Prioritizing tobacco control & its cessation under sustainable development goals with a focus on India

Sustainable development goals (SDGs) were meant to put each and everywhere ‘at par’. The tobacco epidemic globally is one major deterrent to their achievement. While it gets addressed under SDG 3 through the Framework Convention on Tobacco Control (FCTC) - the World Health Organization (WHO) global treaty (the target 3.a of SDG 3), the progress made globally and by India is slow. As a result, many countries may fall short of achieving the target of reducing tobacco usage (taking 2016 as base year) by 30 per cent by the year 2030. India with its high burden of tobacco use and abysmally low quitting along with soaring economic costs of tobacco related diseases and deaths can do better with the engagement of multisectoral stakeholders to strengthen tobacco control under SDGs. Moreover, there is a need to emphasize that the goal of O - Offer to Quit of WHO MPOWER can be achieved through increasing ‘onus’ on policy makers, and strategists, and opportunities for masses, tobacco users, healthcare professionals (HCPs) and enforcers to have tobacco cessation delivered optimally. By doing so, the United Nations can significantly facilitate a reduction in tobacco use and the resultant economic costs. Furthermore, it will assist the WHO to fulfil the targets set for 2030 under SDG 3.a by the FCTC member countries. In addition, it will fulfil the vision and mission defined in the Chandigarh declaration of the 5th National Conference on Tobacco or Health for India to be tobacco free by 2030.

The Impact of Climate Change on Paediatric Dentistry

The effects of global warming and climate change are happening at a faster rate than expected, and they are going to get worse. Global climate change has already started to show the effects on environment—fast melting glaciers, accelerated sea level rise and base shifting of native flora and fauna. There has been an increase in temperature globally with a few countries already showing intense heat waves and extreme cold temperatures. The interrelation between dentistry, environmental impact and human health is still in its nascent stage, but studies in medicine show that the healthcare industry contributes to greenhouse gas emissions and climate change, poor air quality, food and water insecurity, extreme weather events and vector?borne illnesses. The concept of eco?friendly dentistry has evolved in this context for providing environmentally feasible dental solutions. Paediatric dentistry is no exception. The concept of prevention has to be promoted more in paediatric dentistry to provide a positive impact on environment. The prevention of oral diseases will lead to less travel to paediatric dental clinics, less use of dental materials, lesser energy usage, minimal use of single?use plastics and less use of nitrous oxide/general anaesthesia for behaviour management. The greenhouse gases have an effect on teeth of children in relation to early childhood caries (ECC). Here, we discuss the impact of climate change on paediatric dentistry and what changes can be made to provide environment?friendly solutions

miR-145-5p and miR-203a-5p overcome imatinib resistance in myelogenous leukemic cells through metabolic reprogramming-Supplemenntary data

Imatinib is the most effective therapy for chronic myeloid leukemia (CML), but many patients eventually develop resistance to it after an initial satisfactory response. This study investigated the potential of three miRNAs (miR-106b-5p, miR-145-5p, miR-203a-5p) in overcoming imatinib resistance in leukemic cells. The imatinib-resistant K562 (IR-K562) cells were developed and transfected with one of the three miRNAs to evaluate their potency in overcoming imatinib resistance. The changes in the metabolic profile were studied using flux balance analysis (FBA) and the data was validated using qRT-PCR.Among the three miRNAs, the ectopic expression of either miR-145-5p or miR-203a-5p was able to sensitize the IR-K562 cells to imatinib. The concentration of key oncometabolites; glucose, lactate, and glutamine, in the culture media of the miR-transfected IR-K562 cells, reverted to the same levels as seen in imatinib-sensitive K562 cells. In addition, the FBA analysis revealed that the metabolism of lipid, fatty acids, and electron transport chain were significantly altered in resistant cells. The FBA data was also validated at the molecular level. Interestingly, the imatinib treatment coupled with the transfection of miR-145-5p or miR-203a-5p cells could reverse the metabolic flux of IR-K562 to the levels seen in imatinib-sensitive K562 cells. This study highlights the key metabolic changes that occur during development of imatinib resistance. It also identifies the specific miRNAs which can be targeted to overcome imatinib resistance in CML.

miR-145-5p and miR-203a-5p overcome imatinib resistance in myelogenous leukemic cells through metabolic reprogramming

Imatinib is the most effective therapy for chronic myeloid leukemia (CML), but many patients eventually develop resistance to it after an initial satisfactory response. This study investigated the potential of three miRNAs (miR-106b-5p, miR-145-5p, miR-203a-5p) in overcoming imatinib resistance in leukemic cells. The imatinib-resistant K562 (IR-K562) cells were developed and transfected with one of the three miRNAs to evaluate their potency in overcoming imatinib resistance. The changes in the metabolic profile were studied using flux balance analysis (FBA) and the data was validated using qRT-PCR.Among the three miRNAs, the ectopic expression of either miR-145-5p or miR-203a-5p was able to sensitize the IR-K562 cells to imatinib. The concentration of key oncometabolites; glucose, lactate, and glutamine, in the culture media of the miR-transfected IR-K562 cells, reverted to the same levels as seen in imatinib-sensitive K562 cells. In addition, the FBA analysis revealed that the metabolism of lipid, fatty acids, and electron transport chain were significantly altered in resistant cells. The FBA data was also validated at the molecular level. Interestingly, the imatinib treatment coupled with the transfection of miR-145-5p or miR-203a-5p cells could reverse the metabolic flux of IR-K562 to the levels seen in imatinib-sensitive K562 cells. This study highlights the key metabolic changes that occur during development of imatinib resistance. It also identifies the specific miRNAs which can be targeted to overcome imatinib resistance in CML.

A rare case of complicated malaria presenting as warm autoimmune hemolytic anemia

Autoimmune hemolytic anemia (AIHA) has been rarely reported worldwide or from India as the underlying cause of anemia in malaria. We hereby present a case of complicated Plasmodium falciparum malaria with concomitant warm AIHA in a 31-year-old male. Direct Antiglobulin Test (DAT) was positive and elution studies showed pan-agglutination reaction. Clinico-hematological and serological follow-up of the patient was done post artesunate treatment until day 9. We suggest that it is important to establish the immune basis of anemia in malaria patients for guiding the treatment plan for the clinicians and providing packed red blood cell transfusion if required.

Demographic profile of patients seeking teleophthalmology consultations through e-Sanjeevani: Retrospective analysis of 5138 patients from North India

Purpose: To report the demographic profile of patients registered through e?Sanjeevani OPD seeking teleophthalmology services. Methods: This was a cross?sectional data analysis of patients with ocular complaints registered through the e?Sanjeevani platform at a tertiary care center. It was a doctor?to?doctor consultation, where teleophthalmology consultants provided teleconsultation services at subcenters (SCs), primary health centers (PHCs), and community health centers (CHCs). Data regarding the patient’s age, gender, residential address, provisional diagnosis, and treatment prescribed were recorded from May 2021 to February 2022 (9 months). Results: In total, 5138 patients were teleconsulted from the mean age of the patients was 37.64 ± 19.34 years. Among these patients, 44% were males and 56% were females. Most of the teleconsultation calls were made from Palwal district (19.8%), followed by Hisar (14.5%) and Sonipat. The most common provisional diagnosis was dry eyes (21%), followed by allergic conjunctivitis (18%), refractive error (15%), and cataract (14%). These constituted approximately 70% of the diagnosis made through teleconsultations. The rest of the eye problems were diagnosed as stye, blepharitis, nasolacrimal duct obstruction, pterygium, subconjunctival hemorrhage, etc., The majority of the patients were managed medically (56.6%) and approximately 11.6% of the patients were referred for surgical intervention. Conclusion: e?Sanjeevani is an effective way to provide teleconsultations to patients in remote locations. The majority of the patients seeking ophthalmology consultations can be managed conservatively. Patients requiring surgical intervention can be referred timely, thus avoiding any delay in treatment

Conformance of the Food Vendor Carts Design to the Prescribed Standards as per Food Safety and Standards Regulations: Assessment from an Urban Area of North India

Background: Food Safety and Standards Authority of India, established under the Food Safety and Standards Act, 2006, is mandated with disseminating evidence-based standards, regulating the manufacture, storage, distribution, sale, and import of street food, for ensuring the availability of safe and wholesome food for human consumption and matters connected in addition to that or incidental to that. Hence, this study was conducted to ascertain the conformance of the design of street food vendor’s carts to the prescribed standards. Methods: We conducted a cross?sectional study in Chandigarh between July 2017 and March 2018 among 400 street food vendors. The primary dependent variable of the study was conformance. The carts were evaluated for their conformance to the standard recommended design based upon a checklist designed using the guidelines of Food Safety and Standards Regulations, 2011. Results: Almost half of the respondents had an experience of 6–15 years (48.5%) and were earning between Rs. 500 and 1000/day (56.3%). The majority of them (95%) were migrants from other states. Only 26.3% were using mobile vending sites. On regression analysis, better cart score was predicted by age, education, increasing experience, higher income, when food was prepared at home only, and with assistance in the form of helpers. Conclusions: This study indicates that although the policy was formulated 8 years back, the standards of street food carts were still below par in Chandigarh. The government should give technical specifications and ensure uniformity at the national level.

Challenges of objective structured clinical examination as a tool in medical assessment

Medical education is witnessing changes across the globe to produce more competent and responsive medical graduates to meet patients’ growing needs. Medical educators are aspiring for more objective and relevant assessment methods for the evaluation of medical graduates. Objective structured clinical examination (OSCE) introduced in the year 1975 for clinical evaluation has gone through many changes over the past 45 years and matured over time. The article describes the challenges of OSCE as a tool in medical assessment from students’ and organizers’ perspectives. We have also suggested a feasible solution to address the challenges while conducting OSCE to assess medical students.

Is the Rule of Halves in Hypertension Valid Uniformly across India? A Cross-sectional Analysis of National Family Health Survey-4 Data

Background: Hypertension is widely prevalent across India. The rule of halves is commonly used to describe the attrition and gaps in the care cascade of hypertension management across detection, availing treatment, and having controlled blood pressure (BP) on treatment. Objectives: Using nationally representative data, we aimed to assess the rule of halves in hypertension management in different states of India and across sociodemographic, health system, and personal factors. Methods: A descriptive analysis of secondary data from the National Family Health Survey?4 was conducted. We included 770,662 individuals(112,122 men and 658,540 nonpregnant women) of 15–49 years of age. The proportion of individuals not aware of hypertension status among those with high BP, known hypertensives not availing of treatment, and uncontrolled BP among those on treatment were expressed as percentage with a 95% confidence interval (CI). Results: Of those with high BP, 48.5% (95% CI: 47.8%–49.3%) were not aware of their hypertensive status. Among known hypertensives, 72% (95% CI: 71.2%–72.8%) had not availed treatment for hypertension. Among those on treatment, 39.8% (95% CI: 38.7%–40.9%) had uncontrolled hypertension. Conclusion: The rule of halves of India shows that the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke has made relatively good progress with the detection of hypertension and achieving BP control among those on treatment. However, with three?fourth of known hypertensives not availing treatment, more dividends from the detection of hypertension efforts could be realized. The program needs to especially focus on ensuring the treatment for those detected with hypertension.

Anaerobes in cardiac infections: A decade experience from the tertiary care center

Purpose: Anaerobic infections are common yet life-threatening. They are being recovered from all sites of the body, including the cardiovascular system. This study was aimed to determine the retrospective analysis on the isolation of anaerobes in cardiovascular samples received for a decade-long duration. It helps in knowing the frequency of isolation of anaerobic causes of cardiovascular infection. Methods: All cardiovascular samples from the department of Cardio-thoracic vascular surgery from January 2010 to December 2020 were studied. Results: Of 601 samples received, predominant samples were vegetations and valvular tissues of 258, followed by 98 samples of pericardial tissues, 92 samples of embolus, 90 samples of blood and post-operative collections, and 63 excised aneurysms and vascular grafts. Of the total, 15 samples grew anaerobes where Clostridium species were the predominant isolates. Clostridioides difficile was isolated in 2 samples. Conclusions: Anaerobes in cardiovascular samples are uncommon yet form a significant cause of morbidity and mortality. Most infections are from the contiguous spread, penetrating trauma, and hematogenous causing endocarditis or valvular infections. These conditions and samples form the seat of infectious focus and clinical suspicion towards the anaerobic cause of these conditions, especially in conventional routine culture-negative samples. Timely diagnosis of anaerobic infections plays a vital role in the good prognostic outcome of patients undergoing cardiothoracic and vascular surgery.

Effect of Mind Sound Resonance Technique (MSRT) on Fatigue level among Type 2 Diabetics

Background: Fatigue represents a common complaint of patients with diabetes as it can be reported in up to 60% of patients, prominent in patients with type 2 diabetes. It is a major health problem, affects approximately 6% of the world's adult population, and is increasing in epidemic proportions. Evidence suggests that MSRT a yoga-based relaxation techniques significantly reduces anxiety, stress, fatigue and psychological distress. The aim of the study wasObjective: to study the effect of MSRT on fatigue levels among type-2 diabetes patients. Materials and Methods: In this interventional study with a pre-post design on 100 type-2 diabetes patients, were taught MSRT. Assessment were carried out on the 1 and 30 day of the program, using FSS, VAFS. Results: Significant reduction in fatigue levels in both FSS and VAFS respectively (p<0.00). Conclusion: This study provides evidence that MSRT practice is an effective, economical and noninvasive method to combat fatigue in diabetes patients.

Study of Epilepsy and its Correlation with Neuroimaging and Drug Therapy

Background: Thousands of people in the world suffer from epilepsy. Inspite of modern advances, it can be controlled in only 80% of treated once. Diagnosis and treatment of epilepsy is still challenged. The present study is attempted to highlight the importance of clinical findings and role of EEG and CT scan and MRI in diagnosis of epilepsy2.Aim:To study the incidence and epidemiological profile, various types of epilepsy and correlation with MRI, CT SCAN, EEG and the effectiveness of various Anti epilepticdrugs in different types of epilepsy. Settings and Design: This is a prospective study carried out at Civil Hospital, Ahmedabad.Methods:All the patients having 2 and/or more unprovoked seizures and already enrolled patients in epilepsy clinic in 1 year duration from January 1,2020 to December 31,2020 were included.Results &Conclusions:Out of 6930 total admissions, 163 patients with epilepsy were enrolled in this study from age group of 1 month to 12 years. Out of 163 patients, 97 were male and 66 were female. Most common age group affected is of 1-5 years. 128 patients (78.62%) were of generalized epilepsy and 35 patients were of partial epilepsy. Most common precipitating factor in epilepsy is inadequate drug dosages (45%). 45 patients (22.7%) have developmental delay. Abnormal EEG findings were present in 123 patients (75.46%). Abnormal MRI findings were present in 37 patients (22.7%). CT scan was done in 56 patients, 20 were abnormal. 107 patients were on monotherapy and 56 patients were on polytherapy. Valproate is most commonly used drug (76.6%).

Psychotherapy's identity crisis: opening reflections on the historiographies of psychotherapies / A crise de identidade da psicoterapia: reflexões sobre as historiografias das psicoterapias

Abstract This article introduces the work of the transcultural histories of psychotherapies network. Reflecting on the comparative lack of work here, it traces psychotherapies' identity crisis, focussing on nodal points such as the rise of the term, failed attempts to unify the field from Forel to Jung, and the rise of outcome studies. Finally, it situates histories of psychotherapies within the context of adjacent fields: the relation of the history of psychotherapy to the history of science, to Freud studies, to the history of religion and religious studies, to intellectual history, to the history of psychiatry, to the history of medicine, and its place within cultural history.

Resumo O artigo apresenta uma discussão acerca da produção de histórias transculturais da rede de psicoterapias. Reflete sobre a ausência de trabalhos comparativos na área, delineia a crise de identidade das psicoterapias, focaliza pontos nodais, como o surgimento do termo, as tentativas fracassadas de unificar o campo de Forel a Jung e a aparição de estudos de resultados. Finalmente, situa as histórias das psicoterapias no contexto de áreas adjacentes: a relação da história da psicoterapia com a história das ciências, os estudos de Freud, a história da religião e os estudos religiosos, a história intelectual, a história da psiquiatria, a história da medicina e seu lugar na história cultural.

Corynebacterium striatum: An emerging nosocomial skin and soft-tissue pathogen

The genus Corynebacterium is composed of Gram-positive, aerobic, non-motile, non-spore-forming bacilli that are widely distributed throughout the environment. They are usually found as commensals on the skin and are often considered as mere contaminants when isolated from clinical samples. We describe a patient with skin and soft-tissue infections due to Corynebacterium striatum following exploratory laparotomy identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. The clinical importance and pathogenic potential of Corynebacterium species, especially C. striatum, cannot be underestimated. This report is a reminder to physicians of the possible pathogenicity of non-diphtherial Corynebacteria.

The Role of Online Teaching Among the Undergraduate Dental Students During the Current COVID-19 Pandemic in India: A Pilot Study

ABSTRACT Objective: To assess the usefulness of online teaching for undergraduate students during this Corona pandemic, to point the drawbacks of online teaching, and to learn the areas of improvement in online teaching for the future. Material and Methods: A descriptive cross-sectional study on 130 students was done in Bhubaneswar, Odisha, India. The questionnaire consisted of two parts, personal details and specific information. The first part of the questionnaire consisted of questions related to age, gender, etc. The second part had questions pertaining to online teaching. Pearson's Chi-square test was applied and the level of significance was set at 5%. Results: Most of the students (83.3%) were in the view that classroom lectures are the best mean of imparting knowledge, which was significant (p<0.001). A significant number of students (88.1%) agreed that online teaching is the best method of teaching apart from classroom teaching. Almost all the students (93%) agreed significantly that online teaching is the best way to learn in this present pandemic scenario. Most students (59.6%) agreed that connectivity/network issue is a major drawback in online teaching, which is again significant (p<0.001). Conclusion: Here in these testing times, the role of online teaching becomes important for medical/dental students, both undergraduates and postgraduates, to keep up with their studies.

An unusual cause of haemoptysis: hepatobronchial fistula

Haemoptysis is a common clinical problem but a non-specific symptom and can occur in about 100 different clinical conditions. Diagnosing aetiology is not always straight forward. Authors present a case of Hepatobronchial fistula (HBF) which initially diagnosed as tuberculosis due to its atypical presentation and rarity of HBF.

Syzygium aromaticum Derived Phytochemicals against Infections in Feet Crack Caused by Trichophyton rubrum

Phytochemicals from Syzygium aromaticum plant extract traditionally used to cure Feet Crack. Molecular docking method applied using “Biovia Discovery Studio”. “High positive values of -CDOCKER energy and -CDOCKER interaction energy” suggested that Myricetin can effectively deactivate the dihydrofolate reductase enzyme thereby interrupting the life cycle of the organism

Sweeping of the fetal membranes and its effect on duration of pregnancy in low risk cases

Background: This study aimed to determine effectiveness of sweeping of membranes on the duration of pregnancy at term, and its effect on maternal and neonatal outcomes.Methods: In this prospective study, 145 women with uncomplicated pregnancy at 39 weeks or more gestation who were attending regular ANC clinic, were recruited for study, out of them 60 were cases (sweeping group) and 85 were control (no sweeping group). Primary outcome measure was occurrence of spontaneous labour and total duration of pregnancy. Other outcome measures included were interval of onset of labour from membrane sweeping, incidence of premature rupture of membranes, total duration of active labour, mode of delivery, rate of caesarean section and causes, and neonatal and maternal outcome.Results: There were no statistically significant differences between the two groups regarding maternal age, parity and bishops score at recruitment. There was a significant difference observed in spontaneous labour rate and interval time between recruitment to delivery in groups. There was no significant difference regarding mode of delivery, maternal and fetal outcomes.Conclusions: Membrane sweeping is a safe procedure that reduces the incidence of post-term pregnancies if applied at term.

Usefulness of the TG/HDL Ratio in Predicting Cardiovascular Risk: A MMIMSR Experience

The present study was aimed to compare traditional lipid measures with the lipid ratios to establish a bettermarker for the assessment of coronary artery disease (CAD) risk. The comparison of traditional lipid parametersand lipid ratios were made in terms of independent ‘t’ test, area under receiver operating characteristic(AUROC) curve and logistic regression analysis. LDL-C and HDL-C could not correlate well with CAD riskprediction. Strikingly, TG/HDL ratio was found to be more significantly associated in comparison to any ofthe individual lipid parameters as well as TC/HDL and LDL/HDL ratios when compared in terms of AUROCand logistic regression analysis, while LDL/HDL ratio could not correlate. Altogether, these findings infer thatTG/HDL ratio is a better parameter in CAD risk prediction. Additionally, the TG/HDL ratio being calculatedparameter incurs no additional cost to the patients and health care system. Henceforth, the authors suggest theincorporation of the TG/HDL ratio in the routine lipid panel for the better diagnosis and treatment of dyslipidemia.