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Background: Great wellbeing is a pre-essential of human useful and improvement measure. Raised BP stays the main source of death around the world, representing 10.4 million passings each year. Many research has demonstrated the positive effects of inspiratory muscle exercise (IME) on cardiac autonomic function, indicated by reduced sympathetic modulation and increased vagal modulation in young smokers, as well as hypertensive and heart failure patients. Alternate nostril yoga breathing (ANYB) is one of the effective breathing techniques which involve breathing through one nostril at a time while closing the other nostril manually. The normal nasal cycle consists of alternating phases of congestion and decongestion of nasal tissue based on the predominance of parasympathetic or sympathetic tone in the autonomic nervous system. Method: Ethical approval was obtained from the SAFE SEARCH INDEPENDENT ETHICS COMMITTEE. N=30 Essential Hypertensive patients age between 35 to 55, both male and female included in this pilot study and the further study continues with more sample. After taking consent the patients were divided randomly into two groups. Group A Inspiratory muscle training (15) and Group B (15) Alternative nostril yoga breathing. Both groups received treatment for 4 weeks and 5 days/week.

The purpose of this study was to determine long-term survival of inflatable penile prosthesis (PP) and identify potential factors that may influence device survival. We performed a systematic review of Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies of men treated with inflatable PP with at least 5 years of device survival data. We performed a random effects meta-analysis to estimate device survival at 1, 3, 5, 10, 15, and 20 years of follow-up. The robustness of the meta-analysis results was evaluated in a 1-study removed sensitivity analysis and sources of heterogeneity among studies were investigated with subgroup analysis. In 12 studies (20,161 patients; median age 57 years), PP device survival was 93.3% at 1 year, 91.0% at 3 years, 87.2% at 5 years, 76.8% at 10 years, 63.7% at 15 years, and 52.9% at 20 years. The results of the meta-analysis were not significantly influenced by single study effects in a 1-study removed sensitivity analysis. In a subgroup analysis, 5-year device survival rates were 90.6% vs 82.1% (P = .01) comparing newer vs older studies; no other patient or study design characteristic was statistically associated with device survival rates. In conclusion, the median device survival time of an inflatable PP is approximately 20 years. The factors responsible for improved device survival in newer studies remain unclear and warrant further study.

Tumours are the second leading cause of death globally, generating alterations in biological interactions and, as a result, malfunctioning of crucial genetic traits. Technological advancements have made it possible to identify tumours at the cellular level, making transcriptional gene variations and other genetic variables more easily investigated. Standard chemotherapy is seen as a non-specific treatment that has the potential to destroy healthy cells while also causing systemic toxicity in individuals. As a result, developing new technologies has become a pressing necessity. QDs are semiconductor particles with diameters ranging from 2 to 10 nanometers. QDs have grabbed the interest of many researchers due to their unique characteristics, including compact size, large surface area, surface charges, and precise targeting. QD-based drug carriers are well known among the many nanocarriers. Using QDs as a delivery approach enhances solubility, lengthens retention time, and reduces the harmful effects of loaded medicines. Several varieties of quantum dots used in drug administration are discussed in this article, along with their chemical and physical characteristics and manufacturing methods. Furthermore, it discusses the role of QDs in biological, medicinal, and theranostic applications.

Purpose:It was to determine the prevalence of retinal changes in pregnancy induced hypertension (PIH) and any association between the Retinal changes and age, Gravida, Parity, Blood pressure, Proteinuria and Severity of the disease. Study design:Hospital based Cross sectional study. Materials & method:All the patients admitted with a diagnosis of PIH were included in this study. Age, Gravida, Parity, Blood pressure, and Proteinuria were noted from the case record. Fundus examination was done by Indirect Ophthalmolscopy. The finding were noted and were analysed using Microsoft Excel. Result:The mean age of patients was 23.48 years. Prevalence of fundus changes in PIH is 67%. Out of 88 patients, 41 (46.59%) were the primigravida. 3 (7.31%) patients had gestational hypertension, 17 (41.46%) patients had preeclampsia, and 21 (51.21%) had eclampsia. Hypertensive retinopathies were noted in 59 (67%) patients. Retinal detachment was seen in one patient and one patient with papilloedema. There was statistically significant positive association of retinal changes with proteinuria (p= 0.0001), and severity of the PIH (p= 0.004). Conclusions:Retinal changes were seen in 67% of patients with PIH. Better antenatal care and early detection and treatment of PIH cases is needful so that there will be decrease in the chances of developing retinopathy. &nbsp

Introduction Though initially believed to primarily be a respiratory pathogen, the SARS-CoV-2 virus has manifested as a virus that has the potential to affect multiple organ systems causing a wide variety of disease and symptomatology. Case Presentation Here we present a teenager with acute COVID-19 who presented to the hospital with severe rhabdomyolysis causing life-threatening hyperkalemia and acute kidney injury requiring treatment with emergent renal replacement therapy in the intensive care unit. Conclusions Rhabdomyolysis and acute kidney injury are increasingly recognized as complications of acute SARS-CoV-2 infection, and require vigilance given the associated risk of morbidity and mortality.

Introduction: The instruments used to measure QOL are useful methods of transforming subjective measurements into objective data that can be quantified and analyzed, and are also important for assessing the impact of health care interventions on patient’s HRQOL. The uses of a self-administered scale in a specific localize/native language would make research and the clinical management more effective. It is advised that a self-reported measure is translated and adapted to the appropriate culture before it is used with subjects whose first language is not English. A Guajarati version of Quality of Life (MINICHAL) in essential hypertension would provide Guajarati community opportunity to communicate more effectively with their therapist. The availability of a self-administered scale in their native language makes clinical management and research more effective. Methodology: In this observational study, 36 patients with essential hypertension from the Rajkot city included. MINICHAL-QOL was translated into Gujarati from English using Forward – Backward - Forward method. To ensure the face and content validity using group consensus method, each item was examined by group of 6 experts having mean experience of 8.78 years in the field of Physiotherapy. Result: The total value of intra-class correlation coefficient of test–retest reliability was 0.988. Reliability estimated by internal consistency estimated a Cronbach's alpha of 0.879. The translated Gujarati version of MINICHAL-QOL demonstrated good reliability and validity. In validity specifically face validity and content validity suggests valid tool which can be applicable in essential hypertensive patients. Conclusion: The results indicated that the Gujarati version of MINICHAL had been successfully translated from English to Gujarati. The translated Gujarati version of MINICHAL–QOL demonstrated good reliability and validity. So, it can be useful tools to measure quality of life in essential hypertensive patients specifically applicable for Gujarati population. Key words: Gujarati version, MINICHAL, Quality of Life, Reliability, Validity.

Acute surgical services at our trust were moved from two sites to a single site, due to COVID-19. This project was inspired by cases of transfer whereby significant time delays resulted in poorer patient clinical outcome. Aims Methods Results Conclusion Interhospital transfer must focus on maintaining optimal health and outcomes for the patient. A guideline and framework for safe transfers must be implemented and adhered to strictly.

This clinical case series highlights an under-reported and often unidentified complication of implant-retained overdentures that may leave patients with a risk of long-term discomfort and preventable damage to the opposing dentition. A variety of cases is discussed to demonstrate potential problems and symptoms that can flag up signs of parafunctional habits in implant patients, and how these can be managed successfully. CPD/Clinical Relevance: Implant-retained overdentures provide a significant improvement in quality of life; however, careful patient assessment and management is essential to ensure the components do not cause damage to the opposing dentition.

OBJECTIVES Crestal bone formation represents a crucial aspect of the esthetic and biological success of dental implants. This controlled preclinical study analyzed the effect of implant surface and implant geometry on de novo crestal bone formation and osseointegration. MATERIALS AND METHODS Histological and histomorphometrical analysis was performed to compare three implant groups, i.e., (1) a novel, commercially available, gradient anodized implant, (2) a custom made geometric replica of implant "1", displaying a superhydrophilic micro-rough large-grit sandblasted and acid-etched surface and (3) a commercially available implant, having the same surface as "2" but a different implant geometry. The study applied a standardized buccal acute-type dehiscence model in minipigs with observation periods of 2 and 8 weeks of healing. RESULTS The amount of newly formed crestal bone (BATA) around control group (2) and (3) was significantly increased when compared to the test group (1) at the 8-weeks healing time point. Similar results were obtained for all parameters related to osseointegration and direct bone apposition, to the implant surface (dBIC, VBC, and fBIC), demonstrating superior osseointegration of the moderately rough, compared to the gradient anodized functionalization. After 2 weeks, the osseointegration (nBIC) was found to be influenced by implant geometry with group (3) outperforming group (1) and (2) on this parameter. At 8 weeks, nBIC was significantly higher for group (2) and (3) compared to (1). CONCLUSIONS The extent (BATA) of de novo crestal bone formation in the acute-type dehiscence defects was primarily influenced by implant surface characteristics and their ability to promote osseointegration and direct bone apposition. Osseointegration (nBIC) of the apical part was found to be influenced by a combination of surface characteristics and implant geometry. For early healing, implant geometry may have a more pronounced effect on facilitating osseointegration, relative to the specific surface characteristics.

Gastric signet ring cell carcinoma (GSRC) is a rare but increasingly prevalent tumor histotype whose clinical features and natural history are poorly understood, particularly in the USA and minorities. To examine the occurrence, clinico-demographic characteristics, oncologic features, treatment, and outcomes of GSRC in a predominantly minority county hospital setting and benchmark them against data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program. We queried biopsy-proven GSRC cases at a Los Angeles County hospital, from 2004 to 2017. Clinical characteristics, treatment, and survival data were collected and compared to SEER data. We identified 63 patients with GSRC. Compared to SEER, our cohort was significantly younger (52.6 vs. 63.5 years, p

140 Background: HER2 ( ERBB2) over-expression and amplification (HER2+) is seen in a small but distinct subset (2-3%) of mCRC and is enriched in RAS/BRAF wild type (WT) tumors. This subset is characterized by a limited response to anti-epidermal growth factor receptor monoclonal antibody-based (anti-EGFR) therapy and a promising response to dual-HER2 inhibition. Methods: In this multicenter, open label, randomized, phase 2 trial, we enrolled 54 patients with RAS/BRAF WT HER2+ mCRC who had had disease progression after 1 or 2 previous therapies. HER2 status was confirmed centrally with immunohistochemistry (IHC) and in-situ hybridization (ISH). HER2+ was defined as IHC 3+ or 2+ and ISH amplified (dual-probe HER2/CEP17 ratio > 2.0). Patients were then randomly assigned in a 1:1 ratio to receive either TP (trastuzumab [loading 8 mg/kg then 6 mg/kg] + pertuzumab [loading 840 mg then 420 mg] every 3 weeks) or CETIRI (cetuximab 500 mg/m2 + irinotecan 180 mg/m2 every 2 weeks). Crossover was allowed for patients on CETIRI arm to TP (cTP) after progression. Restaging (per RECIST v1.1) was performed at 6 and 12 weeks and then every 8 weeks until progression. The primary endpoint was progression-free survival (PFS). Key secondary endpoints were overall response rate (ORR), overall survival (OS) and safety. Results: A total of 54 (out of planned 62 due to low accrual) patients were randomized to TP (26) and CETIRI (28) between 10/2017 and 12/2021. By 8/18/2022, 20 patients had crossed over to cTP arm. One CETIRI patient was not analyzable. The results for key endpoints by protocol defined stratification factors, prior irinotecan (Piri) (yes or no) and HER2/CEP17 ratio (HCR) (>5 or ≤5), are summarized as of data cut-off of 9/6/2022. PFS did not vary significantly by treatment: medians 4.4 (95%CI: 1.9 – 7.6) months in TP group and 3.7 (95%CI: 1.6 – 6.7) months in CETIRI group (p = 0.35). Grade ≥3 adverse events occurred in 23%, 46% and 40% of patients in TP, CETIRI and cTP groups. Conclusions: Dual-HER2 inhibition with TP appears to be a safe and effective treatment option for patients with RAS/BRAF WT HER2+ mCRC with a promising response rate of 31%. Higher level of HER2 amplification may provide a greater degree of clinical benefit from TP compared to CETIRI. Future correlative efforts will explore biomarkers of response/resistance with this strategy. Clinical trial information: NCT03365882 . [Table: see text]

BACKGROUND: Acute Kidney Disease (AKD) is defined as impaired kidney function present for < 90 days with or without an acute kidney injury (AKI) event. Adults with AKD have an increased risk for progression to chronic kidney disease (CKD) and mortality. There are no data on the epidemiology of AKD in children after transplant. The aim of this study was to evaluate the incidence and risk factors for AKI, AKD, and CKD in children after transplantation. METHODS: This is a retrospective cohort study of all children undergoing non-kidney solid organ transplant between 2011–2019 at UPMC Children’s Hospital of Pittsburgh. AKI and AKD were defined using the Kidney Disease Improving Global Outcomes criteria. Patients with a new estimated glomerular filtration rate < 60 ml/min/1.73m(2) persisting for > 3 months met criteria for new CKD. Variables associated with AKI, AKD, and CKD were analyzed. RESULTS: Among 338 patients 37.9% met criteria for severe AKI, 13% for AKD, and 8% for a new diagnosis of CKD. Stage 3 AKI was independently associated with AKD (OR: 5.35; 95% CI: 2.23–12.86). Severe AKI was not associated with new onset CKD whereas AKD was associated with new onset CKD (OR: 29.74; CI: 11.22–78.82). CONCLUSION: AKD may be superior to AKI in predicting risk of CKD in children after non-kidney solid organ transplantation.

Immunoglobulin G4 (IgG4) cholangiopathy is used to describe regional biliary involvement in a systemic fibro-inflammatory and infiltrative disease, IgG4-related disease. Occasionally, it tends to present with localized disease leading to an extensive workup to rule out malignancy and infections, especially since IgG4-related disease is an uncommon entity. Herein, we present a case of a 68-year-old male who presented with pruritus and steatorrhea with imaging studies revealing a biliary hilar mass concerning for malignancy. Subsequent extensive testing was inconclusive of malignancy and finally noted to have elevated IgG4 levels as part of a broader workup. The patient was started on prednisone with the resulting improvement in his symptoms and the imaging findings.

Rationale: Specialized pro-resolving mediators (SPM—lipoxins, resolvins, protectins, and maresins) are produced via the enzymatic conversion of essential fatty acids, including the omega-3 fatty acids docosahexaenoic acid and n-3 docosapentaenoic acid. These mediators exert potent leukocyte directed actions and control vascular inflammation. Supplementation of animals and humans with essential fatty acids, in particular omega-3 fatty acids, exerts protective actions reducing vascular and systemic inflammation. Of note, the mechanism(s) activated by these supplements in exerting their protective actions remain poorly understood. Objective: Given that essential fatty acids are precursors in the biosynthesises of SPM, the aim of the present study was to establish the relationship between supplementation and peripheral SPM concentrations. We also investigated the relationship between changes in plasma SPM concentrations and peripheral blood platelet and leukocyte responses. Methods and Results: Healthy volunteers were enrolled in a double-blinded, placebo-controlled, crossover study, and peripheral blood was collected at baseline, 2, 4, 6, and 24 hours post administration of placebo or one of 3 doses of an enriched marine oil supplement. Assessment of plasma SPM concentrations using lipid mediator profiling demonstrated a time- and dose-dependent increase in peripheral blood SPM concentration. Supplementation also led to a regulation of peripheral blood cell responses. Here we found a dose-dependent increase in neutrophil and monocyte phagocytosis of bacteria and a decrease in the diurnal activation of leukocytes and platelets, as measured by a reduction in adhesion molecule expression. In addition, transcriptomic analysis of peripheral blood cells demonstrated a marked change in transcript levels of immune and metabolic genes 24 hours post supplementation when compared with placebo. Conclusions: Together, these findings demonstrate that supplementation with an enriched marine oil leads to an increase in peripheral blood SPM concentrations and reprograms peripheral blood cells, indicating a role for SPM in mediating the immune-directed actions of this supplement. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT03347006.

Patients and physicians have increasingly sought minimally invasive procedures such as ultrasound-guided injection for the treatment of peripheral nerve entrapment syndromes. In this series, we assessed subjective outcome data in 14 patients who underwent ultrasound-guided perineural hydrodissection and steroid injection for pronator syndrome secondary to median nerve entrapment in the pronator tunnel. Excellent symptomatic relief (≥75% improvement) was achieved in 70% of nerves with 3-month follow-up data, with no significant change in symptoms between 3 and 6 months. These outcomes suggest that this technique could play a role in the management of pronator syndrome due to median nerve entrapment.

Gastric signet ring cell carcinoma (GSRC) is a rare but increasingly prevalent tumor histotype whose clinical features and natural history are poorly understood, particularly in the USA and minorities.To examine the occurrence, clinico-demographic characteristics, oncologic features, treatment, and outcomes of GSRC in a predominantly minority county hospital setting and benchmark them against data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program.We queried biopsy-proven GSRC cases at a Los Angeles County hospital, from 2004 to 2017. Clinical characteristics, treatment, and survival data were collected and compared to SEER data.We identified 63 patients with GSRC. Compared to SEER, our cohort was significantly younger (52.6 vs. 63.5 years, p 0.01), Hispanic/Latino predominant (81% vs. 20%, p 0.01), had higher overall stage (86% vs. 69% with stage III/IV, p 0.01), and more frequent node involvement (89% vs. 49%, p 0.01). Lower tumor stage, Helicobacter pylori positivity, and surgical intervention were associated with significantly longer median survival (all p 0.05), which was similar in our study compared to SEER (median 12.6 vs. 9.0 months, p = 0.26).Patients with GSRC within the Los Angeles County population have different clinical characteristics compared to what has been reported in SEER. Our cohort was younger, and despite having more advanced disease, did not have shorter survival. Further study is needed to better identify protective and risk factors in this population and improve understanding of the etiopathogenesis and natural history of this malignancy.

Fragility fractures are common in older adults and rare in children. Recent studies have demonstrated that hyponatraemia is a novel risk factor for the development of osteoporosis and hip fractures in older people. Animal studies suggest that hyponatraemia can lead to decreased bone mineral density by stimulating osteoclastic activity in order to mobilise sodium from the bone. Reported is a 16-year-old man with intractable epilepsy and an 11-year history of chronic hyponatraemia (126–135 mEq/L) due to valproic acid induced syndrome of inappropriate antidiuresis who sustained low-impact fragility fractures and had evidence of osteopaenia on both X-ray and dual energy X-ray absorptiometry (DEXA). Hyponatraemia resolved following the discontinuation of valproic acid and bone mineral density normalised on a repeat DEXA 19 months later. This case provides evidence supporting the contention that chronic hyponatraemia contributes to osteopaenia and fragility fractures and that the bone abnormalities are potentially reversible following the correction of hyponatraemia.

This article considers a possible solution to prevent or manage spontaneous alveolar bone growth in ankylosed, infraoccluded teeth in adolescents after elective decoronation, allowing replacement resorption to take place, preserving the surrounding alveolar bone and enabling vertical bone development coronal to the decoronated segment. CPD/Clinical Relevance: To illustrate the advantages of decoronation allowing subsequent replacement of infraoccluded ankylosed teeth with implant-retained restorations and minimal aesthetic compromise.

Palmoplantar pustulosis is a chronic pustular dermatitis of the palms and soles, which is frequently associated with significant pruritus and pain that often limit daily activities. We present the case of a 36-year-old man with severe palmoplantar pustulosis who failed multiple medical therapies and demonstrated marked improvement with high-dose rate brachytherapy. Brachytherapy has the advantage of providing a conformal dose distribution over complex curved surfaces, such as the foot and ankle. Our observation suggests that brachytherapy may be a well-tolerated treatment option for patients with severe, refractory palmoplantar pustulosis.

A 48-year-old man presented with recurrent spontaneous hemothoraces, which ultimately were found to be secondary to a pedunculated costal osteochondroma causing vascular injury. After initially undergoing endovascular coil embolization, he ultimately required segmental rib resection containing the offending lesion for definite treatment. Although a few cases of symptomatic costal osteochondromas have been reported in the literature, as far as we know, no previous reports have provided direct radiologic confirmation of active bleeding or the role of angiographic intervention. In this report, we highlight the importance of CT angiography in establishing a direct link between an osteochondroma and recurrent hemothorax. We also discuss the diagnostic imaging challenges associated with this condition and the use of a multidisciplinary treatment strategy involving both angiographic and operative management.

Low-dose vitamin D supplementation is already recommended in older adults for prevention of fractures and falls, but clinical trials investigating whether higher doses could provide additional protection against acute respiratory infection (ARI) are lacking.To conduct a clinical trial of high-dose versus low-dose vitamin D3 supplementation for ARI prevention in residents of sheltered-accommodation housing blocks ('schemes') and their carers in London, UK.Fifty-four schemes (137 individual participants) were allocated to the active intervention (vitamin D3 2.4 mg once every 2 months +10 μg daily for residents, 3 mg once every 2 months for carers), and 54 schemes with 103 participants were allocated to control (placebo once every 2 months +vitamin D3 10 μg daily for residents, placebo once every 2 months for carers) for 1 year. Primary outcome was time to first ARI; secondary outcomes included time to first upper/lower respiratory infection (URI/LRI, analysed separately), and symptom duration.Inadequate vitamin D status was common at baseline: 220/240 (92%) participants had serum 25(OH)D concentration75 nmol/L. The active intervention did not influence time to first ARI (adjusted HR (aHR) 1.18, 95% CI 0.80 to 1.74, p=0.42). When URI and LRI were analysed separately, allocation to the active intervention was associated with increased risk of URI (aHR 1.48, 95% CI 1.02 to 2.16, p=0.039) and increased duration of URI symptoms (median 7.0 vs 5.0 days for active vs control, adjusted ratio of geometric means 1.34, 95% CI 1.09 to 1.65, p=0.005), but not with altered risk or duration of LRI.Addition of intermittent bolus-dose vitamin D3 supplementation to a daily low-dose regimen did not influence risk of ARI in older adults and their carers, but was associated with increased risk and duration of URI.clinicaltrials.gov NCT01069874.

This article aims to discuss the use of short dental implants in cleft patients, the construction of an implant-retained obturator and the use of a Createch® milled titanium bar with three Locator® overdenture attachments incorporated within the bar. CPD/Clinical Relevance: Implant-retained obturators offer a possible solution for treating patients with isolated cleft palate who are struggling with dentures due to the unfavourable soft and hard tissue profile. This paper demonstrates how to manage such patients and shows all the clinical and laboratory stages involved.