Comparison of nutritional status between patients with alcoholic and non-alcoholic liver cirrhosis.

OBJECTIVE: The aim of the study was to assess and compare the nutritional status of alcoholic and non alcoholic cirrhotic patients. METHODS: 81 patients with liver cirrhosis--41 alcoholic (AC) & 40 non alcoholic (NAC), were selected. Nutritional status was assessed using anthropometric measurements viz. skin fold thickness, arm and muscle circumferences and areas. Food intake was evaluated using 48 hour dietary recall. Creatinine Height Index and Lean Body Mass were calculated from 24 hour urinary creatinine excretion. RESULTS: Mean values of Mid Arm Muscle Area, for both AC and NAC (2947+/-8.12 mm(2) v/s 3534+/-6.96 mm(2) respectively), were below the 5th percentile of Frisancho's cut off, with significant reduction in alcoholics (P = 0.00). Creatinine Height Index (CHI) and Lean Body Mass (LBM) were higher in patients without fluid retention as compared to those with fluid retention. Patients without Ascites showed a positive correlation between body weight and Lean Body Mass (r=0.471; rho=0.438; P=0.00). CONCLUSIONS: Malnutrition is widely prevalent in cirrhotics, with greater impairment in alcoholics. A positive correlation could be elicited between Lean Body Mass & Actual Body Weight in patients without ascites. Creatinine Height Index and Lean Body Mass may be more reliable parameters for the assessment of nutritional status in patients with liver cirrhosis.     

Cardiac function of neonates with congenital hypothyroidism before treatment

Because of previous reports of myocardial dysfunction in adults and children with hypothyroidism, 12 newborns with congenital hypothyroidism were studied using standard electrocardiographic and echocardiographic techniques. The infants were between the ages of 7 and 28 days at the time of study. Five infants were athyrotic, and of these two had delayed skeletal maturation. Electrocardiogram revealed normal heart rates and QRS voltages in all children, while five had abnormal dome-shaped T-waves and absent ST-segments (Mosque sign). Echocardiograms were normal in all patients indicating no myocardial dysfunction or pericardial effusion. This study suggests that myocardial dysfunction is not present in the immediate newborn period of infants with congenital hypothyroidism. It is reasonable to conclude that early detection of congenital hypothyroidism by mass screening may prevent the cardiac affects of hypothyroidism as well as the other known sequelae.     

Comparison of aprotinin and tranexamic acid in adult scoliosis correction surgery

Purpose

A retrospective review of consecutive adult patients undergoing scoliosis correction surgery was performed to compare the effects of aprotinin and tranexamic acid in blood conservation and to define a comprehensive blood conservation strategy for such surgery.

Methods

Medical records of all patients who underwent scoliosis correction surgery in this unit between January 2003 and December 2008 were reviewed. The patients were divided into three cohorts: group 1 receiving no antifibrinolytics, group 2 aprotinin and group 3 tranexamic acid. Information was collected regarding number of vertebral levels fused, pre- and post-operative haemoglobin, intra-operative blood loss and peri-operative autologous and allogenic blood transfusion performed.

Results

Aprotinin was used in 28 patients (38%), tranexamic acid in 26 (36%), while 19 (26%) received no antifibrinolytics. 21 patients had anterior surgery, 34 patients had posterior surgery and 18 had combined anterior and posterior procedures. Mean blood loss in the patients who received aprotinin and tranexamic acid was 710 and 738 ml, respectively. This was significantly less than the patients receiving no antifibrinolytics (972 ml, p = 0.037). Blood transfusion was required in only two patients undergoing anterior correction surgery.

Conclusion

Aprotinin and tranexamic acid reduce blood loss in adult spinal deformity correction surgery. With aprotinin being unavailable for clinical use, we recommend the use of tranexamic acid along with other blood conservation measures for adult spinal deformity correction surgery.     

Is IR an Essential Hospital Service? Analysis of Trauma Procedures at a Level 1 Centre During the First Wave of COVID-19 Pandemic in Australia

CardioVascular and Interventional Radiology -     

Genome evolution during progression to breast cancer

Cancer evolution involves cycles of genomic damage, epigenetic deregulation, and increased cellular proliferation that eventually culminate in the carcinoma phenotype. Early neoplasias, which are often found concurrently with carcinomas and are histologically distinguishable from normal breast tissue, are less advanced in phenotype than carcinomas and are thought to represent precursor stages. To elucidate their role in cancer evolution we performed comparative whole-genome sequencing of early neoplasias, matched normal tissue, and carcinomas from six patients, for a total of 31 samples. By using somatic mutations as lineage markers we built trees that relate the tissue samples within each patient. On the basis of these lineage trees we inferred the order, timing, and rates of genomic events. In four out of six cases, an early neoplasia and the carcinoma share a mutated common ancestor with recurring aneuploidies, and in all six cases evolution accelerated in the carcinoma lineage. Transition spectra of somatic mutations are stable and consistent across cases, suggesting that accumulation of somatic mutations is a result of increased ancestral cell division rather than specific mutational mechanisms. In contrast to highly advanced tumors that are the focus of much of the current cancer genome sequencing, neither the early neoplasia genomes nor the carcinomas are enriched with potentially functional somatic point mutations. Aneuploidies that occur in common ancestors of neoplastic and tumor cells are the earliest events that affect a large number of genes and may predispose breast tissue to eventual development of invasive carcinoma.The cells of a multicellular organism are related to one another by a bifurcating lineage tree whose root is the zygote. DNA replication, chromosome segregation, and cell division during development from the zygote to the adult introduces point mutations and other DNA changes into the genome, which persist in the descendants of the cells in which they occurred. Germ-line point mutations occur at a rate of approximately one per diploid genome per cell division (Kong et al. 2012), but the rate of somatic changes is less well-understood, and is likely to vary by tissue type. Large-scale genomic changes such as aneuploidies are generally thought to be extremely rare in normal tissue.Cancers, in contrast to normal tissue, accumulate much larger numbers of genomic changes, as illustrated by genome sequencing of late-stage tumors (Ley et al. 2008; Stratton et al. 2009; Bignell et al. 2010; Pleasance et al. 2010a; Chapman et al. 2011; Stratton 2011; Banerji et al. 2012; Nik-Zainal et al. 2012a,b). Solid tumors are highly mutated by several mechanisms, such as point mutations, copy-number variations, and chromothripsis (Greenman et al. 2007; Leary et al. 2008; Beroukhim et al. 2010; Liu et al. 2011; Meyerson and Pellman 2011; Stephens et al. 2011; Crasta et al. 2012; Maher and Wilson 2012); relapses or metastases exhibit further mutational evolution (Ding et al. 2010, 2012; Yachida et al. 2010; Navin et al. 2011; Mardis 2012; Turajlic et al. 2012; Walter et al. 2012; Wu et al. 2012). The state of an individual advanced cancer genome sheds little light on the order of genomic changes, however, except in analyses of subclone evolution (Nik-Zainal at al. 2012a; Shah et al. 2012). In an advanced tumor, the earliest driver changes that had predisposed ancestral cells to eventual carcinoma development are confounded with later changes. As a consequence, our understanding of early tumor evolution is still in its infancy.The historically proven approach to understanding evolution is comparative analysis of extant species, whose power was greatly increased by whole-genome sequencing in recent years. Analogous to species comparisons, which are based on evolutionary (bifurcating) lineage trees, comparisons of somatic genomes from a single individual could, in principle, shed light on somatic evolution, but in normal tissue the number of mutations is low. However, given the large number of genomic changes during tumor evolution, it may be possible to dissect the evolutionary history of a cancer by comparing its genome to clinically recognized precursor lesions. In this context, breast cancers provide a proof-of-principle opportunity, due to their frequent association with early neoplastic lesions that are readily identified by morphology (Simpson et al. 2005; Abdel-Fatah et al. 2007; Lopez-Garcia et al. 2010; Bombonati and Sgroi 2011), and whose genomes may provide windows into the earliest stages of tumor evolution.Using whole-genome sequencing of histologically characterized archival (formalin-fixed, paraffin-embedded) samples, we determine lineage relationships of early neoplasias with carcinomas, quantify mutational load and mutation spectra during progression from normal tissue to neoplasia to carcinoma, and find the earliest detectable mutations and aneuploidies in cell lineages ancestral to the lesions. A subset of these early events may have provided the initial oncogenic potential and helped trigger the first clonal expansion. Our analyses reveal variation among the six cases in the specific evolution of neoplasia and tumor, as would be expected for an evolutionary process dominated by stochasticity. The mechanistic commonalities among the cases, however, bear significant implications for our conceptualization of tumor origins and progression.     

Safety assessment of oral photodynamic therapy in rats

Photodynamic therapy (PDT) is based on the synergism of a photosensitive drug (a photosensitizer) and visible light to destroy target cells (e.g., malignant, premalignant, or bacterial cells). The aim of this study was to investigate the response of normal rat tongue mucosa to PDT following the topical application of hematoporphyrin derivative (Photogem®), Photodithazine®, methylene blue (MB), and poly(lactic-co-glycolic acid) (PLGA) nanoparticles loaded with MB. One hundred and thirty three rats were randomly divided in various groups: the PDT groups were treated with the photosensitizers for 10 min followed by exposure to red light. Those in control groups received neither photosensitizer nor light, and they were subjected to light exposure alone or to photosensitizer alone. Fluorescent signals were obtained from tongue tissue immediately after the topical application of photosensitizers and 24 h following PDT. Histological changes were evaluated at baseline and at 1, 3, 7, and 15 days post-PDT treatment. Fluorescence was detected immediately after the application of the photosensitizers, but not 24 h following PDT. Histology revealed intact mucosa in all experimental groups at all evaluation time points. The results suggest that there is a therapeutic window where PDT with Photogem®, Photodithazine®, MB, and MB-loaded PLGA nanoparticles could safely target oral pathogenic bacteria without damaging normal oral tissue.     

Antimicrobial Effect of Conventional Root Canal Medicaments vs Propolis against Enterococcus faecalis, Staphylococcus aureus and Candida albicans

Aim: To evaluate and compare antimicrobial effect of various root canal medicaments against Enterococcus faecalis, Staphylococcus aureus and Candida albicans. Materials and methods: Six root canal medicaments: 2% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX) Calcium hydroxide (Ca(OH)2), EDTA, MTAD and propolis and three microorganisms: Staphylococcus aureus, Enterococcus faecalis and Candida albicans were used. These strains were inoculated in brain heart infusion (BHI) and incubated at 37 degrees C for 24 hours. For the agar diffusion test (ADT), petri plates with 20 ml of BHI agar were inoculated with 0.1 ml of the microbial suspensions, using sterile swabs that were spread on the medium, obtaining growth injunction. Paper disks were immersed in the experimental solutions for 1 minute. Subsequently, four papers disks containing one of the substances were placed on the BHI agar surface in each agar plate. The plates were incubated at 37°C for 48 hours. The diameter of microbial inhibition was measured around the papers disks containing the substances. One way ANOVA followed by Tukey's post-hoc test were used. p-value >0.05 was considered statistically significant. Results: Propolis and other irrigants were found to be effective on C. albicans, S. aureus and E. faecalis. CHX and MTAD were found to be most effective amongst all the materials tested followed by propolis. Conclusion: Propolis showed antimicrobial activity against E. faecalis, S. aureus, C. albicans. It appears that propolis is an effective intracanal irrigant in eradicating E. faecalis and C. albicans. Clinical significance: Propolis is an effective intracanal irrigant in eradicating E. faecalis and C. albicans. It could be used as an alternative intracanal medicament. Keywords: Root canal medicaments, Enterococcus faecalis, Staphylococcus aureus, Candida albicans, Propolis. How to cite this article: Mattigatti S, Jain D, Ratnakar P, Moturi S, Varma S, Rairam S. Antimicrobial Effect of Conventional Root Canal Medicaments vs Propolis Against Enterococcus faecalis, Staphylococcus aureus and Candida albicans. J Contemp Dent Pract 2012;13(3):305-309. Source of support: Nil Conflict of interest: None declared.