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We report the dilemmas faced by the investigators while conducting a study on the social and environmental factors for protection of the mental health of adolescents placed under State protection in Kerala, India. The proposal received counsel and directives from the Integrated Child Protection Scheme authorities, under the Social Justice Department of Kerala state and the Institutional Ethics Committee of the host institution. The investigator faced and had to reconcile conflicting directives and antithetical field realities, with respect to seeking informed consent from the study participants. The physical act of adolescents signing the consent form, rather than the actual process of assent, received disproportionately more scrutiny. The authorities also questioned the privacy and confidentiality requirements raised by the researchers. Of the 248 eligible adolescents, 26 chose to dissent from participating in the study, demonstrating that choices would be made if they are offered. There is a need for more discourse on achieving steadfast adherence to the principles of informed consent, particularly in research on vulnerable groups such as institutionalised children.
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Purpose: Pediatric cataract is a major cause of preventable childhood blindness worldwide. Although genetic mutations or infections have been described in patients, the mechanistic basis of human cataract development remains poorly understood. Therefore, gene expression of structural, developmental, profibrotic, and transcription factors in phenotypically and etiologically distinct forms of pediatric cataracts were evaluated. Methods: This cross?sectional study included 89 pediatric cataract subjects subtyped into 1) prenatal infectious (cytomegalovirus, rubella, and combined cytomegalovirus with rubella infection), 2) prenatal non?infectious, 3) posterior capsular anomalies, 4) postnatal, 5) traumatic, and 6) secondary, and compared to clear, non?cataractous material of eyes with the subluxated lenses. Expression of lens structure?related genes (Aqp-0, HspA4/Hsp70, CrygC), transcription factors (Tdrd7, FoxE3, Maf, Pitx 3) and profibrotic genes (Tgf?, Bmp7, ?SmA, vimentin) in surgically extracted cataract lens material were studied and correlated clinically. Results: In cataract material, the lens?related gene expression profiles were uniquely associated with phenotype/etiology of different cataracts. Postnatal cataracts showed a significantly altered FoxE3 expression. Low levels of Tdrd7 expression correlated with posterior subcapsular opacity, whereas CrygC correlated significantly with anterior capsular ruptures. The expression of Aqp0 and Maf was elevated
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Purpose: To evaluate the effectiveness of vision therapy (VT) in patients with chronic presumed refractory dry eye disease (DED) and concurrent nonstrabismic binocular vision anomalies (NSBVAs). To propose an algorithmic approach to manage patients with refractory DED. Methods: Thirty?two patients with chronic (>1 year) presumed refractory DED and NSBVA were prospectively evaluated. The baseline dry eye evaluation and comprehensive orthoptic evaluation were done. VT was administered by a trained orthoptist for 2 weeks. The binocular vision (BV) parameters and percentage subjective improvement were assessed after the VT. Results: On evaluation, 12 patients (37.5%) had both DED and NSBVA, and 20 patients (62.5%) had only NSBVA. Twenty?nine patients (90.62%) showed significant improvement in BV parameters following VT. Binocular near point of accommodation (median, range) improved from 17 (8–40) to 12 (5–26) mm (P value < 0.0001), and near point of convergence (median, range) improved from 6 (3–33) to 6 (5– 14) (P value 0.004) with VT. Thirty?one patients (96.87%) reported symptomatic improvement after VT, and 62.5% of these showed more than 50% improvement in symptoms. Conclusion: The present study confirms the beneficial role of VT in the treatment of patients with DED with concurrent NSBVA. It is essential to diagnose and treat NSBVA in patients with DED to ensure complete relief of symptoms and patient satisfaction. As there is a significant overlap between symptoms of dry eye disease and that of NSBVA, a complete orthoptic evaluation is recommended in all patients presenting with refractory dry eye disease related symptoms
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Purpose: While there are a few studies that show the prevalence of blindness and ocular morbidity in children, studies on socioeconomic factors in childhood cataracts are scarce. We aimed to study the socioeconomic status, education and occupation of the parents, consanguinity, and gender inequality among children presenting with cataracts. Methods: This was a hospital?based, prospective, descriptive study of 68 children with cataracts (aged 0–18 years). In addition to the data on clinical parameters and surgical management, we also collected data on age, gender, age at which the chief complaint was noticed, consanguinity of parents, socioeconomic class, and occupation and education of parents. All statistical analyses were performed using MedCalc statistical software (MedCalc Software 2019, Ostend, Belgium). Results: Sixty?eight children with pediatric cataract, out of which 36 were bilateral, were studied. Thirty children (44%) were in the age group of 1–5 years. Out of the 36 bilateral cataracts, 25 (69.44%) were males and 11 (30.56%) were females. Thirty (44.1%) had a delayed presentation. Also, 31% belonged to middle class and 28% belonged to lower middle class. Moreover, 65% of the mothers had an undergraduate education. Conclusion: There is a gender?based inequality and late presentation of childhood cataracts. To improve early detection, red reflex screening should be mandatorily done. Further studies are required to identify barriers to access of eye care specific to girls, in order to plan interventions to improve uptake of treatment. The lower socioeconomic status of the patients should be taken into account in the management of this disease.
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Purpose: To evaluate the outcomes of implantation of an iris-claw intraocular lens (IC-IOL) in retropupillary position in aphakic patients. Methods: We conducted a prospective interventional study, including 36 aphakic eyes with inadequate capsular support. The postoperative examination included best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, central corneal thickness (CCT), and anterior segment examination with emphasis on the anterior chamber reaction and shape of pupil. Follow-up was done for 3 months. Results: Thirty-six eyes of 34 patients, including 22 right eyes and 14 left eyes were included. Indications for surgery were complicated cataract surgery in 38.9% (n = 14), aphakia in 27.8% (n = 10), pseudophakic bullous keratopathy in 16.7% (n = 6), dislocated posterior chamber IOL (PCIOL) in 11.1% (n = 4), IC drop in 2.8% (n = 1), and subluxated PCIOL in 2.8% (n = 1). Postoperatively, the visual acuity improved by at least two lines in 32 (88.9%) and worsened in four (11.1%) eyes at the end of three months. Mean postoperative IOP at the end of the third month was 12.42 mmHg (standard deviation [SD] 2.57; range 11.55�.29 mmHg). The mean postoperative CCT at the end of the third month was 542.42 microns (SD 13.77; range 537.76�7.07 microns). Sixteen eyes (44.4%) had horizontally oval pupil, eleven eyes (30.6%) had round pupil, and nine eyes (25%) had irregular pupil. Twenty-three eyes (63.9%) presented with significant anterior chamber reaction and seven eyes (19.4%) had corneal stromal edema on postoperative day 1. Conclusion: Our study demonstrated that retropupillary IC-IOL implantation in eyes without adequate capsular support is an effective and safe procedure with a good visual outcome and fewer complications.
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Interstitial lung disease with nephrotic syndrome and junctionalepidermolysis bullosa is caused by biallelic mutations in theintegrin gene ITGA3 and is associated with death in infancy. Wedescribe a variant of this syndrome with delayed presentation ofsymptoms and prolonged survival.
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BACKGROUND@#Mesenchymal stem cell-based treatments are now emerging as a therapy for corneal epithelial damage.Although bone marrow, adipose tissue and umbilical cord blood are the main sources of mesenchymal stem cells (MSCs),other tissues like the peripheral blood also harbor mesenchymal-like stem cells called peripheral blood-derivedmononuclear cells (PBMNCs). These blood derived stem cells gained a lot of attention due to its minimally invasivecollection and ease of isolation. In this study, the feasibility of using PBMNCs as an alternative cell source to corneallimbal stem cells envisaging corneal epithelial regeneration was evaluated. @*METHODS@#Rabbit PBMNCs were isolated using density gradient centrifugation and was evaluated for mesenchymalcell properties including stemness. PBMNCs were differentiated to corneal epithelial lineage using rabbit limbal explantconditioned media and was evaluated by immuno-cytochemistry and gene expression analysis. Further, the differentiatedPBMNCs were engineered into a cell sheet using an in-house developed thermo-responsive polymer. @*RESULTS@#These blood derived cells were demonstrated to have similar properties to mesenchymal stem cells. Cornealepithelial lineage commitment of PBMNCs was confirmed by the positive expression of CK3/12 marker therebydemonstrating the aptness as an alternative to limbal stem cells. These differentiated cells effectively generated an in vitrocell sheet that was then demonstrated for cell sheet transfer on an ex vivo excised rabbit eye. @*CONCLUSION@#PBMNCs as an alternative autologous cell source for limbal stem cells is envisaged as an effectivetherapeutic strategy for corneal surface reconstruction especially for patients with bilateral limbal stem cell deficiency.
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BACKGROUND@#Mesenchymal stem cell-based treatments are now emerging as a therapy for corneal epithelial damage.Although bone marrow, adipose tissue and umbilical cord blood are the main sources of mesenchymal stem cells (MSCs),other tissues like the peripheral blood also harbor mesenchymal-like stem cells called peripheral blood-derivedmononuclear cells (PBMNCs). These blood derived stem cells gained a lot of attention due to its minimally invasivecollection and ease of isolation. In this study, the feasibility of using PBMNCs as an alternative cell source to corneallimbal stem cells envisaging corneal epithelial regeneration was evaluated. @*METHODS@#Rabbit PBMNCs were isolated using density gradient centrifugation and was evaluated for mesenchymalcell properties including stemness. PBMNCs were differentiated to corneal epithelial lineage using rabbit limbal explantconditioned media and was evaluated by immuno-cytochemistry and gene expression analysis. Further, the differentiatedPBMNCs were engineered into a cell sheet using an in-house developed thermo-responsive polymer. @*RESULTS@#These blood derived cells were demonstrated to have similar properties to mesenchymal stem cells. Cornealepithelial lineage commitment of PBMNCs was confirmed by the positive expression of CK3/12 marker therebydemonstrating the aptness as an alternative to limbal stem cells. These differentiated cells effectively generated an in vitrocell sheet that was then demonstrated for cell sheet transfer on an ex vivo excised rabbit eye. @*CONCLUSION@#PBMNCs as an alternative autologous cell source for limbal stem cells is envisaged as an effectivetherapeutic strategy for corneal surface reconstruction especially for patients with bilateral limbal stem cell deficiency.
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Cellblock technique (CB) is one of the oldest techniques of preparing materials for microscopic examination by paraffin embedding of sediments of fluids. CB enables retrieval of small tissue fragments from fluids, improving the cellular yield and diagnostic accuracy. The main advantage of CB is the potential to make many sections for special stains and ancillary techniques like IHC. Objective: To compare the efficacy of cellblock vs. centrifuged smear examination in effusions and fluids from cystic lesions. Methods: A total of 220 samples which included effusions (pleural, peritoneal, pericardial and synovial fluids), CSF, BAL fluids and fluids from cystic lesions were studied and categorized by both routine centrifuged smear and cellblock preparation by fixed sediment method. For CB categorization, volume of fluid and presence of pellet were given due importance. Results: Majority of the samples were pleural fluids (34.1%) followed by peritoneal fluids (29.1%) and fluids from cystic lesions (22.1%). Male to female ratio was 1.2:1 with peak age between 40- 70 years. On CS 86.8% were benign, 1.8% were suspicious for malignancy, 8.2% were positive for malignancy and 3.3% were inadequate for opinion. CBs were non-contributory in 65.9%, in 27.2%, CBs confirmed CS diagnosis and in 4.5% they established a specific diagnosis. (Sensitivity 63%, specificity 71.7%, PPV 80%, NPV 94.6%)(Kappa value = 0.175, p value=0.001). Volume of the fluid did not matter in malignant effusions and material on CB was seen in majority of these fluids with the presence of pellet formation.Among the non-neoplastic fluids material on CB was seen with volume >10ml with a good pellet formation. Conclusion: CBs were complementary to CS in the overall categorization of benign and malignant groups. However, they appeared to be more useful in diagnosis of malignancy by better-preserved architectural patterns and provided material for ancillary techniques like histochemistry and IHC.In CB, presence of pellet after centrifugation may be an indicator for the availability of material.
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Background: Epilepsy is a disorder characterised by recurrent seizures of cerebral origin with episodes of sensory, motor phenomenon with or without loss of consciousness. The present study was taken up to evaluate the anticonvulsant effect of aqueous extract of leaves of Adhatoda vasica in rats. Objectives of this study is to evaluate the effect of aqueous extract of Adhatoda vasica leaves on Pentylenetetrazol induced seizures in albino rats and to compare the effect of aqueous extract of Adhatoda vasica leaves with standard dose of sodium valproate on Pentylenetetrazol induced seizures in albino rats.Methods: Anticonvulsant activity of aqueous extract of Adhatoda vasica was analysed using PTZ (Pentylenetetrazol) model. Groups used were distilled water as control group, Sodium valproate as standard for Pentylenetetrazol and two doses of aqueous extract of Adhatoda vasica (100mg/kg and 200 mg/kg) for this screening model. Parameters observed for PTZ models were abolition of clonic seizures and time duration between injection of PTZ and onset of seizures.Results: In PTZ model, test group at 200 mg/kg showed 33.33% protection for abolition of clonic seizures, though not comparable to standard group. There was significant increase in the duration of onset of clonic seizures after PTZ injection in both test groups (at 100 mg/kg and 200 mg/kg) when compared to control group.Conclusions: Aqueous extract of leaves of Adhatoda vasica has shown significant anticonvulsant action in PTZ model.
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Background: Anaemia during pregnancy is associated with serious maternal and fetal complications. Cord blood hemoglobin of the newborn is an important indicator of anaemia in newborn at birth. So, this study is done to assess the impact of maternal anaemia on cord blood hemoglobin levels of neonates.Methods: It is a cross sectional study done at government Kilpauk medical college and hospital in the department of paediatrics in year 2016.400 pregnant mothers attending the labour room in Kilpauk medical college were included and cord blood haemoglobin of their babies were collected. Mean cord blood haemoglobin of new-borns born to anaemic mothers (mild, moderate and severe) were compared with cord blood haemoglobin of new-borns born to non-anaemic mothers.Results: Out of 400 mothers,192 mothers were anemic, and 208 mothers were non anemic. The mean maternal hemoglobin among non-anemic mothers was 16.37'0.85 and among the anemic mothers it was 15.03'1.04. The mean cord hemoglobin of neonates born to anemic mothers among the three groups (mild moderate severe) were compared with mean cord hemoglobin of the non-anemic group. The difference between groups were statistically significant with P values <0.05,0.01 and 0.05 respectively.Conclusions: In present study maternal anaemia affects the cord blood haemoglobin of neonates. Present study infers that anaemic mothers deliver babies with lower haemoglobin compared to non-anaemic mothers. Authors have found a linear relationship between maternal haemoglobin and cord blood haemoglobin of the new-borns.
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Background: Epilepsy is the commonest neurological condition affecting people of all ages, race and social class. The present study was taken up to evaluate the anticonvulsant effect of aqueous extract of leaves of Adhatoda vasica in rats. To evaluate the effect of aqueous extract of Adhatoda vasica leaves on maximal electroshock model in albino rats and to compare the effect of aqueous extract of Adhatoda vasica leaves with standard dose of Phenytoin on Maximal electro shock model.Methods: Anticonvulsant activity of aqueous extract of Adhatoda vasica was analysed using MES (Maximal electroshock) model. Phenytoin (25mg/kg) as standard for Maximal electroshock, and two doses of aqueous extract of Adhatoda vasica (100mg/kg and 200mg/kg) were used as test drugs. Parameters observed in MES were abolition of hind limb tonic extension (HLTE) and time taken to regain righting reflex.Results: In MES model, control group showed 0% protection and standard phenytoin group showed 100% protection. Aqueous extract of Adhatoda vasica at 100mg/kg and 200mg/kg showed 33.33% and 50% protection from seizures respectively. The mean duration of time to regain righting reflex was significantly reduced in Adhatoda vasica groups when compared to control group (p <0.001). When groups 100mg/kg and 200mg/kg of Adhatoda vasica were compared for mean difference in the duration of time to regain righting reflex, statistically non-significant results (p >0.05) were obtained.Conclusions: Aqueous extract of leaves of Adhatoda vasica has shown significant anticonvulsant action in MES model.
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Background: To evaluate the performance of Drug Information Centre (DIC) in providing quality drug information services to the health care professionals.Methods: It was a prospective study carried out for a period of six months (June-November 2017). The drug information services provided by the pharmacist at the DIC during ward rounds, direct access, telephone and mail were documented in the drug information request and documentation forms. The quality of drug information provided was assessed with the help of feedback questionnaire which was filled by receivers.Results: A total of 283 queries were received, with a maximum from ward rounds 140(49.47%). On evaluation, it was found that most of the queries were from physicians 207 (73.14%) followed by nurses 33(11.66%), pharmacists 26 (9.18%), patients 17 (6.07%). Among that 178 (62.89%) queries were received from department of general medicine. Most of the queries were intended to update knowledge 110 (38.86%) and for the purpose of better patient care 90 (31.81%). The time frame for an authentic reply ranged from minutes to 24 hours, where a maximum of 110 (38.86%) queries had sent a 24 hours deadline. The majority of the queries were for adverse drug reactions [ADR-60 (21.20%)] and most preferred resources were primary 188 (66.43%).Conclusions: The DIC has always presented and offered itself to be an impressive resource, which is used routinely as an information source by all levels of professionals involved in the health system, in addition to the patients themselves.
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Background: Tinea corporis is a common superficial dermatophytosis seen in tropical countries. This study was done to compare the efficacy and safety of topical antifungal agents, terbinafine versus sertaconazole in the treatment of tinea corporis. Methods: This study was conducted in Babuji Hospital and Chigateri Government Hospital, Davangere. A total of 60 (n=60) patients were included and divided into two groups of 30 patients each in the study. 1st group - received topical 1% terbinafine hydrochloride and 2nd group - received 2% sertaconazole cream. Patients were advised to apply cream twice daily for 4 weeks. Improvement in clinical parameters like erythema, scaling, itching, and potassium hydroxide (KOH) mount were taken for assessing the efficacy of drugs. They were followed-up at the end of 2, 4, and 6 weeks to assess the improvement of the condition. Complete cure rate was defined as mycological cure with a complete absence of clinical signs and symptoms. For safety data of both drugs presence of any local side effects (like stinging sensation, swelling and increased erythema) were analyzed in both groups. Statistical analysis was done using students paired t-test and unpaired t-test. Results: When two groups were compared at the end of 2 weeks, complete cure rate for terbinafine was 80% as compared to 63.3% for sertaconazole (p<0.003). However, at the end of 4 weeks, sertaconazole was as effective as terbinafine and statistically non-significant (p>0.05) results were obtained. KOH mount was negative in both groups at the end of 2nd week. Local side effects like erythema, swelling, stinging sensation were not noticed during the study in both the groups. Conclusion: From this study, it was shown that 2% sertaconazole cream was as effective as 1% terbinafine cream, though 1% terbinafine had higher rates of complete cure at the end of 2 weeks as compared to sertaconazole.
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Black pepper, the king of spices, the most important and widely used spice in the world is the dried mature berries of P. nigrum L. Inorganic nitrogen is assimilated into amino acids glutamine, glutamate, asparagines and aspartate which serve as important nitrogen carriers in plants. The enzymes glutamine synthetase (GS) EC. 6.3.1.2, glutamate synthase (GOGAT) E.C. 1.4.1.14, glutamate dehydrogenase (GDH) E.C.1.4.1.4, aspartate aminotransferase and asparagine synthetase are responsible for biosynthesis of these amino acids. Although extensive studies have been carried out on the epidemiology of the diseases and agronomical aspects of P. nigrum, very few studies have been made on the enzymological aspects especially that associated with the nitrogen assimilation. A better understanding of the various properties of the enzyme will be valuable in the future studies concerned with Nitrogen metabolism in P. nigrum. Main objective of present study was to standardize the extraction and study the properties of GDH from P. nigrum L. Effect of additives and its optimum concentration were determined, standardized homogenizing medium was formulated, standardized assay system formulated, different properties like pH optimum, Substrate saturation and km value determined; it’s all in agreement with the previously reported values, result indicate NADP+/NADPH is the better substrate i.e. the enzyme activity is contributed by chloroplastic form of GDH than by the mitochondrial form.
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Aim: Present study evaluated the efficacy of natural derivative irrigants, Morinda citrifolia juice (MCJ), Aloe Vera and Propolis in comparison to 1% sodium hypochlorite with passive ultrasonic irrigation for removal of the intraradicular E. faecalis biofilms in extracted single rooted human permanent teeth. Materials and Methods: Biofilms of E. faecalis were grown on the prepared root canal walls of 60 standardized root halves which were longitudinally sectioned. These root halves were re-approximated and the samples were divided into five groups of twelve each. The groups were, Group A (1% NaOCl), Group B (MCJ), Group C (Aloe vera), Group D (Propolis) and Group E (Saline). These groups were treated with passive ultrasonic irrigation (PUI) along with the respective irrigants. The root halves were processed for scanning electron microscopy. Three images (X2.5), coronal, middle and apical, were taken for the twelve root halves in each of the five groups. The images were randomized and biofilm coverage assessed independently by three calibrated examiners, using a four-point scoring system. Results: 1% NaOCl with passive ultrasonic irrigation (PUI) was effective in completely removing E. faecalis biofilm and was superior to the natural irrigants like MCJ, Aloe vera and Propolis tested in this study. Conclusion: 1% NaOCl used along with passive ultrasonic irrigation was effective in completely removing E. faecalis biofilm when compared to natural irrigants (MCJ, Aloe Vera and Propolis).
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This study investigated the preference and intake frequency of a list of 15 commonly available high sodium Malaysian foods/dishes, discretionary salt use, and their possible association with demographics, blood pressures and anthropometric measurements among 300 Malaysian university students (114 males, 186 females; 259 ethnic Chinese, 41 Indians; 220 lean, 80 overweight). French fries and instant soup noodle were found to be the most preferred and most frequently consumed salty food, respectively, while salted fish was least preferred and least frequently consumed. Males had a significantly higher intake frequency of at least 6 of the salty foods, but the preference of most salty foods was not significantly different between genders. Ethnic Chinese significantly preferred more and took more frequently traditional and conventional Malaysian foods like asam laksa (a Malaysian salty-sour-spicy noodle in fish stock), salted biscuits and salted vegetable, while Indians have more affinity and frequency towards eating salty Western foods. Body Mass Index was significantly negatively correlated with the intake frequency of canned/packet soup and salted fish while waist circumference was significantly positively correlated with the preference of instant noodle. Also, an increased preference of potato chips and intake frequency of salted biscuits seemed to lead to a decreased WHR. Other than these, all the other overweight/obesity indicators did not seem to fully correlate with the salty food preference and intake frequency. Nevertheless, the preference and intake frequency of asam laksa seemed to be significant negative predictors for blood pressures. Finally, increased preference and intake frequency of high sodium shrimp paste (belacan)-based foods like asam laksa and belacan fried rice seemed to discourage discretionary salt use. In conclusion, the preference and intake frequency of the high sodium belacan-based dish asam laksa seems to be a good predictor for ethnic difference, discretionary salt use and blood pressures.
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Humans , Male , Asian People , Body Mass Index , Demography , Eating , Food Preferences , Obesity , Sodium , Solanum tuberosum , Vegetables , Waist CircumferenceABSTRACT
Blood samples were collected from 61 P. vivax infected fresh and recurrent malaria patients and liver function parameters studied. Plasma albumin, A/G ratio were found decreased significantly (p < 0.001) when compared to controls. Among the group of recurrent malaria patients with more than five attacks lowest values were found and the decrease was directly correlated with the number of attacks. The enzyme activities of plasma LDH, SGPT and thymol turbidity were found increased significantly with the increase in the number of attacks (p < 0.001). The increase was more pronounced in more than 5 attack (R3) group. The levels of total, conjugated and free bilirubin and the enzyme activities of SGOT, alkaline phosphatase were also found increased significantly in all the recurrent malarial groups, when compared to controls, without any correlation between the number of attacks. The isoenzyme pattern of plasma LDH was not altered in either fresh or recurrent malarial attack groups when compared to controls.