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ABSTRACT Objective: To identify and study the existing literature on the efficacy and safety of midazolam compared to inhalation of nitrous oxide in children undergoing dental treatment. Material and Methods: Electronic resources such as PubMed Central, Cochrane Database of Systematic Reviews, Lilacs, Science Direct, and SIGLE were thoroughly searched. The title scan was used to find randomised controlled trials reviewed for inclusion by reading the abstract. Studies comparing the sedative, behavioural, and anxiolytic effects and safety in children undergoing dental treatment under midazolam and nitrous oxide inhalation were included. The Cochrane Reviews system software, Revman 5.4.1, was used to assess the quality of the included studies. Results: 11328 articles were identified by screening the electronic databases, of which 10906 were eliminated after titles were read and duplicates were removed. Ten full-text articles were examined, of which three were excluded as they did not match the eligibility criteria. Hence, a total of 7 studies were included. Midazolam and nitrous oxide inhalation were not statistically different in terms of the success of treatment and behaviour modification. However, midazolam showed a deeper level of sedation and resulted in amnesia in more children when compared to nitrous oxide sedation. All of the included studies were found to have a high risk of bias. Conclusion: Though all the studies included showed an increased risk of bias, midazolam and nitrous oxide inhalation seem equally effective sedative agents for controlling behaviour in children undergoing dental treatment. Midazolam shows a deeper sedation level when given orally and produces a higher rate of anterograde amnesia.
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Midazolam , Dental Care for Children , Hypnotics and Sedatives , Nitrous Oxide , Bibliographies as Topic , Treatment Outcome , Deep SedationABSTRACT
Objective: To describe the findings of short Hammersmith Neonatal Neurologic examination (HNNE) in preterm small for gestational age (SGA) and appropriate for gestational age (AGA) infants at term equivalent age (TEA) and to correlate it with the global score of Hammersmith Infant Neurologic Examination (HINE) performed at 4-6 months of corrected age. Methods: This prospective cohort study was conducted at the high risk follow-up clinic of our center. 52 preterm infants born <35 weeks gestation were examined using HNNE at TEA and followedup till 4-6 months of corrected age to estimate HINE. Results: 20 infants (38.5%) had warning signs and 9 (17.3%) had abnormal signs on short HNNE. 12 (37.5%) AGA infants and 6 (30%) SGA infants had global score <65 at mean corrected age (SD) of 4.3 (0.7) weeks and 4.5 (0.8) weeks, respectively. Very preterm, birth weight <1000 g and SGA was significantly associated with global scores <65. Conclusion: Early identification of warning signs among SGA infants using Short HNNE screening at TEA can be useful to initiate early intervention. There was no statistically significant difference in global scores by HINE among AGA and SGA infants in early infancy.
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Background & objectives: Screening of individuals for early detection and identification of undiagnosed diabetes can help in reducing the burden of diabetic complications. This study aimed to evaluate the performance of Madras Diabetes Research Foundation (MDRF)-Indian Diabetes Risk Score (IDRS) to screen for undiagnosed type 2 diabetes in a large representative population in India. Methods: Data were acquired from the Indian Council of Medical Research–INdia DIABetes (ICMR–INDIAB) study, a large national survey that included both urban and rural populations from 30 states/union territories in India. Stratified multistage design was followed to obtain a sample of 113,043 individuals (94.2% response rate). MDRF-IDRS used four simple parameters, viz. age, waist circumference, family history of diabetes and physical activity to detect undiagnosed diabetes. Receiver operating characteristic (ROC) with area under the curve (AUC) was used to assess the performance of MDRF-IDRS. Results: We identified that 32.4, 52.7 and 14.9 per cent of the general population were under high-, moderate- and low-risk category of diabetes. Among the newly diagnosed individuals with diabetes [diagnosed by oral glucose tolerance test (OGTT)], 60.2, 35.9 and 3.9 per cent were identified under
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The idea of professional ethics is seen as being of the utmost significance in achieving the asked points and objects in advanced educational institutions. Information about professional ethics is given to the people as they develop. They admit this information from their preceptors and family members. The capability to comprehend the applicability of professional ethics and put it into practice allows people to enhance their lives and negotiate both particular and professional objects. It's essential for scholars to consider professional ethics while pursuing advanced education. This idea is pivotal for everyone who works in educational institutions, including directors, heads, professors, and staff members as well as scholars. It's pivotal for people to make sure they communicate easily, establish strong fellowship with others, parade honesty and righteousness, and perform their job scores in an orderly fashion in order to execute professional ethics in an effective manner. The crucial motifs that have been considered in this exploration paper are the description and significance of professional ethics, their pretensions, the different kinds of professional ethics, and ways to strengthen them
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Background & objectives: The National Tuberculosis (TB) Control Programme has transitioned from thrice-weekly to daily drug treatment regimens in India. This preliminary study was conceived to compare the pharmacokinetics of rifampicin (RMP), isoniazid (INH) and pyrazinamide (PZA) in TB patients being treated with daily and thrice weekly anti-TB treatment (ATT). Methods: This prospective observational study was undertaken in 49 newly diagnosed adult TB patients receiving either daily ATT (n=22) or thrice-weekly ATT (n=27). Plasma RMP, INH and PZA were estimated by high-performance liquid chromatography. Results: The peak concentration (Cmax) of RMP was significantly higher (RMP: 8.5 ?g/ml vs. 5.5 ?g/ml; P=0.003) and Cmax of INH was significantly lower (INH: 4.8 ?g/ml vs. 10.9 ?g/ml; P<0.001) in case of daily dosing compared to thrice-weekly ATT. Cmax of drugs and doses was significantly correlated. A higher proportion of patients had subtherapeutic RMP Cmax (8.0 ?g/ml) during thrice-weekly compared to daily ATT (78% vs. 36%; P=0.004). Multiple linear regression analysis showed that Cmax of RMP was significantly influenced by the dosing rhythm, pulmonary TB and Cmax of INH and PZA by the mg/kg doses. Interpretation & conclusions: RMP concentrations were higher and INH concentrations were lower during daily ATT, suggesting that INH doses may need to be increased in case of a daily regimen. Larger studies are, however, required using higher INH doses when monitoring for adverse drug reactions and treatment outcomes.
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The commonest diagnosis of a cystic mass in the pelvis is ovarian cyst, here we report a case of cystic degeneration of broad ligament fibroid mimicking as a ovarian cyst. A 45-year-old lady presented with abdominal discomfort. On evaluation, a pelvic mass of 20 weeks size of varying consistency was noted. Ultra sonogram and Magnetic Resonance Imaging gave a differential diagnosis of right sided broad ligament fibroid and ovarian cyst. Anticipating possible ovarian mass owing to its size, laparotomy was performed and noted a large false broad ligament fibroid which has undergone cystic degeneration. Total abdominal hysterectomy and bilateral salpingo-oopherectomy was performed, however a differential diagnosis of ovarian mass should always be made before surgery.
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Background: The prevalence of childhood obesity is increasing in low-middle income countries like India. Built environment features such as walkability can influence weight-related outcomes but data from developing countries are scanty. Objective: To develop population level walkability index in urban Bengaluru, and examine its association with indices of childhood obesity in school children. Study Design: Nested cross-sectional study based on a cohort. Participants: Normal healthy children aged 6 to 15 years from urban schools in Bengaluru. The children were stratified into different land use classification such as residential, commercial and open space based on residential address. Methods: Anthropometric data, body composition data, measured using air displacement plethysmography. Outcomes: Walkability index derived using residential density, street connectivity and land-use mix environment variables. Results: The mean (SD) of age, body mass index (BMI), BMI zscore and percentage body fat (% Body fat) of 292 (50% boys) children were 10.8 (2.9) year, 17.4 (3.3) kg/m2, -0.27 (1.35) and 20.9% (8.8), respectively. The mean (SD) walkability index was 16.5, which was negatively associated with BMI (slope -0.25 and -0.08) and percentage body fat (slope -0.47 and -0.21) for age 5 and 10 years, respectively in children, but the effects decreased with increasing age. Conclusions: The findings of this pilot study suggest that the neighborhood walkability may be associated with the obesity indices in younger children. Future longitudinal studies are needed to understand how built environment affects health and body composition of children in India and other low-middle income countries.
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Alcoholic liver disease (ALD) is caused by excessive intake of alcohol for many years. The incidence is as high as 25% in the United States, India and several other countries. The disease spectrum varies from fatty liver in initial stages, to hepatitis and finally cirrhosis. Untreated ALD can be fatal. Yet the options for prescription drugs are limited, and not easily available or affordable to the masses worldwide. BV-7310 contains herbal extracts of Phyllanthus niruri, Tephrosia purpurea, Boerhavia diffusa and Andrographis paniculata. The individual plants are known hepatoprotective agents in Ayurveda. The objective of this study was to investigate the safety and efficacy of BV-7310, a proprietary combination standardized formulation, in subjects with ALD. A multi-centric, double-blind, placebo-controlled, randomized study of 61 subjects was conducted for a period of 12 weeks. Subjects on BV-7310 showed improvement in clinical features of ALD as compared to placebo, including reduction and normalization of transaminases. BV-7310 also reduced bilirubin levels to normal, showing improvement in the detoxifying and excretory capabilities of the liver. No significant adverse events were seen in the treatment group. Based on the data shown, BV-7310 shows promise as a safe and effective hepatoprotective in patients of ALD.
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Dooshivisha (cumulative toxicity) is a type of Kritrima visha (artificial poison). It is a transformed state of other types of poison if not eliminated, get collected in small doses leads to this type of poisoning. It is a unique concept of Ayurveda and is the cause of the majority of the health issues in the present era. Acharyas have said different treatment principles for the management of Dooshivisha (cumulative toxicity). Dooshivishari agada is the formulation of choice for its treatment, which is a herbo-mineral formulation comprised of twelve ingredients that are taken in equal amounts for the preparation. Many Acharyas such as Sushruta, Vagbhata, and Bhavaprakasha have explained it in their classical texts. Along with Dooshivisha (cumulative toxicity), it can also be used in its complications, and also for the treatment of all types of poisoning and other associated signs and symptoms.
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Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of upper extremity. It affects approximately 3% of the general adult population in the world. Women are three times more likely to have CTS than men. In conventional system, medications such as corticosteroids, Non-Steroidal anti-inflammatory drugs, etc., are used in management of carpal tunnel syndrome. Surgical decompression of carpal tunnel is the main stay of treatment for CTS. The structures involved in carpal tunnel is mainly the tendons, ligaments and nerves which can closely related with Snayu, thus Carpal tunnel syndrome can be correlated with Snayugata vata affecting Manibandhasandhi. Dahanopkarana used for Vatavyadi affecting Snayu, Sandhi, Asthi are Kshaudra, Guda, Sneha. Agnikarma with Snigdha dravyas have more penetrating capacity than Rooksha dravyas like Shalaka. So, Taptaguda is taken in the present study to assess the effect of Agnikarma in carpal tunnel syndrome. Here the patient was treated with Agnikarma using Taptaguda over the most painful and tender points. Assessments were done before treatment, after treatment, 7th day, 15th day and 30th day. The result showed Agnikarma with Taptha guda was effective in treating Carpal tunnel syndrome
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Lumbar disc herniation is a major health problem, affecting the most productive population globally. It has closest resemblance with Gridhrasi mentioned in Ayurvedic classics. Treatments available in conventional sciences have limitations such as relapse of acute episodes. Here an effort was made to treat a case of L5-S1 disc extrusion with radiculopathy using a comprehensive Ayurveda treatment protocol. The protocol includes a set of treatment procedures along with certain internal medicines. Changes were analysed with the help of VAS scale, SLRT and Oswestry disability index and showed significant improvements. This case is an evidence to demonstrate the effectiveness of Ayurveda treatments in case of LDH with radiculopathy.
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The prevalence of lifestyle diseases like hypertension, diabetes mellitus, dyslipidemia, and obesity, has been exponentially increasing. Metabolic Syndrome (MS) is a lifestyle disorder that has become a major public-health challenge around the world, owing to rising obesity and sedentary lifestyles. Abdominal obesity, insulin resistance, hypertension, and hyperlipidaemia were the common pathological conditions involved in MS. Ayurveda is the science intended for employing the measures of healthy life. There is no direct reference of metabolic syndrome in Ayurveda classics. Different scholars have different opinion about the nearest possible diseases. Some scholars included it in Medapradooshaja vikaras, while others classified it as Sthoulya upadravas or Avaranajanya vikaras. In Charaka Samhita, lack of physical activity and unhealthy eating habits which are the causes of lifestyle diseases are mentioned in Santharpaneeyam adhyayam. Aetiology and symptomatology of Santharpanajanya vikaras shows a remarkable similarity with metabolic syndrome, since it includes sedentary lifestyle and dietary factors. Therefore, MS can be included under the broad umbrella of Santhartanajanya vikaras and Ayurveda can put forward a better management strategy by reassessing the metabolic syndrome on the basis of Santharpanajanya vikaras
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Nursing is one of the professions which require knowledge along with clinical competence to provide high quality nursing care. Objective Structured Clinical Examination (OSCE) and Objective Strucured Practical Examination (OSPE) methods of evaluation have emerged as an alternative to traditional evaluation methods for the skills assessment. This study was planned to train nursing faculties on OSCE and evaluate its effectiveness. The primary objective of the for nursing faculties on knowledge regarding OSCE. A one group pretest-posttest design with a quantitative research approach was used. Convenient sampling method was used include 27 faculties from all the available colleges of Nursing in NCT of Delhi. A structured 15-item questionnaire with multiple choice questions, each comprising four responses with one correct response was used to evaluate the knowledge of the participants regarding OSCE. The twoday training programme comprised the theory sessions and demonstration of OSCE stations ties. The study suggests that there is a need to develop a structured training programme and conduct training for faculties across the country to bring in uniformity in implementation of OSCE method of evaluation in colleges.
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Autoimmune hemolytic anemia (AIHA) secondary to hematological malignancy is well-known and common in the elderly. AIHA associated with infection is less commonly reported in the elderly. We are reporting a case of AIHA in an elderly female with comorbidities, probably secondary to Gram-negative infection. The case was admitted and treated during the peak of the second wave of the COVID pandemic. The treatment of AIHA also had an impact on the progress and outcome of the underlying disease, leading to readmission in a short span of time. The patient also developed a thrombotic complication known to be associated with AIHA.
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There has been a striking increase in the geriatric population worldwide over the last few decades. As the aging process continues to alter functioning of all body systems, the human voice is also significantly affected. The senile voice is characterized by its changes in pitch, hoarseness, tremulousness, and breathiness with reduced harmonics and intensity. Such phonatory changes in the elderly may hinder effective communication, thus bringing down their confidence levels and impairing their quality of life. These characteristic features that distinguish the senile voice from younger speakers are accompanied by age?related changes in the organ of phonation, the larynx. The summative morphological and structural changes occurring in the elderly larynx have been referred to as “Presbylarynx.” The present review article is an attempt by the authors to explore the various anatomical age-related changes occurring in the larynx that may be responsible for altered vocal function in the elderly. An improved understanding of the anatomical basis of the aged voice can give further directions into the management of vocal disorders and improved speech performance in the elderly.
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Emesis is a common experience in first trimester of pregnancy affecting 70 to 80% of all pregnant women. Altered immunological endocrinological and psychological states are responsible for initiation of symptoms. Mild to moderate emesis gravidarum have a significant adverse effect on quality of women's life. Even though onset is physiological its morbidity has to be reduced to minimize disease burden, enhance maternal health and to prevent hyper emesis gravidarum. Anti-emetic and anti-histamines are used in conventional Allopathic practice. Ayurvedic principle is early intervention and prevention of hyperemesis gravidarum with lifestyle modifications and adopting Pathya ahara. This is a case report of emesis gravidarum managed with pharmaco nutrient product –Malarinji modaka
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Background: There is limited access to 1 year of adjuvant trastuzumab in resource-constrained settings. Most randomized studies have failed to prove non-inferiority of shorter durations of adjuvant trastuzumab compared to 1 year However, shorter durations are often used when 1 year is not financially viable. We report the outcomes with 12 weeks of trastuzumab administered as part of curative-intent treatment. Methods: This is a retrospective analysis of patients treated at Tata Memorial Centre, Mumbai, a tertiary care cancer center in India. Patients with human epidermal growth factor receptor (HER2)-positive early or locally advanced breast cancer who received 12 weeks of adjuvant or neoadjuvant trastuzumab with paclitaxel and four cycles of an anthracycline-based regimen in either sequence, through a patient assistance program between January 2011 and December 2012, were analyzed for disease-free survival (DFS), overall survival (OS), and toxicity. Results: A total of 102 patients were analyzed with a data cutoff in September 2019. The median follow-up was 72 months (range 6–90 months), the median age was 46 (24–65) years, 51 (50%) were postmenopausal, 37 (36%) were hormone receptor-positive, and 61 (60%) had stage-III disease. There were 37 DFS events and 26 had OS events. The 5-year DFS was 66% (95% Confidence Interval [CI] 56–75%) and the OS was 76% (95% CI 67–85%), respectively. Cardiac dysfunction developed in 11 (10.7%) patients. Conclusion: The use of neoadjuvant or adjuvant 12-week trastuzumab-paclitaxel in sequence with four anthracycline-based regimens resulted in acceptable long-term outcomes in a group of patients, most of whom had advanced-stage nonmetastatic breast cancer.
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Purpose: To describe the etiology, clinical profile, duration of lagophthalmos cases and thereby, framing a decision for the management based on the severity of Exposure keratitis (EK), Facial palsy (FP) with each etiology and to describe the outcome of the management options. Methods: The method was a prospective review of 120 lagophthalmos cases treated at a single tertiary center from January 2018 to January 2019. The main outcome measures were analysing the association between age, etiology, duration and management of lagophthalmos. Results: Of the 120 patients studied, paralytic etiology was noted in 86 and eyelid etiology in 34 patients. The percentage of various lagophthalmos etiology documented were Bell’s palsy (35.83%), lagophthalmos in ICU patients (15%), traumatic facial palsy(FP) (10.80%), stroke associated FP (6.67%), infection associated FP (6.67%), iatrogenic FP, cicatricial lagophthalmos (5%), lagophthalmos post eyelid surgeries (5%), neoplastic FP(3.33%), congenital FP (1.67%), proptosis induced lagophthalmos (1.67%), floppy eyelid syndrome induced lagophthalmos (0.83%) and lid coloboma associated lagophthalmos (0.83%). A statistically significant correlation was noted between exposure keratitis and age, with an increased prevalence age advances. The management showed significant variation with individual etiology, with some etiologies unquestionably requiring surgical management. Surgical management is crucial as the duration of lagophthalmos increases more than 6 weeks, EK involving pupillary axis and poor FP recovery. Conclusion: This study concludes that the conservative management was sufficient in all cases when the duration is less than 1 week, Exposure keratitis not involving the pupillary axis (EK< Grade II) and FP with good functional recovery ( FP < Grade III). The predominant causes being Bell’s palsy, lagophthalmos in ICU patients and vascular FP. Whereas, cases with poor functional recovery of facial palsy(FP) and permanent eyelid deformation require definitive surgical management like Traumatic FP & cicatricial lagophthalmos
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Objectives: Family history is considered as an important predictor of cardiovascular diseases (CVDs) and diabetes. Available research findings suggest that family history of chronic diseases is associated with perceived risk of disease and adoption of healthy behaviours. We examined the association between family history of cardio-metabolic diseases (CMDs) and healthy behaviours among adults without selfreported CMDs. Methods: Cross-sectional data of 12,484 adults, without self-reported CMDs, from the baseline survey of Centre for cArdiometabolic Risk Reduction in South-Asia (CARRS) cohort study were analysed. Results: Family history was positively associated with non-smoking and high fruits & vegetables consumption in the age group of 45e64 years and moderate to high physical activity in the age group _x0001_65 years after adjusting for sex, education, wealth index, city and body mass index. Conclusions: Understanding perceived risks and cultural or psychological factors related to family history through ethnographic studies may deepen understanding of these associations.