ABSTRACT
Oral cancer is usually preceded by oral potentially malignant disorders (OPMDs) and early detection can downstage the disease. The majority of OPMDs are asymptomatic in early stages and can be detected on routine oral examination. Though only a proportion of OPMDs may transform to oral squamous cell carcinoma (OSCC), they may serve as a surrogate clinical lesion to identify individuals at risk of developing OSCC. Currently, there is a scarcity of scientific evidence on specific interventions and management of OPMDs and there is no consensus regarding their management. A consensus meeting with a panel of experts was convened to frame guidelines for clinical practices and recommendations for management strategies for OPMDs. A review of literature from medical databases was conducted to provide the best possible evidence and provide recommendations in management of OPMDs
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Hereditary spherocytosis (HS) is a type of congenital hemolytic anemia, in which heterogeneous alterations in one of the six genes that encode for proteins involved in vertical associations which tie the red blood cell (RBC) membrane skeleton to the lipid bilayer causes dysfunction or deficiency of cell membrane protein resulting in spherical-shaped, hyper-dense, and poorly deformable RBCs with a shortened life span. We report a case of HS in a 2-month-old female who presented with severe anemia, jaundice, and hepatosplenomegaly. The peripheral blood smear showed spherocytosis and reticulocytosis. The osmotic fragility was positive and direct antiglobin test was negative. The osmotic fragility test and direct antiglobulin test were positive. She was managed with packed RBCs (PRBCs) transfusion and folic acid supplementation
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There were reports of severe acute respiratory syndrome coronavirus 2 infection cases among health?care workers from all around the world. We did a cross sectional study among 533 COVID19 affected health?care workers. About 87.43% of participants were involved in duties not directly related to COVID?19 management. About 19.6% contracted the disease from their colleagues. About 15% of the affected health?care workers had at least one comorbidity and diabetes mellitus was the most common (5%). 57% of participants presented with fever followed by body ache in 40%. Only 0.4% of the participants needed ventilator support during treatment. 36% of the participants reported household transmission from them. Adequate personal protective equipment (PPE) usage and functioning infection control committee in their hospital were reported by most of the participants. The study points towards the need of adequate PPE use in the nonCOVID settings and the need for periodical assessment of infection control practices.
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Spurious thrombocytopenia or pseudothrombocytopenia (PTCP) is an important clinical entity, in which the presence of autoantibodies or anticoagulants used during blood sampling causes in vitro clumping of platelet and thereby resulting in a falsely low automated platelet count. The most common cause of platelet clumping is ethylenediaminetetraacetic acid used as an anticoagulant in the blood samples. The other reasons for PTCP include the presence of autoantibodies such as cold agglutinin, giant platelet, and platelet satellitism. There are very few cases of spurious thrombocytopenia in the newborn period published in the literature. We are reporting a case of PTCP due to platelet satellitism in a baby born to a mother with a similar condition
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Respiratory distress in a newborn can be due to various causes and some need active intervention. Choanal atresia (CA) is a rare congenital anomaly with its incidence estimated to be 1 case/5,000–8,000 births. It is characterized by narrowing or blockage of the nasal passages. It is important to make an early clinical diagnosis with emphasis on timely management as it can be life-threatening. The pediatrician may be not able to pass a feeding tube through the neonate’s nostril even on repeated attempts. Detailed evaluation should be performed for the CHARGE association. High-resolution computed tomography can aid the diagnosis and transnasal endoscopic surgery is the preferred treatment modality. Here is a case report of a term neonate born with severe respiratory distress who was diagnosed to have bilateral CA on evaluation and managed with nasal endoscopic surgery.
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BACKGROUND Nursing and allied health professionals are helping hands for healthcare and are important in the training cascade. We aimed to develop and validate the effectiveness of a web-based learning module on oral health promotion among nursing and allied health professionals. METHODS We developed and validated an oral health module focused on prevention and promotion for a web-based intervention among nurses and allied health professionals. Pre- and post-test assessment was conducted to evaluate the effectiveness of the programme. RESULTS Of a total of 347 participants, 170 (48.9%) had a good knowledge score in the pre-test, and after attending the oral health module their number increased to 267 (76.9%). The mean difference between the pre-test and post-test scores was statistically significant (p<0.005). CONCLUSIONS Training of nurses and allied health professionals on oral health through a web-based module showed improvement in oral health literacy.
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Background: Progressive proteinuria implies worsening of the condition in hypertensive disorders of pregnancy and hence its quantification guides clinician in making decision and planning treatment. The gold standard is 24 hour urine protein estimation. Urine sediment cytology, also known as ‘liquid renal biopsy’ identifies and analyses the extent of renal damage.Methods: Objectives of the study were to compare the efficacy of urine dipstick test to 24 hour urine protein estimation in detecting proteinuria in pre-eclampsic patients and to describe the findings in urine sediment examination in assessing proteinuria in above patients. Urine dipstick test and sediment cytology were performed on the urinary samples of 242 pregnant women with high BP recordings (BP>140/90 mm Hg) which were collected and tested in Department of Pathology, Government Medical College, Kottayam during the study period of 18 months. This was compared with 24 hour urine protein values (gold standard).Results: About 154 patients (63.63%) had significant proteinuria of more than 300mg/24hr. Dipstick method showed 78.57% sensitivity and 81.82% specificity for prediction of significant proteinuria. Positive predictive value and negative predictive value of urine dipstick test were 88.32% and 68.57% respectively. Urine sediment examination revealed the presence of casts only in 11.98% of study population. Conclusions: Diagnostic accuracy of automated urine dipstick test in assessing proteinuria was 79.75%. For grade 1 proteinuria, diagnostic accuracy was 79.81%, for Grade 2 it increased to 93.14% and for grade 3 & 4, accuracy was 98.68%. Urine sediment examination didn’t correlate with proteinuria and hence the extent of renal damage in pre-eclampsia.
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Background: Over usage of electronic gadgets has a serious impact on physical activity of children leading to obesity, depression, anxiety, poor scholastic performance, strain on the eyes and triggering factor for' neck and back pain (due to spondylitis).It is very important to know how to control the screen time of children by parents.Methods: Here, 75 parents were subjected to questionnaire study which contained questions on the information on usage of electronic devices among children and the adverse effects noticed. Results were analyzed using Microsoft excel software.Results: Almost all the 75 cases had access to television, 64 had access to smart phones, 24 had access to IPAD/Tablet, 8 had access to laptop and 4 had access to gaming console. It was found that 45 % were depressed / anxious when gadgets were withdrawn from them. 21 kids had no idea what to do when gadgets were not available. 54 kids had no interest in outdoor playing and 38 children were found to have decreased interaction with other family members.Conclusions: Exposure to gadgets in paediatrics population leads to poor scholastic performance, obesity, depression, decreased interaction with family and many other problems. So, it is very important to have control on child's day to day activities and have constant vigilance on their gadget usage.
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Background: The plant Rotula aquatica Lour. was traditionally well known due to its large number ofpharmacological action and medicinal uses. The plant is a necessary component of many Ayurvedic drugpreparations since historical times. It is widely used as a crucial ancient drug for kidney and bladderstones.Objectives: The main objective of the study was to evaluate the acute toxicity and anti inflammatoryefficacy of methanolic extract of R. aquatica Lour. in in vivo models.Materials and methods: The qualitative phytochemical analysis and invitro antioxidant activity of theroots of methanolic extract of R. aquatica Lour. (MERA) was evaluated. The acute toxicity effect of MERAwas evaluated with two different doses (550, 2000 mg/kg body weight), were administrated orally toWistar rats. The rats were observed for sign and symptoms of toxicity and mortality for 14 days. Theparameters measured including relative organ weight, blood, biochemical and histopathological parameters of hepatic and renal toxicity. The anti-inflammatory effect of MERA was also evaluated incarrageenan and dextran-induced paw edema models.Results: The phytochemical evaluation of MERA shows the presence of secondary metabolites like alkaloids, flavonoids, phenolics and tannins, phytosterols, reducing sugars, proteins and terpenoids. Theresults of in-vitro antioxidant evaluation of MERA reveal its capability to scavenging free radical at alower concentration. The MERA did not show any visible signs of toxicity up to the dose of 2000 mg/kgbody weight. The results obtained from our carrageenan and dextran-induced paw edema model studyalso proved the anti-inflammatory effect of MERA in rat model.Conclusion: The result shows the potential of MERA as an anti-inflammatory drug to reduce the signs ofinflammation devoid of any toxic effect.© 2018 The Authors. Published by Elsevier B.V. on behalf of Institute of Transdisciplinary Health Sciencesand Technology and World Ayurveda Foundation. This is an open access article under the CC BY-NC-NDlicense (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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OBJECTIVE: The causal association of human papillomavirus (HPV) in uterine cervical cancer was well established and this oncogenic virus was reported to be a biomarker for overall recurrence and central pelvic recurrence. The objective of the present systematic review and meta-analysis was to assess the role of HPV DNA testing in early detection of recurrence among cervical cancer survivors after radiotherapy.METHODS: We performed a systematic review and meta-analysis by means of searching electronic databases for published articles between January 1984 and June 2018, on the basis of standard systematic review guidelines prescribed by major agencies namely Cochrane Collaboration (https://www.cochrane.org) and Campbell Collaboration (https://www.campbellcollaboration.org). The meta-analysis component was further modified appropriately for the synthesis of sensitivity and specificity results.RESULTS: A total of 1,055 cervical cancer cases who had received pelvic radiation with or without chemotherapy from ten cohort studies were evaluated. The overall pooled sensitivity and specificity of HPV DNA testing was 0.84 (95% confidence interval [CI]= 0.66–0.94) and 0.35 (95% CI=0.20–0.54) respectively. The positive likelihood ratio was 1.3 (95% CI=1.0–1.7) and the negative likelihood ratio was 0.45 (95% CI=0.18–1.10) with an estimated diagnostic odds ratio of 3 (95% CI=1–9).CONCLUSION: The screening for HPV DNA testing during follow-up facilitates early detection of recurrence after radiotherapy.
Subject(s)
Female , Humans , Cervix Uteri , Cohort Studies , Cooperative Behavior , DNA , Drug Therapy , Follow-Up Studies , Human Papillomavirus DNA Tests , Mass Screening , Odds Ratio , Oncogenic Viruses , Radiotherapy , Recurrence , Sensitivity and Specificity , Survivors , Uterine Cervical NeoplasmsABSTRACT
OBJECTIVE@#The causal association of human papillomavirus (HPV) in uterine cervical cancer was well established and this oncogenic virus was reported to be a biomarker for overall recurrence and central pelvic recurrence. The objective of the present systematic review and meta-analysis was to assess the role of HPV DNA testing in early detection of recurrence among cervical cancer survivors after radiotherapy.@*METHODS@#We performed a systematic review and meta-analysis by means of searching electronic databases for published articles between January 1984 and June 2018, on the basis of standard systematic review guidelines prescribed by major agencies namely Cochrane Collaboration (https://www.cochrane.org) and Campbell Collaboration (https://www.campbellcollaboration.org). The meta-analysis component was further modified appropriately for the synthesis of sensitivity and specificity results.@*RESULTS@#A total of 1,055 cervical cancer cases who had received pelvic radiation with or without chemotherapy from ten cohort studies were evaluated. The overall pooled sensitivity and specificity of HPV DNA testing was 0.84 (95% confidence interval [CI]= 0.66–0.94) and 0.35 (95% CI=0.20–0.54) respectively. The positive likelihood ratio was 1.3 (95% CI=1.0–1.7) and the negative likelihood ratio was 0.45 (95% CI=0.18–1.10) with an estimated diagnostic odds ratio of 3 (95% CI=1–9).@*CONCLUSION@#The screening for HPV DNA testing during follow-up facilitates early detection of recurrence after radiotherapy.
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Objective: To evaluate the anti-bacterial and anti-biofilm activity of ethyl acetate fraction of Rotula aquatica Lour. (EFRA) against clinically isolated uropathogenic Escherichia coli. Methods: In vitro antibacterial and anti-biofilm studies were employed. The antimicrobial activity of EFRA was assayed by the well diffusion method. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the active fraction were determined by Resazurin method. The time-kill kinetic assay, acridine orange-ethidium bromide staining, propidium iodide uptake assay, and scanning electron microscopic (SEM) analysis were done to evaluate the efficacy of EFRA in killing uropathogenic Escherichia coli. The anti-biofilm activity was determined by 3-[4,5-dimethyl-2-thiazolyl]-2, 5-diphenyl-2H-tetrazolium-bromide (MTT) assay and specific biofilm formation assay. Results: The well diffusion assay of EFRA showed a very clear zone of inhibition against Escherichia coli BRL-17. The MIC and MBC of EFRA were 2.5 mg/mL and 5 mg/mL, respectively. The time-kill kinetic assay, fluorescence microscopic analysis, propidium iodide uptake assay, and SEM analysis displayed the effect of EFRA in killing the bacteria. The MTT assay and specific biofilm formation assay showed that EFRA prevented the formation of biofilms. Conclusions: The results of the present study confirm that EFRA could prevent bacterial growth and inhibit its biofilm formation.
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Objective: To evaluate the anti-bacteria! and anti-biofilm activity of ethyl acetate fraction of Rotula aquatica Lour. (EFRA) against clinically isolated uropathogenic Escherichia coli. Methods: In vitro antibacterial and anti-biofilm studies were employed. The antimicrobial activity of EFRA was assayed by the well diffusion method. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the active fraction were determined by Resazurin method. The time-kill kinetic assay, acridine orange-ethidium bromide staining, propidium iodide uptake assay, and scanning electron microscopic (SEM) analysis were done to evaluate the efficacy of EFRA in killing uropathogenic Escherichia coli. The anti-biofilm activity was determined by 3-[4,5- dimethyl-2-thiazolyl]-2, 5-diphenyl-2H-tetrazolium-bromide (MTT) assay and specific biofilm formation assay. Results: The well diffusion assay of EFRA showed a very clear zone of inhibition against Escherichia coli BRL-17. The MIC and MBC of EFRA were 2.5 mg/mL and 5 mg/mL, respectively. The time-kill kinetic assay, fluorescence microscopic analysis, propidium iodide uptake assay, and SEM analysis displayed the effect of EFRA in killing the bacteria. The MTT assay and specific biofilm formation assay showed that EFRA prevented the formation of biofilms. Conclusions: The results of the present study confirm that EFRA could prevent bacterial growth and inhibit its biofilm formation.
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Background & objectives: In developing countries like India, there is a lack of clarity regarding the factors that influence decisions pertaining to life supports at the end-of-life (EOL). The objectives of this study were to assess the factors associated with EOL-care decisions in the Indian context and to raise awareness in this area of healthcare. Methods: This retrospectively study included all patients admitted to the medical unit of a tertiary care hospital in southern India, over one year and died. The baseline demographics, economic, physiological, sociological, prognostic and medical treatment-related factors were retrieved from the patient's medical records and analysed. Results: Of the 122 decedents included in the study whose characteristics were analyzed, 41 (33.6%) received full life support and 81 (66.4%) had withdrawal or withholding of some life support measure. Amongst those who had withdrawal or withholding of life support, 62 (76.5%) had some support withheld and in 19 (23.5%), it was withdrawn. The documentation of the disease process, prognosis and the mention of imminent death in the medical records was the single most important factor that was associated with the EOL decision (odds ratio - 0.08; 95% confidence interval, 0.01-0.74; P=0.03). Interpretation & conclusions: The documentation of poor prognosis was the only factor found to be associated with EOL care decisions in our study. Prospective, multicentric studies need to be done to evaluate the influence of various other factors on the EOL care.
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Background: The global incidence of oral cancer occurs in low-resource settings. Community-based oral screening is a strategic step toward downstaging oral cancer by early diagnosis. The mobile health (mHealth) program is a technology-based platform, steered with the aim to assess the use of mHealth by community health workers (CHWs) in the identification of oral mucosal lesions. MATERIALS AND METHODS: mHealth is a mobile phone-based oral cancer-screening program in a workplace setting. The participants were screened by two CHWs, followed by an assessment by an oral medicine specialist. A mobile phone-based questionnaire that included the risk assessment was distributed among participants. On specialist recommendation an oral surgeon performed biopsy on participants. The diagnosis by onsite specialist that was confirmed by histopathology was considered as gold standard. All individuals received the standard treatment protocol. A remote oral medicine specialist reviewed the uploaded data in Open Medical Record System. Sensitivity, specificity, positive and negative predictive values were calculated. Inter-rater agreement was analyzed with Cohen's kappa coefficient (κ) test, and the diagnostic ability of CHWs, onsite specialist, and remote specialist was illustrated using receiver operating characteristic curve. RESULTS: CHWs identified oral lesions in 405 (11.8%) individuals; the onsite specialist identified oral lesions in 394 (11.4%) individuals; and the remote specialist diagnosed oral lesions in 444 (13%). The inter-rater agreement between the CHW and the onsite specialist showed almost perfect agreement with the κ score of 0.92, and a substantial agreement between CHW and remote specialist showed a score of 0.62. The sensitivity, specificity, positive and negative predictive values of CHWs in the identification of oral lesion were 84.7, 97.6, 84.8, and 97.7%, respectively. CONCLUSION: The trained CHWs can aid in identifying oral potentially malignant disorders and they can be utilized in oral cancer-screening program mHealth effectively.
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A 25-year-old man presented with decreased vision in the left eye with hypopigmented elevated subretinal lesion over the optic disk with abnormal vasculature, subretinal and retinal hemorrhages, and fluid in the macula. An area of high spike over the disk with corresponding orbital shadowing was seen on B scan ultrasonography. Fundus fluorescein angiography revealed abnormal vasculature. Systemic examination revealed facial angiofibroma, ashleaf spot, and dental pits with multiple cortical tubers on CT brain. Intravitreal injection of bevacizumab led to visual and tomographic improvement. Abnormal retinal vascularization and exudation in young individuals may be a presenting feature in tuberous sclerosis.