Clarithromycin is an antibacterial widely used for the treatment of a myriad of infections. Various methods including HPLC have been reported for its drug plasma concentration but they are more complex. In this study, we developed an electrochemical method for estimation of clarithromycin in blood using differential pulse polarography (DPP) after oral administration of pure clarithromycin suspension. The differential pulse polarography of clarithromycin showed peak with peak potential Ep is −1460 mV SCE at pH 6.5 ± 0.1. The developed electrochemical method was standardized and validated for the determination of clarithromycin in blood serum of albino rats. PK analysis included Cmax, Tmax, AUC0-24, elimination rate constant (Kel) and t1/2. Cmax were found to be 1.34 ± 0.16 mg/ml and 1.99 ± 0.22 mg/ml for plain clarithromycin and suspension formulation, respectively. Effects of ammonium tartarate concentration and pH were also studied as specificity parameters. Developed electrochemical method was found to be simple, accurate method for to estimate blood-clarithromycin profile and can also be used similarly for various dosage forms.
Clarithromycin; Polarography; Electrochemical; Serum
With the advent of newer indirect composite resin materials for crown and bridge prosthesis, it has become imperative to evaluate their strength to serve as long term replacements as a substitute to metal ceramic restorations. This study aimed to evaluate and compare the flexural bond strength of three composite resin veneering material to metal, cured by different methods. Specimen were fabricated with pattern resin by duplicating it with machined metal die and divided into three groups. Three composite resin materials were used in this study. Group (A) received Adoro, Group (B) received Targis and Group (C) received Tescera. The bond strength of all specimens was tested with Lloyd’s universal testing machine under three point loading. The highest values for fracture resistance were displayed by light, heat and pressure cured composites followed by composites cured using a temperature of 104 °C and composites with curing temperature of 95 °C. The results indicate that there is a significant difference between the three groups, with the Tescera group specimens exhibiting the highest flexural bond strength. Of the other two groups, Adoro group exhibited higher flexural bond strength than Targis group. The results of this study suggest that Tescera group with curing temperature of 130 °C and pressure of 80 Psi, cured with metal halide unit exhibited the highest flexural bond strength when compared to Adoro and Targis groups.
Flexural bond strength; Indirect composites; Crown and bridge
Vertical and anterioposterior maxillary excesses can be treated with a combination of orthopaedic functional appliances, orthodontics and surgery. Treatment varies according to the age, patient reports for treatment. In patients who are treated with either of the above mentioned treatment modalities, if they require prosthetic replacement on a later date, especially of anterior teeth, prosthetic treatment alone does not give an aesthetic outcome. A partially edentulous, elderly patient with underlying skeletal discrepancy (Class II Skeletal deformity) in relation to 12,11,21,22 was treated with a combination of orthognathic surgery and prosthetic rehabilltation. An orthognathic surgery (leforte I osteotomy) was performed to manage vertical maxillary excess, class II skeletal pattern of maxilla and increased lower third facial height. Dental compensations in the mandibular arch were decompensated surgically with lower subapical osteotomy. Prosthetic restorations of missing anterior teeth were done later, such that facial and dental aesthetics. The records showed that the results were stable 12 months after prosthognathic (prosthodontic and orthognathic) treatment. A team approach enabled the female patient in her fifth decade of life, to receive better function, aesthetics and increased quality of life. Doing prosthetic restorations in patients with underlying skeletal discrepancies may become a challenge , which should be achieved without compromising on final outcome, with a calculated risk benefit ratio.
Prosthognathic; Orthognathic surgery; Fixed prosthesis
It is the responsibility of the dentist to fabricate a denture that is fully functional and perfectly esthetic. One prime oral function that has always been overlooked in this regard is speech. It has been thought that speech will follow mere replacement of teeth and that it is the patient's duty to fine tune this function with practice. Phonetics, esthetics, function and comfort form the foundation of a successful prosthodontic treatment. Accurate approximation of palatal contours of a maxillary complete denture to a patient's tongue can improve speech intelligibility, if other factors such as tooth position, occlusal plane and occlusal vertical dimension are satisfactory. Customizing palatal contours of a maxillary complete denture can be accomplished by using tissue-conditioning material, which provides sufficient working time for a patient to pronounce a series of sibilant sounds while recording dynamic impression of the tongue. This article describes a technique of obtaining palatogram and customizing palatal contours of a maxillary complete denture with autopolymerizing acrylic resin to improve the intelligibility of speech.
Complete denture; palate; palatogram; phonetics; sounds; speech
There is limited literature on the management of cataracts in juvenile xanthogranuloma (JXG). A 2-month-old girl presented to us with hyphema, secondary glaucoma OU and skin nodules suggestive of JXG. She developed bilateral cataracts during her follow-up and was treated successfully with cataract surgery and aphakic rehabilitation.
Cataract surgery; juvenile xanthogranuloma; non-langerhans histiocytic proliferation
No organized school oral health program is existent in India.
The aim of this study is to test the feasibility and efficacy of an economical school oral health promotional intervention with educational and preventive components.
Settings and Design:
School oral health promotional intervention carried out in one of the randomly selected school and evaluated through short duration prospective model.
Materials and Methods:
A total of 100 children with an age range of 10-12 years with no previous history of dental intervention were enrolled. Interventions comprised of oral health education (delivered through lecture and demonstrations by an undergraduate dental student) and topical antibacterial therapy (fluoride varnish and povidone iodine). Outcomes consisted of Knowledge and practices (KAP) regarding oral health, clinical oral health related parameters such as plaque index (PI), gingival index (GI) and caries activity as per Modified Snyder's test. These were reported at baseline, 3 weeks and 6 months follow-up examination by a calibrated examiner.
McNemar Bowker's test, Student's t-test, Pearson Chi-square tests were used.
Highly significant (P < 0.001) improvements in KAP scores, PI scores, GI scores and caries activity were reported at 3 weeks and 6 months follow-up examination.
This small economical school oral health program positively influenced oral health related practices and parameters of oral health such as oral cleanliness, gingival health and caries activity.
Fluoride varnish; oral health education; preventive oral health program; school oral health program; topical povidone iodine
Rehabilitation of a patient with severely worn dentition after restoring the vertical dimension is a complex procedure and assessment of the vertical dimension is an important aspect in these cases. This clinical report describes the full mouth rehabilitation of a patient who was clinically monitored to evaluate the adaptation to a removable occlusal splint to restore vertical dimension for a period 1 month and provisional restorations to determine esthetic and functional outcome for a period of 3 months. It is necessary to recognizing that form follows function and that anterior teeth play a vital role in the maintenance of oral health. Confirmation of tolerance to changes in the vertical dimension of occlusion (VDO) is of paramount importance. Articulated study casts and a diagnostic wax-up can provide important information for the evaluation of treatment options. Alteration of the VDO should be conservative and should not be changed without careful consideration.
Crown lengthening; dental prosthesis; full mouth reconstruction; gingivectomy; removable appliance
Miliaria crystallina is a transient, superficial obstruction of eccrine sweat ducts resulting in rapidly evolving noninflammatory vesicles. The disease is observed frequently in hot, humid, tropical climates and in the neonatal period, most likely due to lack of maturation of the sweat duct during the first few days following birth. It is rarely present at delivery and remains a diagnostic dilemma for the neonatologists. We report a rare case of “Congenital miliaria crystallina” that was present at birth.
Miliaria; Congenital; Vesicular lesion
To study the clinical characteristics and outcome of admitted patients of H1N1 (hemagglutinin -H neuraminidase -N) influenza in a tertiary level hospital, from Oct 2009 to Dec 2010.
Materials and Methods:
A retrospective analysis of 77 confirmed patients admitted in this unit with H1N1 infection.
Of the 77 patients studied, 33 (42.8%) were female. Mean age was 40.88 ± 13.45 years, majority (70.13%) being less than 50 years. Thirty eight (49.3%) patients had at least one co-morbidity, diabetes mellitus being the most common (n = 15, 19.5%). The most common presenting symptom was fever in 75 (97.4%) patients, cough in 67 (87%) and dyspnoea in 59 (76.6%) patients. At admission, mean PaO2/FiO2 ratio was 213.16 ± 132.75 mmHg (n = 60) while mean PaCO2 was 40.14 ± 14.86 mmHg. One or more organ failure was present in 45 (58.4%) patients. Nineteen (24.60%) patients required invasive mechanical ventilation. Circulatory failure was observed in 10 (13%) patients while 2 patients required hemodialysis. Overall, 13% mortality (n = 10) was observed. PaCO2 level at admission (OR 1.093; 95% confidence interval: 1.002-1.193; P = 0.044) and number of organ failure (OR 8.089; 95% confidence interval: 1.133-57.778; P = 0.037) were identified as independent risk- factors for mortality.
Increased duration of dyspnoea prior to admission, pneumonia, low PaO2/FiO2 ratio at admission and 24 hours later, higher PaCO2 values on admission, higher O2 requirement, number of organ failures and use of corticosteroids and delay in specialized treatment were associated with a poorer outcome.
2009 influenza A; H1N1; hospitalized; length of stay; mortality; predictors
Therapeutic relevance of computed tomography (CT) in children with partial seizures is reported to be remarkably low (1-2%). However, in the developing countries where infections involving the nervous system are common, routine CT scan of brain may help in finding treatable causes of seizures.
Aim of this study was to evaluate the significance of CT scan of brain in the management of children with partial seizures.
Materials and Methods:
Children with partial epilepsy, whose predominant seizure type was focal motor seizures, were included in the study. CT scan of brain was done in all children aged between 1 month and 12 years with partial seizures of unknown etiology prospectively. The clinical findings of these children were noted along with the CT findings.
Between August 2001 and July 2002, of the 200 children with seizure disorder 50 children who satisfied the inclusion criteria were included in the study. CT scan of brain was normal in 16 children (32%) and was abnormal in 34 children (68%). Twenty children (~60% of abnormal scan) had potentially correctable lesions: Tuberculoma (n = 13), neurocysticercosis (n = 3), and brain abscess (n = 4). Five children had changes representing static pathology that did not influence patient management. The clinical features correlated with CT findings in 78% children.
Children with partial motor seizures have high probability of having abnormal findings on CT scan of brain, especially, neuro-infections which are potentially treatable. Therefore, CT scan brain should be carried out in all children with partial motor seizures especially, in developing countries.
Children; computed tomography scan; partial seizures
Unlike somatic cells, sperm have several-fold more available-thiols that are susceptible to redox-active agents. The present study explains the mechanism behind the instant sperm-immobilizing and trichomonacidal activities of pyrrolidinium pyrrolidine-1-carbodithioate (PPC), a novel thiol agent rationally created for prophylactic contraception by minor chemical modifications of some known thiol drugs. PPC, and its three derivatives (with potential active-site blocked by alkylation), were synthesized and evaluated against live human sperm and metronidazole-susceptible and resistant Trichomonas vaginalis, in vitro. Sperm hexokinase activity was evaluated by coupled enzyme assay. PPC irreversibly immobilized 100% human sperm in ∼30 seconds and totally eliminated Trichomonas vaginalis more efficiently than nonoxynol-9 and metronidazole. It significantly inhibited (P<0.001) thiol-sensitive sperm hexokinase. However, the molecule completely lost all its biological activities once its thiol group was blocked by alkylation. PPC was subsequently formulated into a mucoadhesive vaginal film using GRaS excipients and evaluated for spermicidal and microbicidal activities (in vitro), and contraceptive efficacy in rabbits. PPC remained fully active in quick-dissolving, mucoadhesive vaginal-film formulation, and these PPC-films significantly reduced pregnancy and fertility rates in rabbits. The films released ∼90% of PPC in simulated vaginal fluid (pH 4.2) at 37°C in 5 minutes, in vitro. We have thus discovered a common target (reactive thiols) on chiefly-anaerobic, redox-sensitive cells like sperm and Trichomonas, which is susceptible to designed chemical interference for prophylactic contraception. The active thiol in PPC inactivates sperm and Trichomonas via interference with crucial sulfhydryl-disulfide based reactions, e.g. hexokinase activation in human sperm. In comparison to non-specific surfactant action of OTC spermicide nonoxynol-9, the action of thiol-active PPC is apparently much more specific, potent and safe. PPC presents a proof-of-concept for prophylactic contraception via manipulation of thiols in vagina for selective targeting of sperm and Trichomonas, and qualifies as a promising lead for the development of dually protective vaginal-contraceptive.
X-linked hyper-IgM syndrome (XHM) is a combined immune deficiency disorder caused by mutations in CD40 ligand. We tested CP-870,893, a human CD40 agonist monoclonal antibody, in the treatment of two XHM patients with biliary Cryptosporidiosis. CP-870,893 activated B cells and APCs in vitro, restoring class switch recombination in XHM B cells and inducing cytokine secretion by monocytes. CP-870,893 infusions were well tolerated and showed significant activity in vivo, decreasing leukocyte concentration in peripheral blood. Although specific antibody responses were lacking, frequent dosing in one subject primed T cells to secrete IFN-g and suppressed oocyst shedding in the stool. Nevertheless, relapse occurred after discontinuation of therapy. The CD40 receptor was rapidly internalized following binding with CP-870,893, potentially explaining the limited capacity of CP-870,893 to mediate immune reconstitution. This study demonstrates that CP-870,893 suppressed oocysts shedding in XHM patients with biliary cryptosporidiosis. The continued study of CD40 agonists in XHM is warranted.
X-linked hyper-IgM syndrome; CD40 ligand; CP-870; 893; CD40-R internalization
Ceramic fracture in metal ceramic restorations are serious and pose an aesthetic and functional dilemma both for the patients and the dentist. This has created a demand for the development of practical repair options which do not necessitate the removal and remake of entire restorations.
To evaluate and compare the effect of four different surface treatments on shear bond strength of metal ceramic specimens with three commercially available porcelain repair systems.
Materials and Methods:
Specimens were fabricated with a base-metal ceramic alloy and divided into three groups, to evaluate three porcelain repair systems. Each group was divided into four subgroups based on surface treatment (A) sandblasting, (B) sandblasting followed by etching with 9% HF (Hydrofluoric acid) on surrounding ceramic, (C) Use of a diamond bur on exposed metal followed by etching with 37% H3PO4 and (D) Control groups (D1, D2, D3 for three groups of porcelain repair system which was not subjected to further treatment after finishing with 240 grit silicon carbide paper grinding. Shear bond strength of each group of specimens based on surface treatment were evaluated with a universal testing machine after storing in distilled water for 7 days. One way ANOVA and Tukey-HSD procedure were used to compare the mean values between and among the groups.
The mean shear bond strength of group III (10.402 ± 1.055) were significantly higher than group I (8.647 ± 0.990) and group II (8.099 ± 0.600) for all surface treatments. However the mean values of shear bond strength of sub-group A were significantly higher than sub-group C and D but were not significantly higher than sub-group B.
The results of this study suggest that in fractured metal ceramic restorations the exposed metal surface treated with sandblasting or sandblasting and etching the surrounding ceramic surface with HF can increase the shear bond strength of the repaired metal ceramic area. Porcelain repair systems which contain hybrid composites and 4-META as primer had increased bond strength.
Ceramic; fracture; intra-oral repair
A hybrid denture is one that is fabricated over a metal framework and retained by screws threaded into the implant abutments. The anterior part of a mandibular hybrid denture is fixed on implants while the posterior part of the denture is extended and cantilevered from implants. This article presents the fabrication of a maxillary over-denture opposing mandibular implant retained hybrid prosthesis. A total of four implants were placed in the mandibular arch. Castable abutments were used to produce the optimal angulations. Framework was waxed, cast recovered, and the fit was refined until the framework seated passively on the master cast. The mandibular denture teeth were waxed to the hybrid framework, and a final wax try-in was performed to verify and correct maxillomandibular relations before processing. The prosthesis was inserted after verification of occlusion, retention, and stability. The rehabilitation of edentulous patients with hybrid dentures has been observed to achieve greater masticatory function and psychological satisfaction than with conventional over-dentures. Producing a passive-fitting substructure for a fixed removable screw retained hybrid prosthesis is arguably one of the most technically complex tasks in implant dentistry. The technique presented may not initially produce a perfectly passive framework, but use of disclosing media and adjusting the internal aspect of the casting can result in non-binding, fully seated prostheses.
Hybrid prosthesis; implant occlusion; passive fit
Metronidazole (MTZ), the FDA-approved drug against Trichomonas vaginalis (TV), is being challenged seriously
by drug resistance, while its inertness to sperm makes it ineffective
as a vaginal contraceptive. Thirteen piperidine dithiocarbamate hybrids
of 2-(2-methyl-5-nitro-1H-imidazol-1-yl)ethane (8–20) were designed to potentiate the
MTZ framework against drug resistance and sperm. New compounds were
1.2–12.1 times more effective against MTZ-susceptible and -resistant
strains of TV. All of the compounds exhibited high safety toward cervical
(HeLa) cells and Lactobacillus. Thirty-eight compounds
were scrutinized by CoMFA and CoMSIA techniques of 3D quantitative
structure–activity relationship. Good predictive rpred2 values for CoMFA and CoMSIA models reflected
the robustness of the predictive ability. This was validated by designing
five new analogues (46–50), which
were potently microbicidal (3–10 and 10–20 times against
MTZ-susceptible and -resistant TV, respectively) and spermicidal.
This in vitro study may have significant clinical relevance, which
could become evident in due course.
dithiocarbamate; metronidazole; piperidine; antitrichomonas; microbicidal; contraception
Unilateral crossbite is a commonly encountered condition in clinical practice. The most frequently employed treatment protocol to manage unilateral crossbite is orthodontic correction or orthognathic surgery or combination of both. When the clinical situation less favours both these modalities of management, a transitional prosthetic appliance—-dentovestibular enhancement prosthetic appliance— can be effectively used to manage this condition.
Unilateral cross bite; Esthetics; Dento vestibular enhancement appliance
Metronidazole, the U.S. Food and Drug Administration-approved drug against trichomoniasis, is nonspermicidal and thus cannot offer pregnancy protection when used vaginally. Furthermore, increasing resistance of Trichomonas vaginalis to 5-nitro-imidazoles is a cause for serious concern. On the other hand, the vaginal spermicide nonoxynol-9 (N-9) does not protect against sexually transmitted diseases and HIV in clinical situations but may in fact increase their incidence due to its nonspecific, surfactant action. We therefore designed dually active, nonsurfactant molecules that were capable of killing Trichomonas vaginalis (both metronidazole-susceptible and -resistant strains) and irreversibly inactivating 100% human sperm at doses that were noncytotoxic to human cervical epithelial (HeLa) cells and vaginal microflora (lactobacilli) in vitro. Anaerobic energy metabolism, cell motility, and defense against reactive oxygen species, which are key to survival of both sperm and Trichomonas in the host after intravaginal inoculation, depend crucially on availability of free thiols. Consequently, molecules were designed with carbodithioic acid moiety as the major pharmacophore, and chemical variations were incorporated to provide high excess of reactive thiols for interacting with accessible thiols on sperm and Trichomonas. We report here the in vitro activities, structure-activity relationships, and safety profiles of these spermicidal antitrichomonas agents, the most promising of which was more effective than N-9 (the OTC spermicide) in inactivating human sperm and more efficacious than metronidazole in killing Trichomonas vaginalis (including metronidazole-resistant strain). It also significantly reduced the available free thiols on human sperm and inhibited the cytoadherence of Trichomonas on HeLa cells. Experimentally in vitro, the new compounds appeared to be safer than N-9 for vaginal use.
The covalent attachment of lysine 63-linked polyubiquitin to the zinc finger domain of IKBKG/NEMO (also known as IKKγ) is necessary for full activation of NF-κB. Impairments of this biochemical mechanism explain the deleterious effects of hypomorphic NEMO mutations on NF-κB signaling function in humans suffering from X-linked ectodermal dysplasia and immunodeficiency. Nevertheless, the biological function of the NEMO zinc finger domain in the regulation of mitogen-activated protein kinase (MAPK) activity is poorly understood. Here we show that dendritic cells from patients with EDI caused by a C-terminal E391X deletion of the zinc finger of NEMO exhibit impaired MAPK activation in response to lipopolysaccharide (LPS) stimulation. Interestingly, DCs from patients with a C417R missense mutation within the zinc finger domain of NEMO in which ubiquitination of NEMO is preserved are also defective in JNK and ERK activity following LPS stimulation. Our findings indicate that the structural integrity of the NEMO ZF domain is more important than its polyubiquitination for full activation of the MAPK. Furthermore, phosphorylation and polyubiquitination of upstream TAK1 were significantly reduced in the E391X zinc finger deleted patients, indicating that the NEMO zinc finger may play an important role in assembling the proximal signaling complex for MAPK activation.
IKBKG; NEMO; IKKγ; MAPK; toll-like receptor; ubiquitination