Trigeminal Neuralgia in Pregnancy: A Management Challenge

Pregnancy is known to aggravate pre‐existing chronic painful conditions. Trigeminal neuralgia (TN), albeit a disease of the elderly, may afflict pregnant females, which can further complicate its management. Teratogenic effects of the commonly used drugs on the developing fetus limit pharmacological treatment. Moreover, safety of commonly performed interventional therapies is marred by their inherent fetomaternal effects and more importantly the risk for radiation effects on the fetus due to the use of fluoroscopy. This rare coexistence of TN in pregnancy has not been reported before. Here we present a case of TN in a young woman, whose pain was aggravated when she became pregnant, and she was treated successfully by conventional radiofrequency ablation of the Gasserian ganglion.     

One-pot sequential multicomponent reaction between in situ generated aldimines and succinaldehyde: facile synthesis of substituted pyrrole-3-carbaldehydes and applications towards medicinally important fused heterocycles

An efficient sequential multi-component method for the synthesis of N-arylpyrrole-3-carbaldehydes has been developed. This reaction involved a proline-catalyzed direct Mannich reaction-cyclization sequence between succinaldehyde and in situ generated Ar/HetAr/indolyl-imines, followed by IBX-mediated oxidative aromatization in one-pot operation. The practical utility of this procedure is shown at gram-scale and the synthesis of diverse bioactive fused heterocyclic scaffolds such as pyrroloquinoline, pyrrolo-oxadiazole, dihydro pyrroloquinoline, and pyrrolo-phenanthridine.

An efficient sequential multi-component method for the synthesis of N-arylpyrrole-3-carbaldehydes has been developed.     

Changes in Caries Experience,Untreated Caries,Sealant Prevalence,and Preventive Behavior Among Third-Graders in New York State, 2002–2004 and 2009–2012

ObjectiveThis study assessed changes in caries experience, untreated caries, sealant prevalence, and preventive behavior among third-grade children in New York State to monitor progress toward state health objectives.MethodsWe analyzed children''s data from the 2002–2004 (n=10,865) and 2009–2012 (n=6,758) New York State Oral Health Survey. We calculated differences in weighted percentages and 95% confidence intervals for caries experience, untreated caries, sealant prevalence, and preventive behavior. We used logistic regression procedures to assess the independent effects and interaction terms on dental caries experience.ResultsThe percentage of children with dental caries and untreated caries decreased from 54.1% and 33.0% in 2002–2004 to 45.2% and 23.6% in 2009–2012, respectively. While this decrease was not uniform across income subgroups, the prevalence of sealants, a key measure of the use of preventive services, increased significantly from 16.7% to 36.0% among lower-income children.ConclusionsMeasurable improvement in reducing dental caries prevalence among third-grade children has been made in New York State, but this improvement was not uniform across subgroups. Specifically, disease prevalence among lower-income children remained high, underscoring the need to strengthen existing programs and identify additional policy and programmatic interventions.Researchers generally agree that the prevalence and severity of dental caries among U.S. and New York State (NYS) school-age children declined steadily from the 1970s to the 1990s. Although this trend has continued for older children in more recent years, this trend is uncertain among younger children aged 2–8 years.^1–3 Findings from analyses of 1988–1994 and 1999–2004 national surveys show that declines in dental caries observed in earlier decades among younger children may have plateaued or dental caries may even be increasing among subgroups of younger children.⁴ Because of the persistent higher disease rate, especially in low-income groups, prevention of tooth decay among children has become the focus of many prevention efforts.^5,6 Since 2001, the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration have provided grants and technical assistance to NYS to strengthen the infrastructure and capacity to promote fluoridation and improve its quality, as well as to strengthen school-based preventive and early treatment programs.Changes have also been made to increase insurance coverage for dental services and improve annual dental visits.^7,8 Child Health Plus, the state Children''s Health Insurance Program (CHIP), was implemented in 1997 to provide public health insurance for near-poor children from families previously not eligible for Medicaid. According to a U.S. Government Accounting Office report, nationally, Medicaid and CHIP beneficiaries, children in particular, showed increases in the use of dental services (from 28% in 1996 to 37% in 2010), but still visited the dentist less frequently than privately insured children (58% in 2010).⁹ In NYS, the Medicaid program enhanced the fee structure for dental procedures in 2000. In addition, professional organizations, advocacy groups, and foundations have made a concerted effort to promote prevention and access to care. The professional recommendation to initiate first dental visit shifted from age 3 to age 1 around 2003.¹⁰ To assess the collective effect of these and other efforts in NYS, we examined data on caries experience, untreated caries, sealant prevalence, and preventive behavior among third-grade children from the 2002–2004 and 2009–2012 NYS Oral Health Survey.     

A new approach to determine solar potential using terrestrial images

Before installing Photovoltaic (PV) panels at a place it is important to estimate the solar potential of the place. Most approaches available in literature do not consider the presence of surrounding obstructions, thus leading to wrong estimates. Light Detection and Ranging (LiDAR) data or 3D (Geographic Information System) GIS based approaches consider obstructions but prove cost-effective only at city-wide scales. This paper presents a cost-effective, accurate, and scalable approach for this purpose. The proposed approach utilizes terrestrial images of surroundings and identifies obstructions present therein. Using the azimuth and elevation angles of the principal axes of the terrestrial images the azimuth and elevation angles of each pixel in these images are determined. Using thresholding and morphological closing the terrestrial images are segmented into sky and non-sky zones. Sun is considered visible at the point of interest if it lies in the sky zone. The position of the Sun is determined using the solar position algorithm and the irradiance reaching the Earth surface is computed using the modified radiative transfer model. Finally, the total irradiance over a chosen time period at a given location is estimated by integrating the irradiances for the duration when the Sun is visible.     

Genetic Variants Influencing Joint Damage in Mexican Americans and European Americans With Rheumatoid Arthritis

Joint destruction in rheumatoid arthritis (RA) is heritable, but knowledge on specific genetic determinants of joint damage in RA is limited. We have used the Immunochip array to examine whether genetic variants influence variation in joint damage in a cohort of Mexican Americans (MA) and European Americans (EA) with RA. We studied 720 MA and 424 EA patients with RA. Joint damage was quantified using a radiograph of both hands and wrists, scored using Sharp's technique. We conducted association analyses with the transformed Sharp score and the Immunochip single nucleotide polymorphism (SNP) data using PLINK. In MAs, 15 SNPs from chromosomes 1, 5, 9, 17 and 22 associated with joint damage yielded strong p‐values (p < 1 × 10^?4). The strongest association with joint damage was observed with rs7216796, an intronic SNP located in the MAP3K14 gene, on chromosome 17 (β ± SE = ?0.25 ± 0.05, p = 6.23 × 10^?6). In EAs, 28 SNPs from chromosomes 1, 4, 6, 9, and 21 showed associations with joint damage (p‐value < 1 × 10^?4). The best association was observed on chromosome 9 with rs59902911 (β ± SE = 0.86 ± 0.17, p = 1.01 × 10^?6), a synonymous SNP within the CARD9 gene. We also observed suggestive evidence for some loci influencing joint damage in MAs and EAs. We identified two novel independent loci (MAP3K14 and CARD9) strongly associated with joint damage in MAs and EAs and a few shared loci showing suggestive evidence for association.