Frequency of Post-Operative Bleeding after Dental Extraction among Patients on Chronic Low Dose Aspirin

Introduction: Anti-platelet drugs are widely used for primary and secondary prevention of cardiovascular and cerebrovascular diseases. The purpose of this study was to determine the frequency of post-operative bleeding after dental extraction among patients on chronic low-dose aspirin. Materials and Methods: This is a descriptive case series in which a total of 378 patients on low-dose aspirin of( 75-100mg) for various cardiovascular causes were included in the study. The duration of the study was from November 2016 to May 2017 total of 6 months. Results: Out of 378 cases, 247 patients (65.4%) were male while 131 patients (34.6%) were female. The mean age of the patients was calculated as 54.8±13.1 years. Regarding pre-morbid, 127 patients (33.6%) were diabetic and 109 patients (28.9%) were hypertensive. The mean duration of taking aspirin was calculated as 3.5±1.7 years. Post-extraction bleeding was noted in 16 patients (4.2%). This was statistically insignificant i.e p-value >0.005. Conclusion: We concluded that simple tooth extraction is safe in patients on a long-term maintenance dose of aspirin, without discontinuation of the drug as it doesn’t cause any significant postoperative bleeding

An Unusual Case of Gastrointestinal Bleeding

A 10-year-old boy presented with a 3-day history of worsening abdominal pain, fever, emesis and melena. Abdominal ultrasound revealed a right upper quadrant mass that was confirmed by computed tomography angiogram (CTA), which showed an 8 cm well-defined retroperitoneal vascular mass. 123Iodine metaiodobenzylguanidine (123MIBG) scan indicated uptake only in the abdominal mass. Subsequent biopsy revealed a paraganglioma that was treated with chemotherapy. This case represents an unusual presentation of a paraganglioma associated with gastrointestinal (GI) bleeding and highlights the utility of CTA and 123MIBG in evaluation and treatment

Recent advancements in oxadiazole-based anticancer agents

Oxadiazole ring system occupies a significant position among heterocyclic templates for medicinal compounds due to its wide spectrum of biological activities. This article entails an in-depth review of the ability of oxadiazole derivatives to induce apoptosis of cancer cells. FDA has approved a number of drugs for the treatment of different types of cancer. There is, however, a continuing need for the development of new anticancer agents due to increasing cases of drug resistance. Moreover, medicinal chemists are continuously struggling to invent selective cytotoxic agents with minimum side effects. This work reviews the significance of oxadiazole ring system and its potential to act as a template for novel anticancer agents.Keywords: Oxadiazole ring system, Anticancer activity, Antitumor activity,  Cytotoxicity, Apoptosi

Whether CEO Succession Via Hierarchical Jumps is Detrimental or Blessing in Disguise? Evidence from Chinese Listed Firms

This study investigates the impact of hierarchical jumps in the CEO’s succession on firms’ financial performance. To contemplate deeply, hierarchical jumps have been categorized into high and low level evaluating the positive impact of high-level hierarchical jump on firms’ performance. Moreover, this study has also formulated hierarchical intensity signifying the idea that despite neglecting senior board members during hierarchical jumps, still marginal increment in the firms’ growth has been observed. Using panel regression technique along with 2sls instrumental regression, this research reveals that hierarchical jumps in CEOs successions are more conducive only if the incumbent CEOs are selected irrespective of age, degree or high hierarchical position within the hierarchical ladder. Lastly, this study enunciates that firms having high total assets boost their performance via hierarchical jumps emphatically

Comparative Evaluation of Parasitological, Serological and DNA Amplification Methods for Diagnosis of Natural Trypanosomal Infection in Equines

Abstract.-The study was conducted to evaluate and compare the parasitological (micro-haematocrit method, MHCT), serological (enzyme-linked immunosorbent assay, ELISA) and molecular (polymerase chain reaction, PCR) methods for diagnosis of trypanosomal infection in equines. Blood samples, taken from 500 animals (horses and donkeys), were primarily screened with formol gel test. Of 500 samples examined, 120 samples were found positive with formol gel test. Later, these samples were further processed for the parasitaemia with MHCT, detection of antibody against trypanosmal antigens positive ELISA and trypanosomal DNA using PCR. Results showed that higher number of positive samples (p < 0.05) were detected with PCR (30.8%) compared to either ELISA (21.6%) or MHCT (17.5%). The sensitivity and specificity of ELISA were 85.7% and 79.5%, respectively compared to PCR which were found to be 100% and 58.97%, respectively. To conclude PCR test was found to be a superior test over MHCT and ELISA for the diagnosis of trypanosome in equines and can be used in field conditions

Chronic pancreatitis: Pediatric and adult cohorts show similarities in disease progress despite different risk factors

Objectives: To investigate the natural history of chronic pancreatitis (CP), patients in the North American Pancreatitis Study2 (NAPS2, adults) and INternational Study group of Pediatric Pancreatitis: In search for a cuRE (INSPPIRE, pediatric) were compared. Methods: Demographics, risk factors, disease duration, management and outcomes of 224 children and 1,063 adults were compared using appropriate statistical tests for categorical and continuous variables. Results: Alcohol was a risk in 53% of adults and 1% of children (p<0.0001); tobacco in 50% of adults and 7% of children (p<0.0001). Obstructive factors were more common in children (29% vs 19% in adults, p=0.001). Genetic risk factors were found more often in children. Exocrine pancreatic insufficiency was similar (children 26% vs adult 33%, p=0.107). Diabetes was more common in adults than children (36% vs 4% respectively, p<0.0001). Median emergency room visits, hospitalizations, and missed days of work/school were similar across the cohorts. As a secondary analysis, NAPS2 subjects with childhood onset (NAPS2-CO) were compared to INSPPIRE subjects. These two cohorts were more similar than the total INSPPIRE and NAPS2 cohorts, including for genetic risk factors. The only risk factor significantly more common in the NAPS2-CO cohort compared with the INSPPIRE cohort was alcohol (9% NAPS2-CO vs 1% INSPPIRE cohorts, p=0.011). Conclusions: Despite disparity in age of onset, children and adults with CP exhibit similarity in demographics, CP treatment, and pain. Differences between groups in radiographic findings and diabetes prevalence may be related to differences in risk factors associated with disease and length of time of CP

Clinical and Practice Variations in Pediatric Acute Recurrent or Chronic Pancreatitis: Report From the INSPPIRE Study

Objective: The aim of the study was to determine whether clinical characteristics and management of pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) differ across INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In Search for a cuRE) sites. Study design: Data were collected from INSPPIRE and analyzed per US regions and "non-US" sites. Between-group differences were compared by Pearson chi-square test. Differences in disease burden were compared by Kruskal-Wallis test. Results: Out of the 479 subjects, 121 (25%) were enrolled in West, 151 (32%) Midwest, 45 Northeast (9%), 78 (16%) South, and 84 (18%) at non-US sites. Hispanic ethnicity was more common in South (P < 0.0001); white race in Northeast (P = 0.009). CP was less common and time from diagnosis of first acute pancreatitis to CP was longer in children at non-US sites (P = 0.0002 and P = 0.011, respectively). Genetic mutations were most common among all groups; PRSS1 variants predominated in Midwest (P = 0.002). Gallstones were more frequent in South (P = 0.002). Endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT) imaging were more commonly utilized in United States compared with non-United States (P < 0.0001), but there were no differences in the use of MRI/MRCP. Disease burden was highest in the West and Midwest, possibly as total pancreatectomy and islet autotransplantation (TPIAT) referral sites were located in these regions. All therapies were less commonly administered in non-US sites (P < 0.0001). Conclusions: This is the first study to describe geographical variations in the INSPPIRE cohort, which possibly reflect variations in practice and referral patterns. The underlying reason behind the lower frequency of CP and fewer treatments in non-United States sites need to be further explored

Risk Factors for Rapid Progression From Acute Recurrent to Chronic Pancreatitis in Children: Report From INSPPIRE

Objective To determine the rate of progression from acute recurrent pancreatitis (ARP) to chronic pancreatitis (CP) in children and assess risk factors. Study Design Data were collected from the INternational Study group of Pediatric Pancreatitis: In search for a cuRE (INSPPIRE) cohort. Kaplan-Meier curves were constructed to calculate duration of progression from initial attack of acute pancreatitis (AP) to CP. Log-rank test was used to compare survival (non-progression) probability distribution between groups. Cox proportional hazard regression models were fitted to obtain hazard ratio (with 95% CI) of progression for each risk variable. Results Of 442 children, 251 had ARP, 191 CP. The median time of progression from initial attack of AP to CP was 3.79 years. The progression was faster in those age ≥6 years at the first episode of AP compared to those age <6 years (median time to CP: 2.91 vs 4.92 years; p=0.01). Children with pathogenic PRSS1 variants progressed more rapidly to CP compared to children without PRSS1 variants (median time to CP: 2.52 vs 4.48 years; p=0.003). Within six years after the initial AP attack, cumulative proportion with exocrine pancreatic insufficiency (EPI) was 18.0% (95% CI: 12.4%, 25.6%); diabetes mellitus was 7.7% (95% CI: 4.2%, 14.1%). Conclusions Children with ARP rapidly progress to CP, EPI and diabetes. The progression to CP is faster in children who were ≥6 years at the first episode of AP or with pathogenic PRSS1 variants. The factors that impact the aggressive disease course in childhood warrant further investigation