Establishment of Age Specific Reference Interval for Aminoacids and Acylcarnitine in Dried Blood Spot by Tandem Mass Spectrometry

The Extended Screening for Inborn Errors of Metabolism is done for aminoacidopathies, fatty acid oxidation disorders and organic acid disorders. In a single dried blood spot, the tandem mass spectrometry is capable of measuring multiple analytes like amino acids, acylcarnitines, nucleosides, succinylacetone and lysophosphatidylcholines. This study was proposed to establish age specific reference internal for aminoacids and acylcartinitine in dried blood spot by tandem mass spectrometry. A total of 480 apparently healthy children were enrolled for the study and sub classified into four groups as follows: Group A: 0-1 month, Group B: 1 month-1 year, Group C: 1-5 year and Group D: 5-12 years each having 120 participants. Sample size were calculated as per CLSI approved guidelines. Tables 1 and 2 presents the age-specific percentile distribution of aminoacids and acylcarnitines established from healthy subjects as per rank-based method recommended by the IFCC and CLSI. Tables 3, 4 and 5 presents the cut-off values of primary and secondary marker/ratios for screening of aminoacidopathies, fatty acid oxidation disorders and organic acid disorders respectively. As a general principle, the interpretation of extended newborn screening results should be based on age specific cut-off established by the laboratory for primary analyte concentration and secondary analyte concentration/ ratios. This study was useful in establishing age specific cut-off values for various amino acids and acylcarnitines in South Indian population. [Table: see text] [Table: see text] [Table: see text] [Table: see text] [Table: see text].

Human navicular bone: a morphometric and morphological evaluation

BACKGROUND

The composition of navicular joint complex is crucial to perform surgical interventions for multiple pathological foot aetiologies. The data on human navicular bone and its facets from Indian population remain scarce in literature.

AIMS AND OBJECTIVES

To evaluate the morphometry and morphology of navicular bone.

METHODOLOGY

A total of 77 (right: 40; left: 37) dried human navicular bones were used. The collected data were entered and analysed in SPSS software.

RESULTS

The anteroposterior diameter of navicular bone on right side was 15.19 mm (13.92, 16.77) and on left side was 15.87 mm (13.83, 17.27). The transverse diameter on right and left sides were 34.21 mm (31.74, 36.6) and 33.59 mm (30.23, 35.43), respectively. The vertical diameter measured on the right was 22.31 mm (21.19, 23.94) and on left 22.53 mm (20.8, 24.24). Morphometric evaluation showed no significant difference between right and left navicular bones. The commonest shape for posterior facet was quadrilateral, on the right (62.5%) and left (40.5%). The most common shape of anterior facet for medial cuneiform is quadrilateral, on the right (85%) and left (89.1%). For intermediate cuneiform, triangular facet was common on the right side (72.5%) and on the left (59.5%). The lateral cuneiform facet was bean shaped on right side (72.5%) and quadrilateral on the left side (32.5%). There was a significant difference in shape distribution between right and left (P < 0.05). The median length of the groove for tibialis posterior tendon was 18.01 mm and 16.19 mm on right and left side, respectively. Cuboid facet was observed in 28 (70%) and 26 (65.9%) navicular bones on right and left sides, respectively.

CONCLUSION

There is no significant difference between right and left bones with regards to morphometric parameters. Morphological evaluation revealed significant difference in the distribution of shape between right and left bones.

Computer-Aided Multi-Epitope Based Vaccine Design Against Monkeypox Virus Surface Protein A30L: An Immunoinformatics Approach

Monkeypox, a viral zoonotic disease resembling smallpox, has emerged as a significant national epidemic primarily in Africa. Nevertheless, the recent global dissemination of this pathogen has engendered apprehension regarding its capacity to metamorphose into a sweeping pandemic. To effectively combat this menace, a multi-epitope vaccine has been meticulously engineered with the specific aim of targeting the cell envelope protein of Monkeypox virus (MPXV), thereby stimulating a potent immunological response while mitigating untoward effects. This new vaccine uses T-cell and B-cell epitopes from a highly antigenic, non-allergenic, non-toxic, conserved, and non-homologous A30L protein to provide protection against the virus. In order to ascertain the vaccine design with the utmost efficacy, protein-protein docking methodologies were employed to anticipate the intricate interactions with Toll-like receptors (TLR) 2, 3, 4, 6, and 8. This meticulous approach led the researchers to discern an optimal vaccine architecture, bolstered by affirmative prognostications derived from both molecular dynamics (MD) simulations and immune simulations. The current research findings indicate that the peptides ATHAAFEYSK, FFIVVATAAV, and MNSLSIFFV exhibited antigenic properties and were determined to be non-allergenic and non-toxic. Through the utilization of codon optimization and in-silico cloning techniques, our investigation revealed that the prospective vaccine exhibited a remarkable expression level within Escherichia coli. Moreover, upon conducting immune simulations, we observed the induction of a robust immune response characterized by elevated levels of both B-cell and T-cell mediated immunity. Moreover, as the initial prediction with in-silico techniques has yielded promising results these epitope-based vaccines can be recommended to in vitro and in silico studies to validate their immunogenic properties.

Pragmatic Treatment Strategies for Polyaromatic Hydrocarbon Remediation and Anti-biofouling from Surfaces Using Nano-enzymes: a Review

In this review, two important environmental pollutants have been considered for its potential remediation using microbial-derived nano-enzymes. Firstly, polyaromatic hydrocarbons (PAHs) are one of the major industrial contaminants in the environment due to their ubiquitous occurrence, toxicity, and proclivity for bioaccumulation. Secondly, biofouling due to biofilm-forming organisms that impact tremendous economic and environmental consequences in many industries, especially marine vessels where it causes an increase in hydrodynamic drag, which results in a loss of ship speed at constant power or a power increase to maintain the same speed with higher fuel consumption and emissions into the atmosphere, particularly Green House Gases (GHGs). Among the remediation strategies, biological routes are found to be promising, efficient, and sustainable. Natural ligninolytic enzymes such as MnP, LiP, laccase, peroxidases, and polysaccharide and protein degradative enzymes are found to be highly efficient for PAH degradation and antifouling respectively. However, large-scale usage of these enzymes is difficult due to various reasons like their poor stability, adaptation, and high-cost production of these enzymes. In recent years, the use of nanoparticles, particularly nano-enzymes, is found to be an innovative and synergistic approach to detoxify contaminated areas with concomitant maintenance of enzyme stability.

The vaccine mandates judgment: Some reflections

This paper scrutinises the Supreme Court Judgment of May 2, 2022, in a vaccine mandate-related petition. The Hon'ble Court's Order reasserts the primacy of right to privacy and Articles 14 and 21 of the Constitution of India. However, in the interest of protection of communitarian health, the Court felt that the Government is entitled to regulate issues of public health concern by imposing certain limitations on individual rights, which are open to scrutiny by constitutional Courts. However, such mandatory vaccination directives with preconditions cannot invade an individual's right to personal autonomy and right to access means of livelihood, and must meet the threefold criteria laid down in K.S.Puttaswamy, a landmark judgment of 2017. This paper examines the validity of the arguments adopted in the Order and suggests certain infirmities therein. Nevertheless, the Order is a balancing act, and worth celebrating. The paper concludes, as a cup that is "a quarter full", as a victory for human rights and as a safeguard against unreasonableness and arbitrariness in medico-scientific decision-making that takes the citizen's compliance and consent for granted. If the State runs amok by way of mandatory health directives, this Order may come to the rescue of the hapless citizen.

Intrathecal pain pumps in pain relief

Chronic pain is a significant global health issue, described as a bio-psychosocial phenomenon that hampers the integration of body, mind, and social functions. To relieve chronic intractable pain, intrathecal drug-delivery devices (IDDDs) are the last resort after conventional treatment options have been exhausted. This article outlines the indications, pharmacological agents, types, techniques, preparation of the patient, and complications of IDDDs for the management of challenging chronic pain (non-neoplastic and cancer-related pain) conditions in patients who have not responded well to a commonly used conventional line of treatment.

A review on biological methodologies in municipal solid waste management and landfilling: Resource and energy recovery

Rapid industrialization and urbanization growth combined with increased population has aggravated the issue of municipal solid waste generation. MSW has been accounted for contributing tremendously to the improvement of sustainable sources and safe environment. Biological processing of MSW followed by biogas and biomethane generation is one of the innumerable sustainable energy source choices. In the treatment of MSW, biological treatment has some attractive benefits such as reduced volume in the waste material, adjustment of the waste, economic aspects, obliteration of microorganisms in the waste material, and creation of biogas for energy use. In the anaerobic process the utilizable product is energy recovery. The current review discusses about the system for approaching conversion of MSW to energy and waste derived circular bioeconomy to address the zero waste society and sustainable development goals. Biological treatment process adopted with aerobic and anaerobic processes. In the aerobic process the utilizable product is compost. These techniques are used to convert MSW into a reasonable hotspot for resource and energy recovery that produces biogas, biofuel and bioelectricity and different results in without risk and harmless to the ecosystem. This review examines the suitability of biological treatment technologies for energy production, giving modern data about it. It likewise covers difficulties and points of view in this field of exploration.

Competencies for Point-of-care Ultrasonography in ICU: An ISCCM Expert Panel Practice Recommendation

How to cite this article: Srinivasan S, Kumar PG, Govil D, Gupta S, Kumar V, Pichamuthu K, et al. Competencies for Point-of-care Ultrasonography in ICU: An ISCCM Expert Panel Practice Recommendation. Indian J Crit Care Med 2022;26(S2):S7-S12.

ISCCM Guidelines for Hemodynamic Monitoring in the Critically Ill

Hemodynamic assessment along with continuous monitoring and appropriate therapy forms an integral part of management of critically ill patients with acute circulatory failure. In India, the infrastructure in ICUs varies from very basic facilities in smaller towns and semi-urban areas, to world-class, cutting-edge technology in corporate hospitals, in metropolitan cities. Surveys and studies from India suggest a wide variation in clinical practices due to possible lack of awareness, expertise, high costs, and lack of availability of advanced hemodynamic monitoring devices. We, therefore, on behalf of the Indian Society of Critical Care Medicine (ISCCM), formulated these evidence-based guidelines for optimal use of various hemodynamic monitoring modalities keeping in mind the resource-limited settings and the specific needs of our patients. When enough evidence was not forthcoming, we have made recommendations after achieving consensus amongst members. Careful integration of clinical assessment and critical information obtained from laboratory data and monitoring devices should help in improving outcomes of our patients.

How to cite this article

Kulkarni AP, Govil D, Samavedam S, Srinivasan S, Ramasubban S, Venkataraman R, et al. ISCCM Guidelines for Hemodynamic Monitoring in the Critically Ill. Indian J Crit Care Med 2022;26(S2):S66-S76.

Alleviation of cadmium phytotoxicity through melatonin modulated physiological functions, antioxidants, and metabolites in tomato (Solanum lycopersicum L.)

The rising concentration of cadmium (Cd) builds a harmful effect on human and plant health associated with food chain contagion. Melatonin (MT) is an indole compound. Hence, the experiment was conducted to understand the physiological and biochemical mechanism of Cd detoxification by exogenous MT in tomato. Pots were filled with 30 ppm of Cd spiked soil and different concentration of exogenous MT was given to the plants through seed treatment (250 ppm), foliar spray viz., 25, 50, and 100 ppm, and both, whereas the foliar spray was given at 30 days after transplanting (DAT) and 46 DAT. When the plants are exposed to Cd stress, it reduces the gas exchange characters. The results revealed that foliar spray of 25 ppm of exogenous MT recorded the highest photosynthetic rate, stomatal conductance, and osmotic potential. MT had a direct interaction with reactive oxygen species scavenging by elevating endogenous antioxidant enzymes as well as the metabolites in plants. The contribution of MT foliar spray of 25 ppm at 30 and 46 DAT can mitigate Cd stress and it has potential implications for ensuring food safety and food security in marginal agriculture.

Hamiltonian Engineering with Multicolor Drives for Fast Entangling Gates and Quantum Crosstalk Cancellation

Quantum computers built with superconducting artificial atoms already stretch the limits of their classical counterparts. While the lowest energy states of these artificial atoms serve as the qubit basis, the higher levels are responsible for both a host of attractive gate schemes as well as generating undesired interactions. In particular, when coupling these atoms to generate entanglement, the higher levels cause shifts in the computational levels that lead to unwanted ZZ quantum crosstalk. Here, we present a novel technique to manipulate the energy levels and mitigate this crosstalk with simultaneous off-resonant drives on coupled qubits. This breaks a fundamental deadlock between qubit-qubit coupling and crosstalk. In a fixed-frequency transmon architecture with strong coupling and crosstalk cancellation, additional cross-resonance drives enable a 90 ns CNOT with a gate error of (0.19±0.02)%, while a second set of off-resonant drives enables a novel CZ gate. Furthermore, we show a definitive improvement in circuit performance with crosstalk cancellation over seven qubits, demonstrating the scalability of the technique. This Letter paves the way for superconducting hardware with faster gates and greatly improved multiqubit circuit fidelities.

Removal of toxic heavy metals using genetically engineered microbes: Molecular tools, risk assessment and management strategies

The direct release of industrial effluent into the water and other anthropogenic activities causes water pollution. Heavy metal ions are the primary contaminant in the industrial effluents which are exceptionally toxic at low concentrations, terribly disturb the endurance equilibrium of activities in the eco-system and be remarkably hazardous to human health. Different conventional treatment methodologies were utilized for the removal of toxic pollutants from the contaminated water which has several drawbacks such as cost-ineffective and lower efficiency. Recently, genetically modified micro-organisms (GMMs) stand-out for the removal of toxic heavy metals are viewed as an economically plausible and environmentally safe technique. GMMs are microorganisms whose genetic material has been changed utilizing genetic engineering techniques that exhibit enhanced removal efficiency in comparison with the other treatment methodologies. The present review comments the GMMs such as bacteria, algae and fungi and their potential for the removal of toxic heavy metals. This review provides current aspects of different advanced molecular tools which have been used to manipulate micro-organisms through genetic expression for the breakdown of metal compounds in polluted areas. The strategies, major limitations and challenges for genetic engineering of micro-organisms have been reviewed. The current review investigates the approaches working on utilizing genetically modified micro-organisms and effective removal techniques.

Insights on synthesis and applications of graphene-based materials in wastewater treatment: A review

Graphene has excellent unique thermal, chemical, optical, and mechanical properties such as high thermal conductivity, high chemical stability, optical transmittance, high current density, higher surface area, etc. Due to their outstanding properties, the attention towards graphene-based materials and their derivatives in wastewater treatment has been increased in recent times. Different graphene-based materials such as graphene oxides, graphene quantum dots, graphene nanoplatelets, graphene nanoribbons and other graphene-based nanocomposites are synthesized through chemical vapor deposition, mechanical and electrochemical exfoliation of graphite. In this review, the specifics about the graphenes and their derivatives, the synthesis strategy of graphene-based materials are described. This review critically explained the applications of graphene-based materials in wastewater treatment. Graphene-based materials were utilized as adsorbents, electrodes, and photocatalysts for the efficient removal of toxic pollutants such as heavy metals, dyes, pharmaceutics, antibiotics, phenols, polycyclic aromatic hydrocarbons have been highlighted and discussed. Herein, the potential scope of graphene-based material in the field of wastewater treatment is critically reviewed. In addition, a brief perspective on future research directions and difficulties in the synthesis of graphene-based material are summarized.

Salvage radiotherapy for postoperative locoregional failure in esophageal cancer: a systematic review and meta-analysis

Locoregional recurrences following surgery for esophageal cancers represent a significant clinical problem with no standard recommendations for management. We conducted this systematic review and meta-analysis with the objective of studying safety and efficacy of salvage radiotherapy in this setting. All prospective and retrospective cohort studies, which studied patients who developed locoregional recurrence following initial radical surgery for esophageal cancer and subsequently received salvage radiation therapy (RT)/chemoradiation with all relevant information regarding survival outcome and toxicity available, were included. The quality of eligible individual studies was assessed using the Newcastle-Ottawa Scale score for risk of bias. R package MetaSurv was used to obtain a summary survival curve from survival probabilities and numbers of at-risk patients collected at various time points and to test the overall heterogeneity using the I2 statistic. Thirty studies (27 retrospective, 3 prospective) published from 1995 to 2020 with 1553 patients were included. The median interval between surgery and disease recurrence was 12.5 months. The median radiation dose used was 60 Gy and 57% received concurrent chemotherapy. The overall incidence of acute grade 3/4 mucositis and dermatitis were 8 and 4%, respectively; grade 3/4 acute pneumonitis was reported in 5%. The overall median follow-up of all studies included was 27 months. The 1-, 2- and 3-year overall survival (OS) probabilities were 67.9, 35.9 and 30.6%, respectively. Factors which predicted better survival on multivariate analysis were good PS, lower group stage, node negativity at index surgery, longer disease-free interval, nodal recurrence (as compared to anastomotic site recurrence), smaller disease volume, single site of recurrence, RT dose >50 Gy, conformal RT, use of concomitant chemotherapy and good radiological response after radiotherapy. Salvage radiotherapy with or without concomitant chemotherapy for locoregional recurrences after surgery for esophageal cancer is safe and effective. Modern radiotherapy techniques may improve outcomes and reduce treatment-related morbidity.

Role of lung ultrasound in diagnosing and differentiating transient tachypnea of the newborn and respiratory distress syndrome in preterm neonates

Aim

To evaluate the accuracy of lung ultrasound in diagnosing and differentiating transient tachypnea of the newborn and respiratory distress syndrome in preterm neonates.

Material and methods

This was a single-center study. From January 2020 to June 2021. A total of 100 preterm neonates, admitted to the neonatal intensive care unit with symptoms of respiratory distress within six hours of birth, including 50 diagnosed with transient tachypnea of the newborn and 50 with respiratory distress syndrome on the basis of clinical examination, laboratory testing, chest X-rays, were recruited in the study. Lung ultrasound was performed in each neonate by a senior radiologist who was blinded to the clinical diagnosis. Lung ultrasound findings in both conditions were analyzed and compared.

Results

Pulmonary edema manifesting as alveolar-interstitial syndrome, double lung point sign and less commonly as white out lungs in the absence of consolidation has 100% sensitivity and specificity in diagnosing transient tachypnea of the newborn. A combination of three signs of consolidation with air or fluid bronchograms, white out lungs and absent spared areas has 100% sensitivity and specificity for diagnosing respiratory distress syndrome. Double lung point sign was seen only in infants suffering from transient tachypnea of the newborn and consolidation with air or fluid bronchograms only in cases of respiratory distress syndrome.

Conclusion

Lung ultrasound can accurately diagnose and reliably differentiate transient tachypnea of the newborn and respiratory distress syndrome in preterm neonates. It has advantages that cannot be replicated by chest radiography. Lung ultrasound may be used as an initial screening tool.

Sustainable strategy on microbial fuel cell to treat the wastewater for the production of green energy

Microbial fuel cell (MFC) is one of the promising alternative energy systems where the catalytic conversion of chemical energy into electrical energy takes places with the help of microorganisms. The basic configuration of MFC consists of three major components such as electrodes (anode and cathode), catalyst (microorganism) and proton transport/exchange membrane (PEM). MFC classified into four types based on the substrate utilized for the catalytic energy conversion process such as Liquid-phase MFC, Solid-phase MFC, Plant-MFC and Algae-MFC. The core performance of MFC is organic substrate oxidation and electron transfer. Microorganisms and electrodes are the key factors that decide the efficiency of MFC system for electricity generation. Microorganism catalysis degradation of organic matters and assist the electron transfer to anode surface, the conductivity of anode material decides the rate of electron transport to cathode through external circuit where electrons are reduced with hydrogen and form water with oxygen. Not limited to electricity generation, MFC also has diverse applications in different sectors including wastewater treatment, biofuel (biohydrogen) production and used as biosensor for detection of biological oxygen demand (BOD) of wastewater and different contaminants concentration in water. This review explains different types of MFC systems and their core performance towards energy conversion and waste management. Also provides an insight on different factors that significantly affect the MFC performance and different aspects of application of MFC systems in various sectors. The challenges of MFC system design, operations and implementation in pilot scale level and the direction for future research are also described in the present review.

Doppler-estimated Carotid and Brachial Artery Flow as Surrogate for Cardiac Output: Needs Further Validation

Selvam V, Srinivasan S. Doppler-estimated Carotid and Brachial Artery Flow as Surrogate for Cardiac Output: Needs Further Validation. Indian J Crit Care Med 2022;26(2):159–160.

Maternal Health: The Mirror of Our Healthcare System

Krishna B, Kulkarni AP, Srinivasan S. Maternal Health: The Mirror of Our Healthcare System. Indian J Crit Care Med 2021;25(Suppl 3):S187–S188.

Parturient with Acute Abdomen

Management of a parturient with an acute abdomen presents unique challenges. We aim to review the common obstetric and nonobstetric causes for acute abdomen in pregnancy, approach to diagnosis, the role of imaging, and management including the scope and timing of operative intervention.

Necrotizing Soft Tissue Infections: More than What Meets the Eye

How to cite this article: Kundu R, Srinivasan S. Necrotizing Soft Tissue Infections: More than What Meets the Eye. Indian J Crit Care Med 2022;26(4):411-413.

Retrieving embolized peripherally inserted central catheter - A novel two step technique

We report a novel two-step percutaneous endovascular technique for retrieval of peripherally inserted central catheter, free ends of which were inaccessible, that had embolized to the segmental branch of left pulmonary artery using SIM 1 catheter and a loop snare, in a 17 year old female patient diagnosed with osteosarcoma right femur. Step one involved, inserting SIM 1 catheter through the heart to hook the embolized peripherally inserted central catheter and bring it down to the lower segment of inferior vena cava. In the second step, a loop snare was used to grasp the free end of peripherally inserted central catheter, and the whole assembly was withdrawn via right common femoral vein access. Patient was monitored for 24 hours and discharged as there were no complications. SIM 1 catheter followed by the use of loop snare as a retrieval system is safe and efficacious and can be considered by an intervention radiologist for retrieval of embolized vascular access device, in which none of the free ends are available to catch hold with a loop snare.

MR Imaging Differences in the Circle of Willis between Healthy Children and Adults

BACKGROUND AND PURPOSE

Asymmetries in the circle of Willis have been associated with several conditions, including migraines and stroke, but they may also be age-dependent. This study examined the impact of age and age-dependent changes in cerebral perfusion on circle of Willis anatomy in healthy children and adults.

MATERIALS AND METHODS

We performed an observational, cross-sectional study of bright and black-blood imaging of the proximal cerebral vasculature using TOF-MRA and T2 sampling perfection with application-optimized contrasts by using different flip angle evolution (T2-SPACE) imaging at the level of the circle of Willis in 23 healthy children and 43 healthy adults (4-74 years of age). We compared arterial diameters measured manually and cerebral perfusion via pseudocontinuous arterial spin-labeling between children and adults.

RESULTS

We found that the summed cross-sectional area of the circle of Willis is larger in children than in adults, though the effect size was smaller with T2-SPACE-based measurements than with TOF-MRA. The circle of Willis is also more symmetric in children, and nonvisualized segments occur more frequently in adults than in children. Moreover, the size and symmetry of the circle of Willis correlate with cerebral perfusion.

CONCLUSIONS

Our results demonstrate that the circle of Willis is different in size and symmetry in healthy children compared with adults, likely associated with developmental changes in cerebral perfusion. Further work is needed to understand why asymmetric vasculature develops in some but not all adults.

Demonstration of a High-Fidelity cnot Gate for Fixed-Frequency Transmons with Engineered ZZ Suppression

Improving two-qubit gate performance and suppressing cross talk are major, but often competing, challenges to achieving scalable quantum computation. In particular, increasing the coupling to realize faster gates has been intrinsically linked to enhanced cross talk due to unwanted two-qubit terms in the Hamiltonian. Here, we demonstrate a novel coupling architecture for transmon qubits that circumvents the standard relationship between desired and undesired interaction rates. Using two fixed frequency coupling elements to tune the dressed level spacings, we demonstrate an intrinsic suppression of the static ZZ while maintaining large effective coupling rates. Our architecture reveals no observable degradation of qubit coherence (T_{1},T_{2}>100  μs) and, over a factor of 6 improvement in the ratio of desired to undesired coupling. Using the cross-resonance interaction, we demonstrate a 180 ns single-pulse controlled not (cnot) gate, and measure a cnot fidelity of 99.77(2)% from interleaved randomized benchmarking.

Age-adjusted Charlson Comorbidity Index: A Simple Tool, but Needs Further Validation in COVID-19 Patients

How to cite this article: Selvam V, Srinivasan S. Age-adjusted Charlson Comorbidity Index: A Simple Tool, but Needs Further Validation in COVID-19 Patients. Indian J Crit Care Med 2021;25(9):963-964.

A Randomized Controlled Trial on a Minimally Invasive Microsurgical Versus Conventional Procedure for the Management of Localized Gingival Recession in Esthetic Zone using Alloderm

Background:

Microsurgical technique is a recent advancement in periodontal plastic surgery, which improves the predictability of periodontal procedures, providing better esthetic results with minimal postoperative discomfort. Alloderm is an alternate to connective tissue grafts, which has been successfully used for root coverage. The present study aims at Comparative assessment of Micro and Conventional surgical techniques for root coverage using coronally positioned flap (CPF) with Alloderm.

Materials and Methods:

Twenty sites with Miller's Class I or II gingival recession defects were selected; sites were randomly divided into control and test groups. Test sites were treated with CPF and acellular dermal matrix (ADM) using Microsurgery and control sites were treated with CPF and ADM using conventional method.

Results:

Conventional and Microsurgical procedures for root coverage showed a statistically significant difference in all clinical parameters from baseline to 3 and 6 months (P < 0.01). The microsurgical technique demonstrated a significant difference in ultrasonographic thickness of gingiva (P < 0.003) and patient satisfaction score (P < 0.005).

Conclusion:

Microsurgical procedure for root coverage was found to be superior to the conventional macrosurgical approach under magnification. Microsurgical sites healed faster with neovascularization demonstrated on ultrasonographic evaluation with improved gingival thickness and patient satisfaction scores.

Seminal exosomes - An important biological marker for various disorders and syndrome in human reproduction

BACKGROUND

Exosomes are nano-sized membrane vesicles, secreted by different types of cells into the body's biological fluids. They are found in abundance in semen as compared to other fluids. Exosomes contain a cargo of lipid molecules, proteins, phospholipids, cholesterol, mRNAs, and miRNAs. Each molecule of seminal exosomes (SE) has a potential role in male reproduction for childbirth. Many potential candidates are available within the seminal exosomes that can be used as diagnostic markers for various diseases or syndromes associated with male reproduction. Also these seminal exospmes play a major role in female reproductive tract for effective fertilization.

AIM

The aim of this review is to focus on the advancement of human seminal exosomal research and its various properties.

METHODS

We used many databases like Scopus, Google scholar, NCBI-NLM and other sources to filter the articles of interest published in exosomes. We used phrases like "Exosomes in human semen", "Composition of exosomes in human semen" and other relevant words to filter the best articles.

RESULTS

Seminal exosomes play a major role in sperm functions like cell-to-cell communication, motility of the sperm cells, maintaining survival capacity for the sperm in the female reproductive tract and spermatogenesis. Also, seminal exosomes are used as a carrier for many regulatory elements using small RNA molecules. miRNAs of the seminal exosomes can be used as a diagnostic marker for prostate cancer instead of prostate specific antigen (PSA). Epididymosomes can be used as a biomarker for reproductive diseases and male infertility.

CONCLUSION

Seminal exosomes could be used as biological markers for various reproductive disorders, male infertility diagnosis, and it can be used in anti-retroviral research for the identification of novel therapeutics for HIV-1 infection and transmission.

COVID-19 ARDS: Can Systemic Oxygenation Utilization Guide Oxygen Therapy?

How to cite this article: Srinivasan S, Panigrahy AK. COVID-19 ARDS: Can Systemic Oxygenation Utilization Guide Oxygen Therapy? Indian J Crit Care Med 2021;25(2):115-116.

SQ3370 Activates Cytotoxic Drug via Click Chemistry at Tumor and Elicits Sustained Responses in Injected & Non-injected Lesions

While systemic immuno-oncology therapies have shown remarkable success, only a limited subset of patients benefit from them. Our Click Activated Protodrugs Against Cancer (CAPAC™) Platform is a click chemistry-based approach that activates cancer drugs at a specific tumor with minimal systemic toxicity. CAPAC Platform is agnostic to tumor characteristics that can vary across patients and hence applicable to several types of tumors. We describe the benefits of SQ3370 (lead candidate of CAPAC) to achieve systemic anti-tumor responses in mice bearing two tumors. SQ3370 consists of a biopolymer, injected in a single lesion, followed by systemic doses of an attenuated protodrug™ of doxorubicin (Dox). SQ3370 was well-tolerated at 5.9-times the maximum dose of conventional Dox, increased survival by 63% and induced a systemic anti-tumor response against injected and non-injected lesions. The sustained anti-tumor response also correlated with immune activation measured at both lesions. SQ3370 could potentially benefit patients with micro-metastatic lesions.