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Background & objectives: Vaccination and natural infection can both augment the immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but how omicron infection has affected the vaccine-induced and hybrid immunity is not well studied in Indian population. The present study was aimed to assess the durability and change in responses of humoral immunity with age, prior natural infection, vaccine type and duration with a minimum gap of six months post-two doses with either ChAdOx1 nCov-19 or BBV152 prior- and post-emergence of the omicron variant. Methods: A total of 1300 participants were included in this observational study between November 2021 and May 2022. Participants had completed at least six months after vaccination (2 doses) with either ChAdOx1 nCoV-19 or an inactivated whole virus vaccine BBV152. They were grouped according to their age (? or ?60 yr) and prior exposure of SARS-CoV-2 infection. Five hundred and sixteen of these participants were followed up after emergence of the Omicron variant. The main outcome was durability and augmentation of the humoral immune response as determined by anti-receptor-binding domain (RBD) immunoglobulin G (IgG) concentrations, anti-nucleocapsid antibodies and anti-omicron RBD antibodies. Live virus neutralization assay was conducted for neutralizing antibodies against four variants – ancestral, delta and omicron and omicron sublineage BA.5. Results: Before the omicron surge, serum anti-RBD IgG antibodies were detected in 87 per cent participants after a median gap of eight months from the second vaccine dose, with a median titre of 114 [interquartile range (IQR) 32, 302] BAU/ml. The levels increased to 594 (252, 1230) BAU/ml post- omicron surge (P<0.001) with 97 per cent participants having detectable antibodies, although only 40 had symptomatic infection during the omicron surge irrespective of vaccine type and previous history of infection. Those with prior natural infection and vaccination had higher anti-RBD IgG titre at baseline, which increased further [352 (IQR 131, 869) to 816 (IQR 383, 2001) BAU/ml] (P<0.001). The antibody levels remained elevated after a mean time gap of 10 months, although there was a decline of 41 per cent. The geometric mean titre was 452.54, 172.80, 83.1 and 76.99 against the ancestral, delta, omicron and omicron BA.5 variants in the live virus neutralization assay. Interpretation & conclusions: Anti-RBD IgG antibodies were detected in 85 per cent of participants after a median gap of eight months following the second vaccine dose. Omicron infection probably resulted in a substantial proportion of asymptomatic infection in the first four months in our study population and boosted the vaccine-induced humoral immune response, which declined but still remained durable over 10 months
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Otitis media (OM) is a common problem involving children. In the majority, the cause is related to dysfunction of the Eustachian tube due to bacterial or viral rhinitis and less commonly due to nasopharyngeal tumors. We present a case of recurrent OM which was evaluated and incidentally found a nasal foreign body for which the patient was asymptomatic. This nasal body was the cause of recurrent OM which is very unusual.
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Mitral stenosis (MS) is a progressive situation caused by obstruction of blood flow across the mitral valve from the left atrium to the left ventricle. It is one of the most common valvular heart lesions found during pregnancy. The chances of significant maternal and fetal morbidity and mortality are more in the case of severe MS. Balloon mitral valvuloplasty (BMV) is a life-saving procedure in pregnancy instead of surgical correction. We are presenting the case of a 24-week pregnant woman with severe MS. She developed pulmonary edema and had undergone successful BMV which allowed her to tolerate her pregnancy decently. It leads to a decrease in the left atrial pressure as well as pulmonary arterial pressure. The patient underwent normal delivery uneventfully. Antibiotics were used with proper consultation and the patient was treated conservatively with excellent maternal and fetal outcomes. BMV is turns out to be a life-saving therapy for severe MS complicated by pulmonary edema.
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Background:Subclinical hypothyroidism (SCH) is a common endocrine disorder but spontaneous course of SCH in India is lacking. The aim of the study is to determine the spontaneous course of SCH and to identify the risk factors, which enhances the occurrence of overt hypothyroidism (OH).Method: This is a real world prospective observational study. 58 SCH were followed up six monthly for one year to determine the course of SCH.Results: After one year of follow up 11 (18.97%) patients progressed to OH. 37 (63.79%) remained in subclinical hypothyroid category. In 10 (17.29%) patients TSH (thyrotropin) normalized. Rate of progression (odds ratio: 4.58; 95% CI: 1.14, 18.28) was significantly more in anti-thyroid peroxidase (TPO) positive group as compared to anti-TPO negative group. Conclusions: This first data from India clearly shows that SCH has a variable course. Rate of progression to OH is high (18.97%) in Indian SCH patients. In a cohort of 58 patients followed for one year only the presence of anti-TPO antibody waspredictive of OH. The initial risk stratification can identify patients with SCH at greatest risk for progression to OH in which treatment is mandatory.
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The Indian Medical Council introduced the Competency based medical education (CBME) in the academic year 2019-20. One of the many new changes in the undergraduate medical curriculum, was the Foundation course (FC) of one month duration, introduced at the beginning of the medical course. The purpose of FC was to prepare the entrant medical students to medical education and profession. Program evaluation is essential to analyse the utility and also for continuous remodelling of of any educational program, so that the primary objectives are achieved. The study hypothesis was that the students would find the foundation course vital and beneficial. This was a mixed method study including quantitative and qualitative methods. Following the conduct of FC, we collected feedback from diverse group of first professional medical students (n= 719) of academic year 2019-20 by administering pre-validated standardized questionnaires using google forms. Majority of students agreed or strongly agreed that the FC experience was educative, interesting, and an enabling experience. Qualitative responses revealed, that the students were pleased to be introduced to the most salient aspects of medical education and profession. The most significant suggestions for improvement were reduction of duration of FC, conducting FC after completing the entire admission process, reduce redundancy in topics and to deliver it more interactively. Our study is unique to have evaluated perception on FC from a large number of students across various government, private and deemed medical institutions in South India. Insights from this study will help to guide effective implementation of FC.
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In the present study, Graphene-TiO2 catalysts are prepared by solvothermal method with varied graphene concentrations (1%, 2.5% and 5%). The prepared nanocomposites were characterized by FTIR, Raman and TEM. The photocatalytic activity towards the destruction of Escherichia coli in water under UV and UV-visible irradiations were studied. Graphene-TiO2 nano composite destructs the bacteria significantly at higher rates than unmodified TiO2 and graphene. The results indicates that, at the beginning, the inactivation of E. coli cells is more due to the generation of reactive oxygen species (ROS) like, OH, H2O2, and O2– . Among all samples, the nano composite containing 2.5 wt.% of graphene exhibits a complete E. coli destruction in a minimum irradiation time of 15 and 20 min under UV–Visible and UV light irradiation respectively. The high photocatalytic activity is achieved with the optimum loading concentration of 2.5 wt. % graphene on titania
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Scrub typhus is a seriously neglected life threatening disease in Asia and the islands of the Pacific and Indian oceans. The causative agent is Orientia tsutsugamushi, an obligate intra-cytosolic bacterium transmitted to vertebrate animals such as human or rodent by larval trombiculid mites (chiggers). Here, we conducted an outbreak investigation in Madhya Pradesh state in central India after sudden upsurge in scrub typhus cases and mortality in humans. Sixty-five live traps were placed for capturing the rodents. The captured rodent species were identified and the samples were subjected to nested PCR targeting 56kDa TSA gene. Analysis revealed for the first-time predominant circulation of Karp genotype in this region. The vector species involved in transmission is Leptotrobidium deliense. In conclusion, we reported the circulation of Karp strain in outbreak regions of Madhya Pradesh and suggest that public health monitoring and surveillance needs to be improved. Studies on antigenic diversity, association of strains with clinical spectrum and pathogenicity in the local setup will be essential for development of region-specific diagnostics and vaccines.
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Vrana i.e., wound and its management has prime importance in surgical practice. Vranashopha has peculiar clinical features and is rapidly spreading pathological condition. The disease isn’t easy to treat even if a doctor knows its stages very well. So the deep and exact knowledge about the Vranashopha and its stages is must for a good doctor. Acharya Sushruta has mention and explained 7 major procedures (Saptopakram) for Vranashopha management which includes the management at its initial stage (Amavastha) through the wound stage (Vranavastha) till the management of the complications of the healed wound (Vaikritapaham). We can categorized these procedures as the first 3 procedure can be used for Amavastha and Pachyamanavastha both, the 4th for Pakwavastha alone, 5th & 6th for the stage of wound and the 7th for the management of complications of healed wound. The description of Saptopakrama is described for both Aam and Pakvasopha means it included Nija and Agantuja both type of Vrana. In this review article, we have tried to describe different types of Shopha, their Lakshanas (signs & symptoms), and their management according to Susruta Samhita in Ayurveda. There are some efforts have also been carried out to collect, discuss and describe the Ayurvedic concept of Saptopakram.
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Background: The prevalence of teenage pregnancy in Assam is higher than the national average as per both NHFS‑4 and NHFS‑5. Four districts in Assam, falling under the NITI‑Aayog Aspiration Districts Transformation program of 2018, namely, Goalpara, Barpeta, Darrang, and Dhubri, have a prevalence of teenage pregnancy at levels higher than the state’s average (12% as per NHFS‑5). Teenage pregnancy affects several health and nutritional indicators. Objectives: The objective of the study was to identify the factors associated with teenage pregnancies in the Aspirational Districts of Assam in both social and public health contexts. Methods: A comparative cross‑sectional study was carried out across these four districts, with sample size of teenage pregnant women as 388 and an equal number of controls. Results: The study presents several factors to be statistically significant, viz., lower level of education of the teenage mothers or their spouses and lesser access to adequate health‑related information by teenage mothers. Furthermore, less number of teenage mothers are aware of contraceptive availability and face objection from spouses to use contraception. A unique factor presented by the study is the higher elopement rate among teenage mothers. Conclusion: Many of the factors upheld by the study are rooted in social and cultural fabric of the communities and could be addressed by mobilizing local institutions like panchayat and religious bodies to act as deterrence to teenage marriages in the communities. Men should also be brought into the fold of discussions on this sensitive subject through information and awareness generation.
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Background: The Declaration of Astana marked a revived global interest in investing in primary care as a means to achieve universal healthcare. Family medicine clinicians are uniquely trained to provide high-quality, comprehensive primary care throughout the lifespan. Yet little focus has been placed on understanding the needs of family medicine training programs. Aim: This study aims to assess broad patterns of strengths and resource challenges faced by academic programs that train family medicine clinicians. Methods: An anonymous online survey was sent to family medicine faculty using World Organization of Family Doctors (WONCA) listservs. Results: Twenty-nine representatives of academic family medicine programs from around the globe answered the survey. Respondents cited funding for the program and/or individual trainees as one of either their greatest resources or greatest limitations. Frequently available resources included quality and quantity of faculty and reliable clinical training sites. Frequently noted limitations included recruitment capacity and social capital. Over half of respondents reported their program had at some point faced a disruption or gap in its ability to recruit or train, most often because of loss of government recognition. Reflecting on these patterns, respondents expressed strong interest in partnerships focusing on faculty development and research collaboration. Lessons learnt: This study provides a better understanding of the challenges family medicine training programs face and how to contribute to their sustainability and growth, particularly in terms of areas for investment, opportunities for government policy and action and areas of collaboration.
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Primary Health Care , Family , Global Health , Community Medicine , Education, Medical , MedicineABSTRACT
The direct anterior approach (DAA) is an established approach for total hip arthroplasty (THA) but has been sparingly tried for revisions. The purpose of this study was to examine the available literature in order to consolidate information available on revision THA using the DAA. A PubMed, Embase, and Scopus search was performed using relevant keywords. Studies reporting on patients undergoing revision THA using DAA were included for analysis. In a review of the literature, nine studies matched the pre-decided inclusion criteria with 319 hip joints undergoing revision THA. Mean follow-up of all included studies was 34 months. The indications of revision after primary THA in decreasing order were aseptic loosening (53%), prosthetic joint infection (20.7%), peri-prosthetic fracture (16.9%), dislocation (7.2%), psoas impingement (1.9%), polyethylene wear (1.2%), pain (0.6%), and instability (0.3%). Of the 319 revisions evaluated, 107 underwent a stem revision, 142 underwent cup revision, 49 underwent a combined revision, and 21 underwent isolated liner/head change. A statistically significant improvement in functional score (P<0.05) was observed for all studies reporting on functional outcomes. A low complication rate (51/319, 16.0%), which includes dislocation (12), infection (12), loosening of the acetabular shell (5), peri-prosthetic fractures (6), haematoma (4), and transient nerve palsy (6), was reported. Based on available level III-IV evidence, DAA appears to be a reliable alternative for revision of the failed hip arthroplasty with acceptable complication rates. Evidence of a higher quality is needed to further characterize its role in revision scenarios.
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ABSTRACT Objective: To evaluate and compare lipid profile level in oral submucous fibrosis (OSMF), oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC) patients. Material and Methods: Thirty histopathologically diagnosed subjects each of OL, OSMF, OSCC were recruited along with 30 healthy controls. 5ml of venous blood is collected and estimated using standard diagnostic kits. Results: The mean of Total cholesterol level in controls was 219.03 mg%, in OSCC, OL and OSMF was 142.89 ± 10.21mg%, 155.44 ± 17.63 mg% and 180.60 ± 13.25 mg%, respectively. The mean low-density lipid level in controls was 137.24 mg and in OSCC, OL and OSMF groups were 109.28 ± 2.16 mg%, 126.63 ± 0.85 mg% and 119.15 ± 0.93 mg%, respectively. The mean of high-density lipid level in controls, OSCC, OL and OSMF was 42.87 ± 0.42 mg%, 36.50 ± 2.31 mg%, 21.13 ± 0.77 mg% and 28.37 ± 1.11mg%, respectively. The mean of very low density lipids level in controls, OSCC, OL and OSMF was 30.12 ± 1.51 mg%, 17.24 ± 0.80 mg%, 22.25 ± 0.93 mg% and 25.89 ± 0.43 mg%, respectively. The mean triglyceride level in controls, OSCC, OL and OSMF was 118.80 ± 9.47 mg%, 91.2 ± 3.03 mg%, 105.05 ± 2.96 mg% and 106.19 ± 3.09 mg%, respectively. Conclusion: Lipid profile levels could be early indicators of precancer and cancer.
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Humans , Male , Female , Adult , Middle Aged , Aged , Oral Submucous Fibrosis/pathology , Leukoplakia, Oral/pathology , Mouth Neoplasms , Carcinoma, Squamous Cell/pathology , Indicators and Reagents , Lipids , Analysis of Variance , Data Interpretation, Statistical , India , Lipoproteins, HDL , Lipoproteins, LDL , Lipoproteins, VLDLABSTRACT
COVID-19 infection has made a great impact on the health and economy of many countries. Low middle-income countries are yet to experience the worst of it. There are lots of issues, such as, appropriate resource management that will come alongside the infection that can make the condition even worse. For how long this virus will stay with us is yet to be known. In the situation, whole surgical management cannot be postponed for a longer period that can damage the patient’s health. There are lots of queries that will also come up with the viral infection, for example, how should we use our limited test kits, when should we use PPE and which one, how should we select surgical cases, how to ensure proper post-operative care, and another vital question how can we protect health workers from getting infected while giving the service.We have made a bunch of recommendations for such countries to ensure proper preparation against this pandemic. These considerations can ensure the highest care for the patients with surgical conditions and also guarantee maximum protection of the health care teams from admission to operation, operation to ward, and ward to discharge
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Chiari malformation is the commonest anomaly of the craniovertebral junction involving both the skeletal as well as the neural structures. It is congenital anomaly of the hindbrain characterised by downward elongation of the brain stem and cerebellum into the cervical portion of spinal cord. Most common presenting symptoms was pain in the nape of neck with sub-occipital headache and weakness. If not intervened early in these cases they may progress to quadriparesis and respiratory failure. This study includes authors experience of 30 surgical corrections of Chiari malformation performed at civil hospital Ahmedabad from 2017 to 2019. The age and sex of the patient, the presence of syrinx, the type of surgical procedure and the clinical outcome were determined post-operatively and on follow up. Cerebro spinal fluid leak and collection were observed in patient who undergone duroplasty only with no leakage in patient undergone syringo-subarachnoid shunt. Overall, tingling/numbness had best improvement showed improvement in 13 out of 16 patients. Power showed improvement in 20 out of 27 patients and pain showed improvement in 18 patients. Wasting, clawing and cerebellar signs and bony deformity showed no improvement in any of the above procedures. Authors can conclude for Chiari malformation decompression with or without duroplasty with additional procedure with post-operative physiotherapy and analgesia is the suitable treatment.
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Background: Ayurveda is primarily based upon use of herbs either singly or in combination (polyherbal).The cow ghee (clarified butterfat) is considered as a precious base for preparing medicines in Ayurveda.Processing of ghee with plant ingredients is renowned for enhancing their therapeutic efficacy.Objective: In present research work, the attempt was made to develop cow ghee based PolyherbalBhallatakadi Ghrita formulations and evaluate them with reference to ‘Murcchana’ and ‘Shata-Dhauta’process.Materials and methods: The research plants were identified, procured, authenticated and processed. Theextracts of plant materials were prepared and used for development of Polyherbal Bhallatakadi Ghrita(PHBG), Polyherbal Bhallatakadi Murcchita Ghrita and Polyherbal Bhallatakadi Shata-Dhauta Ghrita formulations as per Ayurvedic procedures. The prepared ghrita formulations were subjected to organoleptic(colour, odour, taste, appearance and touch), physicochemical (pH, viscosity, moisture content, specificgravity, refractive index, acid value, saponification value, iodine value, peroxide value, Rechert Meisslvalue and Polenske value) evaluation, in-vitro antioxidant and GC-MS analysis. The accelerated and realtime stability studies were carried out to determine shelf life of ghrita formulations.Results: The results of evaluations indicate that, developed PHBG formulations retained the organolepticand physicochemical characteristics of ghee. The shelf life of formulations was found to be in the range of1.6 to 3.3 years at accelerated and 2.2 to 3.8 years at real time stability conditions. All ghrita formulationsexhibited antioxidant activity in dose dependent manner.Conclusion: The standardization or evaluation of Polyherbal Bhallatakadi Ghrita formulations was foundto be crucial for the establishment of a steady biological, chemical or simply a quality assurance profile ofthe drugs
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Background: Withania somnifera (L.) (family-Solanaceae), known as ‘Indian ginseng’ or ‘Ashwagandha’ isacclaimed as an effective adaptogen, immunomodulator, aphrodisiac and sedative. Ashwagandha ghrita isa recognized ghee based Ayurvedic formulation. Few ancient texts suggest murcchana process forpreparation of Ashwagandha ghrita.Objective: The study was undertaken to evaluate probable effects of murcchana process on ghritapreparation with reference to time and storage conditions.Materials and Methods: Ashwagandha ghrita samples were prepared separately using plain ghee (Indiancow's ghee) and murcchana ghee. These formulations were stored separately in different glass bottles atroom temperature and 400C/75%RH. Organoleptic characters (colour, odour, taste, texture and touch)and physicochemical parameters (acid value, peroxide value, iodine value, saponification value, unsaponifiable matter, refractive index and specific gravity) were determined after 3, 6, 9 and 12 months.Plain ghee and prepared ghrita were subjected for antioxidant evaluation by various in vitro methods.Results: Changes were observed in organoleptic characters and physicochemical parameters of plainghee and Ashwagandha ghrita formulations. Alterations in these parameters were more pronounced athigh temperature and on long storage. Ashwagandha ghrita prepared with murcchana process exhibitedbetter antioxidant potential in all in vitro methods.Conclusion: The murcchana process was found to be beneficial towards quality of ghrita. Hence, Ashwagandha ghrita may be prepared along with murcchana herbs and stored in a good quality glass bottleto ensure improved shelf life of ghrita.