Hypnosis and progressive muscle relaxation for anxiolysis and pain control during extraction procedure in 8-12-year-old children: a randomized control trial

Introduction

Hypnosis (H) and Progressive Muscle Relaxation (PMR) have proven to be effective in a variety of medical settings; there is a paucity of their practical application in paediatric dentistry. The study aimed to comparatively evaluate the role of H and PMR on anxiety, heart rate (HR), oxygen saturation (SPO₂), blood pressure (BP), pain, and analgesic requirement during extraction in children.

Materials and methods

Sixty children aged 8–12 years undergoing primary molar extractions were randomly allocated to three groups—H, PMR, and control (C). The anxiety (proposed Visual Facial Anxiety scale), HR, and SPO₂ were measured pre/post-operatively with/without interventions (H, PMR, C) at 4 intervals. The BP and pain (Wong-Baker faces pain scale) were recorded pre- and post-operatively. Need for analgesic post-operatively was assessed.

Results

Statistically significant reduction in anxiety was noted post-extraction in H (0.30 ± 0.80), PMR (0.50 ± 0.69) (p < 0.001*). HR showed a statistically significant drop after H, PMR application. (p < 0.001*) No significant difference in SPO₂ was noted in the three groups (p > 0.05). Pain control was well achieved using H (85%), PMR (70%); BP was well-regulated in the H, PMR compared to C group (p < 0.001*). Need for analgesics was reduced in H (45%), PMR (50%) versus C (100%). Both techniques H, PMR were comparable in all measures.

Conclusion

Hypnosis and PMR are effective techniques for anxiolysis and pain control in paediatric dental patients.

Helicobacter pylori infection in non-ulcer dyspepsia: A cross-sectional study

Background

Helicobacter pylori infection has been known to be associated with dyspepsia for more than two decades; however, studies on this topic in India are limited. This study was carried out to estimate the Helicobacter pylori infection rates in non-ulcer dyspepsia.

Methods

Helicobacter pylori infection rates detected by rapid urease test (RUT) positivity were analyzed in 235 patients presenting to a tertiary care center with dyspepsia having no evidence of peptic ulcer disease on esophagogastroduodenoscopy.

Results

In this study, the prevalence of Helicobacter pylori infection diagnosed by the RUT was found to be 40.85%. Gender-based prevalence was found to be 40.14% and 41.93% for men and women, respectively. The highest prevalence was found in the age group of 30-39 years. The most common area of involvement was the isolated antrum of the stomach as seen in 93 patients.

Conclusion

This study shows a modest RUT positivity rate for Helicobacter pylori infection with the commonest site of involvement being the antrum of the stomach. Further studies will be needed to assess the prevalence of Helicobacter pylori in the community to analyze the extent of infection.

Long-term adherence to home mechanical ventilation: a 10-year retrospective, single-centre cohort study

Background

Sleep-disordered breathing (SBD) can be associated with hypercapnic respiratory failure (HRF). Home Mechanical Ventilation (HMV) is the preferred long-term treatment for patients with chronic HRF. We reviewed the database of a large tertiary referral centre for HMV to study the long-term adherence to HMV in chronic hypercapnic patients.

Methods

Data on adherence and characteristics of patients who received HMV for the treatment of SDB were collected over a decade using electronic patient records. The primary outcome parameter in this study was annual non-adherence rate (patients with HMV usage of <4 hours/night in the service divided by the number of all new patients of the same year), secondary outcomes were patients’ characteristics and reasons for low adherence. HMV adherence clinics were established to improve uptake.

Results

Two thousand and two hundred twenty-eight patients with HRF were under active follow-up on HMV at the end of the recording period. In contrast, a total of 1,900 patients had their HMV contracts terminated over the course of a decade (due to non-adherence, transfer to other services or death). Out of those, 222 patients {62 [52–72] years, body-mass index, BMI 40 [35–43] kg/m², 58.1% male, Epworth Sleepiness Scale, ESS 9 [4–15] points, 4% oxygen desaturation index, 4%ODI 32 [20–71] × hour⁻¹, TcCO₂ 6.6 [6.0–7.2] kPa} met the non-adherence criteria (nocturnal usage 0–4 hours). The annual non-adherence rate was 25.5% of all new setups in 2010, and declined to 3.4% in 2019 (relative reduction of 86%, P<0.001). Patients with Obstructive Sleep Apnoea/Obesity Hypoventilation Syndrome (58.2%), Neuromuscular Diseases (NMD) (26.8%) and COPD (13.6%) accounted for most cases of this non-adherent cohort. The vast majority of the patients (96.1%) were established on full-face masks. In 23.4% of patients, substantial weight loss (>10%) was the most common reason for low adherence; general displeasure (21.3%), uncontrolled symptoms (12.8%), claustrophobia (6.7%), mood (4.8%) and mask intolerance (4.3%) caused problems as well.

Conclusions

Non-adherence to HMV in patients with chronic HRF can affect significant proportions of patients. However, the non-adherent rate substantially decreases when individual treatment solutions are offered in multi-disciplinary clinics.

Retrospective, dual-centre review of imaging findings in neurosarcoidosis at presentation: prevalence and imaging sub-types

AIM

To assess the prevalence of various imaging manifestations in neurosarcoidosis (NS) patients at presentation and to explore if specific imaging findings may cluster in different sub-groups.

MATERIALS AND METHODS

A retrospective, dual-institution, systematic imaging review was undertaken of the magnetic resonance imaging (MRI) findings in 100 consecutive NS patients who presented over a 15-year period. Clustering analysis (k-mode) was performed to evaluate co-occurrence of imaging findings.

RESULTS

Non-enhancing white matter (NEWM) lesions were the most common imaging abnormality (56%), followed by leptomeningeal (47%) and pachymeningeal (32%) involvement. Other common manifestations included cranial nerve involvement (30%), parenchymal granulomas (27%), hypothalamic-pituitary-adrenal axis involvement (26%), and hydrocephalus (14%). Additionally, a higher prevalence of perivascular enhancement (23%), cerebrovascular events (including ischaemic and haemorrhagic events; 17%), and ependymal involvement (20%) were noted than recognised previously. Additional k-mode analysis was performed to explore underlying disease sub-clusters. This was evaluated for clusters varying between two though five (k=2-5). For k=4, the analysis revealed that the imaging findings may possibly be divided into disease sub-sets of four groups, each with varying distribution of imaging manifestations and clinical manifestations.

CONCLUSION

Overall, NEWM lesions and meningeal involvement are the most common imaging manifestations of NS. The prevalence of perivascular enhancement, cerebrovascular events, and ependymal involvement is likely higher than reported previously. Additionally, different imaging findings in NS may cluster together and imaging subtypes in NS possibly exist.

Haploinsufficiency of X-linked intellectual disability gene CASK induces post-transcriptional changes in synaptic and cellular metabolic pathways

Heterozygous mutations in the X-linked gene CASK are associated with intellectual disability, microcephaly, pontocerebellar hypoplasia, optic nerve hypoplasia and partially penetrant seizures in girls. The Cask^+/- heterozygous knockout female mouse phenocopies the human disorder and exhibits postnatal microencephaly, cerebellar hypoplasia and optic nerve hypoplasia. It is not known if Cask^+/- mice also display seizures, nor is known the molecular mechanism by which CASK haploinsufficiency produces the numerous documented phenotypes. 24-h video electroencephalography demonstrates that despite sporadic seizure activity, the overall electrographic patterns remain unaltered in Cask^+/- mice. Additionally, seizure threshold to the commonly used kindling agent, pentylenetetrazol, remains unaltered in Cask^+/- mice, indicating that even in mice the seizure phenotype is only partially penetrant and may have an indirect mechanism. RNA sequencing experiments on Cask^+/- mouse brain uncovers a very limited number of changes, with most differences arising in the transcripts of extracellular matrix proteins and the transcripts of a group of nuclear proteins. In contrast to limited changes at the transcript level, quantitative whole-brain proteomics using iTRAQ quantitative mass-spectrometry reveals major changes in synaptic, metabolic/mitochondrial, cytoskeletal, and protein metabolic pathways. Unbiased protein-protein interaction mapping using affinity chromatography demonstrates that CASK may form complexes with proteins belonging to the same functional groups in which altered protein levels are observed. We discuss the mechanism of the observed changes in the context of known molecular function/s of CASK. Overall, our data indicate that the phenotypic spectrum of female Cask^+/- mice includes sporadic seizures and thus closely parallels that of CASK haploinsufficient girls; the Cask^+/- mouse is thus a face-validated model for CASK-related pathologies. We therefore surmise that CASK haploinsufficiency is likely to affect brain structure and function due to dysregulation of several cellular pathways including synaptic signaling and cellular metabolism.

Evaluation of Volumetric Doses of Organs at Risk in Carcinoma Cervix Patients with HDR Intracavitary Brachytherapy and Comparison of CT-based and Conventional Plans

Background:

Brachytherapy treatment planning in cervix carcinoma patients using two dimensional (2D) orthogonal images provides only point dose estimates while CT-based planning provides volumetric dose assessment helping in understanding the correlation between morbidity and the dose to organs at risk (OARs) and treatment volume.

Objective:

Aim of present study is to compare International Commission on Radiation Units and Measurements Report 38 (ICRU 38) reference point doses to OARs with volumetric doses using 2D images and CT images in patients with cervical cancer.

Material and Methods:

In this prospective study, 20 patients with cervical cancer stages (IIB-IIIB) were planned for a brachytherapy dose of 7Gy per fraction for three fractions using 2D image-based treatment plan and CT-based plan. ICRU 38 points for bladder and rectum were identified on both 2D image-based plan and CT-based plan and doses (D_ICRU) at these points were compared to the minimum dose to 2cc volume (D_2cc) of bladder and rectum receiving the highest dose.

Results:

D_2cc bladder dose was 1.60 (±0.67) times more than D_ICRUb bladder dose whereas D_2cc rectum dose was 1.13±0.40 times D_ICRUr. Significant difference was found between D_ICRUb and D_2cc dose for bladder (p=.0.016) while no significant difference was seen between D_ICRUr and D_2cc dose for rectum (p=0.964).

Conclusion:

The study suggests that ICRU 38 point doses are not the true representation of maximum doses to OARs. CT-based treatment planning is more a reliable tool for OAR dose assessment than the conventional 2D radiograph-based plan.

Thermophilic ligno-cellulolytic fungi: The future of efficient and rapid bio-waste management

To accelerate the process of decomposition using consortia of thermophilic ligno-cellulolytic fungi, different crop residues viz. sorghum (SG), soybean (SS), maize (MS), sugarcane (SC), cotton (CS) and pigeon pea (PS) with a varied C:N ratio and sawdust (SD) having high lignin content were collected and used for decomposition process. Compost quality assessed by evaluating different maturity and stability indices at five succeeding stages [first mesophilic (M1), thermophilic (T), second mesophilic (M2), cooling (C) and humification (H)]. A significant reduction was observed in the C:N ratio, biodegradability index, nitrification index, ratio of water-soluble carbon to organic nitrogen (WSC/Org.N) with an increase in concomitant over time while Ash (%), organic matter loss (%), CEC/TOC ratio, cellulose biodegradation ratio (BR) and lignin/cellulose ratio were significantly increased with time. By correlation study, biodegradability index (BI) and fluorescein diacetate (FDA) hydrolysis emerged as the most suitable compost maturity and stability parameters, respectively. Principal component analysis (PCA) results confirmed that BI, BR, WSC/Org. N and FDA can be regarded as key indicators for assessing compost quality. Our findings conclude that fungal consortia of Tricoderma viride, Rhizomucor pusillus, Aspergillus awamori and Aspergillus flavus can accelerate decomposition time from 8 to 12 months (which is normal farming practice) to 120 days.

Formaldehyde Induces Mesenteric Artery Relaxation via a Sensitive Transient Receptor Potential Ankyrin-1 (TRPA1) and Endothelium-Dependent Mechanism: Potential Role in Postprandial Hyperemia

Formaldehyde (FA), the smallest aldehyde, is generated endogenously, and is widespread in the environment in foods, beverages and as a gas phase product of incomplete combustion. The main metabolite of FA, formate, was increased significantly in murine urine (∼3×) after overnight feeding. Because feeding increases mesenteric blood flow, we explored the direct effects of FA in isolated murine superior mesenteric artery (SMA). Over the concentration range of 30–1,200 μM, FA strongly and reversibly relaxed contractions of SMA induced by three different agonists: phenylephrine (PE), thromboxane A₂ analog (U46,619) and high potassium (60K, 60 mM K⁺). Formate (to 1.5 mM) induced a modest relaxation. FA (>1,500 μM) irreversibly depressed vascular function in SMA indicating vasotoxicity. The sensitivity (EC₅₀) but not the efficacy (% relaxation) of FA-induced relaxations was dependent on blood vessel type (SMA << aorta) and contractile agonist (PE, EC₅₀= 52 ± 14 μM; U46,619, EC₅₀= 514 ± 129 μM; 60K, EC₅₀= 1,093 ± 87 μM). The most sensitive component of FA vasorelaxation was within physiological levels (30–150 μM) and was inhibited significantly by: (1) mechanically impaired endothelium; (2) Nω-Nitro-L-arginine methyl ester hydrochloride (L-NAME); (3) transient receptor potential ankyrin-1 (TRPA1) antagonist (A967079); (4) guanylyl cyclase (GC) inhibitor (ODQ); and, (5) K⁺ channel inhibitor (BaCl₂). A similar mechanism of SMA vasorelaxation was stimulated by the TRPA1 agonist cinnamaldehyde. Positive TRPA1 immunofluorescent staining and gene-specific sequence were present in SMA but not in aorta. These data indicate FA, but not formate, robustly relaxes SMA via a sensitive TRPA1- and endothelium-dependent mechanism that is absent in aorta. Thus, as FA levels increase with feeding, FA likely contributes to the physiological reflex of post-prandial hyperemia via SMA vasodilatation.

Characterizing the hypertolerance potential of two indigenous bacterial strains (Bacillus flexus and Acinetobacter junii) and their efficacy in arsenic bioremediation

AIMS

The aims of the study were to (i) isolate and characterize arsenic-tolerant bacterial strains, (ii) study the plant growth-promoting traits and (iii) explore their bioremediation potential.

METHODS AND RESULTS

Indigenous arsenic hypertolerant bacterial isolates NM02 and NM03 were screened as they were capable of growing at 150 mmol l^-1 As (V) and 70 mmol l^-1 As (III). They were identified on the basis of morphological, physiological and biochemical parameter and 16sDNA sequence as Bacillus flexus and Acinetobacter junii respectively. Genomic DNA analysis for the investigation of ars operon revealed the presence of metalloregulatory arsC gene, suggesting their ability to detoxify arsenic. The analysis for siderophore, phosphate solubilization, indole acetic acid (IAA) and ACC deaminase highlighted the intrinsic plant growth-promoting rhizobacteria traits of both the bacterial strains. The energy dispersive spectroscopy analysis proved the potential of cellular arsenic sequestration within the strains. Moreover, Fourier-transform infrared spectra revealed the repositioning of the spectral bands in As presence, indicating the presence of those functional groups on the bacterial surface that is involved in As adsorption.

CONCLUSIONS

Our results indicate that bacterial strains NM02 and NM03 were identified as potent applicants for arsenic bioremediation and possess the ability to facilitate plant growth.

SIGNIFICANCE AND IMPACT OF THE STUDY

The bacterial strains are proficient in As detoxification and can be employed for arsenic bioremediation; a cost-effective and in situ remediation technique for the polluted soil.

In search of effective H1N1 neuraminidase inhibitor by molecular docking, antiviral evaluation and membrane interaction studies using NMR

Considering the need for discovery of new antiviral drugs, in view to combat the issue of resistance particularly to anti-influenza drugs, a series of 2'-amino, 3'-amino and 2', 4'-dihydroxy chalcone derivatives were designed. Structure-based drug design was used to design inhibitors of influenza virus - H1N1 neuraminidase enzyme. These were further optimized by a combination of iterative medicinal chemistry principles and molecular docking. Based on the best docking scores, some chalcone derivatives were synthesized and characterized by infrared spectroscopy (IR) and proton nuclear magnetic resonance (NMR). The molecules were evaluated for their anti-influenza action against influenza A/Pune isolate/2009 (H1N1) virus by in vitro enzyme-based assay (neuraminidase inhibition assay). We have then selected few of them for multinuclear NMR studies, 31P NMR, in order to probe the molecular mechanism of their antiviral action. Reasonably good correlation between docking scores; anti-influenza activity; and 31P NMR results were observed. The computational predictions were in consensus with the experimental results. It was observed that among tested compounds, derivative 1A, viz. 2', 4'-dihydroxy-4-methoxy chalcone, showed highest activity (IC50 = 2.23 μmol/l) against the virus under study. This derivative 1A can be explored further to provide a future therapeutic option for the treatment and prophylaxis of H1N1 viral infections.

Surface manipulation of a curved polycyclic aromatic hydrocarbon-based nano-vehicle molecule equipped with triptycene wheels

With a central curved chassis, a four-wheeled molecule-vehicle was deposited on a Au(111) surface and imaged at low temperature using a scanning tunneling microscope. The curved conformation of the chassis and the consequent moderate interactions of the four wheels with the surface were observed. The dI/dV constant current maps of the tunneling electronic resonances close to the Au(111) Fermi level were recorded to identify the potential energy entry port on the molecular skeleton to trigger and control the driving of the molecule. A lateral pushing mode of molecular manipulation and the consequent recording of the manipulation signals confirm how the wheels can step-by-step rotate while passing over the Au(111) surface native herringbone reconstructions. Switching a phenyl holding a wheel to the chassis was not observed for triggering a lateral molecular motion inelastically and without any mechanic push by the tip apex. This points out the necessity to encode the sequence of the required wheels action on the profile of the potential energy surface of the excited states to be able to drive a molecule-vehicle.

Electrical burn injury: a comparison of outcomes of high voltage versus low voltage injury in an Indian scenario

Electrical burn injury (EBI) is a mutilating form of injury. The objective of this study was to evaluate the various aspects of EBI and analyse the differences between high voltage injury (HVI) and low voltage injury (LVI). A retrospective study was conducted by reviewing the medical records of all burn admissions from June 2016 to May 2017. A total of 1572 patients were admitted, of which 385 (24.49%) had suffered an electrical injury. 104 (27.01%) patients sustained LVI and 281 (72.98%) HVI. One hundred patients from both groups were randomly selected using the chit method, in order to analyse their differences. In our study, the mean age was 35.23±19.96 in the HVI group and 24.15±14.39 years in the LVI group. Most of the injuries were work related. Events during the early phase of admission included a rise in serum creatine phosphokinases, myoglobinuria, renal failure, abnormal cardiac events and other concomitant injuries in the HVI group (p<0.001). Unfavourable outcomes in the form of amputations, prolonged hospital stay and high mortality rate were observed in the HVI group (8.5%) (p<0.027). However, LVI cannot be overlooked as number of reconstructive surgeries and mean number of operations showed no significant difference between both groups. HVI has a disastrous impact on burn survivors but LVI cannot be underestimated. We advocate a low threshold for managing associated injuries, education on safety principles, for men at work especially, and infrastructure improvement by the state to bring changes to the present scenario.

Candida auris in critically ill patients: Emerging threat in intensive care unit of hospitals

Candida auris has emerged as the multi-drug resistant non-albican candida species in critically ill patients admitted to intensive care units (ICU) causing bloodstream and other infections. It has often been misidentified as Candida famata, Candida sake, Rhodotorula glutinis, or Saccharomyces cerevisiae and Candida haemulonii by automated identification systems. We, in this study, discuss three patients who acquired Candida auris infection after 15 to 20days of their stay in medical ICU. Medical equipment, use of multiple antibiotics, and poor hand hygiene are the most probable predisposing factors attributing to its colonization at multiple anatomical sites leading to bloodstream infection. Candida auris might substantially contaminate the environment of colonized or infected patients making its eradication difficult. Patient screening for Candida auris, especially during prolonged ICU stays, along with strict infection prevention and control strategies needs to be adopted to break its persistence.

Role of radiological imaging and interventions in management of Budd-Chiari syndrome

Budd-Chiari syndrome (BCS) is a clinical condition resulting from impaired hepatic venous drainage, in which there is obstruction to the hepatic venous outflow at any level from the small hepatic veins to the junction of the inferior vena cava and the right atrium leading to hepatic congestion. The diagnosis of BCS is based on imaging, which can be gathered from non-invasive investigations such as ultrasonography coupled with venous Doppler, triphasic computed tomography (CT) and magnetic resonance imaging (MRI). Apart from diagnosis, various interventional radiology procedures aid in the successful management of this syndrome. In this article, we present various imaging features of BCS along with various interventional procedures that are used to treat this diverse condition.

Biomaterials in Medicine - A Bioengineering Perspective

Biomaterials are considered with an emphasis on those used in artificial organs. Attention is drawn to the importance of the polymeric biomaterials and factors which affect their properties. Functions of membranes, sorbents, blood tubing, ventricular diaphragms and cell culture substrates are examined in order to obtain a summary of fundamental properties. Observations are made on the importance of blood compatibility assessment and its association with a biomaterial structure-property relationship. Blood-biomaterial interactions are discussed in terms of an overall relationship between the three components –- blood, biomaterial and antithrombotic agent, with examples given of factors influencing each component. Cell-biomaterial interactions are examined in the areas of toxicity evaluation and the promotion of cell attachment and growth, where an overall relationship is described for the cell, growth medium and growth factors, and the biomaterial acting as a substrate.