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Cytotoxic drugs are highly efficacious and also have low therapeutic index. A great degree of caution needs to be exercised in their usage. To optimize the efficacy these drugs need to be given at maximum tolerated dose which leads to significant amount of toxicity to the patient. The fine balance between efficacy and safety is the key to the success of cytotoxic chemotherapeutics. However, it is possibly more rewarding to obtain that balance for this class drugs as the frequency of drug related toxicities are higher compared to the other therapeutic class and are potentially life threatening and may cause prolonged morbidity. Significant efforts have been invested in last three to four decades in therapeutic drug monitoring (TDM) research to understand the relationship between the drug concentration and the response achieved for therapeutic efficacy as well as drug toxicity for cytotoxic drugs. TDM evolved over this period and the evidence gathered favored its routine use for certain drugs. Since, TDM is an expensive endeavor both from economic and logistic point of view, to justify its use it is necessary to demonstrate that the implementation leads to perceivable improvement in the patient outcomes. It is indeed challenging to prove the utility of TDM in randomized controlled trials and at times may be nearly impossible to generate such data in view of the obvious findings and concern of compromising patient safety. Therefore, good quality data from well-designed observational study do add immense value to the scientific knowledge base, when they are examined in totality, despite the heterogeneity amongst them. This article compiles the summary of the evidence and the best practices for TDM for the three cytotoxic drug, busulfan, 5-FU and methotrexate. Traditional use of TDM or drug concentration data for dose modification has been witnessing a sea change and model informed precision dosing is the future of cytotoxic drug therapeutic management.

The demand for accurate, faster, and inexpensive sequencing of deoxyribonucleic acid (DNA) is increasing and is driving the emergence of next-generation sequencing (NGS) technologies. NGS can provide useful insights to help researchers and clinicians to develop the right treatment options. NGS has wide applications in novel fields in biology and medicine. These technologies are of great aid to decode mysteries of life, to improve the quality of crops to detect the pathogens, and also useful in improving life qualities. Thousands to millions of molecules can be sequenced simultaneously in parallel using various NGS methods. NGS can identify and characterize the microbial species more comprehensively than culture-based methods. Recently, the NGS approach has been used for oral microbial analysis. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this clinical trial was to assess and compare the clinical outcomes of Bioflx crowns (BFCs) with stainless steel crowns (SSCs) in primary molars (PMs). Materials and Methods: This prospective splitmouth randomized controlled clinical trial was conducted between March 2022 and June 2023. Thirty-eight patients (17 females and 21 males) with a mean age of 5.21 years participated in this study. Each child (n = 38) received both SSC and BFC. Clinical and radiographic follow-up was performed at baseline, 3, 6, and 12 months using the modified United States Public Health System scoring criteria to evaluate various parameters. Results: At the 3 and 6 months' follow-up, no significant difference was observed between the two groups. However, at 1-year follow-up, a statistically significant difference (P < 0.05) was evident in the frequency between the two groups for the criteria of crown retention after cementation and anatomic form of the crown, indicating a preference for SSC over prototype 1 BFC. Conclusion: The 12-month results indicate that BFC performed similarly to the established SSC for the restoration of PMs providing better esthetics. [ABSTRACT FROM AUTHOR]

Background: This study highlights the vital role of Machine Learning in aiding myocardial infarction (MI) diagnosis, crucial in remote areas with limited medical resources. By leveraging ML algorithms and accessible patient data, it offers a valuable tool for early MI detection and risk assessment in underserved regions, potentially improving patient outcomes and healthcare delivery. Methods: In this case-control study, data from 1,200 individuals (300 MI, 900 non- MI) were collected. Significant variables were identified using correlation. Eight ML models were built based on the patient's historical 24 variables and evaluated using the F1 score, Cohen's Kappa, and AUROC. We also conducted real-time clinical validation to assess the practical applicability of the model. Results: In terms of training time, logistic regression (LR) with L2 regularization, AdaBoost, and XGBoost models showed significantly higher times (410ms, 520ms, and 220ms, respectively). LR had the lowest errors (1.67% training, 1.11% testing) and achieved a high accuracy of 96%, notable precision, recall, and an impressive AUC of 98.87%. In real-time clinical validation, LR and XGBoost performed exceptionally well, boasting F1 scores of 96.27% and 98.70%, respectively, solidifying their effectiveness for predictive accuracy in a clinical setting. Conclusion: In real-time clinical validation, LR and XGBoost based on patient's historical data showcased impressive predictive power, highlighting their potential in clinical settings. These models can be helpful to improve the diagnosis of MI in Remote Areas with Limited Medical Resources. [ABSTRACT FROM AUTHOR]

Background: Traumatic birth experience is an unaddressed arena, especially in Asian women, with several societal stigmas lingering around. Aim: A study was undertaken to simultaneously assess the post-partum mental and physical health follow-up of maternal near-miss (MNM) women and compare it with women of uneventful deliveries. Materials and Methods: The prospective cohort study enrolled 88 MNM women (case cohort) and 80 women with an uneventful peri-partum period (control cohort) at the same time. The participants were followed up with Edinburgh Postnatal Depression Scale (EDPS), PTSD Checklist – Civilian Version (PLC-C), and a 36-item short-form-survey form over 6 months after the delivery. Results: The case group had higher mean EPDS and PLC-C scores, with poor quality of life (QOL) performance, compared to the control group at 6 weeks and 3 months, and 6 months follow-up (P < 0.05). At the sixth-week follow-up visit, the study observed that 28 (31.8%) women from the case group required a psychiatry consultation compared to the control group with only two (2.5%) participants (P < 0.001). At 3 months, an evident difference was noted on various QOL parameters, such as limitations due to physical health and emotional problems, energy fatigue, general health, and health change parameters between the two groups (P < 0.05). The difference persisted at 6-month follow-up as well for limitations due to physical health, energy fatigue, and general health parameters only (P < 0.05). Conclusion: There is an urgent need for a multi-departmental collaborative approach at the hospital level and policy-making decisions at higher levels for the mental health of Asian women facing MNM events. [ABSTRACT FROM AUTHOR]

Background: Assessment of dental anxiety in children is difficult because of their immature cognitive and emotional development. Drawings are well well-established emotion assessment tool. These can be used as nonverbal methods of communication for expressing the children's anxiety and emotions. Art therapy utilizes creative therapy interventions to deal with children suffering from emotional problems. Aims and Objectives: The aim of the study is (1) To assess the drawings of children for the presence of dental anxiety. (2) To study the effectiveness of art therapy on dental anxiety in children. Materials and Methods: One hundred and twenty children within the age group of 6–12 years were part of this study. The pretest assessment of dental anxiety was done using Frankl and Five facial anxiety scales. All the participants received local anesthesia during their first treatment session. At the end of the treatment session, all the participants were asked to draw a picture of their experience. The drawn figures were assessed by a psychologist. The children were allotted randomly into the study group (n = 60) and control group (n = 60). Art therapy was given to 60 children in the study group for three consecutive appointments. The posttest assessment of dental anxiety was done using Frankl and Five facial anxiety scales after completion of the entire dental treatment. Results: The pretest scores revealed very high level of dental anxiety in 33 (55%) children in study group and 34 (56.67%) children in control group. The posttest scores of study group, who received the art therapy, revealed that 24 (40%) children had little anxiety and 32 (53.33%) children had some anxiety. Whereas in the control group, the posttest scores showed 20 (33.33%) children had high anxiety and 39 (65%) children had very high anxiety scores. There was a significant correlation between the objective score of dental anxiety and the subjective scores of CD: H. Conclusion: Drawings can be used as an assessment tool for the detection of dental anxiety and art therapy effectively reduces the anxiety in pediatric patients undergoing dental treatment. [ABSTRACT FROM AUTHOR]

Background: N-acetyl transferase 2 (NAT2) polymorphism testing could not see the light of success as a biomarker tool in tuberculosis management. Additionally, the antitubercular treatment (ATT) drug's reintroduction regimen variations exist because of the scarcity of robust preclinical evidence on ATT drug metabolism. Objective: The experiment was planned to understand the pharmacokinetic (PK) behavior of isoniazid and acetylisoniazid (AcINH) in a Wistar rat model of acute liver injury induced by carbon tetrachloride (CCl4) and preclinical drug-induced liver injury (DILI) model induced with CCl4 + anti-Tuberculosis (TB) drugs together. Materials and Methods: Thirty rats were used for the experiment and were divided into five groups. All rats were administered a single 0.5 ml/kg CCl4 intraperitoneal injection on day 0 to induce an animal model of DILI. Group I rats received CCl4 alone. Groups II--V were started on additional gavage feedings of isoniazid (H) alone, H plus rifampicin (R), H plus pyrazinamide (Z), and H, R, and Z together, respectively, daily for 21 days subsequently. Isoniazid and AcINH PK assessment was accomplished on day 20 of continuous once-daily dosing. Liver function test (LFT) monitoring was done at baseline on days 1, 7, and 21. On the last day of experiments, all experimental rats were sacrificed. Results: Three-week ATT administration sustained the CCl4-induced LFT changes. Area under the curve (AUC) values for isoniazid and AcINH were found to be 2.24 and 1.69 times higher in the H + R group compared with the CCl4 + H group, respectively (P < 0.05). Isoniazid and AcINH maximum concentration (Cmax) reached the highest, while isoniazid clearance reached the lowest in the H + R group. AcINH AUC increased by double in the CCl4 + Isoniazid+Rifampicin +Pyrazinamide (HRZ) group compared with the CCl4 + H group (P < 0.05). Biochemical, histological, and antioxidant changes were consistent with the new liver injury model's development. Conclusion: Rifampicin almost doubles up the isoniazid and AcINH exposure, in presence if DILI. [ABSTRACT FROM AUTHOR]

Background: We investigated the pharmacokinetic behavior of pyrazinamide (PZA) and pyrazinoic acid (PA) in the presence of carbon-tetrachloride (CCl4) plus antitubercular treatment (ATT) drug-induced liver injury (DILI) in rats. Methods: Thirty rats utilized in the experiment were separated equally into five groups. Each rat was injected with 0.5 ml/kg CCl4 intra-peritoneal injection on day zero. Group, I rats did receive only CCl4 (single i.p. injection, 0.5 ml/Kg in olive oil in a 1:1 ratio). Groups II, III, IV, and V did receive daily oral PZA, PZA plus isoniazid (INH), rifampicin (RMP) plus pyrazinamide (PZA), and three drugs together, respectively, for 21-days. Pharmacokinetic sampling was performed at 0, 0.5,1,3,6,12 and 24 hours post-dosing on day-20. Liver function test (LFT) was assessed at days 0,1,7, and 21 days after CCl4 and ATT administration, and rats were sacrificed on the last experiment day. Results: ATT treatment maintained the liver function changes initiated by CCl4 administration. An evidential LFT rise was observed in groups administered with pyrazinamide. Co-administration of Isoniazid caused a 2.02 and 1.78 times increase in Area-under-the-curve (AUC) values of PZA and PA, respectively (p < 0.05). Histological and oxidative-stress changes supported the biochemical and pharmacokinetic observations. Conclusion: The enzyme inhibitory capacity of isoniazid is well-preservd in CCl4-induced liver injury. [ABSTRACT FROM AUTHOR]

Introduction: The aim of study is to determine if laser irradiated enamel may be a viable alternative to acid etching for orthodontic bonding of molar tubes. Method: Sixty extracted permanent molars were divided into 3 groups of 20 each. Group I was irradiated with Er:YAG laser for 15 s, group II with Er;Cr:YSGG laser for 15 s, and group III was etched with 37% phosphoric acid. Ten samples from each group were observed under scanning electron microscope and later all 60 samples were bonded with molar tubes. Molar tubes were debonded and shear bond strength was recorded. Adhesive remnant index was measured under electron microscope (2000×). Results: Shear bond strength with Er:YAG laser etching was significantly higher than with acid etching and Er;Cr:YSGG laser etching. Er:YAG laser etching, and Er;Cr:YSGG laser etching showed Type III etching pattern with microcracks while acid etching showed Type I etching pattern. Adhesive remnant index was significantly higher for Er:YAG laser etching as compared to conventional acid etching. Conclusion: Er:YAG and Er;Cr:YSGG laser etching is a viable alternative to acid etching for bonding of bondable molar tubes. [ABSTRACT FROM AUTHOR]

Byline: Aashima. Arora, Amol. Patil Sir, On February 9, 2018, valproate was expelled from the first-line antiepileptic category in the UK for pregnant and childbearing age group and reserved for [...]

India is the second most prominent maker and formation of E-bikes on the world. The core of vehicle industry that was revaluated with the welcome of eco-obliging improvement is good to go to see sunrise of new time in bike industry. The primary purpose of this study is to the identify the relationship between the factors and customer satisfaction. Factors considered for research are Price, Suspension, Charging Time, Built Quality, Warranty, Maintenance Cost, Security Alerts, Brand Name, Mileage, Motor Power. Descriptive research design has been used and convenience sampling method used for the collecting the data. Structured questionnaire used for the collecting primary data. Regression Analysis was being performed on the data collected to find out the factors that was studied affecting the satisfaction of the Okinawa E-bike customers. Finding of the study Expressions E-bikes, climate satisfying, moderate [ABSTRACT FROM AUTHOR]

Background and Aim: There has been a lack of uniformity on how to triage coronavirus disease 2019 (COVID-19) patients visiting the emergency units of hospitals. Triage tools are themselves spreading the pandemic in hospital areas. The present study compared a master two-step (M2ST) exercise stress test versus a 6-min walk test (6MWT) in COVID-19–positive patients visiting the emergency unit of a hospital. Materials and Methods: Thirty-nine patients underwent 6MWT followed by M2ST, while another set of 38 patients underwent M2ST followed by 6MWT in this randomized, crossover, open-label, and noninferiority study. The exercise tests assessed the change from baseline in SpO2, heart rate (HR), respiratory rate, blood pressure, exertion, and dyspnea on the modified-Borg scale. Results: Noninferiority was established for SpO2 (P < 0.05), systolic blood pressure (SBP; P < 0.001), and diastolic blood pressure (DBP; P < 0.05), but not for HR (P = 0.3) and respiratory rate (P = 0.6). The difference between the pretest and posttest (delta change) values for the parameters SpO2, respiratory rate, HR, SBP, and DBP correlated significantly (P < 0.001) with Pearson correlation coefficient (r = 0.764, 0.783, 0.473, 0.838, and 0.783, respectively). The delta change values of modified-Borg scale for dyspnea (P = 0.291) and exertion (P = 0.208) were statistically insignificant between the two exercise tests. However, the correlation between the tests was statistically significant (P < 0.001). Conclusion: M2ST, a timesaving, cost-effective, and easy to perform exercise stress test, has been identified as a reliable alternative for 6MWT. [ABSTRACT FROM AUTHOR]

Background: Several phyto-chemicals have been identified and suggested as potential therapeutic options for hepatotoxicity management. Objective: To assess the hepatoprotective effect of scopoletin, a pure phyto-chemical, in carbon tetrachloride (CCl4)-induced hepatotoxicity model in Wistar rats. Methods: Thirty-six rats in total, six in each group, were utilized in this study. Animals in group 1 received normal saline; those in group 2 received carbon tetrachloride in olive oil (0.5 ml/kg, i.p. in ratio 1:1); those in groups 3, 4, and 5 received oral scopoletin (1 mg/kg, 5 mg/kg, 10 mg/kg dose-wise groups); and those in group 6 received N-acetyl cysteine (NAC) 150 mg/kg. Blood sampling was performed on day - 3, day 1, and day 7 of the CCl4 administration. Rats were sacrificed on day 7 of the experiment for histological examination and oxidative stress measurement of the liver. Results: The 5 mg/kg scopoletin group showed a maximum reduction in AST levels [727.33 ± 29.15 in medium dose (MD) group vs 1526.66 ± 60.72 in the experimental control (EC) group (P < 0.001) and ALT levels of 532.66 ± 24.23 in MD group vs 894.83 ± 52.47 in EC (P < 0.01)]. The dose-dependent action was not observed with scopoletin doses. The protective effect of scopoletin was confirmed by MDA and GSH levels (P < 0.05) coupled with histo-pathological findings. In the present study, a reversible model of CCl4-induced hepatotoxicity was observed to get normalized in a week's time. Conclusion: The study confirms the hepatoprotective action of scopoletin in an acute model of hepatic injury with the putative anti-oxidant mechanism. [ABSTRACT FROM AUTHOR]

In the present investigation, we introduce the two subclasses S α Σ(γ, ρ, λ, µ, ξ, δ) and SΣ(γ, ρ, λ, µ, ξ, δ; β) of normalized analytic bi-univalent functions defined in the open unit disk and associated with the Ruscheweyh’s operator. Further, we obtain bounds for the second and third Taylor-Maclaurin coefficients of the functions belong to these subclasses. We also provide relevant connections with earlier investigations of other researchers. [ABSTRACT FROM AUTHOR]

Streamflow is one of the key variables in the hydrological cycle. Simulation and forecasting of streamflow are challenging tasks for hydrologists, especially in sparsely gauged areas. Coarse spatial resolution remote sensing soil moisture products (equal to or larger than 9 km) are often assimilated into hydrological models to improve streamflow simulation in large catchments. This study uses the Ensemble Kalman Filter (EnKF) technique to assimilate SMAP soil moisture products at the coarse spatial resolution of 9 km (SMAP 9 km), and downscaled SMAP soil moisture product at the higher spatial resolution of 1 km (SMAP 1 km), into the Soil and Water Assessment Tool (SWAT) to investigate the usefulness of different spatial and temporal resolutions of remotely sensed soil moisture products in streamflow simulation and forecasting. The experiment was set up for eight catchments across the tropical climate of Vietnam, with varying catchment areas from 267 to 6430 km2 during the period 2017–2019. We comprehensively evaluated the EnKF-based SWAT model in simulating streamflow at low, average, and high flow. Our results indicated that high-spatial resolution of downscaled SMAP 1 km is more beneficial in the data assimilation framework in aiding the accuracy of streamflow simulation, as compared to that of SMAP 9 km, especially for the small catchments. Our analysis on the impact of observation resolution also indicates that the improvement in the streamflow simulation with data assimilation is more significant at catchments where downscaled SMAP 1 km has fewer missing observations. This study is helpful for adding more understanding of performances of soil moisture data assimilation based hydrological modelling over the tropical climate region, and exhibits the potential use of remote sensing data assimilation in hydrology. [ABSTRACT FROM AUTHOR]

Pulmonary tumor embolism (PTE) and pulmonary tumor thrombotic microangiopathy (PTTM) are rare etiologies for rapidly progressive dyspnea in the setting of undiagnosed metastatic cancer. They occur most frequently in association with adenocarcinomas, with PTE being most frequently associated with hepatocellular carcinoma and PTTM being most commonly reported with gastric adenocarcinoma. Pulmonary tumor embolism and PTTM appear to be a disease spectrum where PTTM represents an advanced form of PTE. Pulmonary tumor embolism and PTTM are mostly identified postmortem during autopsy as the antemortem diagnosis remains a clinical challenge due to the rapidly progressive nature of these rare diseases. We report 2 cases of rapidly progressive respiratory failure leading to death, due to tumoral pulmonary hypertension resulting from PTE and PTTM, diagnosed postmortem. Both of the patients were middle-aged females, nonsmokers, and had a gastrointestinal source of their primary malignancy. [ABSTRACT FROM AUTHOR]

Cosmic Ray Neutron Sensing (CRNS) has become an effective method to measure soil moisture at a horizontal scale of hundreds of meters and a depth of decimeters. Recent studies proposed to operate CRNS in a network with overlapping footprints in order to cover root-zone water dynamics at the small catchment scale, and, at the same time, to represent spatial heterogeneity. In a joint field campaign from September to November 2020 (JFC-2020), five German research institutions deployed 15 CRNS sensors in the 0.4 km2 Wüstebach catchment (Eifel mountains, Germany). The catchment is dominantly forested (but includes a substantial fraction of open vegetation), and features a topographically distinct watershed. In addition to the dense CRNS coverage, the campaign featured a unique combination of additional instruments and techniques: hydro-gravimetry (to detect water storage dynamics also below the root zone); ground-based and, for the first time, airborne CRNS roving; an extensive wireless soil sensor network, supplemented by manual measurements; and six weighable lysimeters. Together with comprehensive data from the long-term local research infrastructure, the published dataset (available at https://doi.org/10.23728/b2share.afb20a34a6ac429ca6b759238d842765) will be a valuable asset in various research contexts: to advance the retrieval of landscape water storage from CRNS, wireless soil sensor networks, or hydrogravimetry; to identify scale-specific combinations of sensors and methods to represent soil moisture variability; to improve the understanding and simulation of land-atmosphere exchange as well as hydrological and hydrogeological processes at the hill-slope and the catchment scale; and to support the retrieval soil water content from airborne and spaceborne remote sensing platforms. [ABSTRACT FROM AUTHOR]

Objectives. The main purpose of the study was to assess the material wear, antagonistic natural primary teeth wear, and microhardness of zirconia (ZR), a recently launched novel glass-fiber-reinforced composite crown (GFRC). The research question was, are these aesthetic crowns resulting in antagonistic natural primary tooth wear and the crown material itself? Methods. Forty-five primary canines were divided into three groups (15 per group) and mounted against Zr (Group A), GFRC (Group B), and natural teeth as control (Group C) in the wear test machine. All samples were assessed for surface wear with pre- and post-3-dimensional scanning. In addition, microhardness was assessed for all three groups. Results. The mean microhardness value for the Zr disc was 1157 ± 7 HV; for the GFRC disc, it was 29.35 ± 2 HV; while with natural teeth, it was 105 ± 4 HV. There was a statistically significant difference in teeth wear in the prescan and postscan in the natural tooth (p < 0.05) group, highly significant difference (p < 0.001) in the ZR group, and no significant difference in the GFRC group. Conclusion. There is more significant wear loss of glass-fiber-reinforced composite discs as compared to zirconia. In addition, the wear of the antagonistic tooth with zirconia and natural teeth is more remarkable than with GFRC. There is a vast difference of microhardness between natural teeth and zirconia (almost 10 times higher) which suggests further scope of study. Clinical Relevance. Pediatric dentistry deals with the transition of dentition from primary to permanent through mixed dentition. Selection of restorative material needs to be done cautiously when we are dealing with primary teeth and young permanent teeth as antagonistic teeth. Wear of the crown material itself and opposing natural teeth are essential factors that should be considered in selecting crowns in clinical practice. The present study results can be extrapolated to clinical practice, and the practitioner can consider various factors in selecting full-coverage crowns for primary teeth. The vast difference in aesthetic crowns and natural teeth microhardness indicates a further need for research. Additionally, there is no literature published for the recently launched GFRCs. [ABSTRACT FROM AUTHOR]

Acute maxillary sinusitis infection with Burkholderia cepacia in a noncystic fibrosis patient should be considered as a potential differential diagnosis to attempt to eradicate the infection owing to its morbidity. We report a case of 52-year-old female with orbital cellulitis and acute maxillary sinusitis due to B. cepacia. The combined management with intravenous antibiotics and surgical debridement of the sinuses helped in eradication of the infection. The main purpose of presenting this article is the rarity of species occurring in maxillary sinus without cystic fibrosis or nasal polyps. [ABSTRACT FROM AUTHOR]

Byline: Zainab. Arsiwala, Amol. Patil, Madhuri. Mehta, K. Morwani We have come a long way in vestibular schwannoma surgery. In the present era, the incidence of morbidity, mortality, meningitis, facial [...]

Byline: Amol. Patil, Yashashri. Shetty, Snehalata. Gajbhiye, Sweta. Salgaonkar Background and Aims: When a drug is used in a way that is different from that described in regulatory body approved [...]