In patients with moderate-to-severe obstructive sleep apnea syndrome, 3 months of CPAP therapy lowers blood pressure and partially reverses metabolic abnormalities. (Funded by Pfizer; ClinicalTrials.gov number, NCT00694616.).

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This article reports the accidental public radiation exposure in a scrap market in Delhi, India, on March 2010. The source, a gamma unit containing Cobalt-60 pencils, was improperly disposed of by a research institution in violation of national regulations for radiation protection and safety of radioactive sources. The unit was sold off to unsuspecting scrap dealers who dismantled the equipment. This event subsequently caused the most severe radiation accident reported in India to date, resulting in seven radiation injuries and one death. The clinical course of five of the patients treated at the All India Institute of Medical Sciences hospital, New Delhi, is summarised in this report. All five patients suffered from the haematological form of the acute radiation syndrome and local cutaneous radiation injury as well. While four patients exposed to doses between 0.6 and 2.8 Gy survived with intensive or supportive treatment, the patient with the highest exposure of 3.1 Gy died due to acute respiratory distress syndrome and multi-organ failure on Day 16 after hospitalisation. The incident highlights the current gaps in the knowledge, infrastructure and legislation in handling radioactive materials. Medical institutions need to formulate individualised triage and management guidelines to immediately respond to future public radiological accidents.

Patients with autoimmune rheumatic diseases (AIRD) are suspected to have less robust immune responses during COVID-19 due to underlying immune dysfunction and the use of immune-suppressive drugs. Fifty consecutive patients with a diagnosis of AIRD on disease-modifying drugs were included at around 30 days after a confirmatory test for COVID-19. Fifty controls matched one to one for age, sex, and severity of COVID-19 were also included at around 30 days after testing positive for COVID-19. Antibody titers for anti-spike protein IgG and anti-nucleocapsid protein IgG were estimated. Cases (mean age 45.9 ± 13; 76% females) and controls (mean age 45.9 ± 13; 76% females) had similar proportion of comorbidities. Of the cases, 4 had moderate and 1 had severe COVID-19, while 3 and 1 of controls had moderate and severe COVID-19 respectively. Positivity of anti-N IgG was similar between patients (80%) and controls (90%) (p = 0.26). Similarly, anti-S IgG was positive in 82% of patients and 86% of controls (p = 0.79). Both the antibodies were negative in seven (14%) patients and five (10%) of controls (p = 0.76, Fischer exact test). Only anti-N IgG titers were lower in patients as compared to controls. In four patients with rheumatoid arthritis, two with spondyloarthritis and one with eosinophilic fasciitis both antibodies were not detectable. They did not differ from the rest of the cohort in clinical characteristics. The patients with AIRD had adequate protective antibody responses to COVID-19 at a median of 30 days post-infection. Thus, the presence of AIRD or the use of immunosuppressants does not seem to influence the development of humoral immune response against COVID-19. Key Points • Patients with autoimmune rheumatic diseases (AIRD) are suspected to have less robust immune responses. • In our cohort of 50 patients with AIRD with confirmed COVID-19, only seven did not have detectable protective antibodies at 30 days post infection. • Patients with AIRD on immunosuppressants have adequate protective antibodies post COVID-19 disease, at rates similar to that in health controls.

Background The response of periodontal ligament cells (PDLC) from adult subjects in comparison to those obtained from younger ones to mechanical forces has been a matter of interest recently because of induced senescent changes. This study evaluated and compared cell surface changes and activity, integrin beta 1, and β-actin mRNA fold changes as well as klotho protein secretion capabilities of PDLC from young and adult donors before and after subjecting to orthodontic forces. Methods A total of 40 subjects with bimaxillary dentoalveolar protrusion requiring extraction of first premolars for orthodontic treatment were selected and divided into two groups. Force ranging from 80 to 90 g was applied to maxillary first premolars and extraction was carried out at two different time periods—pre-treatment (control group) and 28 days after force application (experimental group). Periodontal ligament was obtained, and cell surface changes and activity were observed with atomic force microscopy (AFM) and fluorescent tagging. mRNA fold change of integrin beta-1 and β-actin mRNA, as well as beta-galactosidase assay, was performed, and levels of klotho protein were evaluated. Results AFM nanoindentation and fluorescent tagging indicated increased surface morphological changes in younger cells compared to adult ones. We observed a decrease in integrin beta 1 but an increase in β-actin mRNA levels in PDLC obtained from younger subjects compared to adults, while an increase was observed in SA-β-GAL from adult cells. The level of klotho protein was lower in adult cells in comparison to younger ones. Limitations Large sample studies are required to find out a variation in aging characteristics between young and adult PDLC. Conclusions The study observed significant differences between PDLC obtained from younger and adult subjects in response to orthodontic force application.