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Background: Various techniques have been advocated for over half a century for the fabrication of transfer trays for indirect orthodontic bonding. Authors have aimed to provide better light curing and accuracy of bracket positioning to avoid bracket failure and get the best possible results., Aim: This study is aimed to compare bracket failure rate when transfer trays were fabricated with a glue gun material and polylactic acid (PLA) filament for an indirect bonding procedure., Materials and Methods: Customized transfer trays were fabricated using a glue gun material and PLA filament, and an indirect bonding procedure was performed. Bracket failure was assessed at regular intervals with adhesive remnant index (ARI) scoring, and reasons for bracket failure were assessed., Results: Kolmogorov-Smirnov test was employed to test the normality of data. A Chi-square test was performed for the quantitative variables. Results showed higher bracket failure in the PLA transfer tray groups and in the mandibular arch, especially in the posterior region. Adhesive remnant index scores of 2 followed by 3 were prevalent, and the most common reason for bracket failure was an excessive force during PLA transfer tray retrieval followed by masticatory forces., Conclusions: Both the transfer tray methods are effective for an indirect bonding procedure. Polylactic acid transfer trays showed more bracket failure as compared to glue gun transfer trays, especially in the mandibular posterior region due to excessive force applied during tray retrieval., Clinical Significance: This study aims to provide valuable information regarding the efficiency of various in-house methods of fabricating customized transfer trays and their effect on bracket failure rates.

Aim: To assess third and fourth cervical vertebra morphologic dimensions as per the cervical vertebral maturation stage proposed by Hassel and Farman from 7 to 18 years., Materials and Methods: A cross-sectional radiographic study was conducted on 264 participants within an age-group of 7-18 years who were further categorized into six subgroups having an interval of 1 year and 11 months chronologic age. The maturation stage and morphometric evaluation of the cervical vertebra were assessed for the same patient. The maturation stage was assessed as per the morphologic classification given by Hassel and Farman. The morphometric evaluation was assessed by measuring the anterior (AH3 and AH4), vertebral body (H3 and H4), posterior heights, and anteroposterior width (APW3 and APW4) of third and fourth cervical vertebra in millimeters which was carried out with the help of "IC measure software." One-way analysis of variance (ANOVA), Tukey's multiple comparison, and Spearman's correlation coefficient were utilized to determine the significance and correlation between the vertebral maturation and millimetric measurement between age-groups. The multiple comparison levels were set at 0.05 level of significance., Results: A high significant correlation was observed between PH3 and APW3 ( r , 0.737 ** ). Moderate significant correlation was observed with H3 and PH3 ( r , 0.605 ** , 0.640 * ), and APW3, APW4 ( r , 0.534 ** , 0.614 * ) in the initiation stage in both the vertebrae; AH3, H3 ( r , 0.498 ** ) and H3, APW3 ( r , 0.576 ** ) in deceleration stage. A negative moderate significant correlation between AH4, PH4 ( r , -0.691 ** ) was observed in the deceleration stage. The transition, maturation, and completion stages did not reveal any significant correlation., Conclusion: Significant morphologic difference was observed among all the stages of vertebral maturation. Higher dimensions were observed among males. Anteroposterior width had the highest dimension. Significant morphometric changes were observed in stages of maturation and transition stages., Clinical Significance: The dimensions of anterior, vertebral, and posterior height of the third and fourth cervical vertebra can supplement in identifying the precise morphologic classification whenever there is an overlap in the opinion of staging cervical vertebral maturation based on Hassel and Farman.

Background: Venous thromboembolism is a significant source of morbidity and mortality following total hip replacement and total knee replacement. Apixaban has been proven to be efficacious without increased risk of bleeding in phase-III trials in patients undergoing total knee replacement and total hip replacement. Due to paucity of data on safety of apixaban in Indian patients, this phase-IV study was conducted to evaluate safety of apixaban in patients undergoing total knee replacement and total hip replacement., Methods: In this non-comparative phase-IV clinical trial, patients undergoing elective total knee replacement or total hip replacement surgery, or a revision of at least one component of total knee replacement or total hip replacement, were enrolled. The eligible patients were given the approved dosage of apixaban 12 to 24 h after completing the skin wound closure. The primary safety outcome was the composite of the International Society on Thrombosis and Haemostasis-defined major bleeding and clinically relevant non-major bleeding events at the end of the treatment. The secondary efficacy endpoint was the composite of venous thromboembolism/all-cause death at the end of the treatment., Results: A total of 498 patients received apixaban prophylaxis therapy. Six (1.2%) bleeding adverse events were observed during the treatment period. Only one bleeding event was adjudicated as an International Society on Thrombosis and Haemostasis-defined clinically relevant non-major bleeding event (moderate severity). There were no fatal bleeding events and no deaths following the treatment. One venous thromboembolism event, that is, symptomatic distal left leg DVT, was reported in a total knee replacement patient and was adjudicated during the treatment period., Conclusion: Apixaban demonstrated a favorable safety profile for venous thromboembolism prevention in Indian patients undergoing total knee replacement or total hip replacement., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Background: Direct orthodontic bracket bonding consumes significantly more chairside time in comparison to indirect bonding. The primary drawback of indirect bonding is incomplete penetration of the curing light through transfer trays, leading to bracket bond failure. The primary objective in a clinical setting is to minimize the chairside time. This technique of indirect bonding reduces chairside time, is economical, utilizes minimum armamentarium, and provides adequate light penetration and accuracy., Technique: Impressions were made, casts were poured and marked for the desired bracket position as per MBT prescription. Bonding agent was used to stabilize the brackets on the working model. A 3D printing pen and polylactic acid (PLA) filament were used to fabricate transfer trays for indirect bonding. The tray with brackets held in the desired position was transferred to the oral cavity and cured., Conclusions: Fabrication of complete or partial transfer trays for indirect bonding using PLA with the help of a 3D printing pen is a precise, easy-to-use, economical, and reliable method that reduces chairside time., Clinical Significance: When compared with other methods of indirect bonding, the PLA transfer tray made with a 3D printing pen was easy to fabricate with brackets held firmly in the tray for a precisely desired position. The tray fit snugly and permitted light curing of composite from all surfaces of brackets and removal of flash. This method significantly reduced the overall time of the indirect bonding procedure.

Background & Objectives: : Various biological markers of subclinical atherosclerosis have been proposed to predict cardiovascular events in patients with diabetes mellitus (DM). However, there are only a few clinical studies assessing the role of invasive biomarkers [CD-36, peroxisome proliferator-activated receptor gamma (PPAR-γ) and YKL-40] in Indian patients with type 2 DM (T2DM). Hence, the present study was conducted to assess protein levels and gene expression of CD-36, PPAR-γ and YKL-40 in patients with T2DM and compare that with hypertensive and healthy controls., Methods: : All the participants were subjected to medical history, anthropometric measurements and biochemical and biomarker (ELISA and real-time polymerase chain reaction) estimations. The study groups consisted of patients with T2DM (>5 yr) with hypertension (n=55), patients with T2DM (<2 yr) without hypertension (n=28), hypertensive controls (n=31) and healthy controls (n=30)., Results: : Gene expressions of YKL-40 and CD36 were significantly higher in patients with T2DM (>5 yr) with hypertension compared to healthy controls (P=0.006). In addition, a significant increase in serum levels of sCD36, PPAR-γ and YKL-40 was observed in patients with T2DM (>5 yr) with hypertension compared to healthy controls (P< 0.05). Serum levels as well as gene expression of CD36 showed significant correlation with serum levels as well as gene expression of PPAR-γ (ρ=0.45 and ρ=0.51; P< 0.001), respectively., Interpretation & Conclusions: : CD36 and YKL-40 may be potential inflammatory biomarkers for early onset of atherosclerosis in patients with T2DM., Competing Interests: None

Background and Objective: Epilepsy, the most common neurological disorder, has treatment failure rate of 20 to 25%. Inter-individual variability in drug response can be attributed to genetic polymorphism in genes encoding different drug metabolizing enzymes, drug transporters (P-gp), and enzymes involved in sodium channel biosynthesis. The present study attempted to evaluate association of polymorphisms of CYP2C9, CYP2C19, and ABCB1, and P-gp activity with treatment response in patients with epilepsy., Materials and Methods: Patients with epilepsy on phenytoin and/or phenobarbital and/or carbamazepine were categorized into responders and non-responders as per the International League Against Epilepsy. Plasma drug concentration was estimated by high-performance liquid chromatography. P-gp activity was measured by flow cytometry using rhodamine efflux. The polymerase chain reaction (PCR-RFLP) was used to study polymorphisms of ABCB1 (C3435T), CYP2C9 (416 C > T, and 1061 A > T), and CYP2C19 (681 G > A and 636 G > A)., Results: Of total 117 patients enrolled in this study, genotype data was available for 115 patients. P-gp activity was higher in non-responders (n = 68) compared to responders (n = 47) (P<0.001). No association of 416 C > T and 1061 A > T in CYP2C9 or 681 G > A and 636 G > A in CYP2C19 was observed with response phenotype in genotypic analysis. Significant genotypic (odds ratio, OR = 4.5; 95% CI, 1.04 to 20.99) and allelic association (OR = 1.73; 95% CI, 1.02 to 2.95) was observed with ABCB1 C3435T and response phenotype., Conclusions: The response to antiepileptics seems to be modulated by C3435T in ABCB1 or P-gp activity. At present, role of other genetic factors in treatment responsiveness in epilepsy appears limited, warranting analysis in a larger cohort.

Background: Increased arterial stiffness may be an important path- way linking diabetes mellitus to increased cardiovascular risk., Aim: The study was conducted to assess the surrogate markers of arterial stiffness in patients with Type 2 diabetes mellitus (T2DM), and compare with age-matched hypertensive and healthy controls. Also the effect of age and blood pressure on these markers was evaluated., Settings and Design: This cross-sectional study was carried out at a tertiary care hospital in West India., Methods: After a detailed medical history and anthropometric evaluation, all the participants were subjected to measurements of Arterial Stiffness Index (ASI), Pulse Wave Velocity (PWV), and Augmentation Index (AIx) using a non-invasive oscillometric method. The four study groups consisted of patients with T2DM (>5 years) along with hypertension, newly diagnosed patients with T2DM (<2years) without hypertension, hypertensive controls, and healthy controls., Results: PWV, ASI, AIx were elevated in patients with T2DM compared to healthy controls (p<0.05). Patients with T2DM above 60 years had higher carotid-femoral PWV, ASI and AIx than those below 60 years (p<0.05). ASI and AIx were significantly increased in patients with T2DM with hypertension having systolic BP > 140 mmHg compared to those with systolic BP < 140 mmHg. A very strong correlation between PWV and AIx in patients with T2DM and hypertensive controls was observed., Conclusion: This study reveals that markers of arterial stiffness (PWV, ASI, AIx) were increased significantly in patients with T2DM compared to healthy controls. Age and systolic blood pressure had significant influence on these markers. Thus, oscillometric markers have potential utility in identifying subclinical atherosclerosis in patients with T2DM.

Background: Feeding mode during infancy and its effect on deciduous tooth appearance in oral cavity in two generations and among genders., Aim and Objective: Study aimed to compare and correlate times and patterns of deciduous tooth eruption in breastfeeding (OBF), partial breastfeeding (PBF) and spoon feeding (SF) infants and initiation of semisolid food feeding (SSF) in infants. It also aimed to address the variations in the time of eruption of first deciduous tooth and its pattern in two generations who had more than a decade of difference in ages., Materials and Methods: An open-ended questionnaire study was conducted on mothers of 265 patients from two groups, generation 1 (G1)- adults who were aged 20-35 years and second group, generation 2 (G2) - children who were below 5 years of age ., Results: A statistical significance was observed with respect to age, gender, generations, and frequency of breastfeeding, partial breastfeeding and time of initiation of semisolid food., Conclusion: There is a delayed eruption of teeth in present generation. For girls, it occurs at age of 7.88 months and for boys, it occurs at the age of 8.08 months.

Introduction: Smoking is a worldwide major cause of preventable morbidity and mortality. Smoking affects the cardiovascular system by several mechanisms. The present study was planned to study the effect of smoking on the cardiovascular autonomic functions among smokers., Material and Methods: Hundred male subjects who were in the age group of 25 to 40 years, who included 50 smokers and 50 non - smokers who formed the control group were selected for the present study. The participant subjects were selected from among the staff members, residents and the patients from the routine OPD. Prior informed written consents were obtained from them after explaining to them, the procedure and the purpose of the study tests. The Cardiovascular Autonomic Function Tests were assessed by using a CANWIN AUTONOMIC ANALYSER which was available in the department., Results and Conclusion: After applying the 'Z'-test for the difference between the two sample means, it was observed that there was a highly significant difference between the mean values of the para-sympathetic function tests among the smokers and the non - smokers (i.e. p<0.01) The Resting Heart Rate had significantly increased and the Expiration: Inspiration Ratio, the 30:15 Ratio (Response to standing) and the Valsalva Ratio had significantly decreased in the smokers as compared to those in the non - smokers. After applying the 'Z'-test for the difference between the two sample means, it was observed that there was no significant difference between the mean values of the Postural hypotension test (i.e. p>0.05) and that there was a highly significant difference between the mean values of the Sustained handgrip test in the smokers and the non - smokers (i.e. p<0.01).

Background: Therapeutic drug monitoring (TDM) is an important adjunct to the treatment of epilepsy. However, few studies have actually correlated plasma levels of antiepileptic drugs (AEDs) with treatment response. The present audit aimed to study (i) the association between seizure control and number of AEDs, plasma AED concentration, and concomitant use of antitubercular drugs; (ii) the pattern of indications for TDM requisitions; and (iii) the association between referral for toxicity and plasma AED concentration., Methods: This observational and retrospective study was carried out to analyze the TDM data of patients referred between January 2008 and December 2011. As per the International League Against Epilepsy Task Force 2009, patients were categorized into responders and nonresponders. Plasma AED levels were interpreted as below, within, and above the reference range., Results: Of 3206 TDM requisitions, 67% were monotherapy and 33% were 2 or more AEDs. Only 8% were responders as against 92% nonresponders. Of 95 patients on concomitant antituberculosis treatment, 72 were nonresponders, with odds ratio (95% confidence interval) 3.71 [2.19 to 6.23]. Breakthrough seizure (37%) was the most common indication followed by suspected toxicity and routine monitoring in 22% each and suspected nonadherence in 11% of the total requests. In 52% of patients, plasma levels were below the reference range, and they were equally distributed amongst responders and nonresponders. Among patients referred for suspected phenytoin toxicity, only 59% (50.6 to 67.8) had plasma concentrations above the reference range., Conclusions: TDM continues to remain an important tool to support dose individualization when the patient is receiving multiple AEDs or other drugs such as antitubercular medicines, to assess compliance, and to monitor and treat toxicity.

The stress either physical or mental, leads to cardiovascular morbidity. Newly admitted medical students are likely to be exposed to various stresses like change of environment, demanding medical education and different teaching protocol in a medical college. Pranayama is known since ancient times to relieve stress and stabilize autonomic function of the body. Therefore it was decided to study effect of Pranayama on stress and cardiovascular autonomic function. The subjects were first M.B.B.S students and the sample size was 59 consisting of 27 males and 32 females. The group of students thus selected was briefed about the study. After the orientation session, informed written consent was taken, stress questionnaire was put and the autonomic function tests were done. This was followed by practice of Pranayama for 2 months, 1 hour/day for 5 days/week and again stress questionnaire was put and the autonomic function tests were performed on the study group. The above tests were done before and after the practice of Pranayama. The results obtained were analyzed using SPSS software. The stress level has reduced after 2 months of practicing various pranayama as evident by decrease in total stress score which is highly significant. VLF and LF in n.u have reduced significantly after practice of pranayama signifying reduction in sympathetic drive to heart. HF in n.u has increased significantly after practice of pranayama for 2 months showing the increase in parasympathetic output to the heart. LF/ HF ratio reduced significantly after 2 months of practice of pranayama indicating a better sympatho vagal balance with resting balance tilting toward better parasympathetic control.

To determine whether changes mixed-venous PCO2 or PO2 affect cardiac output independent of changes in arterial blood gases, we used extracorporeal gas exchange to increase mixed-venous PCO2 or decrease mixed-venous PO2 in adult sheep. Sheep were anesthetized, mechanically ventilated, and connected to a veno-venous extracorporeal circuit. The circuit included a gas exchanger which was used to increase mixed-venous PCO2 or decrease mixed-venous PO2; the native lungs were ventilated to maintain arterial PCO2 and PO2 at control levels. When mixed-venous PCO2 was increased by 32% above control levels for a period of 60 min, cardiac output increased significantly to 28% above control levels. Cervical vagotomy abolished this response. In contrast, decreasing mixed-venous PO2 by 29% did not increase cardiac output. These results demonstrate that increasing mixed-venous PCO2 can increase cardiac output independent of changes in arterial blood gases and that intact vagus nerves are necessary for this response to occur., (Copyright 1997 Academic Press.)