Comparative Evaluation of Smear Layer Removal Using Four Different Irrigation Techniques: An in-vitro Study

INTRODUCTION: Irrigation is the vital part of root canal debridement. Usually post biomechanical preparation, the canal walls are covered by smear layer. It is important to remove this layer before obturation for better bond between the filling and walls. Conventional needle irrigation doesn’t give us adequate cleaning, therefore, new irrigation techniques are being tried to facilitate better smear layer removal. AIM: The aim was to evaluate and compare the smear layer removal by PATS,  EndoActivator device, Passive ultrasonic irrigation and side vent needle irrigation from canal walls. MATERIALS AND METHODS:  60 extracted mandibular premolars were instrumented up to 35/.04 with Heroshaper files. Samples were divided into 4 groups randomly before final irrigation as follows: Group I (n=15): Irrigation with side vent needles (Nexus ltd.,India), Group II (n=15): Irrigation with EndoActivator (Advanced Endodontics, Santa Barbara, CA ) Group III (n=15): Irrigation with PATS ( InnovationsEndo,India), Group IV (n=15): Irrigation with ultrasonic tips (Mani inc.). Teeth were split and one-half of each tooth was chosen for SEM examination.  The images were taken at apical third and scoring was done according to criteria by Torabinejad et al in 2003. Data obtained were analyzed using Kruskal-Wallis analysis of variance followed by Mann–Whitney U-test for individual comparison. RESULTS: All irrigating systems remove smear layer but PUI has better cleaning ability as compared to other groups. CONCLUSION: Passive ultrasonic irrigation shows better smear layer removal as compared to other technique

The formulation and evaluation of mouth dissolving tablet Levocetirizine by using synthetic Superdisintegrants

Aim of this research work was to develop mouth dissolving tablet that disintegrates rapidly in mouth by using tasteless complex of Levocetirizine and β-CD. Mouth dissolving Tablets also called as Orodispersible tablets. Formulated Levocetirizine β-CD complex was characterized by infrared spectroscopy, thermal analysis and X-ray diffraction pattern. Tablets were developed by direct compression method. Superdisintegrants like Sodium starch glycolate (SSG), Crosscarmellose sodium (CCS) and Crosspovidone (CP) were used for the formulation. Every formulation was subjected to in-vitro tests like wetting time, disintegration test and dissolution test. The in-vitro study showed that increasing the concentration of superdisintegrants lowers the wetting time (WT) and disintegration time (DT) and enhances the drug release percentage of the formulations. The formulation CPX5 was the most effective formulation as it showed wetting time of 12 seconds, disintegration time of 20 seconds and cumulative % drug release of 41 and 99% at 1 and 10 minutes respectively. The study showed that the formulations containing SSG and CP as the superdisintegrants showed better drug release pattern than the formulations with other superdisintegrants. The study also showed that SSG as the superdisintegrant was more effective for the formulation of orodispersible tablets of levocetirizine dihydrochlorid

Study of In-vitro Antioxidant and Antibacterial activity of leaf extract of Azadirachta indica, and Ocimum sanctum in different organic solvents and Cow urine

Background: Neem (Azadirachta indica), Tulsi (Ocimum sanctum) and Cow urine (Bos indicus) has been widely used as a therapeutic potential or additive agent in different ethnomedicinal practices as well as modern science also proved its therapeutic potential to treat various diseases and balance the body conditions. Aims: Alone study on Neem, Tulsi and Cow urine (CU) has been widely performed but this study aims to evaluate the individual as well as synergistic antioxidant and antibacterial activity of Neem, and Tulsi’s leaves extract in different organic solvents and Cow urine. Materials and Methods: Antioxidant activity was carried out by using 2,2-Diphenyl1-picrylhydrazyl (DPPH) radical scavenging activity and the antibacterial activity was tested by the agar disc diffusion method against gram-positive (Staphylococcus aureus)  and gram-negative (Escherichia coli, Proteus vulgaris and Klebsiella species) bacteria. Results: The antioxidant and antibacterial activity is concentration-dependent. The neem extract in chloroform shows the highest ZOI against S. aureus (14±2). Similarly, the neem extract in cow urine (8±0.86) and tulsi extract in methanol (8±1.04) shows the highest ZOI against E. coli. Against K. species cow urine is most effective (9±0.29) followed by neem extract in chloroform and cow urine (8±0.77). In P. vulgaris almost all sample shows ZOI around 7 mm. In synergistic antibacterial study tulsi and neem extract in cow urine shows the highest ZOI against E. coli (12±1.75) and P. vulgaris (10±1.44). The tulsi and neem extract in hexane is not effective against S. aureus and E. coli but effective in P. vulgaris and K. species (ZOI 7 mm). Tulsi and neem extract in chloroform, methanol, and cow urine show similar ZOI (9 mm). In DPPH free radical scavenging activity the methanolic extract of tulsi shows the highest inhibition of free radicle (96.35±0.001), followed by methanolic extract of neem (84.85±0.042). The fresh cow urine inhibits (25.19±0.037) followed by neem extract in chloroform (24.53±0.003), neem extract in cow urine (21.8±0.012), tulsi extract in chloroform (20.86±0.047), tulsi extract in hexane (19.5±0.031), tulsi extract in cow urine (18.33±0.023) and the least inhibition by neem extract in hexane (6.74±0.042)

IMPORTANCE OF NANOCARRIERS AND PROBIOTICS IN THE TREATMENT OF ULCERATIVE COLITIS

Ulcerative colitis (UC) is an inflammatory chronic disease primarily affecting the colonic mucosa; the extent and severity of colon involvement are variable. Ulcerative colitis is identified by mucus diarrhea, tenesmus, bowel distension, and anemia. 5-aminosalicylic acid drugs, steroids, and immune suppressants are used for the therapy of ulcerative colitis. The mainchallenges in the management of thediseaseare drug-related side-effects and local targeting. To overcome these challengesprobiotics and micro and Nanoparticulate systemauspiciousapproaches to overcome drug-related adverse side effects and local targeting.Upon ingestion, the probiotics can result in beneficial health effects. Probiotics and micro and nanoparticulate approaches for suitable targeting and overcome the drug-associated side effect. Probiotics are mainly used as gut modulators but are also nowadays explored for their use in ulcerative colitis.The current therapeutic goals are to achieve clinical remission along with mucosal healing, avoidance of complications such as side effects of the drug and to improve the quality of life. The use of probiotics to increase the health of the intestine and used to block or manage intestinal disorders. They may prevent the induction of inflammatory reactions. Probiotics must be inspected for efficacy in the prevention and management of a wide spectrum of gastrointestinal diseases, like antibiotic-associated diarrhea.Micro and Nanoparticulate drug delivery system has been achieving huge importance for targeting of the drug to colon locally at a controlled and sustained rate

EN-BIRTH Data Collector Training - Handbook and Manual

The EN-BIRTH study aims to validate selected newborn and maternal indicators for routine facility-based tracking of coverage and quality of care for use at district, national and global levels. The item contains the EN-BIRTH_Trainer's Manual (14 June 2017) and EN-BIRTH_Training Handbook (23 May 2017)

EN-BIRTH Data Collector Training - Supporting Annexes

The EN-BIRTH study aims to validate selected newborn and maternal indicators for routine facility-based tracking of coverage and quality of care for use at district, national and global levels. The item contains consent forms and participant information, in addition to standard operating procedures (SOP) for adverse clinical events, and managing distress in interviews. The full complement of annex files used during the training can be requested via this site if required

Effect of natalizumab on disease progression in secondary progressive multiple sclerosis (ASCEND). a phase 3, randomised, double-blind, placebo-controlled trial with an open-label extension

Background: Although several disease-modifying treatments are available for relapsing multiple sclerosis, treatment effects have been more modest in progressive multiple sclerosis and have been observed particularly in actively relapsing subgroups or those with lesion activity on imaging. We sought to assess whether natalizumab slows disease progression in secondary progressive multiple sclerosis, independent of relapses. Methods: ASCEND was a phase 3, randomised, double-blind, placebo-controlled trial (part 1) with an optional 2 year open-label extension (part 2). Enrolled patients aged 18–58 years were natalizumab-naive and had secondary progressive multiple sclerosis for 2 years or more, disability progression unrelated to relapses in the previous year, and Expanded Disability Status Scale (EDSS) scores of 3·0–6·5. In part 1, patients from 163 sites in 17 countries were randomly assigned (1:1) to receive 300 mg intravenous natalizumab or placebo every 4 weeks for 2 years. Patients were stratified by site and by EDSS score (3·0–5·5 vs 6·0–6·5). Patients completing part 1 could enrol in part 2, in which all patients received natalizumab every 4 weeks until the end of the study. Throughout both parts, patients and staff were masked to the treatment received in part 1. The primary outcome in part 1 was the proportion of patients with sustained disability progression, assessed by one or more of three measures: the EDSS, Timed 25-Foot Walk (T25FW), and 9-Hole Peg Test (9HPT). The primary outcome in part 2 was the incidence of adverse events and serious adverse events. Efficacy and safety analyses were done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01416181. Findings: Between Sept 13, 2011, and July 16, 2015, 889 patients were randomly assigned (n=440 to the natalizumab group, n=449 to the placebo group). In part 1, 195 (44%) of 439 natalizumab-treated patients and 214 (48%) of 448 placebo-treated patients had confirmed disability progression (odds ratio [OR] 0·86; 95% CI 0·66–1·13; p=0·287). No treatment effect was observed on the EDSS (OR 1·06, 95% CI 0·74–1·53; nominal p=0·753) or the T25FW (0·98, 0·74–1·30; nominal p=0·914) components of the primary outcome. However, natalizumab treatment reduced 9HPT progression (OR 0·56, 95% CI 0·40–0·80; nominal p=0·001). In part 1, 100 (22%) placebo-treated and 90 (20%) natalizumab-treated patients had serious adverse events. In part 2, 291 natalizumab-continuing patients and 274 natalizumab-naive patients received natalizumab (median follow-up 160 weeks [range 108–221]). Serious adverse events occurred in 39 (13%) patients continuing natalizumab and in 24 (9%) patients initiating natalizumab. Two deaths occurred in part 1, neither of which was considered related to study treatment. No progressive multifocal leukoencephalopathy occurred. Interpretation: Natalizumab treatment for secondary progressive multiple sclerosis did not reduce progression on the primary multicomponent disability endpoint in part 1, but it did reduce progression on its upper-limb component. Longer-term trials are needed to assess whether treatment of secondary progressive multiple sclerosis might produce benefits on additional disability components. Funding: Biogen

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

EN-BIRTH Data Collection Tools

The EN-BIRTH study aims to validate selected newborn and maternal indicators for routine facility-based tracking of coverage and quality of care for use at district, national and global levels. The item contains the following data collection tools: Register data extraction, Observation checklist (labour and delivery ward), Observation checklist (kangaroo mother care), Patient record verification tools for antenatal corticosteroid administration, Patient record verification tools for antibiotic administration, and the Maternal recall survey

EN-BIRTH Data Collector Training – Training Module material

The EN-BIRTH study aims to validate selected newborn and maternal indicators for routine facility-based tracking of coverage and quality of care for use at district, national and global levels. The item contains PowerPoint slides used for the nine modules of the Data Collector's Training Programme delivered during May and June 2017. Module 1 (introduction) provides an overview of the training syllabus; Module 2 (Registration) helps tracking officers to understand their roles and responsibilities in the project and how to best execute them; Module 3 (Observation: Labour & Delivery) is intended to help Labour & Delivery observers to conduct themselves, and their work, in accordance with project guidelines and training handbook; Module 4 (Observation: Resuscitation - Nepal) covers the function of CCTV cameras and the value of collecting extra observation data from filmed clinical events; Module 5 (Observation: KMC) outlines expectations and practices to be applied by KMC (kangaroo mother care) observers; Module 6 (Data Extraction & Verification) outlines how data collectors should extract and verify register data and record information in the app extraction form in the L&D ward and KMC ward; Module 7 (Maternal Pre-discharge Recall Survey) outlines how to conduct high-quality interviews and administer the maternal pre-discharge recall survey; Module 8 (Supervision) equips supervisors with the skills to be good team managers, ensure team effectiveness and happiness, respond to incidents in the health facility, and monitor data quality; and finally Module 9 (Training Summary) provides a recap of key information taught over the week