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ABSTRACT Introduction: There is an ongoing need to identify various pathological factors that can predict various survival parameters in patients with upper tract urothelial carcinoma (UTUC). With this review, we aim to scrutinize the impact of several pathological factors on recurrence free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) in patients with UTUC. Materials and Methods: Systematic electronic literature search of various databases was conducted for this review. Studies providing multivariate hazard ratios (HR) for various pathological factors such as tumor margin, necrosis, stage, grade, location, architecture, lymph node status, lymphovascular invasion (LVI), carcinoma in situ (CIS), multifocality and variant histology as predictor of survival parameters were included and pooled analysis of HR was performed. Results: In this review, 63 studies with 35.714 patients were included. For RFS, all except tumor location (HR 0.94, p=0.60) and necrosis (HR 1.00, p=0.98) were associated with worst survival. All the pathological variables except tumor location (HR 0.95, p=0.66) were associated with worst CSS. For OS, only presence of CIS (HR 1.03, p=0.73) and tumor location (HR 1.05, p=0.74) were not predictor of survival. Conclusions: We noted tumor grade, stage, presence of LVI, lymph node metastasis, hydronephrosis, variant histology, sessile architecture, margin positivity and multifocality were associated with poor RFS, CSS and OS. Presence of CIS was associated with poor RFS and CSS but not OS. Tumor necrosis was associated with worst CSS and OS but not RFS. Tumor location was not a predictor of any of the survival parameters.
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Introduction: Corneal ulcer is one of the important causesfor ocular morbidity in India. Early presentation with promptdiagnosis and treatment result in good visual rehabilitation.Aim: The aim of this study was to assess the etiology ofcorneal ulcer among patients attending the tertiary careteaching hospital of Jharkhand.Material and Methods: This was a prospective observationalhospital-based study conducted at the Department ofOphthalmology, at a tertiary care hospital, in Jharkhand.Data related to socioeconomic status, predisposing factor,and course of disease was collected. Results were analyzedon the basis of history, slit lamp examination, and appropriatelaboratory investigation.Result: During the study period of one year, 1013 patientswith the clinical diagnosis of corneal ulceration wereevaluated, mean age of the patient was 53 years and majorityof patients of infectious keratitis were in between 46 and 60(45%) age group. Incidence in male was higher than (59%)that of female. The left eye was more commonly involved(53%) as compared to the right eye (47%). Farmers (47%)followed by Industrial worker (27%) were most commonoccupation involved. Incidence of fungal keratitis (42%) washigher than bacterial (31%) and viral (11%).Conclusion: Proper diagnosis and management of cornealulcer is very much necessary among exposed population.Incidence of fungal corneal ulcer is very high amongagriculture and industrial workers and lack of awareness andpoor treatment leads to corneal blindness. Use of protectiveeye wear, masks and face shields may play a key role inprevention of the disease
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Background: The first hour and day following childbirth is a period of rapid change within child and mother, with a potential for immediate crises as more than half of global maternal deaths occur during the postnatal period, of which 45 percent maternal and three- quarters of neonatal deaths occur within one day after deliver. Despite of the importance of this period, less than half of mother and newborn get the checkup done in first 24 hours in the state of Uttar Pradesh in India. This quantitative study explored the factors associated with early postpartum hospital discharge.Methods: This was a hospital-based study in which exit interviews were done using structured questionnaire from 278 recently delivered women at two randomly selected Community Health Centres of Gonda and Bareilly districts each, from Uttar Pradesh. The outcome variable was duration of hospital stay. Descriptive results were presented with comparison of factors within district, followed by bivariate analyses and linear regression was done to adjust for confounders.Results: Longer distance of house from facility (0.07; 95 percent CI 0.04, 0.01; p<0.001), if informed about new-born care (0.49; 95 percent CI 0.01, 0.85; p 0.01), if ASHA had fewer visits to women house (-0.06; 95 percent CI -0.12, -0.1; p 0.01) were found to be the determinant of longer stay after adjusting for all variables that were found significant in bivariate analysis and were biologically plausible.Conclusions: The present study concludes that there is lack of awareness among women and their relatives. Inadequate information provided by front line workers were some of the major factors influencing hospital stay pattern.
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Abstract Introduction Auditory neuropathy spectrum disorder (ANSD) features the presence of otoacoustic emissions, poor speech identification score and absent auditory brainstem response. Objective The present study was designed to evaluate the functioning of all six semicircular canals in individuals with ANSD and to compare it with those of normalhearing individuals. Methods A total of 50 individuals participated in the present study, in which Group I comprised25normal-hearingindividuals, and GroupII comprised25individualswithANSD. All of the participants underwent case history, pure tone audiometry, immittance, otoacoustic emissions, auditory evoked response and video head impulse test (vHIT). Results The independent sample t-test revealed significantly lower vestibulo-ocular reflex gain values in individuals with ANSD. A presence of 100% corrective refixation saccades was observed in the same group. The Pearson correlation test revealed no significant correlation between vestibulo-ocular reflex (VOR) gain with duration of hearing loss and pure tone thresholds for any of the three orthogonal planes. The chisquared test revealed no association between the VOR gain values and the presence or absence of saccades in any of the semicircular canals (p>0.05). Conclusion Huge percentages of individuals with ANSD have been found to have associated vestibular dysfunction as well. Therefore, the vHIT can be used as one of the important tests of the vestibular test battery to evaluate all six semicircular canals in individuals with ANSD.
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Background: The aim was to study the current prescribing and drug utilization pattern in Ophthalmology Department of a tertiary care teaching hospital. Drug utilization study is a part of pharmaco-epidemiological exercise quantifying the extent, nature and determinants of drug use in a population. Periodic audit of drug usage pattern forms an essential tool to ascertain the role of drug in a society, increase therapeutic efficacy and improve cost effectiveness of the therapy. It is an introspective and critical instrument providing positive impact on health care delivery to the patient. With this background, the present study was carried out to analyze the prescription pattern and drug utilization by measuring the WHO drug use indicators in ophthalmology department of a tertiary care teaching hospital.Methods: The prescriptions of 961 outpatients were included and analyzed using a predesigned case record form OPD prescription of each patient. Patient and prescription related parameters were analyzed.Results: Prescription analysis showed that the average number of drugs per prescription was 1.85. The drugs were prescribed in the form of eye drops (67.42%), followed by ointments (14.37%), capsules (15.45%), and tablets (2.71%). The dosage form and frequency of drug administration was indicated for all of the drugs prescribed, the duration of treatment for 60.97% of the drugs prescribed. Antimicrobial agents and tear substitute together constituted above 50% of all the drugs. Percentage of drugs prescribed by generic name and from NEDL was 31.62% and 37.22%, respectively. Patient抯 knowledge of correct dosage was 70.44%.Conclusions: This study showed that there is scope for improvement in prescribing patterns in areas of writing generic names of drugs, essential drugs, writing legible and complete prescriptions.
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Introduction: Airway management is an essential component in the first aid of medical emergencies in the combat medical care. Though Endotracheal tube (ETT) is considered ideal for airway management, supraglottic airway devices (SGA) are gaining popularity as an alternative. We studied the use of a novel SGA device (BASKA® mask) in hospital which can be extended to the combat situation. Methods: In this randomised, clinical study, we compared two airway devices (ETT and Baska® Mask) for ventilation in patients (n=100) undergoing laparoscopic surgery. We evaluated the mean airway seal pressure, ease of insertion, time taken for insertion and the complication rates with the use of airway devices. The data were analyzed using appropriate statistical tests. Results: We found that the mean airway seal pressures were comparable with the two devices. The first–time success rate for insertion was higher with the Baska® mask than with the ETT (94% vs 70%) respectively (p < 0.001). The overall device insertion success rates were comparable between the two devices (100% vs 96% respectively, p = 0.5412). Conclusion: Baska® mask is comparable on various parameters to the ETT and is easier to insert due to its flexible head. This is relevant for airway management during combat medical support in field situations.
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Objective: To study the bioactivity of methanolic extract of Brassica juncea on animal model of diabetes mellitus along with its effect on diabetic and metabolic parameters. Methods: Diabetes mellitus was induced in rats by injecting streptozotocin (60 mg/kg) intraperitonealy. Blood glucose was measured on day 3 by GOD-POD method to confirm the diabetes mellitus. Rats having fasting blood glucose > 250 mg/dL were further selected for study and they were divided into four groups, control, control + streptozotocin, streptozotocin + metformin (75 mg/kg) and streptozotocin+ extract of B. juncea (450 mg/kg). Each group consisted of six rats of either sex. Metformin and experimental extract were administered for 21 d. Triglyceride, cholesterol level were measured on day 21 by commercially available kit. Blood glucose was measured on days 7 and 21. Anti-oxidant potential was assessed by estimating extent of lipid peroxidation (LPO) by malondialdehyde (MDA), nitric oxide (NO), superoxide dismutase (SOD) and glutathione (GSH) in liver, kidney, pancreas, muscle tissues on day 21. Unpaired and paired student's t-test was applied for statistical analysis. Results: The extract of B. juncea showed significant decrease in blood glucose level on day 21. The treatment group showed significant difference in oxidative stress by increasing SOD and GSH and decreasing LPO and NO activity on day 21. The treatment did not show statistically significant difference of cholesterol, and triglycerides level on day 21. Conclusion: The study showed anti-hyperglycemic and anti-oxidative properties of methanolic extract of B. juncea.
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School children often encounter traumatic injuries like a crown fracture. They create serious functional, esthetic and psychological problems. Achievement of promising restoration that preserves its aesthetics and strength is the greatest desire for both children and their parents and is a challenging task for the dentist. The restorative options in these cases usually include composite resin and porcelain laminate veneers. This article describes treatment of a paediatric patient with porcelain laminate veneers for restoring unaesthetic maxillary anterior teeth.
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OBJECTIVES: Transpositioning of the inferior alveolar nerve to prevent injury in lower jaw has been advocated for orthognathic, pre-prosthetic and for implant placement procedures. However, the concept of infra-orbital nerve repositioning in cases of mid-face fractures remains unexplored. The infraorbital nerve may be involved in trauma to the zygomatic complex which often results in sensory disturbance of the area innervated by it. Ten patients with infraorbital nerve entrapment were treated in similar way at our maxillofacial surgery centre. MATERIALS AND METHODS: In this article we are reporting three cases of zygomatico-maxillary complex fracture in which intra-operative repositioning of infra-orbital nerve into the orbital floor was done. This was done to release the nerve from fractured segments and to reduce the postoperative neural complications, to gain better access to fracture site and ease in plate fixation. This procedure also decompresses the nerve which releases it off the soft tissue entrapment caused due to trauma and the organized clot at the fractured site. RESULTS: There was no evidence of sensory disturbance during their three month follow-up in any of the patient. CONCLUSION: Infraorbital nerve transposition is very effective in preventing paresthesia in patients which fracture line involving the infraorbital nerve.
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Humans , Follow-Up Studies , Jaw , Mandibular Nerve , Nerve Compression Syndromes , Orbit , Paresthesia , Surgery, OralABSTRACT
Background: This study was designed to compare adverse effects on serum lipid profile and blood sugar level in the treatment with two commonly used drugs perindopril and telmisartan in cases of hypertension. This was an “observational” and “cross-sectional” study. Methods: A total of 100 patients were included in each, Groups A and B. In both groups, half the patients were given perindopril 4 mg OD and half were given telmisartan 40 mg OD for 24 weeks. Total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides (TG), fasting blood sugar (FBS), and postprandial blood sugar (PPBS) level was estimated initially and then at 4th, 12th, and 24th week. Statistical analysis was done using ANOVA. Results: With perindopril initial means of TC, HDL, LDL, TGs, FBS, and PPBS in Groups A and B were 190.32, 49.76, 117.96, 165.04, 84.56, 122.60, and 188.80, 51.64, 118.52, 159.12, 93.92, 133.60, respectively. After 24 weeks, these values were 190.84, 50.68, 118.60, 163.84, 83.48, 120.20, and 190.96, 52.04, 118.28, 157.56, 93.96, 133.68, respectively (p > 0.05). With telmisartan, initial means of TC, HDL, LDL, TG, FBS, and PPBS in both groups were 188.08, 49.76, 118.84, 167.20, 83.72, 120.68, and 188.08, 46.88, 121.96, 167.84, 91.44, 131.72, respectively. After 24 weeks, these values in both groups were 189.36, 49.80, 120.04, 165.96, 82.60, 118.36 and 186.12, 45.28, 121.08, 167.72, 92.76, 129.56 respectively (p > 0.05). Conclusions: It concluded that both perindopril and telmisartan had not any significant adverse effects on plasma lipid profile and blood sugar level in both groups.
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Background & objectives: Due to the inability to cultivate Mycobacterium leprae in vitro and most cases being paucibacillary, it has been difficult to apply classical genotyping methods to this organism. The objective of this study was therefore, to analyze the diversity among M. leprae strains from Uttar Pradesh, north India, by targeting ten short tandem repeats (STRs) as molecular markers. Methods: Ninety specimens including 20 biopsies and 70 slit scrappings were collected in TE buffer from leprosy patients, who attended the OPD of National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Tajganj, Agra, and from villages of Model Rural Health Research Unit (MRHRU) at Ghatampur, Kanpur, Uttar Pradesh. DNA was extracted from these specimens and ten STRs loci were amplified by using published and in-house designed primers. The copy numbers were determined by electrophoretic mobility as well as sequence analysis. Phylogenetic analysis was done on variable number of tandem repeats (VNTRs) data sets using start software. Results: Diversity was observed in the cross-sectional survey of isolates obtained from 90 patients. Allelic index for different loci was found to vary from 0.7 to 0.8 except for rpoT for which allelic index was 0.186. Similarity in fingerprinting profiles observed in specimens from the cases from same house or nearby locations indicated a possible common source of infection. Such analysis was also found to be useful in discriminating the relapse from possible reinfection. Interpretation & conclusions: This study led to identification of STRs eliciting polymorphism in north Indian strains of M. leprae. The data suggest that these STRs can be used to study the sources and transmission chain in leprosy, which could be very important in monitoring of the disease dynamics in high endemic foci.
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DNA, Bacterial/genetics , Female , Genetic Variation , Genotype , Humans , India , Leprosy/microbiology , Male , Microsatellite Repeats , Molecular Epidemiology , Molecular Typing/methods , Mycobacterium leprae/classification , Mycobacterium leprae/genetics , Phylogeny , Polymorphism, GeneticABSTRACT
Background & objectives: Drug efflux pumps have been contributing factor(s) in the development of multidrug resistance in various clinically relevant bacteria. During efflux pump gene expression studies on mycobacteria, we have found a previously uncharacterized open reading frame (ORF) Rv2459 to be overexpressed in drug stressed conditions. The objective of the present study was to investigate the role of this ORF as a drug efflux pump, which might add new information in our understanding about the alternative mechanisms of drug resistance in mycobacteria. Methods: The open reading frame Rv2459 of Mycobacterium tuberculosis encoding a probable drug efflux protein has been cloned using pSD5 E.coli-Mycobacterium shuttle vector and overexpressed in M. tuberculosis H37Rv. This ORF was named as jefA. Overexpression of this gene in clones has been verified by real-time reverse transcription PCR. Minimum inhibitory concentrations (MICs) of recombinant as well as non-recombinant clones were determined by resazurin microtitre assay plate method (REMA) with and without efflux pump inhibitors carbonyl cyanide m-chlorophenylhydrazone (CCCP) and verapamil. Results: In recombinant strains of M. tuberculosis, the overexpression of this gene led to an increase in MIC of anti-tubercular drugs isoniazid and ethambutol when tested by REMA. In the presence of CCCP and verapamil, the recombinant strains showed decrease in MIC for these drugs. Bioinformatic analysis has shown a close relation of JefA protein with drug efflux pumps of other clinically relevant bacteria. In homology derived structure prepared from nearest available model, it was observed that amino acids forming TMH 1, 8 and 11 participated in ethambutol specificity and those forming TMH 2, 7 and 10 participated in isoniazid specificity in JefA. Interpretation & conclusion: The increased transcription of jefA leads to increased resistance to ethambutol and isoniazid in M. tuberculosis via efflux pump like mechanism and contributes in the development of resistance to these drugs. JefA amino acid sequence is well conserved among clinically important bacterial genera, which further provides evidence of being a potent drug efflux pump. The involvement in drug resistance and very little homology with any of the human proteins makes JefA important to be included in the list of potential drug targets.
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Amino Acid Sequence , Bacterial Proteins/chemistry , Bacterial Proteins/genetics , Bacterial Proteins/physiology , Base Sequence , Cloning, Molecular , Cluster Analysis , Computational Biology , DNA Primers/genetics , Drug Resistance, Microbial/genetics , Ethambutol , Isoniazid , Membrane Transport Proteins/chemistry , Membrane Transport Proteins/genetics , Membrane Transport Proteins/physiology , Microbial Sensitivity Tests , Models, Molecular , Molecular Sequence Data , Mycobacterium tuberculosis/genetics , Open Reading Frames/genetics , Phylogeny , Reverse Transcriptase Polymerase Chain Reaction , Sequence Analysis, DNAABSTRACT
OBJECTIVE: The use of non-platinum drugs in concurrent chemoradiation in carcinoma cervix has not been well explored and hence a two arm study was planned to compare the outcome of concomitant cisplatin or gemcitabine in locally advanced carcinoma cervix. METHODS: Thirty six patients were evaluated in this study for response rates and complications. These patients were divided into two arms, sixteen patients in the cisplatin arm and twenty patients in the gemcitabine arm. Cisplatin and gemcitabine were given as i.v. infusion at doses of 40 mg/m2 and 150 mg/m2 respectively for five weeks concomitant with radiotherapy. All patients had received pelvic radiotherapy to a dose of 50 Gy/25 fraction/5 weeks by four field box technique followed by high-dose-rate brachytherapy (3 sessions, each of 7.5 Gy to point A). RESULTS: Median follow up was of 10.4 months (range, 3 to 36 months) and 10.9 months (range, 2 to 49 months) in the cisplatin and gemcitabine arms, respectively. At first follow up, 68.8% in the cisplatin arm and 70% in the gemcitabine arm had achieved complete response (p=0.93). Similar response rates were noted in different stages in both arms. None of the patients except one developed grade 4 toxicity. Similar toxicity profiles were observed in both arms. Local disease control, distant disease free survival and overall survival was 68.8% vs. 70%, 93.8% vs. 85%, 68.8% vs. 60% in the cisplatin and gemcitabine arms, respectively. CONCLUSION: Weekly gemcitabine had similar disease control and tolerable toxicity profile with cisplatin. Gemcitabine may be used as an alternative to cisplatin in patients with compromised renal function.