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Introduction: December 2019, witnessed the emergence of a novel coronavirus in human population. Later named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has since spread across the globe and results into coronavirus disease 2019 (COVID-19) pandemic. Objective: The objective of this study was to evaluate COVID-19 infection positivity rate, its age and gender wise prevalence and to compare the results of rapid antigen detection test with gold standard real time RT-PCR for early detection of SARS-CoV-2 virus. Methods: An observational study was conducted in the Department of Microbiology and Molecular Biology of Krishna Institute of Medical Sciences, Secunderabad, Telangana. Results: A total of 208 patients’ specimens (nasopharyngeal swab) were compared within a period of one and half month. Infection positivity rate was observed as 26.92% (n=56). Our study revealed that among all 56 COVID-19 positive patients, 60.71% (n=34) were symptomatic whereas 39.2% (n=22) were asymptomatic. Conclusion: We conclude that after comparing with real time RT-PCR, antigen detection assay is not as sensitive as molecular test especially during the early stages of infection but this has potential to become an important tool for mass screening for COVID-19 and can be considered as fast and economic diagnostic tools in the remote areas where the laboratory facilities for molecular tests are not accessible.

In early December 2019, an outbreak of novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) as it is now called, occurred in Wuhan City, Hubei Province, China. On January 30, 2020 the World Health Organization declared the outbreak as a Public Health Emergency of International Concern. Vaccines to prevent human coronavirus infections are not yet available. Coronavirus disease 2019 (COVID-19) spreads primarily when people are in close contact with small droplets produced by an infected person, identified as “super spreaders”. COVID-19 can be fatal among high-risk groups patients >60 yr. The envelope spike “S” protein receptor binding domain of SARS-CoV-2 use host receptor angiotensin-converting enzyme 2 (ACE2) to enter the cells of airway epithelium and alveolar type 2 (AT2) pneumocytes, and pulmonary cells. The most common clinical features are fever (80-90%), cough (60-80%) and breathlessness (18-46%). The other symptoms include myalgia, sore throat, loss of taste and smell, headache, nausea, vomiting and diarrhoea. Infection control practices to be followed stringently by Health Care Workers (HCW). Standard precautions to be maintained. Specimen to be packed in triple container packing. Cold temperature to be maintained during transport and storage. Laboratory tests of COVID-19 are broadly categorized into two methods: (1) Nucleic acid based assay: RT-PCR, TrueNAT, CBNAAT & (2) Immunoassay: Can be broadly divided into 2 types: Antigen based assay: Rapid antigen test, Antibody based assay: enzyme-linked immunosorbent assay (ELISA).

The world is in dire need of safe, effective coronavirus disease 2019 (COVID-19) vaccine strategies. Since its emergence in November 2019, it has spread to 188 countries and 25 territories around the globe, despite elaborate efforts by World Health Organization (WHO) and governments to contain the infection, primarily owing to the highly infectious nature of this virus. Present article reviews various aspects in process of vaccine designing, vaccine platforms and current efforts and progress of COVID-19 vaccine candidates. The founding of the COVID-19 vaccines global access (COVAX) facility by Gavi, the coalition for epidemic preparedness innovations (CEPI) and the WHO is an attempt to garner resources and unite higher- and lower-income countries for the coordinated, rapid, transparent and equitable access to COVID-19 vaccines worldwide.

Background: Mycobacterium tuberculosis infection usually manifests as pulmonary tuberculosis and rarely as extra-pulmonary tuberculosis (EPTB). In recent past, there is an increase in the cases of extra-pulmonary tuberculosis. The diagnostic difficulty owing to paucibacillary nature of EPTB poses a challenge in diagnosis and consequently treatment. In this scenario, Polymerase chain reaction (PCR) serves as a convenient tool which gives results within a short time along with other conventional methods in the diagnosis of extra-pulmonary tuberculosis. Aims: To detect Mycobacterium tuberculosis complex (MTBC) by DNA PCR in clinically suspected cases of EPTB. Materials and methods: Clinical samples from suspected cases of EPTB were collected and processed according to the standard guidelines. Smears prepared were subjected to Ziehl-Neelsen (ZN) staining. Nested PCR was performed on extracted DNA from homogenized samples using commercial kit with MTB target gene of IS6110. Results: A total of 156 samples were received for molecular diagnosis of EPTB over a year. They were all subjected to ZN staining and PCR test. All 156 samples were negative for AFB by ZN staining. Out of total 156 samples, 8(5.12%) samples were detected positive by MTB-DNA PCR test. The most common site of EPTB found in this study was pleura (14.28%). Other sites included genito-urinary tract (13.33%), CNS (4.65%) and endometrium (3.44%). Conclusion: Early diagnosis and treatment of EPTB reduces complications and morbidity in affected patients. Though PCR is expensive; in diagnostic dilemma in suspected cases of EPTB, it can be included in diagnostic panel to clinch the diagnosis early and start pre-emptive treatment.

BACKGROUND: Free radical-induced oxidative stress is the root cause for many human diseases. Naturally occurring antioxidant supplements from plants are vital to counter the oxidative damage in cells. The main objective of the present study was to characterize the antioxidant and antiproliferative potential of rice bran extracted from an important Indian rice variety, Njavara and to compare the same with two commercially available basmati rice varieties: Vasumathi, Yamini and a non medicinal variety, Jyothi. METHODS: Methanolic extracts of rice bran from four varieties; Vasumathi, Yamini, Jyothi and Njavara were used to study their total phenolic and flavonoid contents, in vitro antioxidant activities including total antioxidant activity, scavenging of nitric oxide and 1,1-Diphenyl-2-picrylhydrazyl (DPPH) radical, reducing power and cytotoxic activity in C6 glioma cells. Correlation coefficient and regression analysis were done by using Sigmastat version 3.1 and Stata statistical package respectively. RESULTS: Rice bran methanolic extract from Njavara showed the highest antioxidant and cell cytotoxic properties compared to the other three rice varieties. IC50 values for scavenging DPPH and nitric oxide were in the range of 30.85-87.72 microg/ml and 52.25-107.18 microg/ml respectively. Total antioxidant activity and reducing power were increased with increasing amounts of the extract. Total phenolic and flavonoid contents were in the range of 3.2-12.4 mg gallic acid-equivalent (GAE)/g bran and 1.68-8.5 mg quercetin-equivalent (QEE)/g bran respectively. IC50 values of cytotoxic assay (MTT assay) were 17.53-57.78 microg/ml. Correlation coefficient and regression analysis of phenolic content with DPPH and NO scavenging, MTT (-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide) assay, total antioxidant assay and reducing power showed a highly significant correlation coefficient values (96-99%) and regression values (91-98%). CONCLUSION: The results of the present study show that the crude methanolic extract from Njavara rice bran contains significantly high polyphenolic compounds with superior antioxidant activity as evidenced by scavenging of free radicals including DPPH and NO. Njavara extracts also showed highest reducing power activity, anti-proliferative property in C6 glioma cells. In conclusion, it is conceivable that the Njavara rice variety could be exploited as one of the potential sources for plant--based pharmaceutical products. [ABSTRACT FROM AUTHOR]

Extramammary Paget disease is a rare dermatological condition resembling Paget disease that occurs most commonly in the anogenital area and axilla. We present the case of an elderly male who had come with complaints of an itchy, erythematous and raised lesion in the perianal region for 3 months that did not respond to antifungals. A biopsy was taken from the lesion site and the diagnosis was confirmed by histopathological examination. It is important to be aware of conditions like extramammary Paget disease when an elderly individual presents with a non-specific pruritic lesion in the perianal area that is non-responsive to treatment; the diagnosis of which can be made only by doing a biopsy from the concerned site. This highlights the importance of histopathological examination in such ambiguous cases., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Montelukast Sodium (MK) is a leukotriene receptor antagonist, an oral drug generally prescribed to control chronic asthma symptoms. This research aims to provide the transdermal delivery of this drug in a controlled release profile as a better mode of drug delivery, specifically for the pediatric and elderly population. Transdermal delivery of the drug not only improves the drug's bioavailability but also maintains the concentration of the drug in the plasma without increasing the frequency of the drug dosage. Transdermal film formulations were developed using sodium alginate (SA) and lignosulphonic acid (LS) as the matrix and PEG-400 or Glycerine (Gly) as the plasticizers. Various physiochemical characteristic evaluations of the formulated films were conducted, revealing that the formulation with Glycerine as the plasticizer had a smooth surface and was flexible. It was observed that this formulation had the highest moisture uptake capacity and the lowest moisture loss capacity when compared with the other two formulations. It was also observed that the barium chloride cross-linked formulation had a higher swelling index when compared with calcium chloride cross-linked films. The surface pH of all the formulations was monitored to be around 7.5. In the in vitro release studies, the cross-linked films showed a controlled release over 36 h compared with the non-cross-linked films. Based on the observations and results, the cross-linked film formulation showed a better-controlled release of the drug and could potentially increase its bioavailability. TGA analysis of the polymeric mixture demonstrated the thermal stability of the SA blends, which enhanced the flexibility of the SALS blend with Glycerine. XRD of samples confirmed the amorphous nature of SALS blends with Gly, which influences the flexibility of the blend. The blends are further investigated for morphology using SEM to test their compatibility with the drug., Competing Interests: The authors declare no conflict of interest., (© 2023 Published by Elsevier Ltd.)

Purpose: Mandibular pathologies causing extensive defects in pediatrics is relatively rare, and sparse literature is available for the reconstructive options of the same. The main aim is to provide optimum esthetics and function., Materials and Methods: PubMed, Cochrane CENTRAL, Embase, MEDLINE and Scopus databases were searched for articles published only in English language up to May 2021, involving reconstruction of hemi or total mandibulectomy defects in patients with the age of 8 years or less, associated with benign or malignant pathology. Primary outcome variable was the success of reconstruction. Qualitative analysis was performed using a microsoft excel-sheet., Results: Of the 2201 articles reviewed, only fourteen were selected for data extraction. 22 patients were included. Fifteen were benign, six were malignant pathologies, and one was not defined. Hemi-mandibulectomy was performed in twenty-one cases, while one underwent total mandibulectomy. Condyle was preserved in five cases, while was removed in nine. Single-stage reconstruction was done in nineteen cases, while second-stage reconstruction was done in the other three. Reconstruction was done with fibular graft in thirteen cases, while CCG was used in others with variable follow-up time. Though minor complications were observed, success was observed in all cases post reconstruction with either fibula or CCG graft, defined either by function, or growth., Conclusion: Irrespective of the age-group, nature of pathology and size of the defect, reconstruction should be considered with either fibula or CCG in single-stage, as they are equally efficacious, with minor complications. Well-defined reconstructive paradigm should be developed for pediatric mandibular reconstruction., Competing Interests: There is no conflict of interest to declare from any of the authors., (© 2022 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.)

Many pathogens can cause cancer, but cancer itself does not normally act as an infectious agent. However, transmissible cancers have been found in a few cases in nature: in Tasmanian devils, dogs, and several bivalve species. The transmissible cancers in dogs and devils are known to spread through direct physical contact, but the exact route of transmission of bivalve transmissible neoplasia (BTN) has not yet been confirmed. It has been hypothesized that cancer cells from bivalves could be released by diseased animals and spread through the water column to infect/engraft into other animals. To test the feasibility of this proposed mechanism of transmission, we tested the ability of BTN cells from the soft-shell clam ( Mya arenaria BTN, or MarBTN) to survive in artificial seawater. We found that MarBTN cells are highly sensitive to salinity, with acute toxicity at salinity levels lower than those found in the native marine environment. BTN cells also survive longer at lower temperatures, with 50% of cells surviving greater than 12 days in seawater at 10 °C, and more than 19 days at 4 °C. With one clam donor, living cells were observed for more than eight weeks at 4 °C. We also used qPCR of environmental DNA (eDNA) to detect the presence of MarBTN-specific DNA in the environment. We observed release of MarBTN-specific DNA into the water of laboratory aquaria containing highly MarBTN-diseased clams, and we detected MarBTN-specific DNA in seawater samples collected from MarBTN-endemic areas in Maine, although the copy numbers detected in environmental samples were much lower than those found in aquaria. Overall, these data show that MarBTN cells can survive well in seawater, and they are released into the water by diseased animals. These findings support the hypothesis that BTN is spread from animal-to-animal by free cells through seawater.

This parallel blocked randomized controlled trial was done in two groups of 30 patients each to determine if placement of an antibiotic oral pack on the hard palate after hard palatal fistula repair reduces nasal air emission and fistula re-occurrence. Group A had an oral pack on the hard palate for 5 days post-operatively while group B did not. In group A, percentage of nasal air emission was tested using nasometry with and without pack. Paired t-tests were performed to compare nasal emissions for patients with and without pack. Recurrence of fistulas after 6 months between group A and B was tested using odds ratio. Effect of nasal air emission on fistula rates was tested using paired t-tests. There was a significant increase (p < 0.0001) in nasal emission after removal of the pack in group A. Fistula re-occurrence tended to be higher in group B (no pack) than group A but this was not significant (p = 0.242). There was no correlation between nasal air emission and fistula rates. In patients with recurrent fistulae, placement of an oral pack after fistula repair diminishes nasal air emission. Whether this has an impact on re-occurrence of fistulae needs to be investigated further., (© 2021 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.)

Aim: This study aimed to systematically review available literature of in vitro studies on apical extrusion of debris through rotary instrumentation in comparison to manual instrumentation in pediatric endodontics, and also to perform a comparison between various rotary instrumentation systems for assessment of debris extrusion., Materials and Methods: A comprehensive search was conducted on PubMed, Medline, Cochrane Library, Embase, Scopus, and Google Scholar without any language restriction and year of publication. A planned search strategy was made for PubMed and applied to other databases. After full-text reading, 7 articles were selected for quantitative synthesis. Modified CONSORT checklist of items for reporting in vitro studies of dental materials was used for quality assessment of included studies., Results: Root canal preparation with rotary instrumentation led to lesser apical debris extrusion than manual instrumentation. Self-adjusting file system was associated with the least debris extrusion among all included studies, followed by ProTaper Next, Kedo-S, ProTaper, K3, Mtwo, Revo-S, and Wave One., Conclusion: More apical debris extrusion was seen with manual instrumentation than rotary instrumentation. Furtrhermore, variance in debris extrusion was seen with different rotary file systems., Competing Interests: None

Among anesthesia-related life-threatening complications, respiratory failure requiring reintubation is common. However, studies evaluating patient characteristics for extubation failure are scarce in the literature. Such knowledge is important to increase awareness and for the development of strategies to improve the safety of anesthesia care. We retrospectively reviewed 196 cases that were reported to our quality assurance (QA) committee from 2004 to 2014 at 3 hospitals. The reintubation rate was 0.09% (n=196). More reintubations occurred in the operating room than the postanesthesia care unit (58% vs 30%). Ninety-three reintubated patients (47%) were 65 years or older. Most patients were in ASA class 3 or 4 (76%) and had a surgical procedure lasting longer than 3 hours. Eleven reintubated patients (5%) died during the hospital course. The exact causes of reintubation could not be determined because of limited data in our QA database. We conclude that although the individual risk of reintubation for each patient is low, the reintubated patients have a higher mortality rate. The study findings emphasize the need for extra vigilance before anesthesia providers attempt extubation of a patient who is elderly, underwent surgery over 3 hours, has chronic obstructive airway disease, or has ASA class 3 or 4 status., Competing Interests: Name: Ratan K. Banik, MD, PhD Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: Partly supported by the Department of Anesthesiology, University of Minnesota. Name: Kate Honeyfield, BA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: Partly supported by the Department of Anesthesiology, University of Minnesota. Name: Sana Qureshi, MD Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: Partly supported by the Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York. Name: Shamantha G. Reddy, MD, FASA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: Partly supported by the Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright © by the American Association of Nurse Anesthetists.)

Objectives: The aim of this study was to determine Relapse and TMD as postoperative complication in skeletal class III patients undergoing bimaxillary orthognathic surgery., Materials and Methods: Data was obtained by database searching using The Cochrane Central Register of Controlled Trials (central), PUBMED, SCOPUS, EMBASE, Google scholar, National Medical library, New Delhi. The titles and abstracts of the electronic search results were screened and evaluated by two observers for eligibility according to the inclusion and exclusion criteria., Results: 5261 articles were retrieved for the review. Among these, 3474 duplicate articles were removed. 418 studies were selected based on the eligibility criteria. For the present review, 30 articles were included after elimination according to the inclusion criteria. The Prisma diagram flowchart demonstrates our selection scheme. Quality assessment criteria to evaluate the studies were decided by two review authors in accordance with CONSORT guidelines. Each study was assessed using the evaluation method described in the Cochrane Handbook for Systematic Reviews. Among the 30 studies included in the review, marked degree of relapse in the mandible was noted from 3 months - 1 year postoperatively in 8 studies, 5 studies reported both TMD prevalence and relapse, whereas only 4 studies reported TMD disorder alone., Conclusion: Complications of relapse and TMD are associated with bimaxillary orthognathic surgery procedures. More RCTs and CCTs are needed in this regard to get better quality evidence. This review was registered with PROSPERO: CRD42020211342., (© 2021 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.)

This article represents the point of view and philosophy of GSR Institute of Craniomaxillofacial and Facial Plastic Surgery (GSRIFCS) in the management of craniofacial and cleft patients. GSRICFS is a 50 bedded state of art high volume cleft centre in Hyderabad which has accomplished greater than 30000 cleft surgeries. Cleft surgery in India has improved greatly over the last 70 years since the innovations of the Colombo plan to now, resulting in better healthcare facilities, research and transfer of knowledge globally. In this period, the deprivations of the past, due to lack of available, accessible or affordable care or awareness of outpatients and their parentage, of the possibilities, some of cultural origin such as various superstitions leading to isolation and social stigma, have been largely but not completely overcome. There were minimal centres in the past, which provided care, and this was partly due to scarcity of funding, lack of training and non-sustainability of skilled human recourses. Surgery for cleft requires not only a sophisticated infrastructure, but instrumentation, specialized anesthetists and high-end post-operative care along with a multidisciplinary team involving surgeons, anesthetists, paediatricians, psychologists, orthodontists and specialized nurses for optimal outcomes. The article elaborates the vision, mission and plan in establishing the GSRICFS and how it might form a model for the future of cleft care in LMICs., Competing Interests: There is nothing to declare.There is no conflict of interest to declare from any of the authors., (© 2021 Published by Elsevier B.V. on behalf of Craniofacial Research Foundation.)

The paper reviews various classifications and surgical techniques for the treatment of temporomandibular joint ankylosis. PubMed, EBSCO, Web of Science, and Google Scholar were searched using a combination of keywords. Articles related to classification, resection-reconstruction of the temporomandibular joint, and management of airway obstruction were considered and categorized based on the objectives. Seventy-nine articles were selected, which included randomized clinical trials, non-randomized controlled cohort studies, and case series. Though several classifications exist, most classifications are centered on the radiographic extent of the ankylotic mass and do not include the clinical and functional parameters. Hence there is a need for a comprehensive staging system that takes into consideration the age of the patient, severity of the disease, clinical, functional, and radiographic findings. Staging the disease will help the clinician to adopt a holistic approach in treating these patients. Interpositional arthroplasty (IA) results in better maximal incisal opening compared with gap arthroplasty, with no significant difference in recurrent rates. Distraction osteogenesis (DO) is emerging as a popular technique for the restoration of symmetry and function as well as for relieving airway obstruction. IA, with a costochondral graft, is recommended in growing patients and may be combined with or preceded by DO in cases of severe airway obstruction. Alloplastic total joint replacement combined with fat grafts and simultaneous osteotomy procedures are gaining popularity. A custom-made total joint prosthesis using CAD/CAM can efficiently overcome the shortcomings of stock prostheses.

Introduction: The objective was to compare the clinical efficacy of silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) in arresting active caries in primary teeth and first permanent molars in children., Materials and Methods: The study protocol was registered in PROSPERO (CRD42020205675). A systematic search was performed in PubMed, Scopus, Embase, Cochrane Library, and gray literature for randomized controlled trials (RCTs) published in English language with a minimum follow-up of 6 months, comparing the caries arrest potential of SDF with ART in primary teeth and first permanent molars in children. The risk of bias and quality assessment of the studies was done using the Cochrane Collaboration Tool and Joanna Briggs Institute Critical Appraisal Tool. Data analysis was performed using RevMan software; the outcomes were summarized in meta-analysis (MA) using the random-effects model, and the odds ratio (OR) at 95% confidence interval (CI) was computed., Results: A total of 1059 studies were identified, out of which 562 remained after removal of duplicates. Eight studies were considered for full-text eligibility, and four studies were included in the qualitative review. Three out of four studies were conducted on primary dentition, whereas one study was done on erupting first permanent molars in children. MA of the two studies compared 30% SDF with ART in primary molars at 12 months and revealed the OR to be 2.02 (95% CI: 0.86-4.71; I 2 = 62%; P = 0.10)., Conclusion: The current review points to the lack of solid evidence comparing SDF with ART for arresting active caries in primary teeth, especially in the first permanent molars. No statistically significant difference between 30% SDF and ART in primary molars at 12 months was found in the present review. Well-designed RCTs are required to determine a minimum concentration of SDF which is effective and safe for caries arrest in children., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of International Society of Preventive and Community Dentistry.)

Background: Orofacial cleft, one of the most common congenital deformities, presents with a plethora of defects, subjecting the patient to a multitude of treatments from a young age. Among the oral hard tissue problems, absence of a maxillary permanent tooth in the cleft region either due to congenital absence or extraction due to compromised prognosis is a common finding. Conventionally, the missing tooth is replaced using a removable or fixed partial denture; however, the treatment modality does not satisfactorily meet patient expectations. The most recent decade has seen increasing use of dental implants in the cleft region; however, the outcome of an immediately loaded dental implant is still elusive for orofacial cleft patients., Objective: This protocol is for a single-arm clinical trial aimed at determining the treatment outcome of immediately loaded dental implants in patients with a nonsyndromic orofacial cleft., Methods: Patients meeting the set criteria will be sequentially enrolled until a sample size of 30 dental implants is met and will undergo the proposed treatment according to the predecided protocol. All patients will be followed up at the designated time intervals to record various clinical and radiographic parameters. Implant success will be defined based on the criteria elucidated by Misch et al in the Pisa, Italy Consensus. A quality-of-life assessment questionnaire will also be recorded at the end of patient's follow-up to determine their acceptance of the treatment., Results: A total of 30 dental implants will be placed in patients with a nonsyndromic orofacial cleft. Obtained results will be statistically analyzed to determine the treatment outcomes and success., Conclusions: This study will help determine the feasibility of immediately loaded dental implants in compromised bone sites such as those presented in cleft patients and will help in generating findings that can be used to fill the lacunae currently present in the holistic treatment of cleft patients., Trial Registration: Clinical Trial Registry of India CTRI/2020/09/027997; http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=47659&EncHid=&userName=dental%20implants., International Registered Report Identifier (irrid): PRR1-10.2196/25244., (©Rizwana Mallick, Sweta Kale Pisulkar, Srinivas Gosla Reddy. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 05.05.2021.)

Objectives: To compare the postoperative outcomes in impacted mandibular third molar extraction using piezosurgery and conventional rotary technique; and to assess the stress levels in both the techniques by measuring salivary cortisol levels., Methods: Ten patients with symmetrical impacted lower third molars were included in this split mouth pilot study. Measurements for mouth opening and swelling were taken preoperatively on the day of surgery and 1 week after surgery. Pain was evaluated using Visual Analog Scale (VAS) from first postoperative day for six consecutive days. Saliva collection for analysis of cortisol levels was done at four time intervals - before starting the procedure, immediately after the procedure, 20 min and 1 week later. The mean in two groups was compared using paired t-test/Wilcoxon signed rank test as applicable. Friedman test was used to compare multiple readings of pain and salivary cortisol., Results: Reduction in mouth opening was more in rotary group than piezosurgery group but was not statistically significant (p = 0.092). Increase in facial swelling was more in the rotary group than piezosurgery group with statistically significant values (p = 0.020). Rotary group had higher values for postoperative pain as compared to piezosurgery on all the days and the difference was statistically significant on each day except second postoperative day. Salivary cortisol levels were elevated in both the groups with the mean values higher in group I (rotary) than in group II (Piezosurgery)., Conclusion: Extraction of impacted lower third molar results in more favourable outcome when carried out by piezosurgery technique. Further studies are needed to compare the salivary cortisol response in rotary and piezosurgery techniques., Competing Interests: There is no conflict of interest to declare by the authors., (© 2020 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.)

Are the steps that have been taken to arrest the spread of COVID-19 justifiable? Specifically, are they likely to have improved public health understood according to widely used aggregate population health measures, such as Quality Adjusted Life Years (QALYs) and Disability Adjusted Life Years (DALYs) as much or more than alternatives? This is a reasonable question, since such measures have been promoted extensively in global and national health policy by influential actors, and they have become almost synonymous with quantification of public health. If the steps taken against COVID-19 did not meet this test, then either the measures or the policies must be re-evaluated. There are indications that policies against COVID-19 may have been unbalanced and therefore not optimal. A balanced approach to protecting population health should be proportionate in its effects across distinct health concerns at a moment, across populations over time and across populations over space. These criteria provide a guide to designing and implementing policies that diminish harm from COVID-19 while also providing due attention to other threats to aggregate population health. They should shape future policies in response to this pandemic and others., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Context: Preeclampsia is often asymptomatic, and hence, its detection depends on signs or investigations. The platelet (PLT) parameters, in cases of preeclampsia with normal PLT count, are seldom analyzed. Hence, this study was undertaken to study the PLT parameters in nonthrombocytopenic preeclampsia cases., Aim: The aim was to evaluate the use of PLT indices as severity markers in nonthrombocytopenic preeclampsia cases., Subjects and Methods: This prospective study was done on 120 cases of severe preeclampsia, 115 cases of preeclampsia without severe features, and 203 normal pregnant women admitted in the obstetrics wards during the study period of 1 year. The PLT indices obtained by analyzing anticoagulated blood were recorded., Statistical Analysis Used: Analysis of variance test was used to see the significance of association. Receiver operating characteristic (ROC) curve and binary regression analysis was used to estimate the cutoff value and examine the predictive value of the PLT parameters in the disease progression of preeclampsia., Results: Even in the absence of thrombocytopenia, mean platelet volume (MPV) and PLT distribution width were significantly higher in severe preeclampsia group ( P < 0.001) and were also positively correlating with mean arterial pressure (r = 0.38 and 0.20, respectively). ROC curve analysis showed that MPV had the highest area under the curve of 0.78 (95% confidence interval [0.719-0.842]). Cutoff value of >10.95 fl for MPV was found to have significant predictive value for disease progression in preeclampsia., Conclusions: Even in the absence of thrombocytopenia, PLT indices, especially MPV, have a good diagnostic significance in detecting severe preeclampsia. Further studies are required to evaluate their role as biomarkers in preeclampsia., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Journal of Laboratory Physicians.)

Background: Growing patients with cleft lip and palate (CLP) exhibit maxillary deficiency due to early surgical intervention. Maxillary protraction with expansion is the recommended treatment modality for deficient maxilla. Facemask is a conventional protraction appliance, and Maxgym is a new protraction appliance. The purpose of this study is to compare the efficacy of Maxgym with Facemask using finite-element analysis., Methods: A three-dimensional finite-element model consisting of 49,807 nodes and 185,620 tetrahedral-shaped elements was created using computed tomography scan of a patient with unilateral CLP. F1, F2, and F3 represent different protraction forces of facemask, and M1, M2, and M3 represent different protraction forces of Maxgym. E1 represents slow maxillary expansion (SME) force, and E2 represents rapid maxillary expansion (RME) force. Facemask and Maxgym forces were applied parallel to the occlusal plane from the middle of the clinical crown on the buccal side of the first premolars. The forces E1 and E2 were also applied on the middle of the crown height on the lingual side of the first premolars and the first molars to simulate expansion. The amount of displacement for Maxgym and Facemask forces in transverse direction was analyzed designating specific nodes to represent dental and skeletal structures., Results: The dental and skeletal structures were displaced in transverse direction under all loading conditions. Only expansion or protraction force resulted in transverse displacement of nodes. RME produces greater transverse displacement as compared to SME. Maxgym forces produce greater transverse displacement as compared to facemask. Maxgym with RME produces greater transverse displacement as compared to Maxgym with SME, whereas facemask with RME produces greater transverse displacement as compared to facemask with SME., Conclusions: Maxgym forces produce greater transverse displacement as compared to facemask with or without expansion., Competing Interests: None

Lineage analysis of autoreactive B cells can reveal the origins of autoimmunity. In the autoimmune disease pemphigus vulgaris (PV), desmoglein 3 (DSG3) and DSG1 autoantibodies are predominantly of the IgG4 subclass and less frequently of IgG1 and IgA subclasses, prompting us to investigate whether anti-DSG IgG4 B cells share lineages with IgG1, IgA1, and IgA2. Combining subclass-specific B cell deep sequencing with high-throughput antibody screening, we identified 80 DSG-reactive lineages from 4 PV patients. Most anti-DSG IgG4 B cells lacked clonal relationships to other subclasses and preferentially targeted DSG adhesion domains, whereas anti-DSG IgA frequently evolved from or to other subclasses and recognized a broader range of epitopes. Our findings suggest that anti-DSG IgG4 B cells predominantly evolve independently or diverge early from other subclasses and that IgA is most often not the origin of IgG autoreactivity in PV. These data provide insight into how autoreactivity diversifies across B cell subclasses., (Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.)

pH-sensitive drug carriers that are sensitive to the acidic (pH = ~6.5) microenvironments of tumor tissues have been primarily used as effective drug/gene/siRNA/microRNA carriers for releasing their payloads to tumor cells/tissues. Resistance to various drugs has become a big hurdle in systemic chemotherapy in cancer. Therefore delivery of chemotherapeutic agents and siRNA's targeting anti apoptotic genes possess advantages to overcome the efflux pump mediated and anti apoptosis-related drug resistance. Here, we report the development of nanocarrier system prepared from kojic acid backbone-based cationic amphiphile containing endosomal pH-sensitive imidazole ring. This pH-sensitive liposomal nanocarrier effectively delivers anti-cancer drug (Paclitaxel; PTX) and siRNA (Bcl-2), and significantly inhibits cell proliferation and reduces tumor growth. Tumor inhibition response attributes to the synergistic effect of PTX potency and MDR reversing ability of Bcl-2 siRNA in the tumor supporting that kojic acid based liposomal pH-sensitive nanocarrier as efficient vehicle for systemic co-delivery of drugs and siRNA.

Introduction: Malignant tumour in upper lid is a surgical challenge to oculoplastic surgeon. Full thickness defect created after removal of large tumour promptly treated with modified cutler beard procedure using autogenous auricular cartilage. Surgical procedure is two staged: In first stage, removal of the tumour followed by full thickness flap repaired; In second stage, opening the closed lid with lid margin repair. Post-operatively, there is good anatomical, functional and cosmetic restoration of the eyelid similar to the other eye., Aim: To evaluate the efficacy of the modified Cutler-Beard procedure using autogenous ear cartilage for tarsal plate reconstruction in the repair of 70-100% upper eyelid defects., Materials and Methods: This is a prospective, interventional case series of 16 patients over a period of three years. Patients with upper eyelid defects, secondary to removal of tumour, greater than or equal to 70% were included. Of these patients, those with lymph node involvement, distant metastasis, lower eyelid involvement, corneal infiltration or intra-orbital extension were excluded. FNAC was done in all the cases. Created defect was measured in mm (length and width) and later expressed in percentage. Pre and Post-operative measurement of Levator Palpebrae Superioris (LPS) was done. Pre and Post-operative measurement of Margin to Reflex Distance (MRD1) were also noted., Results: Upper eyelid recreation was successful in all patients without complications. Pre-operative LPS action ranged from 0-4 mm, while post-operative LPS action was 12-14 mm. Pre-operative MRD1 ranged from -4 millimeters to -1 mm, while post-operative MRD1 was +3 to +4 millimeters. The follow-up period ranged from six months to two years. Every patient had a successful upper eyelid reconstruction., Conclusion: The modified Cutler-Beard procedure using an autogenous auricular cartilage graft is an effective procedure for repair of large upper eyelid defects, with acceptable functional and cosmetic results. Furthermore, it is particularly useful in resource-poor areas, due to lower cost than other available options.

Background: Human immunodeficiency virus (HIV) pandemicity is a major concern today as it causes greater loss of productivity than any other disease. HIV infection leads to profound immune deficiency and patients become highly susceptible to opportunistic infections (OIs). HIV epidemic in India is heterogeneous in nature, both in terms of routes of transmission as well as geographical spread., Aims: (1) Determine prevalence of OIs among HIV-seropositive patients and their relation to CD4 count and to focus on the routes of transmission. (2) Analyze the route of transmission., Methods: This is a single-center prospective study including all the patients attending acquired immunodeficiency syndrome (AIDS) care center during the period of January 2014 to December 2014., Results: Among 71 patients included in this study, mean age was 30 years, 57.7% (41 patients) were male, 42.3% (30 patients) were female. Mean CD4 cell count of the study group was 260.11 and of patients on antiretroviral therapy increased subsequently to 553.37 cells/ml. Among the infections, the prevalence of candidiasis, tuberculosis (TB), tinea infections, seborrheic dermatitis, giardiasis, cryptosporidiosis, and Entamoeba histolytica were 36.6%, 29.58%, 4.22%, 2.82%, 4.22%, 1.4%, and 1.4%. Most predominant routes were heterosexual transmission at 94.3%. It was followed by vertical transmission seen in 2.8%. Homosexual transmission is 1.4% and intravenous drug abuse 1.4%., Conclusion: The frequency of infections among HIV/AIDS patients has got a similar linear relation with CD4 cell count. This study reports data will serve as a matrix for future evaluation. It is concluded that candidiasis, TB are the most common infections in the HIV-seropositive patients in the present study group.

Background: Sense of coherence (SOC) is an important psychological factor that enables people to cope with stressors and successfully maintain and improve health. Oral health affects general health and impacts quality of life. The aim of the present study is to assess the association between SOC and oral health status among 16 to 17-year-old preuniversity students in Virajpet, Karnataka, India., Materials and Methods: A total of 361 subjects were included in the study by stratified cluster random sampling method. Sense of coherence was measured using the Kannada-translated 13-item scale proposed by Antonovsky. Oral health status was measured using oral hygiene index - simplified (OHI-S), Silness and Loe Plaque index, Community Periodontal Index (CPI) and Loss of Attachment (LA) as well as decayed-missing-filled teeth (DMFT) index. Chi-square test and analysis of variance were used to evaluate the association between SOC and oral health., Results: There was no statistically significant association of plaque index and caries experience with SOC, whereas the SOC scores were found to be significantly associated with loss of attachment and OHI-S among the subjects. The distribution of the mean number of sextants with loss of attachment was more among males., Conclusion: Sense of coherence has a role to play in the maintenance of oral health. There is a need to closely examine the psychodynamic factors that affect oral health., Clinical Significance: There is good evidence that SOC is a resource capable of promoting health, strengthening resilience, and developing a subjectively positive state of health.

We show that there are a number of ways to transform an arbitrary polarization state into another with just two quarter wave plates (QWPs). We have verified this geometrically using the trajectories of the initial and final polarization states corresponding to all the fast axis orientations of a QWP on the Poincaré sphere. The exact analytical expression for the locus of polarization states has also been given, and describes the trajectory. An analytical treatment of the equations obtained through matrix operations corresponding to the transformation supports the geometrical representation. This knowledge can be used to obtain the Mueller matrix by just using QWPs, which has been shown experimentally by exploiting projections of the output states on the input states.

Cinnamoyl amides isolated from Zanthoxylum armatum (Rutaceae) and their synthetic analogues were tested for their insecticidal activity against the second instar larvae of diamondback moth, Plutella xylostella (L.) (Lepidoptera: Yponomeutidae) to determine the promising structures with insecticidal activity. Most of the test compounds showed promising activity against larvae of P. xylostella. However, the activities of different compounds varied depending on the presence of different substituents at various positions of both the aromatic rings A and B. Among the tested compounds, 8, N-(3-bromo-4-methoxyphenethyl)cinnamamide showed best larvicidal activity with an LC50 = 62.13 mg/L followed by 6, N-(3׳-bromophenethyl)cinnamamide (LC50=128.49 mg/L) and 2 N-(4׳-methoxyphenylethyl)cinnamamide (LC50 = 225.65 mg/L).

Vector vortex beams are classified into four types depending upon spatial variation in their polarization vector. We have generated all four of these types of vector vortex beams by using a modified polarization Sagnac interferometer with a vortex lens. Further, we have studied the non-coaxial superposition of two vector vortex beams. It is observed that the superposition of two vector vortex beams with same polarization singularity leads to a beam with another kind of polarization singularity in their interaction region. The results may be of importance in ultrahigh security of the polarization-encrypted data that utilizes vector vortex beams and multiple optical trapping with non-coaxial superposition of vector vortex beams. We verified our experimental results with theory.

Introduction: Pretracheal tubercular abscess is a rare presentation of extra pulmonary tuberculosis even in TB- endemic areas (WHO, 2014 [3]). It usually presents in posterior triangle group of lymph nodes (Baskota et al., 2004 [2])., Presentation of Case: We report a case of a lower midline swelling in anterior part of the neck of 6 months duration, with dysphagia of 1 month duration. Radiological diagnosis was established as tuberculous abscess and was drained. Patient was started on anti tuberculous treatment., Discussion: Swellings anatomically located in the area of anterior group of lymph nodes should be dealt with high degree of suspicion for tubercular etiology especially in TB-endemic areas (WHO, 2014 [3]). Anterior group of lymph node involvement is very rare. To differentiate, proper radiological assessment is needed to differentiate between thyroid nodule and lymph node pathology., Conclusion: Pre operative assessment is often under estimated. Adequate evaluation will avoid major surgery for a benign pathology like tuberculosis., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

A stereoselective synthesis of decahydrofuro[3,2-d]isochromene derivatives has been achieved by the condensation of 2-cyclohexenylbutane-1,4-diol with aldehydes in the presence of a stochiometric amount of BF3·OEt2 in dichloromethane at -78 °C. Similarly, the condensation of 2-cyclopentenylbutan-1,4-diol with aldehydes provides the corresponding octahydro-2H-cyclopenta[c]furo[2,3-d]pyran derivatives in good yields with high diastereoselectivity. It is an elegant strategy for the quick construction of tricyclic architectures with four contiguous stereogenic centers in a single step. These tricyclic frameworks are the integral part of numerous natural products.

Withania somnifera (L.) Dunal is an important Indian medicinal plant that produces withanolides, which are triterpenoid steroidal lactones having diverse biological activities. To enable fast and efficient functional characterization of genes in this slow-growing and difficult-to-transform plant, a virus-induced gene silencing (VIGS) was established by silencing phytoene desaturase (PDS) and squalene synthase (SQS). VIGS of the gene encoding SQS, which provides precursors for triterpenoids, resulted in significant reduction of squalene and withanolides, demonstrating its application in studying withanolides biosynthesis in W. somnifera leaves. A comprehensive analysis of gene expression and sterol pathway intermediates in WsSQS-vigs plants revealed transcriptional modulation with positive feedback regulation of mevalonate pathway genes, and negative feed-forward regulation of downstream sterol pathway genes including DWF1 (delta-24-sterol reductase) and CYP710A1 (C-22-sterol desaturase), resulting in significant reduction of sitosterol, campesterol and stigmasterol. However, there was little effect of SQS silencing on cholesterol, indicating the contribution of sitosterol, campesterol and stigmasterol, but not of cholesterol, towards withanolides formation. Branch-point oxidosqualene synthases in WsSQS-vigs plants exhibited differential regulation with reduced CAS (cycloartenol synthase) and cycloartenol, and induced BAS (β-amyrin synthase) and β-amyrin. Moreover, SQS silencing also led to the down-regulation of brassinosteroid-6-oxidase-2 (BR6OX2), pathogenesis-related (PR) and nonexpressor of PR (NPR) genes, resulting in reduced tolerance to bacterial and fungal infection as well as to insect feeding. Taken together, SQS silencing negatively regulated sterol and defence-related genes leading to reduced phytosterols, withanolides and biotic stress tolerance, thus implicating the application of VIGS for functional analysis of genes related to withanolides formation in W. somnifera leaves., (© 2015 Society for Experimental Biology, Association of Applied Biologists and John Wiley & Sons Ltd.)

We show, both theoretically and experimentally, that the propagation of optical vortices in free space can be analyzed by using the width [w(z)] of the host Gaussian beam and the inner and outer radii of the vortex beam at the source plane (z=0) as defined in [Opt. Lett.39, 4364 (2014)10.1364/OL.39.004364OPLEDP0146-9592]. We also studied the divergence of vortex beams, considered as the rate of change of inner or outer radius with the propagation distance (z), and found that it varies with the order in the same way as that of the inner and outer radii at z=0. These results may be useful in designing optical fibers for orbital angular momentum modes that play a crucial role in quantum communication.

Background: The associational studies between periodontitis and rheumatoid arthritis are less documented, although they are found to have similar inflammatory pathogenesis. Resistin, a novel adipokine is suggested to be a common link between periodontitis and rheumatoid arthritis. The aim of the present study was to reinforce the inter-relationship between periodontitis and rheumatoid arthritis by using resistin as a potent inflammatory marker., Materials and Methods: Hundred patients (aged >30 y) of either sex were selected for this study and were divided equally into four groups of 25 patients each. Group A consisted of healthy individuals, Group B consisted of patients with chronic periodontitis, Group C of patients with rheumatoid arthritis and Group D had patients suffering from both arthritis and periodontitis. Periodontal parameters assessed were plaque index (PI), modified gingival index (GI) and probing depth (PD). Panoramic radiographs were taken to confirm the diagnosis of periodontitis. Rheumatoid arthritis was confirmed by the rheumatologists and seropositivity for rheumatoid factor (RF) was checked. Resistin levels were analysed in GCF collected from all the four groups and statistical analysis was done by using Pearson correlation coefficient., Results: The GCF of all the patients showed presence of resistin. The level of resistin was highest in Group D patients and least in Group A patients. On analysing the samples together positive co-relation was found between GCF resistin and PD, PI, GI and RF., Conclusion: Resistin levels are increased in both chronic periodontitis and rheumatoid arthritis. Therefore, the increased level of GCF resistin can be regarded as potential inflammatory marker for periodontitis and rheumatoid arthritis.