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Caries results in the demineralization and destruction of enamel and dentine, and as the disease progresses, irreversible pulpitis can occur. Vital pulp therapy (VPT) is directed towards pulp preservation and the prevention of the progression of inflammation. The outcomes of VPT are not always predictable, and there is often a poor correlation between clinical signs and symptoms, and the events occurring at a molecular level. The inflamed pulp expresses increased levels of cytokines, including tumour necrosis factor (TNF)‐α, interleukin (IL)‐1α, IL‐1β, IL‐4, IL‐6, IL‐8, IL‐17 and IL‐23, which recruit and drive a complex cellular immune response. Chronic inflammation and sustained cytokine release can result in irreversible pulp damage and a decreased capacity for tissue healing. Other chronic inflammatory diseases, such as psoriasis, inflammatory bowel diseases and rheumatoid arthritis, are also characterized by an dysregulated immune response composed of relatively high cytokine levels and increased numbers of immune cells along with microbial and hard–soft tissue destructive pathologies. Whilst anti‐cytokine therapies have been successfully applied in the treatment of these diseases, this approach is yet to be attempted in cases of pulp inflammation. This review therefore focuses on the similarities in the aetiology between chronic inflammatory diseases and pulpitis, and explores how anti‐cytokine therapies could be applied to manage an inflamed pulp and facilitate healing. Further proof‐of‐concept studies and clinical trials are justified to determine the effectiveness of these treatments to enable more predictable outcomes in VPT. [ABSTRACT FROM AUTHOR]

Four patients developed maculo-papular rash while one patient developed non-blanchable petechial rash. Although many studies have reported pruritus limited to injection site, none have mentioned generalized pruritus as an adverse effect of vaccine.7,8 Since there may be a lag period of days to weeks between COVID-19 vaccine and onset of pruritus, patients may not always associate the two and hence pruritus associated with vaccine may be under-reported. Morbiliform as well as delayed skin rash have been reported post COVID-19 vaccination.9,10 Rest of the adverse effects reported in our study were infrequent as compared to telogen effluvium and urticaria. [Extracted from the article]

Background: There is limited research quantifying the direct and indirect economic costs associated with intellectual disability (ID) in Australia. Costs incurred by families, governments and broader society include time spent providing care, absenteeism and increased healthcare utilisation. The purpose of this research is to quantify the costs associated with ID in childhood using a range of methods to collect cost data. Methods: Costs included healthcare service utilisation, pharmaceutical use, caregiver productivity losses and time spent providing care because of the child's disability. The sample comprised caregivers with a child with ID aged between 2 and 10 years old recruited in Australia. Healthcare service utilisation and pharmaceutical use were obtained from routinely collected administrative claims data. Healthcare utilisation not captured in the routinely collected administrative data and absenteeism data were obtained from a retrospective recall‐based questionnaire. Time spent providing care because of the child's disability was obtained using a time‐use diary. Results: The total cost of ID in Australia was estimated to be AUD 72 027 per year per child, and the total cost of ID in childhood was estimated to be AUD 12.5 billion per year. The cost to governments of ID in childhood was estimated to be AUD 6385 per child per year, resulting in a total cost to government of AUD 1.1 billion per year. Conclusions: This is the first study to estimate the direct and indirect costs associated with ID in childhood. The results of this research demonstrate the considerable economic impact of ID in childhood on families, governments and broader society in terms of both direct and indirect costs. An understanding of the cost implications of any intervention are critical in assisting policymakers in planning and prioritising of health services. [ABSTRACT FROM AUTHOR]

Background: Children with intellectual disability (ID) frequently have significant educational, social and health care needs, resulting in caregivers often experiencing a wide range of negative effects. This paper aims to determine the impact of childhood ID on caregivers' health‐related quality of life (HRQoL) across co‐morbid diagnostic groups. The second aim of this study is to determine the risk factors associated with lower HRQoL in this population. Methods: Caregivers of a child with ID aged between 2 and 12 years old completed an online survey to determine their HRQoL using the EQ‐5D‐5L measure. They were also asked demographic questions and about their dependent child's level of behavioural and emotional difficulties. Results: Of the total sample of 634 caregivers, 604 caregivers completed all five questions of the EQ‐5D‐5L. The mean age of caregivers was 39.1 years and 91% were women. Caregivers spent on average 66.6 h per week caring for their child related to their child's disability. The mean EQ‐5D‐5L score of caregivers was 0.80 (95% confidence interval: 0.79, 0.82), which is below the estimated Australian population norms (mean utility score of 0.92) for the age‐equivalent population. Caregivers of children with autism spectrum disorders reported the lowest HRQoL (0.77, 95% confidence interval: 0.74, 0.79) of the five included co‐morbid diagnostic groups. Caregivers with a lower income, a perceived low level of social support and children with higher degree of behavioural and emotional problems were likely to have a statistically lower HRQoL. Conclusions: This is the first study to produce utility values for caregivers of children with ID. The utility values can be used to compare health states and can be used to inform comparative cost‐effectiveness analyses. Demonstrating that caregivers of children with ID have reduced HRQoL and that this is associated with the degree of behavioural and emotional problems has important policy implications, highlighting the potential for policy interventions that target behavioural and emotional problems to improve outcomes for caregivers. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of a counselling intervention in antenatal care settings for pregnant women who report domestic violence.Design: Pre-experimental study with pretest-posttest design.Settings: Two public hospitals in Mumbai, India.Sample: In all, 2778 pregnant women accessing antenatal care (ANC) in the hospitals from February to November 2016 were approached for study participation; 2515 women consented. These women were screened by trained counsellors for domestic violence during pregnancy (domestic violence during pregnancy). Domestic violence during pregnancy was reported by 16.2% (408) of women. Of these, 155 women sought counselling services. Post-intervention analyses were carried out with 142 women at 6 weeks post-delivery; 13 women were not contactable.Methods: The 442 women who reported domestic violence during pregnancy were provided a minimum of two counselling sessions by trained counsellors during their ANC visits. A counselling intake form was used to collect pre- and post-intervention data.Main Outcome Measures: Prevalence of domestic violence during pregnancy, change in women's ability to cope, safety, and health.Results: Prevalence of domestic violence during pregnancy (16.1%) was comparable to those of common obstetric complications routinely screened for during ANC. In all, 60-65% women reported cognitive changes such as recognising impact of violence and need to speak out against it. In all, 50.7% women took action at the individual level to address domestic violence during pregnancy. This change was not statistically significant (P-value 0.193). Of the women studied, 35.9% adopted at least one safety measure, and 84% of the women reported better health status post-intervention.Conclusions: Routine enquiry and counselling for domestic violence during pregnancy are effective in improving women's ability to cope, safety, and health.Funding: This study was funded by The John D. and Catherine T. MacArthur Foundation.Tweetable Abstract: Improving coping strategies, safety and health of pregnant women who reported domestic violence by providing counselling in antenatal care setting. [ABSTRACT FROM AUTHOR]

The concept of seeding giant-sized ocean salt water aerosols in the eye-wall of a cyclonic storm abruptly increasing cloud condensation nuclei ( CCN) concentration is investigated. To bring this to effect, design of a novel injection mechanism - a modified naval artillery shell, tailor made for the Indian Navy fleet, containing sea-salt solution to disperse the CCN is proposed. The effect of the seeding is modeled using a robust optimized warm rain microphysical scheme - amenable for quick local forecasts within the Weather Research and Forecast framework. The combined protocol results in a significant decrease in precipitation tendencies upon landfall. [ABSTRACT FROM AUTHOR]

Summary: Melia dubia, a multipurpose tree species, is gaining importance to meet the demand supply gap of timber, plywood and pulpwood. In June 2016, a serious outbreak of wilt disease was observed in M. dubia seedlings planted in the Central Nursery of Forest Research Institute (FRI), Dehradun, India. The disease led to the destruction of one hundred thousand (100,000) seedlings. Earlier in June 2012, serious wilting of M. dubia seedlings was observed in Haryana, India. The pathogen was identified as Fusarium solani following standard laboratory procedures and sequence analysis of the internal transcribed spacer (ITS) region of the ribosomal DNA (rDNA). The pathogenicity of three isolates has been proved under greenhouse conditions. This is the first report of F. solani causing wilt of M. dubia. [ABSTRACT FROM AUTHOR]

IgA vasculitis (earlier known as Henoch-Schonlein purpura) is the most common vasculitis characterized by triad of purpura, arthritis, and abdominal pain. A 20-year-old male presented with fever, pain abdomen, vomiting, and joint pains of 3 days duration. Skin biopsy showed inflammatory infiltrate around the vessels with plump endothelial cells, leucocytoclasia, and extravasation of red blood cells characteristic of vasculitis (Fig. [Extracted from the article]

R. Thakur, S. Arora, R. Nada, M. Minz, K. Joshi. Prospective monitoring of BK virus reactivation in renal transplant recipients in North India. Transpl Infect Dis 2011: 13: 575-583. All rights reserved Abstract: Background. BK nephropathy (BKN) is an important complication of renal transplantation with a reported incidence between 1% and 10% in different parts of the world. Early diagnosis is important to plan early therapeutic strategies. The epidemiology and evolution of BKN is relatively unknown in India and hence, the present study has been designed to prospectively monitor the activation of BK virus (BKV) in renal transplant recipients in India. Patients and methods. In this study, 32 renal allograft recipients were prospectively monitored with protocol biopsies of allografts, BKV DNA load in plasma, and viral particles in urine by electron microscopy (EM) on day 1, and at 1, 3, and 6 months. Additionally, the baseline BKV DNA load in plasma was quantitated in 21 corresponding donors. Results. On follow-up in 32 recipients, 9.7%, 23.8%, 19.2%, and 13.3% of patients showed viral profiles by EM at day 1, 1 month, 3 months, and 6 months, respectively. BKV DNA positivity in plasma was 25.8%, 42.9%, 15.4%, and 20% at day 1, 1 month, 3 months, and 6 months, respectively, with mean BKV copy number/mL plasma of 1796, 1029, 2611, and 3318, respectively. A total of 15.7% (17/108) urine samples of 32 renal recipients were positive by urine EM. Out of 100 protocol biopsies, none developed histologically demonstrable cytopathic effects of BKN, although 8% biopsies were SV-40 large T antigen (SV-40 T Ag) positive. By quantitative real-time polymerase chain reaction assay, 27/108 (25%) of recipients' plasma samples were positive for BKV. Peak viremia and viruria occurred at 1-3 months post transplantation. The baseline viremia in donors was predictive of viremia positivity in the post-transplantation period at 1 month. Twenty-four episodes of graft dysfunction were attributed mainly to rejection. Conclusion. The study shows a total of 15.7% and 25% urine and plasma samples were positive for BKV at any time during a 6-month follow-up. The highest incidence of BK viruria and viremia occurred at 1 month. In protocol biopsies, focal positivity of SV-40 T Ag was seen in 8% biopsies. [ABSTRACT FROM AUTHOR]

The global epidemic of type 2 diabetes demands the rapid evaluation of new and accessible interventions. This study investigated whether Aegle marmelos fruit aqueous extract (AMF; 250, 500 and 1000 mg/kg) improves insulin resistance, dyslipidemia and [beta]-cell dysfunction in high fat diet fed-streptozotocin (HFD-STZ)-induced diabetic rats by modulating peroxisome proliferator-activated receptor-[gamma] (PPAR[gamma]) expression. The serum levels of glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of [beta]-cell function (HOMA-B), lipid profile, TNF-[alpha] and IL-6 were evaluated. Further, the TBARS level and SOD activity in pancreatic tissue and PPAR[gamma] protein expression in liver were assessed. In addition, histopathological and ultrastructural studies were performed to validate the effect of AMF on [beta]-cells. The HFD-STZ treated rats showed a significant increase in the serum levels of glucose, insulin, HOMA-IR, TNF-[alpha], IL-6, dyslipidemia with a concomitant decrease in HOMA-B and PPAR[gamma] expression. Treatment with AMF for 21 days in diabetic rats positively modulated the altered parameters in a dose-dependent manner. Furthermore, AMF prevented inflammatory changes and [beta]-cell damage along with a reduction in mitochondrial and endoplasmic reticulum swelling. These findings suggest that the protective effect of AMF in type 2 diabetic rats is due to the preservation of [beta]-cell function and insulin-sensitivity through increased PPAR[gamma] expression. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Summary Previous estimates for the end-tidal concentration of desflurane that allows removal of the laryngeal mask airway in 50% of anaesthetised adults (ED50) have ranged from 2.1% to 5.3%. To assess which value is correct, we studied 32 female patients (aged 30-50 years) undergoing intracavity caesium implants for cervical carcinoma under general anaesthesia. Anaesthesia was induced with propofol 2-3 mg.kg−1 and maintained with desflurane in a 50% nitrous oxide-oxygen mixture. At the end of surgery, a predetermined target end-tidal desflurane concentration (starting at 4%) was maintained for 10 min using Dixon's up-down method and the laryngeal mask airway was removed. The target end-tidal concentration in the next patient was increased or decreased by 0.5% depending upon the response of the previous patient. Removal of the laryngeal mask airway without coughing, clenching, biting, movement or any adverse airway event during or within 1 min after removal was considered to be successful. We found that the laryngeal mask airway can be successfully removed in 50% (ED50) and 95% (ED95) of the anaesthetised adults at end-tidal desflurane concentrations of 2.4% (95% CI 1.3-2.9) and 3.8% (3.1-9.6), respectively. [ABSTRACT FROM AUTHOR]

N. Gupta, S. K. Arora, A. Rajwanshi, R. Nijhawan and R. Srinivasan Histoplasmosis: cytodiagnosis and review of literature with special emphasis on differential diagnosis on cytomorphology Background: Human infection with Histoplasma capsulatum runs the gamut from asymptomatic to disseminated disease. In immunocompromised patients, a tiny inoculum can lead to widespread disseminated infection. Early diagnosis and initiation of treatment is therefore important. Objective: To review the cases of histoplasmosis diagnosed on fine needle aspiration cytology (FNAC) and to discuss the clinical presentation, associated inflammatory response, load of organisms and differential diagnosis on cytomorphology in these cases. Methods: Retrospective review of seven cases of histoplasmosis at a tertiary-care centre during the period from 1998 to 2009 was performed. Clinical presentation along with cytomorphological features were studied and discussed in detail. Results: The mean age of patients was 48.6 years and six out of seven were male. History of immunodeficiency (HIV) was available in five cases. Six patients presented with peripheral and/or abdominal lymphadenopathy. One patient had nodular shadows in both lungs and two also had skin lesions. On cytological smears, a variable load of uniform round to oval, about 2–4 μm in diameter, budding yeasts were seen intracellularly (within histiocytes) as well as extracellularly. In one case (HIV positive), these organisms were also seen within neutrophil polymorphonuclear leucocytes. In two cases, an inflammatory response in the form of epithelioid cell granulomas along with multinucleated giant cells was seen. Conclusions: FNAC is a reliable tool to recognize infection with H. capsulatum in tissues. This infection can cause a variable inflammatory response, which should be considered while reporting on such cases. [ABSTRACT FROM AUTHOR]

Aim To determine the position and shape of the apical foramina in posterior teeth derived from an Indian population. Methodology A total of 800 freshly extracted maxillary and mandibular premolar and molar teeth from a native Haryana population were collected. Apices of teeth were stained with methylene blue and then examined stereomicroscopically (40×). The following observations were made: number of apical foramina; size and shape of the minor apical foramen; accessory foramina frequency, and deviation of the minor apical foramina (frequency and distance) from the apex. Results The mean maximum and minimum diameter of the minor apical foramina ranged from 0.158 to 0.323 mm. The most common minor apical foramen shape was oval (81%). Frequency of accessory foramina was between 2% and 41% for the various tooth types. The frequency of deviation of the minor apical foramina from the anatomic apex varied from 43% to 83% and the distance of deviation in all the teeth was between 0.052 and 2.921 mm. Conclusions The incidence of oval canals was higher in this Indian population compared to other populations. In 92% and 96% of teeth the difference between the maximum and the minimum diameter of all foramina was less than or equal to 0.20 and 0.25 mm, respectively. Therefore, four to five instrument sizes larger than the first binding file would have been necessary to shape the minor apical foramen of more than 95% of the teeth included in this study to make them round. [ABSTRACT FROM AUTHOR]

Lactic acid bacteria (LAB) have been extensively used for centuries as starter cultures to carry out food fermentations and are looked upon as burgeoning “cell factories” for production of host of functional biomolecules and food ingredients. Low-calorie sugars have been a recent addition and have attracted a great deal of interest of researchers, manufacturers, and consumers for varied reasons. These sweeteners also getting popularized as low-carb sugars have been granted generally recommended as safe (GRAS) status by the U.S. Federal Drug Administration (USFDA) and include both sugars and sugar alcohols (polyols) which in addition to their technological attributes (sugar replacer, bulking agent, texturiser, humectant, cryoprotectant) have been observed to exert a number of health benefits (low calories, low glycemic index, anticariogenic, osmotic diuretics, obesity control, prebiotic). Some of these sweeteners successfully produced by lactic acid bacteria include mannitol, sorbitol, tagatose, and trehalose and there is a potential to further enhance their production with the help of metabolic engineering. These safe sweeteners can be exploited as vital food ingredients for development of low-calorie foods with added functional values especially for children, diabetic patients, and weight watchers. [ABSTRACT FROM AUTHOR]

High-intensity low-calorie sweeteners saccharin, acesulfame-K, sucralose and aspartame were used as a replacement for sucrose in the manufacture of burfi . Burfi sweetened with low-calorie sweeteners ranked lower (P < 0.05) but was still acceptable in various textural attributes at all periods of storage in comparison to the control with sucrose. The low hardness, adhesiveness, springiness and accordingly, gumminess and chewiness in burfi samples sweetened with low-calorie sweeteners were because of the lack of compactness. It was evident from the scanning electron microscopy that the compactness of the network in burfi decreased with the use of low-calorie sweeteners. The results of the sensory evaluation have shown the successful use of low-calorie sweeteners in the preparation of burfi with a slight difference in its overall acceptability, thus providing an alternate variety to the health-conscious consumers. PRACTICAL APPLICATIONS The consumption of sweets is an integral part of the Indian dietary system. An estimated 54% of India's milk production is converted into products, both traditional and western, with 50% share of traditional products. But in recent years, the manufacturers are diversifying the production to include the specialty items that cater to specific targeted populations. Diabetic-friendly traditional sweet is a new category for such products, the production of which is being contemplated by many enterprising manufacturers. The results have shown the possibility of using low-calorie sweeteners in the preparation of indigenous dairy products, i.e., burfi. The manufacture of indigenous dairy products with low-calorie sweeteners will provide a successful outlet for traditional milk products, and this will provide an alternate variety to the health-conscious consumers. [ABSTRACT FROM AUTHOR]

The effect of load variation on the microhardness and microcracks of SrC4H4O6·3H2O (STT) single crystals has been studied. The crystals are grown by using a controlled chemical reaction in silica hydrogel medium. We confirm the applicability of Hays and Kendall's law. There is some anisotropy in the hardness observed on different faces. We show different types of cracking in the crystal during loading. Fracture toughness, brittleness index, and yield strength of the grown crystals have also been determined using the fracture mechanism. [ABSTRACT FROM AUTHOR]

The potential for a drug-drug interaction between modafinil and dextroamphetamine, each at steady state, was investigated in an open-label, randomized, single-period studyin 32 healthy male and female volunteers. All subjects received modafinil orally once daily for 28 days (200 mg on Days 1-7; 400 mg on Days 8-28). On Days 22 to 28, half of the subjects also received dextroamphetamine (20 mg) orally 7 hours after modafinil. Samples for pharmacokinetic (PK) profiling were obtained on Days 21 and 28. The mean changes in PK parameters for modafinil and its two circulating metabolites between the two groups were not statistically significantly different, except Cmax for modafinil acid. Adverse events obtained in the two groups were similar and mild or moderate in nature. The results indicate that administration of low-dose dextroamphetamine in this dosing regimen does not alter the steady-state pharmacokinetics of modafinil. The combination has a similar tolerability profile as modafinil alone. [ABSTRACT FROM AUTHOR]

Modafinil has been reported to produce a concentration-related suppression of CYP2C9 activity in vitro in primary cultures of human hepatocytes. To determine whether this effect occurs in vivo, the pharmacokinetics of (S)-warfarin was investigated after single oral doses of racemic warfarin (5 mg; COUMADIN) in a placebo-controlled, single-blind, single-period study in 28 volunteers. Subjects received an oral dose of warfarin prior to administration of modafinil (200 mg for 7 days, followed by 400 mg for 21 days) or placebo and they received another after 4 weeks of treatment. Treatment with modafinil did not significantly alter the pharmacokinetics of (S)- or (R)-warfarin relative to placebo. Since (S)-warfarin is predominantly metabolized via CYP2C9, the results indicate that the marked suppression of CYP2C9 activity in vitro does not translate into a similar effect clinically. However, limitations arising from investigation of single doses of warfarin preclude global conclusions about the potential for more subtle interactions after chronic warfarin administration. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the importance of rechecking fetal kidneys at a routine third-trimester growth scans, even if they were reported as normal during second trimester anomaly scan. Out of 15 cases, 8 fetuses (53%) had mild urinary tract dilatation (UTD A1) and 7 fetuses (47%) had UTD A2-3. [Extracted from the article]

Evolving from an era of predominantly diagnosing and monitoring pregnancies at risk of adverse outcomes, scientific perspective and clinical work are now increasingly shifting towards early prediction and the development of options for the prevention of untoward pregnancy events. "FGR classifier 1" (CFGR 1), based on 14 genes with differential DNA coverage, was noted to have the highest classification performance for predicting FGR, in both the first and second trimesters, with an accuracy of over 80%. The main limitation of this study is that it did not include the FGR fetuses who are appropriate for gestational age (a group which constitute around one-third of FGR babies). [Extracted from the article]

Esophageal injury or perforation is a rare but life threatening complication of transesophageal echocardiogram (TEE). Most of the patients manifest symptoms within 24 hours of the procedure and upper esophagus is the most common site of injury. We report a patient who underwent TEE for the evaluation of severe valvular insufficiency and 4 days after the procedure developed an esophageal tear in its mid portion associated with profuse upper gastrointestinal bleeding. Though delayed esophageal perforation in the lower segment has been previously reported after a perioperative TEE, no such report exists to our knowledge, in the setting of a nonsurgical TEE. [ABSTRACT FROM AUTHOR]