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Background In 2018, the World Health Organisation (WHO) released interim guidelines, advising a change of regimens to dolutegravir-based first- and second-line antiretroviral therapy (ART), based on which, in 2021, the National Aids Control Organisation (NACO) updated its guidelines to include the tenofovir + lamivudine + dolutegravir (TLD) regimen as a first line of therapy for all people living with HIV (PLHIV) and second- and third-line regimens to dolutegravir-based regimens. Considering this change of regimen, the adverse drug reaction (ADR) profiling and longitudinal prescription pattern of antiretroviral and concomitant medications in adult patients at the ART centre of a tertiary care hospital were assessed in this study. Methods Ninety-seven PLHIV out of all the patients who attended the ART centre from September 2021 to July 2022 were enrolled and followed up for six months. The ADRs that occurred during this period were collected along with details of prescription patterns and analyzed by descriptive statistics. Causality assessment for ADR was done using the World Health Organisation-Uppsala Monitoring Centre (WHO-UMC) scale. Results Seventy-eight percent (n=76 out of 97) of patients experienced at least one ADR, and 128 ADRs were seen in 97 patients. The most common ADRs were increased alkaline phosphatase (39.0%, n=128), dyslipidaemia (12.5%, n=128), and nephrotoxicity (10.1%, n=128). The drug most suspected of causing ADRs was dolutegravir (27.5%, n=342). The most common therapeutic regimen was TLD (71.2%, n=97). The most prescribed drug was lamivudine (30.6%, n=1183). The most prescribed concomitant medication was cotrimoxazole (15%, n=312). Conclusions Dolutegravir-based regimens have been implemented for PLHIV in a phased-out manner from previous non-dolutegravir-based ART regimens, which is in line with the recent NACO guidelines. However, it has also led to an increase in dolutegravir-associated ADRs like increased alkaline phosphatase, dyslipidaemia, and nephrotoxicity. Continuous monitoring of prescriptions and ADRs can add to our knowledge regarding their use and ADRs.
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The histo-morphology of the arterial walls is typically made of 3 distinct layers or tunics designated as intima, media and adventitia. Based on the composition of the media, the arteries are classified into elastic and muscular types. The common iliac artery is an elastic artery, whereas its branches, the external and internal iliac arteries are muscular arteries. In this study, the presence of smooth muscle bundles outside the adventitia was noted in 93 samples taken from the iliac arterial system and the reasons for their presence have been hypothesized.
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Adventicia , Arteria Ilíaca , Aorta Abdominal , Arterias , Músculo Liso VascularRESUMEN
AIM: To establish an effective combination of drying time and drying method of the tray adhesive so that maximum bond strength can be achieved between impression tray and impression material. MATERIALS AND METHODS: Cylindrical specimens of auto-polymerizing resin and addition silicone impression material were made. A total of 150 specimens were tested. They were divided into two groups Dentsply and GC. Each group was further divided into five subgroups: ⢠Drying with compressed air for half the time as recommended by the manufacturer ⢠Drying with air blower for half the time as recommended by the manufacturer ⢠Open air drying as recommended by the manufacturer ⢠Open air drying for 15 minutes ⢠Open air drying for 1 hour The samples were tested for tensile bond strength using the universal testing machine. The results were subjected to statistical analysis. RESULT: Open air drying as recommended by the manufacturer was better than drying with a blower or compressed air. There was no significant difference between open-air drying for 5 minutes and open-air drying for 15 minutes or 1 hour. CONCLUSION: Open air drying as recommended by the manufacturer, i.e. 5min, showed good bond strength and drying for more than 5mins does not significantly increase bond strength. CLINICAL SIGNIFICANCE: Tray adhesive should not be dried with compressed air or air blower. Tray adhesive should be applied and kept to dry according to the manufacturer's recommended time.
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Recubrimiento Dental Adhesivo , Adhesivos , Cementos Dentales , Ensayo de Materiales , Polivinilos , Siloxanos , Resistencia a la TracciónRESUMEN
Hemorrhage from the pancreatic duct, referred to as hemosuccus pancreaticus or pseudohemobilia, is a rare cause of gastrointestinal (GI) bleeding. This potentially life-threatening complication of pancreatitis may pose a significant diagnostic and therapeutic dilemma, especially in patients who do not exhibit symptoms such as abdominal pain, jaundice, or GI bleeding. Here we describe a 55-year-old male with a known history of chronic calcifying pancreatitis, who presented with repeated episodes of melena associated with paroxysms of abdominal pain and frequent drop in hemoglobin requiring hospitalization. Initial endoscopic evaluation was negative. Endoscopy was repeated after an episode of melena which showed blood spurting from the ampulla. Further evaluation with abdominal CT scan, CT angiogram and conventional angiogram revealed no source of blood loss. Hence emergency surgery was done. There was evidence of splenic vein rupturing into the pancreatic duct.