3 supplementation, he remained hypophosphateamic 0.5mmol/L. Myeloma screen and PET FDG were normal. However, he was noted to have an increased fractional urinary phosphate excretion indicating poor renal phosphate reabsorption. One possible cause of this is elevated FGF-23, which was confirmed with FGF-23 assay (include levels and normal range). The patient underwent PET Ga-DOTATE imaging, utilising a tracer specific for somatostatin receptors found on neuroendocrine tumours. This showed a T9 pedicle lesion and a CT-guided biopsy confirmed a mesenchymal tumour as the cause of FGF-23 secretion, resulting in TBMO and insufficiency fractures. The patient has become asymptomatic on calcitriol and phosphate supplementation. He is now being considered for radiofrequency ablation therapy. Conclusion This case illustrates the need for a thorough investigation of symptomatic, treatment-refractory hypophosphataemia. Although mild hypophosphatemia could indicate adult-onset rickets, rarer causes such as FGF-23 secreting tumours should be considered. These tumours are notoriously difficult to locate; Ga-DOTATE PET is probably superior to other imaging modalities including FDG-PET in isolating mesenchymal tumours. Disclosures K. Fisher None. S. Melath None. S. Patel None.

Dentin hypersensitivity (DH) is a rising concern in clinical dentistry that causes pain and discomfort and negatively affects the quality of life of patients. Indian Society of Periodontology conducted a nationwide survey, involving 3000 dentists in December 2020, which revealed significant knowledge gaps regarding DH, viz., under-diagnosis, incorrect differential diagnosis, and treatment strategies/recommendations for the management of DH patients in daily clinical practice. The current paper has been envisioned and conceptualized to update the practicing Indian dentists regarding the so-called enigma of dentistry "Dentin Hypersensitivity," based on the best available contemporary evidence. An expert panel was constituted comprising 30 subject experts from across the country, which after extensive literature review and group discussions formulated these recommendations. The panel advocated routine screening of all dentate patients for exposed dentin areas and DH to avoid under-diagnosis of the condition and suggested an early preventive management. Consensus guidelines/recommendations for the use of desensitizing agents (DAs) at home, including the use of herbal agents, are also provided within the backdrop of the Indian context. The guidelines recommend that active management of DH shall be accomplished by a combination of at home and in-office therapies, starting with the simplest and cost-effective home use of desensitizing toothpastes. A diagnostic decision tree and a flowchart for application in daily practice are designed to manage the patients suffering from DH or presenting with exposed dentin areas in dentition. Various treatment methods to manage DH have been discussed in the paper, including the insights from previously published treatment guidelines. Further, a novel system of classification of DH patients based on specific case definitions has been developed for the first time. Explicit charts regarding the available treatment options and the chronology of institution of the agent, for the management in different case categories of DH, have been provided for quick reference. The management strategy takes into account a decision algorithm based on hierarchy of complexity of treatment options and intends to improve the quality of life of the patient by long-term maintenance with an innovatively defined triple C's or 3Cs approach.

International audience; Five new chiral MnIII complexes [Mn((1R, 2R)-Salcy)N3]∞⋅CH3CN (1), [Mn((R,R)-Salcy)N3]∞ (2), [Mn((R,R)-Salcy)N3] (4), [Mn((R,R)-Salcy)(H2O)N3]⋅C4H8O (5) and [Mn((R,R)-Salcy)NCS] (6) have been synthesized and characterized by X-ray structural analysis and magnetic measurements (Salcy=N,N′-bis(salicylidene)-1,2-diaminocyclohexane. The four azido complexes have been obtained from the previously known [Mn((R,R)-Salcy)(CH3OH)N3] (3) by crystallization from various solvents. Compounds 1 and 2 are trans-μ-1,3-azide bridged coordination polymers. While 1 forms helical chains, the chain in 2 is formed via translation of a dimeric helicate repeat unit. Compound 3 is a methanol coordinated mononuclear azido complex which forms a 2D-network through H-bonding. Compounds 4 and 6 are phenoxo-bridged dimers without inversion center. Compound 5 is an aqua coordinated mononuclear azido complex, which forms a 1D-chain through O−H⋅⋅⋅N hydrogen bonding involving axial ligands. In all six compounds MnIII exhibits a characteristic Jahn−Teller elongation. The magnetic coupling in 1 and 2 leads to antiferromagnetic interaction along the chain (2 J=−11.6 cm−1 for 1 and –11.9 cm−1 for 2) through the μ-1,3-azide bridge. Compound 3 is weakly antiferromagnetic due to hydrogen bonding interactions in the lattice. The phenoxo dimers (4 and 6) do not have measurable exchange interaction, the low temperature susceptibility being influenced mainly by zero-field splitting.

Four new isostructural salts, [M(phen)3](I2Br)2·3CH2Cl2 where, M=Co (1), Ni (2), Cu (3), or Zn (4) have been synthesized by reacting the metal nitrates with 1,10–phenanthroline (phen) in presence of potassium bromide and iodine in a two phase procedure. The [Cu(phen)3]2+ coordination corresponds to tetragonally elongated octahedron while the other three are much more symmetrical. The pure Cu2+ complex as well as other salts doped with Cu2+ give hyperfine resolved EPR spectra in a wide temperature range showing dynamic Jahn–Teller distortion. The trihalide ion is nearly linear with bond distances in the range, I–I (2.786–2.833 A) and I–Br (2.759–2.794 A). Geometry optimization (DFT and MP2 methods) predicts a much more unsymmetrical “gas phase” structure for I2Br− ion. Calculated Raman frequencies are in reasonable agreement with observed values. Electronic spectral results show that the integrity of the trihalide ion is retained in solution. Three new isostructural compounds having the general formula [M(phen)3](I2Br)2 having nearly symmetrical I2Br− ion are synthesized and characterized.

In this paper, a novel virtual inertia scheme using model predictive control (MPC) is proposed which is capable of reducing the rate of change of voltage (ROCOV) during power disturbances in a DC microgrid (DC-MG). The control scheme is implemented in the bi-directional interlinking converter (BIC) which interfaces the DC-MG with the utility grid. The proposed MPC based virtual inertia scheme completely eliminates the traditional proportional integral based cascaded inner current and outer voltage loop structure of the BIC. The proposed technique ensures a fast dynamic response and is capable to quickly reduce the ROCOV of the DC bus during power disturbances. The control technique also ensures unity power factor (upf) operation of the grid connected BIC. The efficacy of the proposed control scheme has been validated with MATLAB/SIMULINK simulations and the results are presented.

International audience; Four new copper complexes, viz. [Cu(2-aminopyridine)(N3)2(H2O)2]n (1), [Cu3(3-aminopyridine)2(N3)6]n (2), [Cu(3-aminopyridine)(N3)22]n (3), and [Cu(4-aminopyridine)2(N3)2]n (4), have been synthesized with isomeric aminopyridines, viz. 2-aminopyridine (2-ap), 3-aminopyridine (3-ap), and 4-aminopyridine (4-ap), to probe the role of ligand and reactant molar ratios in directing the polynuclear assemblage and the associated magnetic properties. Ligand geometry is quite influential as can be seen through the versatile structures formed, viz. a hydrogen bonded layer of [small mu ]-1,1 azide bridged Cu dimers in 1; a network of two different types of dimers (Cu1-Cu2 & Cu3-Cu3[prime or minute]) involving [small mu ]-1,1; [small mu ]-1,3; [small mu ]-1,1,3; & [small mu ]-1,1,3,3 azide bridges in 2; a ladder structure in which [small mu ]-1,1 azide bridges form the rungs and [small mu ]-1,3 azide bridges form the rails of the ladder in 3; and a 1-D polymer chain involving [small mu ]-1,1 azide bridges in 4. Consistent with the bridge geometry, compounds 1 & 2 display ferromagnetic interactions, while 3 & 4 display antiferromagnetic interactions. The rather unexpected antiferromagnetic interactions in 3, in spite of [small mu ]-1,1 azide bridged rungs may be due to the crossover near the bridge angle. The ferromagnetic interactions in 1 and 2 are supported by DFT calculations.

Background:Anti-Ku antibodies have been associated with various connective tissue diseases, including myositis, arthritis, interstitial lung disease and glomerulonephritis1.Objectives:We present a case of a woman initially diagnosed with biopsy proven Kikuchi-Fujimoto disease who later developed a rapidly progressive myositis in association with anti-Ku antibodies.Methods:A 47 year-old woman, originally from Myanmar, presented with lymphadenopathy, myalgia, fatigue, livedo reticularis and low-grade fever for the previous 6 months. This was initially diagnosed as a viral infection. Her myalgia progressed with proximal muscle weakness in both legs and associated rise in creatine kinase levels to 349U/L (normal range 25-200). She also developed dyspnoea, an erythematous rash, mouth ulcers and unintentional weight loss.Blood tests show a lymphopenia and progressively rising CK, with a maximum level of 516 U/L. MRI whole body confirmed a widespread diffuse myositis in her upper and lower limbs, with an unusual ‘speckled’ pattern. High resolution CT Chest was normal. C3 0.40 g/l (normal range 0.75-1.65) and C4 0.12 g/l (0.14-0.54) were low, with a positive ANA (1:160) and Ro-60 antibody. dsDNA, antiphospholipid screen and virology screens were all negative. Extended myositis panel revealed positive anti-Ku antibodies. Axillary lymph node biopsy confirmed necrotising lymphadenitis, consistent with Kikuchi-Fujimoto disease.Results:She was initially treated with low dose Prednisolone and Hydroxychloroquine, with a limited response. Due to progressive myositis, pulsed IV Methylprednisolone 1g was provided over 3 days and mycophenolate mofetil (MMF) was started.An inpatient stay was needed after developing an axillary node abscess and a chest infection. This was treated with intravenous antibiotics and repeated aspirations. Due to progressive myositis on a background of sepsis, intravenous immunoglobulin (IVIG) was administered over 5 days. Our patient made a good recovery, with normalization of CK levels and resolution of the myositis noted on repeat MRI scan. She remains on MMF as maintenance therapy.Conclusion:Anti Ku antibodies appear to be associated with 2 spectrums of disease – elevated CK levels with interstitial lung disease and renal disease associated with anti-dsDNA antibodies1To our knowledge this is the first report in association with Kikuchi-Fujimoto disease. The combination of MMF and IVIG appears to have been effective treatment and her renal function remains stable, although we are monitoring the patient carefully for the possible development of interstitial lung disease.References:[1]Spielmann L, Nespola B, Séverac F, et al. Anti-Ku syndrome with elevated CK and anti-Ku syndrome with anti-dsDNA are two distinct entities with different outcomes. Annals of the Rheumatic Diseases 2019;78:1101-1106.Disclosure of Interests:None declared

Background Rheumatoid arthritis (RA) treatment is target driven. The aim is to prevent joint damage and relieve pain and functional loss. X-ray (XR) erosions are an unambiguous sign of disease activity and progression. Objectives We aimed to review our practice in looking for erosions in our biologic treated patients. We chose this group as they were likely to have the most severe and clearly defined RA. Methods 100 random biologic treated patients from our biologics database were selected for analysis. We used patient letters and our digital imaging system (PACS) for further information. Our PACS has records running back to 2004. Results Mean age was 58 years. 77% were female. Mean duration of RA was 10.6 years (range 0.9–44 years). 46 were currently receiving etanercept; 17 tocilizumab; 15 adalimumab; 14 certolizumab; 5 rituximab and 3 abatacept. 61 patients were current prednisolone users. The mean duration of biologic treatment was 4.8 years. 44 patients had received more than one biologic drug; 17 more than two. Mean DAS was 3.4. 72 patients had had previous documented hand XRs; 25 (34%) of these had erosions. The mean duration since the last hand XR was 37 months. 27 patients had had 2 previous hand XRs; 11 had had 3, 4 had had 4 and 2 had had 6 previous XRs. In 19 cases hand erosions appeared to have progressed in the patients who had had more than one XR. 44 patients had had previous foot XRs; 15 (34%) had erosions. 26 patients had had more than one foot XR. 36 patients had had previous joint ultrasound (US); in 17 (47%) US suggested active synovitis. The mean duration since the last US was 17 months. Conclusions Our patients had relatively high disease activity despite biologic treatment, over half were also on steroids and significant numbers had had several biologic switches. Despite this only around two thirds of patients had had previous hand XRs documented over an average of 10 years RA duration, and there was a long average time since the last imaging. US rates were lower, but scans were more recent, perhaps suggesting a more modern trend to US over XR. Less than half of patients had had foot XRs. Although there was a lower rate of foot XRs the rate of erosions was similar in hand and foot XRs, suggesting similar patterns of joint damage. Interestingly, despite erosions being a hard end point in most treatment trials, NICE guidance only suggests XR early in RA in ‘people with persistent synovitis’1 and EULAR guidance suggests assessing for ‘structural damage’ without specifying time intervals.2 Although newer imaging techniques may be more sensitive, XRs remain cheap, quickly accessible and allow objective assessment, particularly in long term patients being assessed for biologic switches. Our audit suggests that this well established and useful measure of disease burden may currently be relatively neglected. References [1] https://www.nice.org.uk/guidance/qs33 [2] http://ard.bmj.com/content/early/2017/03/17/annrheumdis-2016-210715 Disclosure of Interest None declared

L-type voltage gated calcium channels play essential role in contraction of various skeletal and vascular smooth muscles, thereby plays important role in regulating blood pressure. Dihydropyridine receptors have been targeted for development of newer antihypertensive agents, one of the structurally analogs nucleus dihydropyrimidines have been reported earlier by us as a potential agent toward development of calcium channel modulator. A pre-synthetic QSAR was run and on the basis of structure activity relationship a series of twenty three molecules was synthesized and studied by myosin light chain kinase assay (MLCK), Angiotensin Converting Enzyme (ACE) colorimetric assay, non-invasive blood pressure (NIBP) and invasive blood pressure (IBP) methods. Molecules with significant efficacy were studied for their single crystal X-ray diffraction, molecular docking, molecular dynamics and post-synthetic QSAR. The NIBP and IBP methods screened molecules with better percentage inhibition versus time compared to standard drug Nifedipine. The lead compound ethyl 2-methyl-4-(3-nitrophenyl)-4H-pyrimido [2,1-b] [1,3] benzothiazole-3-carboxylate (26) presented a triclinic structure with polymeric chain packing in lattice. 26 exhibited IC50 on MLCK assay of 2.1±1.7 μM with selectivity of L-type calcium channels and comparative to Nifedipine. It offered satisfactory physicochemical properties with partition coefficient of (ClogP) 4.64. Its pharmacokinetic profile is also good with Cmax at 0.40 μg/ml by oral route with Tmax reaching in 0.5 h which means in 30 min. 26 also exhibits superior t1/2 of 5.4 h and oral bioavailability of (F) 56.75% with an AUC0-∞ of 0.84 μg h/ml. Molecular docking studies indicates toward the interaction of lead compound via hydrogen bonds with Lys144, Glu181 and Asp183, it forms the Van der Walls interactions with Ser18, Asp20, Asn187, Pro185, Glu180, Glu181 and Arg10 with Glide score and Glide energy to be -3.602 and -47.098, respectively. Post-synthetic QSAR of newly synthesized molecules indicates toward improvement with respect to steric descriptor which contributed negatively in former series.

Background: Orthodontic wires are the corner stones of the science and art of orthodontics and they remain in the patient’s mouth for a prolonged period of 18-24 months. It is but natural to expect that they will undergo some biodegradation when in the oral environment during that period. This study aims to compare the biodegradation characteristics of four different orthodontic wires, stainless steel, nickel titanium (NiTi), titanium molybdenum alloy (TMA), and copper NiTi and to assess whether these biodegradation products, are within acceptable limits. Materials and Methods: This study involved the incubation of four different wires in artificial saliva and analyzing the amount of metal released from them at the end of a 28 days study period. The metals analyzed for where nickel, chromium, copper, cobalt, manganese, iron, molybdenum, and titanium. The artificial saliva was changed on days 7, 14, and 21 to prevent the saturation of metals in the artificial saliva. At the end of 28 days, these four samples of artificial saliva of each wire were mixed together and analyzed for the eight metals using an inductively coupled plasma spectroscope. Results: The results showed only the release of nickel, chromium, and iron from stainless steel wire, nickel from NiTi wire, nickel, and chromium from copper NiTi and none from TMA wire. Conclusion: The metals released from arch wires are of such minute quantities to be of any biologic hazard. The amount of metals released is well within acceptable biocompatible limits. Though this study has analyzed the biodegradation of various orthodontic wires, orthodontic wires are never used alone in mechanotherapy. Orthodontic wires along with multiband appliance system with which it is always used and in combination with accessories like face bows may release more metals.

Background: Interferon regulatory factor 6 (IRF6) is a transcription factor with distinct and conserved DNA and protein binding domains. Mutations within the protein binding domain have been significantly observed in subjects with orofacial cleft relative to healthy controls. In addition, recent studies have identified loss of expression of IRF6 due to promoter hypermethylation in cutaneous squamous cell carcinomas. Since mutational events occurring within the conserved domains are likely to affect the function of a protein, we investigated whether regions within the IRF6 gene that encodes for the conserved protein binding domain carried mutations in oral squamous cell carcinoma (OSCC). Materials and Methods: Total chromosomal DNA extracted from 32 post surgical OSCC tissue samples were amplified using intronic primers flanking the exon 7 of IRF6 gene, which encodes for the major region of protein binding domain. The PCR amplicons from all the samples were subsequently resolved in a 1.2% agarose gel, purified and subjected to direct sequencing to screen for mutations. Results: Sequencing analysis resulted in the identification of a mutation within exon 7 of IRF6 that occurred in heterozygous condition in 9% (3/32) of OSCC samples. The wild type codon TTC at position 252 coding for phenylalanine was found to be mutated to TAC that coded for tyrosine (F252Y). Conclusions: The present study identified for the first time a novel mutation within the conserved protein binding domain of IRF6 gene in tissue samples of subjects with OSCC.

Three three-dimensional coordination polymers,viz.poly[[diaqua-μ4-oxydiacetato-di-μ4-sulfato-dipraseodymium(III)] hemihydrate], [Pr2(C4H4O5)(SO4)2(H2O)2]·0.5H2O, (I), poly[[diaquadi-μ3-oxydiacetato-μ3-sulfato-dineodymium(III)] 1.32-hydrate], [Nd2(C4H4O5)2(SO4)(H2O)2]·1.32H2O, (II), and poly[[diaquadi-μ3-oxydiacetato-μ3-sulfato-disamarium(III)] 1.32-hydrate], [Sm2(C4H4O5)2(SO4)(H2O)2]·1.32H2O, (III), were obtained by hydrothermal reactions of the respective lanthanide oxides and ZnSO4with oxydiacetic acid (odaH2). The Nd3+and Sm3+compounds form isomorphous crystal structures in which the lanthanide cations are nine-coordinate, having a tricapped trigonal prismatic coordination. The Pr3+compound has an entirely different crystal structure in which two types of coordination polyhedra are observed,viz.nine-coordinate (trigonal prism) and ten-coordinate (bicapped square antiprism). The sulfate anions show various coordination modes, one of which has only rarely been observed crystallographically to date.

In this paper, a loss optimized and cost effective droop control scheme is proposed for a DC microgrid coupled to a weak rural distribution grid. The active power exchange limits between the DC microgrid and the utility grid have been derived considering the Indian voltage regulation standards as set by Central Electricity Authority at the point of common coupling. In the grid-connected mode, the DC microgrid is connected to the utility grid via a bidirectional interfacing converter (BIC). The proposed scheme ensures an optimal operation of battery energy storage converter (BESC) and BIC in terms of loss and cost. The scheme employs a dedicated communication link based on controller area network (CAN) protocol making the system operation smarter and intelligent. The method guarantees the maintenance of the DC bus voltage at the nominal value under all operating scenarios. The performance of the control scheme has been validated with experiments. Case by case experimental results included.

Three Mn(III,III) complexes containing dibenzoylmethane (dbm), Mn 2 (OMe) 2 (dbm) 2 (ClH 2 CCOO) 2 ( 1 ), Mn 2 (OMe) 2 (dbm) 2 (Cl 2 HCCOO) 2 ( 2 ) and Mn 2 (OMe) 2 (dbm) 2 (Cl 3 CCOO) 2 ( 3 ) were synthesized. Crystal structure determination and magnetic characterization were done for 2 . The Mn⋯Mn distance in complex 2 is 2.865 A. It exhibits antiferromagnetic coupling with exchange parameter | J | = 20.4 cm −1 ( H = −2 JS A S B ). All three complexes, though insoluble in common solvents, catalyse the disproportionation of hydrogen peroxide when dispersed on silica gel with turnover numbers ∼150–300. DFT simulations showed that bridging moieties have remarkable effect on intermetallic distances in dimanganese(III,III) complexes.

[Cu(en)(phen)2]+ is crystallized along with two phenanthroline and eight lattice water molecules either as a chloride or a nitrate salt. The cation has almost identical structural and spectral properties which correspond to a tetragonally elongated octahedral geometry with the en ligand in the equatorial plane. EPR parameters reveal a slight rhombicity in the coordination polyhedron. Even though both compounds have the same composition (except for the anions), the hydrogen bond networks involving the lattice water molecules and anions are quite different in the two compounds. There are also extensive π-stacking interactions involving the phenanthroline molecules, both coordinated and non-coordinated. The non-bonding interactions have a major directing role in the crystallization of the tris-chelate cation. The analogous mixed ligand complex of 2,2-bipyridine could not be crystallized.

Reaction of pyridine-2,6-dicarboxylic acid (dipicH2) with ammonium ceric nitrate and Cu(II) salts yielded three heterometallic compounds all of which contain [Ce(dipic)3]2− linked to aquo-Cu(II) complex units. Part of the Ce(IV) gets reduced by solvent during the reaction leading to [(Ce(dipic)3Ce(H2O)8)2Cu(H2O)4][Ce(dipic)3]2·12H2O (1). Other lanthanide(III) ions could take the place of Ce(III) as demonstrated by the preparation of [(Ce(dipic)3La(H2O)8)2Cu(H2O)4][Ce(dipic)3]2·12H2O (4), which is isomorphous with compound 1. [Ce(dipic)3Cu(H2O)4]·8H2O (2) is a one-dimensional coordination polymer in which two types of aquo-Cu(II) complex units which differ in the orientation of the tetragonal axis alternate along the chain. The central Cu(H2O)22+ unit in the trinuclear anion of [Cu(H2O)6][Ce(dipic)3Cu(H2O)2Ce(dipic)3]·8H2O (3) is chelated by two carboxylate groups in trans positions in off-axis mode. In all the four complexes, the Cu(II) centres are magnetically isolated leading well-resolved EPR spectra in polycrystalline samples.