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Presents a letter to the editor about the efficacy on the use of cefotoxin disk diffusion method for the detection of methicillin-resistant staphylococcus aureus as compared to the gold standard polymerase chain reaction.

Objective: This research seeks to understand food insecurity experiences among students at a large public university in the southern United States. Participants: Participants consented and completed an online survey disseminated on campus in April-May 2021 (N = 418). The participants sampled were predominantly undergraduate (78.2%), females (72.4%), who lived off campus (54.1%), and were racially/ethnically diverse. Methods: Descriptive statistics, multivariable logistic regression, and chi-squared tests were used to examine the differences and association between demographic characteristics and behaviors and food insecurity status. Results: About 32% students surveyed had experienced food insecurity in the last year, which resembles national trends. There were significant differences in students' food insecurity status by race, sexual orientation, first-generation status, residential category, and main mode of transportation. Food insecurity impacted academic and socioeconomic student behaviors. Conclusions: This research has implications for improving the academic, physical, and psychological wellbeing of university students and should inform future programs and policies.

The escalating rates of rape and sexual assault cases underscore the essential need to analyze associative evidence of sexual assault to ensure justice. The condom, when used during the act of sexual assault/rape, leaves behind traces of lubricant that could be instrumental in establishing the link between the victim and perpetrator. This leading evidence is crucial especially when the traditional DNA analysis is challenging owing to the lack of biological evidence. The present study employs the use of ATR FTIR spectroscopy coupled with the chemometric, to discern the chemical discrimination of condom lubricants. The study also aimed to investigate simulated real-case scenarios by analysing the effect of different matrices such as vaginal fluid, menstrual blood, and undergarment substrates (cotton, polyester and nylon) on condom traces. The difference in the spectral profile of pre-coitus and post-coitus samples was also investigated. The results of the present study are noteworthy, unveiling the efficacy of discriminating the condom lubricants of different brands and other frequently used household lubricants with 100% sensitivity, specificity, and accuracy. Condom lubricants are detected despite the presence of contaminants such as menstrual blood, and vaginal fluid, across different substrates and, in post-coital conditions. In conclusion, this study presents a comprehensive approach to analysing condom lubricants, offering a potential breakthrough in the investigation of sexual assault cases, coupled with the ability to counter false accusations., Competing Interests: Declarations. Ethical approval: The study received ethical approval from the Institutional ethical committee vide letter number “NFSU-DC/1101/IHEC/2023-FS-1”. The research protocol and procedures were thoroughly reviewed to ensure compliance with ethical standards. Informed consent: Participants were provided with clear and thorough information about the objectives and procedures of the study. Written informed consent was taken from all the participants prior to their involvement in the study. Confidentiality: Precautionary measures were taken to safeguard the confidentiality of the donors information. The collected data was anonymized and stored securely to protect the privacy of the participants. Voluntary participation: The participation of the donors in the study was entirely voluntary. The participants were informed of their right to withdraw at any stage without any consequences. Necessary statements have been added in the manuscript as well. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Antimicrobial Resistance (AMR) due to non-responding viruses, fungi, bacteria and parasites leads to discovery of new antimicrobial medicines which can control the risk of disease spread, severe illness, disability and death. Heterocyclic chemistry has always been a continuous supplier of novel antimicrobial agents which are in great demand in pharma sector. Therefore, compounds such as 1-(Chloromethyl)-1H-Benzotriazole, 1; 1-((1-H-benzo[d][1,2,3]triazol-1-yl)methyl)phenyl hydrazine, 2; 1-((1-H-benzo[d][1,2,3]triazol-1-yl)methyl)hydrazine, 3; and N-(benzo[e][1,2,4]triazin-4(3-H)-ylmethylbenzenamine, 4 were designed, and synthesized through conventional and microwave-assisted methods. All of these novel benzotriazoles were explored through in-vitro antimicrobial studies and in silico studies. Antimicrobial activity was carried out against bacterial strains Escherichia coli , Bacillus subtilis , and fungal strains Aspergillus niger and Candida albicans at concentrations 5, 10 and 15 mg/ml. In silico studies was carried out with 4CAW: Aspergillus fumigatus N-myristoyl transferase in complex with myristoyl CoA and a pyrazole sulphonamide ligand. Our antimicrobial and molecular docking studies revealed that all of the derivatives showed promising activity, moreover molecular docking gave significant values of ligand posed energy and docking run elapsed time which further endorsed the astonishing characteristic of benzotriazole derivatives esp. N-(benzo[e]a[1,2,4] triazin-4(3-H)-ylmethylbenzenamine for biological and therapeutic leads., Competing Interests: Conflict of interestThe authors declare no conflict of interest., (© Association of Microbiologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: In 2013, we initiated a comprehensive multispectrum robotic cardiac surgery program with emphasis on the totally endoscopic approach. We reviewed the outcomes of mitral valve (MV) procedures within this context., Methods: A retrospective review of 1714 robotic endoscopic cardiac surgeries performed at our institution between September 2013 and February 2024 was conducted. Of these, outcomes of 550 consecutive heterogeneous patients undergoing robotic totally endoscopic MV operations were analyzed. Data were collected according to the Mitral Valve Academic Research Consortium definitions., Results: The mean age was 63 years, and 217 patients (39%) were female. The mean Society of Thoracic Surgeons risk of mortality was 2.1% (range, 0.15%-19.4%). MV repair occurred in 98% of patients with degenerative mitral regurgitation (MR). Concomitant procedures included Cox-maze cryoablation in 127 (23%) patients, tricuspid valve repair in 54 (9.8%), septal myectomy in 15 (2.7%), totally endoscopic coronary bypass in 6 (1.1%), and aortic valve replacement in 3 (0.5%). Endoaortic balloon occlusion was used in 392 patients (71%), ventricular fibrillatory arrest in 114 (21%), and transthoracic aortic clamp in 44 (8%). Observed to expected 30-day mortality was 0.6. Mean length of hospital stay was 2.8 days. MV repair 30-day surgical success was 95.9% and procedural success was 93.0%. Postoperative echocardiography revealed no or trace residual MR in 95% and mild residual MR in 5%. Five-year freedom from reoperation for recurrent MR was 95.7%., Conclusions: Robotic endoscopic MV surgery is feasible within the context of a comprehensive multispectrum robotic cardiac surgery program., Competing Interests: Disclosures Husam Balkhy discloses he is a proctor for Intuitive Surgical, maker of the Da Vinci robot, and Edwards Lifesciences, maker of the IntraClude device. The remaining authors have nothing to disclose. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: Robotic beating-heart totally endoscopic coronary bypass (TECAB) is performed using single or bilateral internal thoracic arteries with good results. Despite slow adoption and limited industry support, we have evolved our practice and continue to routinely perform TECAB. We describe our series of 874 patients undergoing robotic beating-heart TECAB with up to 10-year follow-up., Methods: A retrospective review of all patients (n = 874) undergoing robotic beating-heart TECAB (July 2013 to April 2024) was performed. Patients were contacted for midterm follow-up, and angiographic data were collected in those undergoing hybrid revascularization. Multivariate regression analysis and Cox proportional hazard modeling were used to analyze risk factors for early/midterm outcomes. Primary end points were midterm all-cause mortality and major adverse cardiac/cerebrovascular events., Results: Mean Society of Thoracic Surgeons score was 1.5 ± 2.2%. In total, 470 (54%) underwent multivessel TECAB, of whom 86% received bilateral internal thoracic arteries. There was 1 intraoperative conversion (0.11%). Mean length of stay was 2.3 ± 0.8 days. Hospital mortality was 0.80% (observed/expected 0.54). A total of 393 patients (45%) underwent hybrid revascularization. Early graft patency was 97% (left internal thoracic artery-left anterior descending artery patency 98%). Midterm follow-up was 100% at mean 48 months (longest 10.6 years). Cardiac-related mortality and all-cause mortality were 2.2% and 18%, respectively. Freedom from major adverse cardiac/cerebrovascular events was 93%. In multivariate analysis, left-main disease ≥70% was a risk factor for midterm cardiac mortality (odds ratio, 6.7; confidence interval, 1.9-24, P = .003)., Conclusions: In this series of 874 patients with up to 10-year follow-up, we show that robotic TECAB can be performed with excellent early and midterm results using an iterative approach, despite significant challenges. Further industry support and wider surgeon adoption are necessary to ensure sustainability of this procedure., Competing Interests: Conflict of Interest Statement H.H.B. reports proctor for Intuitive. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Multi-arterial grafting (MAG) with bilateral internal thoracic arteries (BITAs) is superior to single internal thoracic artery (ITA) and veins, however, sternal wound infection (SWI) is a deterrent to using BITA, especially in diabetic and obese patients. Sternal-sparing approaches, including robotic totally endoscopic coronary artery bypass (TECAB), may mitigate this risk. We reviewed outcomes of robotic TECAB with BITA grafting., Methods: A total of 871 patients underwent robotic TECAB at our institution from 7/2013 to 4/2024. Of these, 406 patients received BITA grafts and are the subject of this review. Early and mid-term clinical outcomes were reviewed and angiographic patency in those undergoing hybrid revascularization with percutaneous coronary intervention (PCI) after TECAB. All cases were performed via a beating-heart robotic approach, with standard TECAB port placement., Results: The mean age of the cohort was 67±9 years and 16% were female. The mean Society of Thoracic Surgeons (STS) risk was 1.47%±2.2%. Thirty-nine percent were diabetic (15% insulin-dependent) and 39% had a body mass index (BMI) ≥30 kg/m 2 . Twenty percent had an ejection fraction (EF) ≤40%. Ninety-eight percent of cases were completed off-pump and there were no conversions to sternotomy. The mean number of grafts per patient was 2.2±0.4. The mean intensive care unit (ICU) and hospital length of stay (LOS) were 1.22±0.62 and 2.44±0.83 days, respectively. Postoperative complications included atrial fibrillation in 13%, acute kidney injury (AKI) in 3.4%, return to theatre for bleeding in 0.7%, postoperative myocardial infarction (MI) in 0.2%, and stroke in 0.2%. Thirty-day mortality was 1.2% [observed/expected (O/E): 0.89]. Return to full activities and work occurred at mean of 14±8.6 and 17±13 days, respectively. Two hundred and two patients (50%) had 'advanced' hybrid revascularization (with at least two arterial grafts and stents). ITA early graft patency in this cohort of patients was 271/278 (98%) with 100% left ITA to left anterior descending artery (LITA-LAD) patency. Mid-term follow-up was complete in all patients at mean of 51±36 months (longest follow-up at 10 years). All-cause mortality was 13% and cardiac-mortality was 2.5%. Freedom from angina was 96%, and freedom from repeat revascularization was 94%., Conclusions: Use of the beating-heart robotic TECAB approach facilitates BITA grafting to achieve multi-vessel arterial revascularization of the left coronary system, with excellent 10-year outcomes., Competing Interests: Conflicts of Interest: H.H.B. is a proctor for Intuitive Surgical. The other authors have no conflicts of interest to declare., (2024 Annals of Cardiothoracic Surgery. All rights reserved.)

Competing Interests: Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Balkhy is a proctor for Intuitive Surgical. All other authors have nothing to disclose.

Background: Subjective cognitive complaints (SCC) may be an early indicator of future cognitive decline. However, findings comparing SCC and objective cognitive performance have varied, particularly in the memory domain. Even less well established is the relationship between subjective and objective complaints in non-amnestic domains, such as in executive functioning, despite evidence indicating very early changes in these domains. Moreover, particularly early changes in both amnestic and non-amnestic domains are apparent in those carrying the Apolipoprotein-E ɛ4 allele, a primary genetic risk for Alzheimer's disease (AD)., Objective: This study investigated the role of the ɛ4 allele in the consistency between subjective and objective executive functioning in 54 healthy, cognitively intact, middle-aged and older adults., Methods: Participants ( M age  = 64.07, SD  = 9.27, range = 48-84; ɛ4+ = 18) completed the Frontal Systems Behavior Scale (FrSBe) Executive Dysfunction Scale (EXECDYS) to measure subjective executive functioning (SEF) and multiple executive functioning tasks, which were condensed into a single factor., Results: After accounting for age, depression, and anxiety, objective executive functioning performance significantly predicted SEF. Importantly, ɛ4 moderated this effect. Specifically, those carrying the ɛ4 allele had significantly less accurate self-awareness of their executive functioning compared to ɛ4 non-carriers., Conclusions: Utilizing an approach that integrates self-evaluation of executive functioning with objective neurocognitive assessment may help identify the earliest signs of impending cognitive decline, particularly in those with genetic risk for AD. Such an approach could sensitively determine those most prone to future cognitive decline prior to symptom onset, when interventions could be most effective., Competing Interests: The authors have no conflict of interest to report., (© 2024 – The authors. Published by IOS Press.)

Objectives: The aim of the study was to assess the effectiveness of ZOE-based, calcium hydroxide, and epoxy resin-based sealers on modification with three herbal extracts., Materials and Methods: Methanolic extracts of selected herbs were combined with ZOE-based, calcium hydroxide, and epoxy resin-based sealers. Cultures were prepared from E. faecalis and C. albicans and agar plates prepared. Prepared mixtures were inoculated in punched holes, and inhibitory zones were measured., Results: No statistical significance was obtained on comparing mean scores of test groups., Conclusion: None of the combinations used was found to be significantly better than others., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Pharmacy and Bioallied Sciences.)

Objectives: The study's objective was to contrast the two distinct rotary file techniques used to shape mandibular first molars., Materials and Methods: The investigation involved twenty recently removed mandibular molars. A digital single-lens reflex (DSLR) camera was placed in a fixed position, a muffle block was built, and images of each tooth's three cross sections were obtained. The specimens were split into the following two groups at random: Rotary files from WaveOne were used to prepare group A and Mtwo rotary files were used to prepare group B., Results: At the coronal, middle, and apical thirds of the root canals, WaveOne file system demonstrated improved centering ability compared with the Mtwo file system ( P 0.05)., Conclusion: When compared to the Mtwo file system, WaveOne file system demonstrated improved centering capabilities and needed significantly less time to build the curved canals., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Pharmacy and Bioallied Sciences.)

Aim: The study was done to evaluate extraction of teeth without altering the aspirin therapy., Materials and Method: Hundred patients taking aspirin therapy requiring extraction of teeth were separated into two groups with 50 samples in each. Group I continued the aspirin therapy during extraction of teeth on one occasion, and the same patients who discontinued the aspirin therapy 72 hours before extraction of teeth on another occasion become Group II., Result: The mean blood loss showed slightly increased bleeding in Group I in comparison to Group II. The average bleeding time and mean INR was statistically significant among both groups. The mean clotting time and mean platelet count were not statistically significant among groups., Conclusion: There was no alteration in bleeding after extraction in patients with low doses of aspirin therapy., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Pharmacy and Bioallied Sciences.)

A 56-year-old female diagnosed with hypertrophic obstructive cardiomyopathy and myocardial bridge (MB) of the left anterior descending (LAD) coronary artery underwent septal myectomy with resolution of her left ventricular outflow tract gradient. She had ongoing refractory symptoms of exertional angina and fatigue for over a decade and finally presented to our clinic to be re-evaluated for treatment. Provocative angiographic testing confirmed significant ischemia secondary to LAD MB. She underwent robotic totally endoscopic off pump unroofing of the LAD MB with complete relief of her symptoms and return to full activity. We conclude that patients undergoing septal myectomy for hypertrophic obstructive cardiomyopathy should be evaluated for MB and undergo unroofing of the bridge at the time of surgery., Learning Objective: A myocardial bridge (MB) is a condition in which a coronary artery, most often the left anterior descending, takes an intramuscular route and is covered by the myocardium leading to compression and potential ischemia. This case report adds to the growing body of evidence supporting the significance of considering MB in the overall management of hypertrophic obstructive cardiomyopathy, and the symptomatic relief that a patient can obtain from an unroofing procedure., Competing Interests: Dr. Balkhy is a proctor for Intuitive Surgical. All other authors have nothing to disclose., (© 2024 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Objective: This systematic review evaluates the variation in molar bite force (MBF) with the type and severity of dental malocclusion in young adults with permanent dentition., Methods: We searched seven electronic databases until December 31, 2021, and identified 1898 articles, of which 22 full-texts were reviewed. Eight clinical studies with subjects having permanent dentition with various dental malocclusions and quantifying maximal bite force were included for the review. Newcastle Ottawa scale was used to assess the risk of bias and GRADE to study the certainty of evidence. Articles were evaluated for the primary outcome (variation of MBF in different malocclusion groups) and confounding factors affecting MBF., Results: All studies measured MBF in individuals with normal and malocclusion, with 2329 subjects having permanent dentition. A positive correlation of Class I normal occlusion with the bite force was seen compared to Class II and III malocclusion. Unilateral crossbite patients had lesser bite force. Six studies with 1023 males and 1175 females showed MBF more in males than females. In 3 studies (332 subjects), no significant difference for MBF between the right and left sides of the jaws was measured., Conclusion: MBF decreases significantly with vertical and transverse craniofacial and dental discrepancy. Normal sagittal occlusion has more molar bite force than patients with different malocclusions. Also, MBF is more in males than females, and it increases with age., Registration: PROSPERO CRD42021249328., (© 2022 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.)

Background: The COVID-19 pandemic has made dentists very assiduous about cross-infection during dental treatment, thereby delaying dental radiographs for treatment. However, patients needing dental emergency treatment in the ongoing pandemic require relevant intra/extraoral dental radiography for adequate diagnosis and treatment planning., Methods: This article is aimed at adding to the hot debate: Is delay for intraoral radiographs justified or a possible proxy? As a narrative review, it provides an insight into the reasons for delaying intra-oral dental radiographs during in the pandemic and options of the nontraditional radiographic techniques available until the pandemic subsides. Discussion and Conclusion . Cross-contamination concerns through respiratory droplets grow while using intraoral film holders that stimulate gag reflex, coughing, saliva secretion, and if proper disinfection protocols are not applied. Since the patients' acquiring emergency dental treatment cannot be neglected, the return-to-work guidelines by the health regulatory bodies urge to prioritize extraoral radiographic imaging techniques to curb the infection, offering the best diagnostic efficacy. The dental professionals can consider cone-beam computed tomography (CBCT) scans and sectional dental panoramic radiographs (SDPRs), followed by a risk assessment for COVID-19, a safer modality in reducing cross-contamination and assuring an innocuous environment for both patient and coworkers., Competing Interests: The authors declare no conflict of interest for this article., (Copyright © 2022 Harneet Kaur et al.)

Early detection of infectious diseases is crucial for reducing transmission and facilitating early intervention. In this study, we built a real-time smartwatch-based alerting system that detects aberrant physiological and activity signals (heart rates and steps) associated with the onset of early infection and implemented this system in a prospective study. In a cohort of 3,318 participants, of whom 84 were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), this system generated alerts for pre-symptomatic and asymptomatic SARS-CoV-2 infection in 67 (80%) of the infected individuals. Pre-symptomatic signals were observed at a median of 3 days before symptom onset. Examination of detailed survey responses provided by the participants revealed that other respiratory infections as well as events not associated with infection, such as stress, alcohol consumption and travel, could also trigger alerts, albeit at a much lower mean frequency (1.15 alert days per person compared to 3.42 alert days per person for coronavirus disease 2019 cases). Thus, analysis of smartwatch signals by an online detection algorithm provides advance warning of SARS-CoV-2 infection in a high percentage of cases. This study shows that a real-time alerting system can be used for early detection of infection and other stressors and employed on an open-source platform that is scalable to millions of users., (© 2021. The Author(s).)

Background: Fibrous dysplasia (FD) is a developmental hamartomatous bone disease characterized by a blend of fibrous and osseous entities. Though rarely malignant, the tumor can vary from being small and asymptomatic, to a fairly large sized lesion, progressing gradually, compromising occlusion and facial esthetics. Treatment approach depends on the stage of skeletal maturity. It primarily involves surgical management for stabilizing the disease process. Post-surgical comprehensive dental treatment is necessary for restoring form and function of the jaws and teeth. This article describes comprehensive orthodontic management of severe malocclusion in a surgically operated case of FD maxilla., Case Summary: A 19-year female presented with a chief complaint of excessive gingival display when smiling. Dental history included swelling of gums around the upper right front teeth, diagnosed at the age of 15 as FD of the right anterior maxillary segment and treated with surgical recontouring of the dysplastic bone. The clinical and radiological examinations showed adequate post-surgical healing. The surgically treated dysplastic area presented with right canting of the maxillary anterior occlusal plane. The maxillary teeth were torqued palatally, with the root of the right maxillary canine exposed clinically. We discuss sequential management of the associated malocclusion with comprehensive fixed orthodontics, along with special precautions taken to prevent reactivation of the quiescent and healed lesion., Conclusion: The adequate healing of fibro-dysplastic bone post-surgery must be allowed before initiating orthodontic tooth movement in the dysplastic bone. Periodic follow-ups are needed to monitor stability of occlusion and any relapse of the lesion., Competing Interests: Conflict-of-interest statement: The authors deny any conflict of interest related to this study., (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.)

The large amount of biomedical data derived from wearable sensors, electronic health records, and molecular profiling (e.g., genomics data) is rapidly transforming our healthcare systems. The increasing scale and scope of biomedical data not only is generating enormous opportunities for improving health outcomes but also raises new challenges ranging from data acquisition and storage to data analysis and utilization. To meet these challenges, we developed the Personal Health Dashboard (PHD), which utilizes state-of-the-art security and scalability technologies to provide an end-to-end solution for big biomedical data analytics. The PHD platform is an open-source software framework that can be easily configured and deployed to any big data health project to store, organize, and process complex biomedical data sets, support real-time data analysis at both the individual level and the cohort level, and ensure participant privacy at every step. In addition to presenting the system, we illustrate the use of the PHD framework for large-scale applications in emerging multi-omics disease studies, such as collecting and visualization of diverse data types (wearable, clinical, omics) at a personal level, investigation of insulin resistance, and an infrastructure for the detection of presymptomatic COVID-19., (© 2021. The Author(s).)

Background: Lung cancer is one of the most commonly diagnosed cancers and is the leading cause of cancer-related deaths. Metastatic bone disease occurs in 20% to 40% of patients with lung cancer, and these patients often present with pain or skeletal-related events (SREs) that are associated with decreased survival. Bone-modifying agents such as denosumab or bisphosphonates are routinely used; however, to our knowledge, there has been no quantitative synthesis of randomized controlled trial data to determine the most effective pharmacologic treatment of metastatic bone disease because of lung cancer., Questions/purposes: We aimed to perform a network meta-analysis of randomized trials to identify the bone-modifying agent that is associated with the (1) highest overall survival, (2) longest time to SRE, (3) lowest SRE incidence, and (4) greatest likelihood of pain resolution., Methods: We conducted our study according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol and pre-registered the analysis on PROSPERO (ID: CRD42019124364). We performed a librarian-assisted search of MEDLINE, PubMed, EMBASE, Cochrane Library, and Chinese databases including China National Knowledge Infrastructure and Wanfang Data. We included randomized controlled trials reporting outcomes specifically for patients with lung cancer treated with a bisphosphonate or denosumab. SREs included pathologic fractures, spinal cord compression, hypercalcemia of malignancy, or pain resulting in surgical intervention or radiation therapy. We excluded trials exclusively reporting surrogate outcomes such as changes in bone turnover markers. Screening, data extraction, risk of bias evaluation, and Grading of Recommendations Assessment, Development, and Evaluation evaluations were performed in duplicate. We included 131 randomized controlled trials that evaluated 11,105 patients with skeletal metastases from lung cancer. The network meta-analysis was performed using a frequentist model and the R statistical software. Results are reported as relative risks or mean differences, and the I2 value is reported for heterogeneity. The P-score, a measure of ranking certainty that accounts for standard error, is reported for each outcome. Heterogeneity in the network was considered moderate for overall survival and time to SRE, mild for the incidence of SRE, and low for pain resolution., Results: For overall survival, denosumab was ranked above zoledronic acid and estimated to confer a mean of 3.3 months (95% CI 0.3-6.3) of increased overall survival compared with untreated patients (P-score = 89%). For the time to SRE, denosumab was ranked first with a mean of 9.1 additional SRE-free months (95% CI 6.7-11.5) compared with untreated patients (P-score = 99%), while zoledronic acid conferred an additional 4.8 SRE-free months (95% CI 3.6-6.1). Reduction in the incidence of SREs was not different between patients treated with denosumab (relative risk 0.54; 95% CI 0.33-0.87) and those treated with zoledronic acid (relative risk 0.56; 95% CI 0.46-0.67). Patients treated with the combination of ibandronate and systemic therapy were more likely to experience successful pain resolution than untreated patients (relative risk 2.4; 95% CI 1.8-3.2)., Conclusion: In this comprehensive synthesis of all available randomized controlled trial evidence guiding the pharmacologic treatment of bone metastases from lung cancer, denosumab was ranked above zoledronic acid for overall survival and time to SRE and was not different for reducing the incidence of SRE. Both were superior to no treatment for each of these outcomes. Given this, we encourage physicians to consider the use of denosumab or zoledronic acid in treating this patient population. The combination of ibandronate and systemic therapy was the most effective at reducing pain because of metastases. No cost-effectiveness analysis has yet been performed for denosumab and zoledronic acid on patients with metastatic lung cancer, and this represents an avenue for future research., Level of Evidence: Level I, therapeutic study., Competing Interests: Each author certifies that neither he or she, nor any member of his or her immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2021 by the Association of Bone and Joint Surgeons.)

Introduction: Dentin hypersensitivity (DH) adversely affects quality of life by impairing the ability to eat and drink certain foods, therefore, should be addressed promptly with a contingency plan that includes initial treatment with a noninvasive prophylactic home care approach, followed by in-office treatment if desired result is not achieved., Aim: The purpose of this study was to evaluate the effectiveness of four different pastes containing 5% NovaMin (Sensodyne Repair and Protect ® ), Propolis (Phytoshield Propolis ® ), 5% potassium nitrate (Sensodyne ® ), and 8% arginine (Colgate Sensitive Pro Relief ® ) based toothpastes in the treatment of DH., Materials and Methods: One hundred dentin slices were cut from the crown section of molars. Etching with 37% orthophosphoric acid was done to open the tubules. Scanning electron microscope (SEM) study was done to ensure that the tubules are opened. The dentin specimens were divided into four groups: Group 1 -5% NovaMin, Group 2 - Propolis, Group 3 - 5% potassium nitrate, and Group 4 - 8% arginine. Samples were brushed for 2 min twice daily with a soft toothbrush for 15 days and were stored in distilled water. The samples were rinsed under running water to remove the toothpaste. The SEM was performed to check the obliteration of tubules., Results: 5% NovaMin group showed more completely occluded dentinal tubules when compared to other groups. The differences among all the groups were statistically significant ( P ≤ 0.05)., Conclusion: In the present study, all materials, NovaMin, Propolis, potassium nitrate, and arginine, were effective in occluding dentinal tubules but NovaMin appeared most proficient in occluding tubules, followed by arginine, potassium nitrate, and Propolis. Topical NovaMin is an upcoming agent demonstrating desensitization and remineralization properties., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Indian Society of Periodontology.)

Early detection of infectious disease is crucial for reducing transmission and facilitating early intervention. We built a real-time smartwatch-based alerting system for the detection of aberrant physiological and activity signals (e.g. resting heart rate, steps) associated with early infection onset at the individual level. Upon applying this system to a cohort of 3,246 participants, we found that alerts were generated for pre-symptomatic and asymptomatic COVID-19 infections in 78% of cases, and pre-symptomatic signals were observed a median of three days prior to symptom onset. Furthermore, by examining over 100,000 survey annotations, we found that other respiratory infections as well as events not associated with COVID-19 (e.g. stress, alcohol consumption, travel) could trigger alerts, albeit at a lower mean period (1.9 days) than those observed in the COVID-19 cases (4.3 days). Thus this system has potential both for advanced warning of COVID-19 as well as a general system for measuring health via detection of physiological shifts from personal baselines. The system is open-source and scalable to millions of users, offering a personal health monitoring system that can operate in real time on a global scale.

Background: In growing patients with skeletal discrepancies, early assessment of functional factors can be vital for the restoration of normal craniofacial growth., Aim: To compare airway volumes in patients with mandibular retrognathism with the normal anteroposterior skeletal relationship, thereby assessing the association between cephalometric variables and airway morphology., Methods: Cone-beam computed tomography volume scans, and lateral cephalograms, 3-dimensional airway volume and cross-sectional areas of 120 healthy children (54 boys and 66 girls mean age 15.19 ± 1.28) which were done for orthodontic assessment were evaluated. The subjects were divided into 2 groups based on the angle formed between point A, Nasion and point B (ANB) values and cephalometric variables (such as anterior and posterior facial height, gonial angle etc. ) airway volumes, and cross-sectional measurements were compared using independent t tests. Pearson's correlation coefficient test was used to detect any relationship of different parts of the airway and between airway volume and 2-dimensional cephalometric variables., Results: Means and standard deviations for cephalometric, cross-sectional, and volumetric variables were compared. ANB, mandibular body length and facial convexity were statistically highly significant ( P < 0.01) whereas condylion to point A, nasal airway and total airway volume ( P < 0.05) were statistically significant. The nasal airway volume and the superior pharyngeal airway volume had a positive correlation ( P < 0.01), nasal airway was correlated to middle ( P < 0.05) and total airway superior had a relation with middle ( P < 0.05), inferior and total airway ( P < 0.05), middle was related to all other airways; inferior was also related to all the airways except nasal. Lateral cephalometric values were positively correlated with the airway volume with Frankfurt Mandibular Plane Angle and facial convexity showed significant correlations with total airway volume ( P < 0.05). Additionally, ANB angle was significantly correlated with total airway volume and superior airway ( P < 0.05)., Conclusion: The mean total airway volume in patients with retrognathic mandible was significantly smaller than that of patients with a normal mandible., Competing Interests: Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript., (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: The aim of the retrospective observational study was to compare the precision of landmark identification and its reproducibility using cone beam computed tomography-derived 3D cephalograms and digital lateral cephalograms in unilateral cleft lip and palate patients., Methods: Cephalograms of thirty-one (31) North Indian children (18 boys and 13 girls) with a unilateral cleft lip and palate, who were recommended for orthodontic treatment, were selected. After a thorough analysis of peer-reviewed articles, 20 difficult-to-trace landmarks were selected, and their reliability and reproducibility were studied. These were subjected to landmark identification to evaluate interobserver variability; the coordinates for each point were traced separately by three different orthodontists (OB A , OB B , OB C ). Statistical analysis was performed using descriptive and inferential statistics with paired t -tests to compare the differences measured by the two methods. Real-scale data are presented in mean ± SD. A p -value less than 0.05 was considered as significant at a 95% confidence level., Results: When comparing, the plotting of points posterior nasal spine (PNS) ( p < 0.05), anterior nasal spine (ANS) ( p < 0.01), upper 1 root tip ( p < 0.05), lower 1 root tip ( p < 0.05), malare ( p < 0.05), pyriforme ( p < 0.05), porion ( p < 0.01), and basion ( p < 0.05) was statistically significant., Conclusion: In patients with a cleft lip and palate, the interobserver identification of cephalometric landmarks was significantly more precise and reproducible with cone beam computed tomography -derived cephalograms vis-a-vis digital lateral cephalograms.

The objective of the current study was to evaluate intra- and interobserver bone volume measurements and effect of orientation on the reliability of bone volume evaluation in as-acquired vis-à-vis oriented cone beam computed tomography scans using Osirix software and possible correlation between gender, age, and bone volume required. For this, 31 cone beam computed tomography (CBCT) scans of 14 girls and 17 boys (aged 9-13) with unilateral cleft lip and/or palate who met the inclusion criteria were analyzed. Efficacy and reliability of third party software Osirix for bone volume calculation was assessed using as acquired and oriented volumes by three specialists (a radiologist, an orthodontist, and an oral maxillofacial surgeon). The dataset and readings were anonymized to prevent any bias. Two-way mixed model analysis on as-acquired and oriented observations exhibited intra-class coefficient (ICC) values ≥ 0.90. Wilcoxon signed rank test ( p = 0.10) and Kruskal-Wallis ANOVA ( p = 0.46) indicated that although a clinical difference in volume assessment was seen between as-acquired and oriented observations (inter-observer and intra-observer), it was statistically insignificant. Spearman's bi-variate correlation analysis revealed a significant relation between the type (side) of cleft and bone volume required to fill the defect ( p < 0.05). Although there was clinical difference in bone volume measurement by the three observers, it was insignificant statistically. Clefts on the left side in the patients had significantly more bone required than the right side, whereas age and gender had no relation with bone needed to fill the defect. OsiriX software provided good reliability in measurements of bone volume.

SARS-CoV-2, a virus causing severe acute respiratory syndrome, has inundated the whole world, generating global health concerns. There is a wildfire-like effect, despite the extensive range of efforts exercised by the affected countries to restrain the expanse of this pandemic, owing to its community spread pattern. Dental specialists in the upcoming days will likely come across patients with presumed or confirmed COVID-19 and will have to ensure stringent infection prevention and control to prevent its nosocomial spread. This paper strives to provide a brief overview of the etiology, incubation, symptoms, and transmission paradigms of this novel infection and how to minimize the spread in a dental healthcare setting. This review presents evidence-based patient management practice and protocols from the available literature to help formulate a contingency plan with recommendations, for the dental practices prior to patients' visit, during in-office dental treatment, and post-treatment, during the pandemic and after., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this article., (Copyright © 2020 Anuraj Singh Kochhar et al.)

Objectives: To provide a comprehensive summary of the implications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) on orthodontic treatment, contingency management, and provision of emergency orthodontic treatment, using currently available data and literature., Materials and Methods: Orthodontically relevant sources of information were searched using electronic databases including PubMed and Google Scholar and current reports from major health bodies such as Centers for Disease Control and Prevention, World Health Organization, National Institutes of Health, and major national orthodontic associations., Results: Where available, peer-reviewed and more recent publications were given priority. Due to the rapidly evolving nature of COVID-19 and limitations in quality of evidence, a narrative synthesis was undertaken. Relevant to orthodontics, human-to human transmission of SARS-CoV-2 occurs predominantly through the respiratory tract via droplets, secretions (cough, sneeze), and or direct contact, where the virus enters the mucous membrane of the mouth, nose, and eyes. The virus can remain stable for days on plastic and stainless steel. Most infected persons experience a mild form of disease, but those with advanced age or underlying comorbidities may suffer severe respiratory and multiorgan complications., Conclusions: During the spread of the COVID-19 pandemic, elective orthodontic treatment should be suspended and resumed only when permitted by federal, provincial, and local health regulatory authorities. Emergency orthodontic treatment can be provided by following a contingency plan founded on effective communication and triage. Treatment advice should be delivered remotely first when possible, and where necessary, in-person treatment can be performed in a well-prepared operatory following the necessary precautions and infection prevention and control (IPAC) protocol., (© 2020 by The EH Angle Education and Research Foundation, Inc.)

This article is a rumination on the outbreak of the dreaded coronavirus disease-2019 (COVID-19) pandemic which has engulfed both the developed and the developing countries, thereby causing widespread global public health concerns and threats to human lives. Although countries have made varied efforts, the pestilence is escalating due to the high infectivity. It is highly likely that dental professionals in upcoming days will come across COVID-19 patients and SARS-CoV-2 carriers, and hence must ensure a tactful handling of such patients to prevent its nosocomial spread. Despite the avalanche of information that has exploded in relation to this rapidly spreading disease, there is a lack of consolidated information to guide dentists regarding clinical management including precautions to take materials to use and postprocedure care, during and after the COVID-19 pandemic. Available sources of information have been analyzed, while relying on peer-reviewed reports followed by information available from the most respected authoritative sources, such as WHO, Centers for Disease Control and Prevention (CDC), and ADA. This review aims to provide a comprehensive summary from the available literature on COVID-19, its insinuation in dentistry, recommendations that have been published, and the actual in-practice implications, so a plan can be formulated and adapted to the circumstances of each dental practice during the pandemic and the times to follow., How to Cite This Article: Kochhar AS, Bhasin R, Kochhar GK, et al . Dentistry during and after COVID-19 Pandemic: Pediatric Considerations. Int J Clin Pediatr Dent 2020;13(4):399-406., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.)

BACKGROUND: Inverse psoriasis is characterized by erythematous nonscaly plaques in intertriginous regions. Similarly, erythrasma, a superficial infection caused by Corynebacterium minutissimum ( C. minutissimum ), is also found in skin folds with red-brown lesions, making the distinction between psoriasis and erythrasma difficult. No studies have previously determined whether these two clinically similar cutaneous disorders can occur concurrently. METHODS: Thirty patients with inverse psoriatic plaques were examined using a standard Wood's lamp to visualize porphyrins associated with C. minutissimum . RESULTS: Just over half (56.6%) of patients with inverse psoriatic plaques showed evidence of this bacterium. Specifically, 45.5 percent of inverse psoriatic lesions were found to be positive for C. minutissimum , with the highest prevalence of erythrasma located in the gluteal cleft. CONCLUSION: Clinical suspicion for C. minutissimum should be high in patients with inverse psoriasis due to the organism's potential to trigger or exacerbate psoriatic lesions. Further studies are indicated to determine the response to treatment in patients with this combination., Competing Interests: FUNDING:No funding was provided for this study. DISCLOSURES:The authors have no conflicts of interest relevant to the content of this article., (Copyright © 2020. Matrix Medical Communications. All rights reserved.)

Purpose: Bladder-preserving curative radiation therapy (RT) has been established as an excellent treatment option for select patients with muscle-invasive bladder cancer (MIBC). However, some clinicians have concerns that good outcomes are only achievable at high-volume facilities (HVFs) and academic centers (ACs), questioning successful reproducibility of curative RT at smaller centers. This study sought to determine whether treatment at ACs or HVFs was associated with better overall survival (OS) than treatment at nonacademic centers or lower-volume facilities., Methods and Materials: We performed a retrospective cohort study of National Cancer Database patients (n=2763) with cT2 to cT4 N0 M0 transitional cell MIBC who received curative RT (60-70 Gy) with or without concurrent chemotherapy. Cox proportional hazards models were used to estimate the instantaneous hazard of death as a function of univariate and multivariate patient characteristics and clinical measures., Results: Univariate analysis showed that academic facility type was significantly associated with improved OS (hazard ratio [HR], 0.88; 95% confidence interval [CI] 0.79-0.98; P=.02) whereas higher case volume was not associated with improved survival (HR, 0.97; 95% CI 0.92-1.01; P=.15). Multivariate analysis showed no differences in OS for treatment at ACs versus nonacademic centers (HR, 0.94; 95% CI 0.84-1.06; P=.31) or HVFs versus lower-volume facilities (HR, 0.99; 95% CI 0.94-1.04; P=.60). The 2-year OS rate was 54.5% (95% CI 52.5%-56.4%), and the 5-year OS rate was 28.9% (95% CI 27.0%-30.8%)., Conclusions: Although some providers are cautious about offering curative RT at all centers, this large hospital-based study suggests that facility type and volume are not significantly associated with OS for patients undergoing curative RT after we account for other clinically relevant risk factors. The results of this study demonstrate that curative RT in the treatment of MIBC may be considered for patients regardless of facility type or volume., (Copyright © 2017 Elsevier Inc. All rights reserved.)

While some electrolyte disturbances are immediately life-threatening and must be emergently treated, others may be delayed without immediate adverse consequences. We discuss a patient with alcoholism and diabetes mellitus type 2 who presented with volume depletion and multiple life-threatening electrolyte and metabolic derangements including severe hyponatremia (serum sodium concentration [S Na ] 107 mEq/L), hypophosphatemia ("undetectable," <1.0 mg/dL), and hypokalemia (2.2 mEq/L), moderate diabetic ketoacidosis ([DKA], pH 7.21, serum anion gap [S AG ] 37) and hypocalcemia (ionized calcium 4.0 mg/dL), mild hypomagnesemia (1.6 mg/dL), and electrocardiogram with prolonged QTc. Following two liters of normal saline and associated increase in S Na by 4 mEq/L and serum osmolality by 2.4 mosm/Kg, renal service was consulted. We were challenged with minimizing the correction of S Na (or effective serum osmolality) to avoid the osmotic demyelinating syndrome while replacing volume, potassium, phosphorus, calcium, and magnesium and concurrently treating DKA. Our management plan was further complicated by an episode of significant aquaresis. A stepwise approach was strategized to prioritize and correct all disturbances with considerations that the treatment of one condition could affect or directly worsen another. The current case demonstrates that a thorough understanding of electrolyte physiology is required in managing complex electrolyte disturbances to avoid disastrous outcomes., Competing Interests: The authors declare that they have no competing interests.

Background: Achieving durable local control while limiting normal tissue toxicity with definitive radiation therapy in the management of high-risk brain metastases remains a radiobiological challenge. The objective of this study was to examine the local control and toxicity of a 5-fraction stereotactic radiosurgical approach for treatment of patients with inoperable single high-risk NSCLC brain metastases., Methods: This retrospective analysis examines 20 patients who were deemed to have "high-risk" brain metastases. High-risk tumors were defined as those with a maximum diameter greater than 2 cm and/or those located within an eloquent cortex. Patients were evaluated by a neurosurgeon prior to treatment and determined to be inoperable due to tumor or patient characteristics. Patients were treated using the CyberKnife® SRS system in 5 fractions to a total dose of 30 Gy, 35 Gy, or 40 Gy., Results: Twenty patients with a median age of 65.5 years were treated from April 2010 to August 2014 in 5 fractions to a median total dose of 35 Gy. At a median follow up of 11.3 months local tumor control was observed in 18 of 20 metastases (90 %). Both local failures were observed in patients receiving a lower dose of 30 Gy. Median pre-treatment dexamethasone dose was 10 mg/day and median post-treatment nadir dose was 0 mg/day. Salvage intracranial therapy was required in 45 % of patients. Symptomatic radionecrosis was observed in 4 of 20 patients (20 %), two of which were treated to 40 Gy and the remainder to 35 Gy. Kaplan-Meier 1-year, 2-year, and median survival were calculated to be 45 %, 20 %, and 13.2 months, respectively., Conclusions: Five-fraction SRS to a total dose of 35 Gy appears to be a safe and effective management strategy for single high-risk NSCLC brain metastases, while a total dose of 40 Gy leads to an excess risk of neurotoxicity.

Background: Leprosy is a chronic granulomatous disease and affects many internal organs in addition to the skin and peripheral nerves. Endocrine dysfunction is often silent and is often missed in patients of leprosy leading to significant morbidity. We studied the presence of occult endocrine disorders in leprosy patients and compared the same with disease parameters., Materials and Methods: We evaluated 40 patients of leprosy (aged 18-70 years, any duration) in this cross-sectional, observational study. All subjects were assessed for pituitary, thyroid, adrenal, gonadal function, and dynamic testing was done when deemed necessary. The participants were divided into two groups: Group 1 (Leprosy, n = 40) and Group 2 (Controls, n = 20) and the data were analyzed with appropriate statistical tests., Results: The study participants (35 males, 5 females) had a mean age of 36.4 ± 11.3 years, and duration of the disease was 2.5 ± 5.5 years. Eleven out of 40 patients showed results consistent with an endocrine disorder, including subclinical hypothyroidism (n = 4), sick euthyroid syndrome (n = 3), growth hormone (GH) deficiency (n = 2), primary hypogonadism (n = 2) and secondary hypogonadism in one patient. One patient had partial hypopituitarism (GH deficiency and secondary hypogonadism) and none of the controls showed any hormonal dysfunction. Testosterone levels showed inverse correlation with the number of skin patches (P = 0.0006)., Conclusion: Occult endocrine dysfunction is seen in a quarter of patients with leprosy. Thyroid and gonadal axes abnormalities are common, and the severity is more in lepromatous forms of the disease. Further large studies are required to confirm the findings observed in our study.

Angioedema associated with angiotensin converting enzyme inhibitors (ACEIs) is due to the accumulation of bradykinin and its metabolites. Angiotensin receptor blockers (ARBs) produce anti-hypertensive effects by blocking the angiotensin II AT1 receptor action; hence bradykinin-related side effects are not expected. However, we notice the occurrence of ARB-induced angioedema as not a very rare side effect. Visceral drug-induced angioedema has been reported with ACEIs, not with ARBs. This underlying review will help educate readers on the pathophysiology and recent guidelines pertaining to ACEI- and ARB-induced visceral angioedema.

A 51-year-old female with a history of type 1 diabetes mellitus (DM) presented with sudden onset of pain and swelling of the left thigh. Her initial evaluation revealed mildly elevated erythrocyte sedimentation rate and creatine phosphokinase. Venous and arterial Doppler studies were negative for DVT and arterial thrombus. Further imaging with CT scan and then MRI revealed an irregular, enhancing space-occupying lesion of the left upper and mid-thigh. Subsequent muscle biopsy showed myonecrosis and proliferative myositis. Both findings are consistent with diabetic myonecrosis, which is a microvascular complication of long-standing poorly controlled DM. The patient was treated with analgesics, supportive care, and optimization of glycemic control. While short-term prognosis is good with adequate healing in a few weeks to several months, long-term prognosis is poor due to underlying extensive vascular disease. Although radiological findings are very suggestive of the diagnosis, most clinicians still need tissue biopsy to rule out other serious conditions such as infections and malignancy.

Background: Readmission rates are projected to serve as quality measures that have the potential to negatively impact hospital and physician reimbursement. Individual physicians and hospitals are developing plans to reduce readmission rates. Successful plans should be based on specific data obtained from each individual type of practice., Objective: To analyze the etiological factors responsible for readmissions to various teaching services in a community hospital. This will serve to identify potentially correctable factors that will be the basis for developing practice-specific plans to reduce readmissions., Design: Retrospective detailed chart review., Setting: Community teaching hospital affiliated with a large academic health care system., Participants: Patients admitted to teaching services at a community hospital., Measurements: Data are presented as descriptive analysis., Results: Advanced chronic medical conditions (31%), patients' lifestyle choices (28%), and new unrelated diagnoses (21%) are the major causes of readmissions. The remaining small percentage of readmissions is attributed to premature discharge, poor discharge planning, poor post-discharge follow-up, medication errors, and failure to implement medical care guidelines., Limitations: Retrospective study from a single center., Conclusions: Causes of readmission are diverse. Although most are universal, the relative contribution of each factor is unique to each population. Institutions should generate their own data in order to direct their resources toward 'high return' areas. Current studies emphasize the role of physicians and health systems in reducing readmission rates. However, the area of readmissions related to patients' behaviors is not well explored. Our study identified the role of patients' lifestyle choices as a major cause of readmission.

A single nucleotide polymorphism (SNP) in SDF-1, the natural ligand for the HIV-1 coreceptor CXCR4, is implicated to have protective effects against HIV-1 infection. Dendritic cells are the first to encounter HIV-1 at mucosal sites and virus binding occurs via receptors known as DC-SIGN. Variations in the number of repeats in the neck region of DC-SIGN and DC-SIGNR are reported to possibly influence host susceptibility to HIV-1 infection. We examined the SNP of SDF1-3'A by PCR-restriction fragment length polymorphism (RFLP) and repeat region polymorphisms in DC-SIGN and DC SIGNR by PCR in healthy HIV seronegative individuals, high risk STD patients seronegative for HIV, and HIV-1 seropositive patients from northern India. The detected polymorphisms were confirmed by cloning and sequencing. The genotypic frequency of SDF1-3'A/SDF1-3'A in the 100 HIV-seronegative healthy individuals, 150 HIV seronegative STD patients, and 100 HIV-1 seropositive patients were 4%, 18% and 7%, respectively. A significantly higher frequency of SDF1-3'A/SDF1-3'A was observed in high risk STD patients as compared to HIV seropositive (p=0.014) and healthy HIV-1 seronegative tested individuals (p=0.001), suggesting a protective role of SDF1-3'A in HIV-1 infection. DC-SIGN polymorphism was rare and genotype 7/7 was predominant in all groups studied. DC-SIGNR was highly polymorphic and 11 genotypes were observed among the different study groups. The precise role of the polymorphic variants of DC-SIGNR needs to be elucidated in the population.

Objective: To evaluate the comparative efficacy of low dose daily versus alternate day plasma exchange in patients with severe myasthenia., Methods: Thirty three patients with myasthenia gravis (Osserman's stage II b and III) were randomized to receive alternate day (n = 17) or daily low dose plasma exchange (n = 16). Plasma exchange were carried on each patient, number of exchanges varying subject to their requirements and 20-25 ml/kg plasma was removed during each session. Myasthenia gravis disease scale (MGDS) score was evaluated before and after the procedure. Time to wean off ventilator, removal of nasogastric tube and total duration of hospital stay were also assessed., Results: There was no statistically significant difference between daily vs. alternate day group with regards to change in MGDS score, percentage change in MGDS score, and complication rates. A decreased hospital stay was observed in patients on daily plasma exchange which almost reached statistical significance., Conclusion: We conclude from our study that daily and alternate day plasma exchange are similar in their efficacy and complication rates, however the daily schedule could be a preferred modality due to decreased hospital stay.

Host genetic factors play an important role in susceptibility to HIV-1 infection and progression to AIDS. Mutations in genes encoding chemokine receptors and their ligands, viz., CCR5delta32, CCR2-64I and SDF1-3'A are implicated to have protective effects against HIV-1 infection and/or disease progression. The distribution of these gene polymorphisms and their role in the course of the disease varies between individuals of different racial, ethnic and risk groups. We have examined the allelic frequencies of CCR5delta32, CCR2-64I and SDF1-3'A in 500 healthy North Indians tested seronegative for HIV-1, by PCR-RFLP. The plasma levels of stromal derived factor (SDF-1) protein were estimated in 75 individuals using ELISA kit. Frequencies of CCR5delta32, CCR2-64I and SDF1-3'A alleles in 500 individuals were 1.5%, 9.1% and 20.4%, respectively. The SDF1-3'A homozygosity was confirmed by PCR product cloning and sequencing. The relative hazard values calculated on the basis of the three locus genotype of each individual revealed high relative hazard values (>0.9). The plasma levels of SDF-1 ranged from 1.77 to 3.42 ng/ml and were comparable between the three genotypes of SDF-1. This is the first study to assess the plasma level of SDF-1 protein in Asian Indians. Low frequency of the protective allele CCR5delta32 observed in this study suggests high vulnerability of North Indians to HIV-1 infection. The precise role of SDF1-3'A in HIV-1 infection needs to be elucidated.

Unlabelled: We present the histories, clinical findings, and hospital course of three patients who developed hypoglycemia after receiving gatifloxacin. Possible mechanisms for the hypoglycemia are outlined. CASE 1: A 89-year-old diabetic male receiving glyburide was given a single dose of gatifloxacin for bronchitis. Thirteen hours later, he was found to be unresponsive with a blood glucose level of 34 mg/dL. The hypoglycemia resolved within 24 hours of stopping gatifloxacin. CASE 2: A 80-year-old nondiabetic woman with end-stage renal disease and recent surgery was treated with gatifloxacin, cefepime, and metronidazole for pneumonia. Sixteen hours later, her serum glucose level was 61 mg/dL, and over the next 24 hours was as low as 39 mg/dL. The hypoglycemia resolved within 40 hours of stopping gatifloxacin. CASE 3: A 58-year-old diabetic man receiving glyburide was admitted for myocardial infarction and renal failure. Twelve hours after receiving gatifloxacin for pneumonia, his blood glucose level was 60 mg/dL and was as low as 42 mg/dL between 2 and 22.5 hours of a second dose of gatifloxacin. The hypoglycemia resolved within 24 hours of stopping gatifloxacin., Conclusions: Gatifloxacin use may precipitate hypoglycemia in diabetic patients receiving oral hypoglycemic agents and in nondiabetic patients with chronic renal failure. Discontinuation of gatifloxacin results in improvement in glucose homeostasis.