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Background:There is a need to identify novel markers for CAD, independent of traditional CV risk factors. One of these is gamma?glutamyl transferase (GGT), a marker of increased oxidative stress. Given the high prevalence of CAD in Asian Indians, the link of GGT and CAD in them needs to be studied. Aim: To assess GGT in patients with angiographically documented CAD. Methods and Results: Two hundred patients aged 58.1 ± 9.95 years, 73% males, hypertension 56%, diabetes 40% were included. Mean GGT was 63.6 ± 44.33 (10–269 U/L). The levels of GGT progressively increased in those with single/double or triple?vessel CAD (36.5, 61.5, and 87 U/L, respectively, P < 0.001). Using objective criteria of CAD burden (SYNTAX and Gensini scores), we reaffirmed these findings. GGT in patients with SYNTAX tertiles 0–22, 23–32, and 33 was 33, 62, and 97 U/L, respectively and in Gensini tertiles 0–17.65, 17.66–56.65, ?56.66 was 32, 52, and 88 U/L, respectively, all P < 0.001. SYNTAX score 23 was present in only 23% patients in GGT tertile 1 (<41 U/L), whereas60% and 94% in GGT tertiles 2 and 3 had SYNTAX 23. Significant positive correlation was seen between GGT and SYNTAX (r = 0.634) and Gensini score (r = 0.772). Conclusions: In this study, GGT had an independent correlation with angiographic severity of CAD and SYNTAX and Gensini scores. Although the existing evidence seems biologically plausible, more studies are needed to explore the potential role of this inexpensive marker for predicting disease burden in patients with CAD.
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Background & objectives: Lack of awareness is one of the major reasons for the high morbidity and mortality associated with cancers. The present study was aimed to evaluate the awareness of prevalent cancers among the rural population in a district of north India and its association specifically with mobile phone usage. Methods: Using a stratified random sampling technique, households in three villages of Gautam Buddh Nagar district of India were selected. A house-to-house survey on cancer awareness was conducted among adults in selected households and data were analyzed to check for the association of such an awareness with sociodemographic factors and internet usage. Results: The study included 59 males and 145 females, with majority (115) being in the age group of 18-30 yr. Although most (96.5%) of the participants were aware of cancer, the common risk factors and warning signs of cancer were known to only a few. Specific risk factors for cervical and breast cancers were, however, not known to a majority (79.9% and 72.2%). A significant association between the awareness of general risk factors and warning signs as well as specific aspects including risk factors for breast, cervical and oral cancer, HPV vaccine and the education level of the participants (P<0.05 for all). Knowledge of risk factors, warning signs and cancer prevention modalities was higher among mobile phone users who accessed internet for health information. There was no significant association between age group and cancer risk factor awareness, though females were more aware of the risk factors for breast cancer (P=0.002). Interpretation & conclusions: The findings of this study highlight the existing low level of awareness of cervical and breast cancers among the rural population. The association of cancer awareness with education level and mobile phone-based internet usage suggests the potential utility of internet-based platforms such as m-health programmes for cancer prevention activities
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Background: In terms of morbidity and death, adverse drug reactions (ADR) have been highlighted as a worldwide burden. Determining the origin of ADRs remains a tough issue and no one approach for determining causation has been adopted as the gold standard throughout the world. Aim and Objectives: The objectives of the present study were (1) to evaluate the causality of ADRs using World Health Organization-Uppsala Monitoring Center (WHO-UMC) and Naranjo Algorithm ADRs causality assessment tools and (2) to evaluate the agreement and correlation between two universally used approaches for causality assessment of ADRs viz. WHO-UMC system and Naranjo algorithm. The secondary objective was to assess the reported ADRs in a tertiary care hospital in Northern India. Materials and Methods: The present study was a retrospective cross-sectional study. A total of 180 patients of ADRs from different departments of tertiary care hospital which were reported by Pharmacovigilance unit over a period of April 2018 to May 2019 were assessed. The causality assessment for these reported ADRs were done by WHO-UMC system and Naranjo algorithm. The agreement between these two methods calculated by Cohen’s kappa (?) statistics and Spearman’s correlation was used to evaluate the correlation between these two methods. Results: According to WHO-UMC criteria, 55.5% of adverse event instances were of the probable type, 34.4% were possible, 9.4% of cases were improbable, and 0.5% of cases were definite. According to the Naranjo methodology, 80.5% of adverse outcomes were likely, while 19.4% were feasible. The WHO and Naranjo causality comparisons had a positive and fair agreement (= 0.29), according to Cohen’s kappa test. Between the WHO-UMC scale and the Naranjo algorithm, the Spearman’s correlation coefficient was determined to be 0.409. Conclusion: “Probable” was the most common causality category observed by the WHO-UMC scale and the Naranjo algorithm. The WHO-UMC scale and the Naranjo algorithm have a good and reasonable agreement.
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Objective:To explore natural compounds as potential inhibitors against main protease (Mpro) of SARS-CoV-2. Methods:In the current study, systematic molecular docking analysis was conducted using AutoDock 4.2 to determine the binding affinities and interactions between natural compounds and Mpro. Selected natural compounds were further validated using a combination of molecular dynamic (MD) simulations and molecular mechanic Poisson-Boltzmann surface area (MM/PBSA) free energy calculations. Results:Out of twenty natural compounds, four natural metabolites namely, amentoflavone, guggulsterone, puerarin, and piperine were found to have strong interaction with Mpro of SARS-CoV-2 based on docking analysis. During MD simulations, all four natural compounds bound to Mpro at 50 ns and MM/G/P/BSA free energy calculations showed that all four shortlisted ligands had stable and favorable energies with strong binding to Mpro protein. Conclusions:Guggulsterone is a potential inhibitor of COVID-19 main protease Mpro. Further in vitro and pre-clinical studies are needed.
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Purpose@#Adverse effects are noticeable immediately after vaccination, especially when vaccinated to healthy people at the time of vaccination. The vaccine may cause adverse events which are very rare but adverse event following immunization surveillance becomes correspondingly more important in a less studied population like India. Hence, there is a need for carrying out a study pertaining to vaccine safety in the pediatric population of age 0–12 years and assessing the events occurring post-vaccination. @*Materials and Methods@#A prospective observational study was conducted in three primary healthcare centers and two tertiary care hospitals for 6 months from April 2016 to September 2016 with a total of 826 children enrolled. Detected adverse events for suspected vaccines were analyzed for causality by the World Health Organization causality assessment instrument. Sex-specific differences in incidences of adverse events were assessed. @*Results@#The cumulative adverse events were found highest in pentavalent vaccines (510 incidences, 62.04%) followed by the bacillus Calmette-Guérin vaccine (189 incidences, 22.99%). The study didn’t reveal any significant association in incidences of adverse events following immunization and sex of the children. @*Conclusion@#Vaccine safety surveillance studies are need of the hour in developing countries to maintain public trust in vaccines, the ultimate objective being to have vaccines with the most favorable benefit-risk profile. The present study discussed the various adverse events following immunization and suggested the absence of any sex-specific difference in incidences of adverse events in children.
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Ossicular defect is although more common in squamosal type of chronic suppurative otitis media, it can also occur in mucosal type of the disease. Its preoperative knowledge not only helps surgeon to plan for ossicular reconstruction in a better way but also to counsel the patient accordingly. We wanted to determine the prevalence of ossicular chain defect and preoperative identification of clinical and audiological factors as indicators of ossicular defects in patients with Mucosal CSOM.METHODSThis is a hospital based cross sectional study of 2 years. Patients 15 to 60 years of age, having inactive mucosal type of Chronic Suppurative Otitis Media, posted for Tympanoplasty were included in the study. Findings on history, clinical, audiological and intraoperative otomicroscopic examination were recorded and analysed.RESULTSOssicular necrosis was noted in 21 (23.33%) of total 90 patients. On statistical analysis, patients of age >30 years (p=0.019, duration of ear discharge >10 years (p=0.003), those having large and subtotal perforation (p<0.001), adhesion of tympanic membrane edges to promontory (p=0.04), incudostapaedial joint area exposure (p=0.01) and air-one gap >40 dB (p <0.001) were found to be statistically significantly associated with ossicular erosion.CONCLUSIONSAll patients of mucosal type of chronic suppurative otitis media should be assessed in detail so as to get a clue of ossicular defects to be prepared for its repair and will not come as a surprise during surgery.
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Introduction: Anti tuberculosis drug resistance is a majorpublic health problem that threatens progress made in TBcare and control. Globally prevalence of MDR TB(Multidrugresistance tuberculosis i.e.resitance to Isoniazid andRifampicin) is estimated around 4.1% in new cases and 19%in previously treated cases according to WHO report. Clinicaldepression is common but often neglected problem amongTB patients. This study was conducted to know problem ofdepression among MDR Tb patients. Aims and objectives ofthis study were to determine the prevalence of depression inpeople with TB at the time of anti-TB treatment initiation andto assess factors associated with baseline depression.Material and methods: It is a observational study conductedin tertiary care centre. After obtaining proper consent andethical consent data was collected using PHQ 9 score. Datawas analysed using appropriate statistical methods.Results: Out of total 100 patients 80% were PulmonaryTuberculosis(PTB) while 20% were ExtrapulmonaryTuberculosis (EPTB). Around 56% patients were male while44% were female. Prevalence of depression was 51%.Conclusion: Depression is common problem among MDRTB which is preventable and can be managed if identified atearly stage.
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Introduction: Obstructive sleep apnea syndrome is the mostcommon sleep disordered breathing (SDB) and is associatedwith recurrent episodes of upper airway (UA) collapse duringsleep. Arousal from sleep is required to re-establish the airwaypatency. Patients with OSAS have various structural andfunctional abnormalities of the upper airway during sleep,which may reflect on their pulmonary function tests.Material and methods: We performed spirometry in 50diagnosed OSAS patients. Spirometric indices like FEF50/FIF50 >1 and saw tooth appearance of FV loops were studied.Their association with OSA and grades of OSA was evaluatedusing statistical analysis.Results: It was found that these spirometric indices werecommon in OSAS patients but their association with grades ofOSA were not statistically significant.Conclusion: Spirometry findings can point toward diagnosisof OSA but these findings are absent in most OSA patients.
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Handheld X-ray devices are now offered in dental practice. Handheld X-ray units challenge the concept of a restricted access to the “controlled area” as they are held by the operator. Although an integral lead shield is provided, the distance from the body is variable, dependent on how the device is held. Currently, there are voluntary guidelines provided by the NCRP for dental radiation protection. Hand-Held portable X-ray devices are increasingly used for intraoral radiography.
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Background: Accurate knowledge of gestational age of the foetus is essential for planning a timely and uneventful outcome. Biparietal diameter, head circumference, abdominal circumference and femur length reliably predict gestational age. The humerus length is not widely used as biometric parameter for determining the GA so the present study was done to estimate foetal gestational age by measuring humerus length between 18 to 36 weeks of normal singleton pregnancies and to compare humerus length with routine parameters.Methods: This was a hospital based descriptive cross-sectional study, 200 women with viable singleton pregnancy, with known LMP, between 18 weeks to 36 weeks of gestation were included. Various foetal measurements such as biparietal diameter, head circumference, abdominal circumference, femur length and humerus length were measured using electronic calipers on ultrasound. Data were statistically analyzed.Results: The mean humerus length at 18 weeks was 25.27±1.16 mm and at 36 weeks of gestation was 57.11±1.58 mm. Simple linear regression analysis shows a strongly significant linear relationship between humerus length and gestational age. Where, gestational age (weeks) Y= 0.5213 x humerus length (X) + 4.905; with high degree of correlation coefficient (R2 =0.9785 and P≤0.0001). When Compared with BPD, HC, AC and FL, humerus length also shows a linear correlation.Conclusions: The measurement of the humerus length can be an important additional parameter for estimating gestational age along with other parameters and can be used to predict the gestational age of fetuses in special circumstances.
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Aim: This randomized, triple-blinded parallel study was aimed to evaluate the effects of two different local drug delivery (LDD)systems incorporating green tea and turmeric extracts as an adjunct to scaling and root planing (SRP) in the treatment ofchronic periodontitis (CP).Materials and Methods: Thirty-four subjects randomized to receive either Gel A or Gel B containing green tea or turmericextract were included in the study. Following SRP, probing pocket depth (PPD), relative attachment level, gingival marginposition (GMP), bleeding on probing, gingival index, and periodontal inflammatory surface area were recorded at baseline and8 weeks after treatment with Gel A or Gel B.Results: Mean PPD reduction from baseline to 8 weeks was −24.57% for Gel A while for Gel B, it was −22.99%. On comparisonof GMP values for Gel A and Gel B at baseline (3.03±1.10 and 2.80±1.06) and at the end of 8 weeks (3.27±1.41 and 3.27±1.14),a statistically significant difference was noted. However, the percentage change was positive (7.69% and 16.67%) in both groups.Conclusion: Both LDD gel systems were equally beneficial and showed a noteworthy reduction in the clinical parametersrecorded when used as an adjunct to SRP in the treatment of CP.
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Background: Greatest risk of acute diarrhea outbreaks occurs in over-populated communities & refugee settings characterized by poor sanitation, unsafe drinking-water and increased person to person transmission. Because the incubation period is very short, number of cases can rise extremely quickly and it calls for a prompt and thorough investigation. There were reports of cases of acute diarrhoea and based on the preliminary field work, the existence of an outbreak was confirmed. Hence it was decided to investigate the outbreak with objectives to determine the causes and source of acute diarrhoea outbreak at Narasapura village in Kolar and to suggest control measures.Methods: The cross sectional study was conducted in Narasapura village of Kolar which is a fast growing industrial area. All the households and migratory settlements of the affected area were included. Attack rates of the disease were computed, epidemic curve drawn and the results were analyzed to draw conclusions. Control measures were applied simultaneously.Results: The diarrhoea attack rate at AD colony was 10%. Males (65%) were more affected compared to females (35%). 15.4% stool samples were positive for Vibrio cholera and 18% of the water samples was found to be non-portable. Vibrio cholerae O1 biotype El Tor serotype Ogawa strain was implicated as the cause for present outbreak.Conclusions: Cholera continues to be a public health problem in migratory settings, causing disease outbreaks. Environmental risk factors and lack of awareness are the contributory factors which need to be addressed.
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Objective: The current work is intended towards the development of a novel, simple and precise high-performance thin layer chromatographic (HPTLC) method coupled with a densitometer for the estimation of teriflunomide (TEF) present in the marketed formulation. Methods: The chromatographic development was performed on aluminum plates coated with silica gel 60 F254 using toluene: ethyl acetate: glacial acetic acid (7.5:2: 0.5 v/v/v) as the mobile phase. Densitometric scanning was achieved at the absorbance maxima, UV 284 nm. Results: Well separated band was observed with Rf value 0.46. The calibration curve plotted in the concentration range 100-700ng/band exhibited an excellent linear relationship with the r2 value of 0.9928. The method was found to comply with all the validation parameters as per the ICH guidelines. Conclusion: The method ensures minimal use of mobile phase with minimal run time compared to other reported analytical methods. This validated method can be used by quality control laboratories for the routine quantitative analysis of tablets consisting of Teriflunomide.
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Aim:The purpose of this study was to comparatively evaluate the validity of Golden Proportion, Recurring Esthetic Dental (RED) proportion and Golden Percentage in maxillary anterior teeth in population of Himachal Pradesh.Methods and Materials:Dentulous stone casts of maxillary arch were made of the subjects who met the inclusion criteria. Conditions for inclusion criteria included that the individuals:1) should be of Himachaliorigin with agreeable smiles 2) have well aligned anterior dentition 3) should be between age group of 20-40 years Total of 200 students representing Himachal Pradesh population were included. Measurements were done for the spaces in the grids using the digital caliper. Results:1)The Golden Proportion ratio of 1.3 and 1.4 were more commonly observed in 27.5% and 40% respectively than 1.618 which was observed in 5.5% under study of the population. 2)A Paired sample t-test showed there was no significant gender based difference in Lateral/Central incisor Red Proportion.(P-value>0.05) except for the Canine/Lateral Red Proportion. (P-value<0.05). 3)The Golden Percentage for males in central and lateral incisors and canine was 22.48%, 15.96% and 11.08% respectively. The mean value for females in central and lateral incisors and canine was 22.72%, 16.25% and 10.97% respectively. Conclusions:Golden percentage could be used for aesthetic correction and was found to be more applicable in the population included in this study. Golden percentage could be used for aesthetic correction and are more applicable to natural dentition in the population of Himachal Pradesh.
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Purpose: The purpose of the study was to evaluate the effect of titanium dioxide and zirconia nanoparticles on transverse strength of heat cure PMMA resin routinely used for complete denture fabrication.Methods: One hundred samples of PMMA resin were made and divided into five groups (20 samples for each group). The test specimens were divided into five groups depending on the concentration of reinforcing nanoparticles as Group 1,2,3,4 and 5; Group 1: PMMA unreinforced (control group), Group 2: PMMA reinforced with 2.5% nanozirconia, Group 3: PMMA reinforced with 5% nanozirconia, Group 4: PMMA reinforced with 2.5% titanium dioxide nanoparticles, and Original ResearchArticle Group 5: PMMA reinforced with 5% titanium dioxide nanoparticles. Universal testing machine was used to conduct a three-point bending test and evaluate the transverse strength of samples. Comparison of mean transverse strength for various groups was carried out by employing one‑way analysis of variance and Bonferroni post hoc tests.Results:The highest and lowest mean transverse strength were observed in Group 3 and 1, respectively. Bonferroni post hoc test showed increase in transverse strength after reinforcement to be statistically significant between all the groups (P = .05) except between the samples of group G1 and G5 and G2 and G3.Conclusion: Addition of nanoparticles in all concentrations significantly increased transverse strength of heat cure PMMA resin as compared to control group. The best result was obtained after adding 5% of nanozirconia particles to the conventional heat polymerized acrylic resin
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Background: Ongoing study is an effort to find out, do timelyintervention & to treat patients of DVT in patients undergoinglower limb arthroplasty as the complication could be disastrous.Material & Method: This prospective study was carried out inthe department of Orthopedics & center of joint replacement inAnanta Institute of Medical sciences from Sept 2016 to Aug2017 with assistance from department of Radiodiagnosis. Totalof 40 patients were included in the study who have undergonetotal or hemi replacement. On the day of admission duplexultrasound scanning with color Doppler was done & repeatedafter the desired procedure. Pre & post-surgery scan werecompared & outcome of the comparison was evaluated.Conclusion: In our study very few patient developed DVT &none had pulmonary embolism & other serious adverse effectof DVT. Although no serious complication happened but it hasa potential of producing life threatening complication so all theprecious life specially elder, have to be closely monitored& necessary action i.e. prior color Doppler, anticoagulation,immediate post-surgery physiotherapy, DVT pump, should betaken before & after major lower limb orthopedic procedure.
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This study investigated the color stability of reline resin after two methods of disinfection i.e microwave disinfection and chemical disinfection. A stainless steel moldwith a breakaway compartment (10 mm in diameter by 0.7 mm thickness) was made to fabricate specimens of various resins. Each material was mixed according to manufacturer’s instructions and applied into the mold. Prior to color stability testing, specimenswere cleaned in distilled water for 20 minutes to kill any microorganisms that may had contaminated the discs during fabrication. And then specimens were immersed in Sodium Perborate Monohydrate 200 ml of solution for 15 days and microwaved for 15 days sothat it is comparable to chemical disinfection soaking. The color stability of each specimen was measured again using spectrophotometer and values were obtained. The data of ∆E, ∆L, ∆b, ∆a were analysed by 2 way repeated measures ANOVAs test. Significant statistic changes in color parameters ∆L, ∆a, ∆b of the reline resin DPI, Ufi Gel Hard And Kooliner were observed when dentures were disinfected by Sodium Perborate Monohydrate 2% solutions. The color stability of the reline resin was influenced by time, regardless of disinfection or non disinfection. This can be attributed to bleaching (whitening) effect of reline material. Discoloration Original Research Article of resin based materials may be caused by intrinsic or extrinsic factors. Intrinsic factors are related to internal alterations in material resulting from physicochemical reactions or residual monomer oxidation with time. Thus the initiator, quantity and type of monomer and the polymerisation efficiency can affect the color stability of resin based materials. The color stability deviation value ∆E significantly increased to maximum for chemical disinfectant, least for Control group and intermediate for microwaved group. Ufi Gel showed the highest deviation ∆E and Control Group showed the lowest deviation according to results
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Introduction: Intraoperative trans-esophageal echocardiography (TEE) has been found to underestimate severity of aortic stenosis (AS) compared to trans-thoracic echo (TTE). We conducted a prospective study comparing pre induction TTE and intra operative TEE grading of AS in patients posted for aortic valve replacement surgeries. Methods: Sixty patients with isolated AS who were undergoing aortic valve replacement were enrolled in our study. Baseline TTE was done and after induction of anesthesia, TEE was done. Mean gradient across aortic valve, peak jet velocity, aortic valve area (AVA) by continuity equation and dimensionless index (DI) were assessed in both. Results: Mean gradient decreased from 56.4 in TTE to 39.8 mm Hg in TEE leading to underestimation of AS in 74.5% of patients (P < 0.0). Mean of peak jet velocity also decreased from 500 in TTE to 386cm/s in TEE (P < 0.01). In 76 % of patients this led to reduction of AS grade from severe to moderate. Mean AVA was 0.67 cm2 in TTE and 0.69 cm2 in TEE. Though there was 0.02 cm2 increase, it was not statistically significant (P = 0.07). All the patients remained as severe AS in TEE. DI mean was 0.19 in both TTE and TEE (P = 0.14).It led to underestimation of severity in 6% of patients in TEE. Conclusion: Our study shows that AVA measurement by continuity equation and DI are reliable in grading aortic stenosis while performing intraoperative TEE. Mean gradient and jet velocity can be significantly reduced.
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Context: Cardiac anesthesiologists play a key role during the conduct of cardiopulmonary bypass (CPB). There are variations in the practice of CPB among extracorporeal technologists in India. Aims: The aim of this survey is to gather information on variations during the conduct of CPB in India. Settings and Design: This was an online conducted survey by Indian College of Cardiac Anaesthesia, which is the research and academic wing of the Indian Association of Cardiovascular Thoracic Anaesthesiologists. Subjects and Methods: Senior consultants heading cardiac anesthesia departments in both teaching and nonteaching centers (performing at least 15 cases a month) were contacted using an online questionnaire fielded using SurveyMonkey™ software. There were 33 questions focusing on institute information, perfusion practices, blood conservation on CPB; monitoring and anesthesia practices. Results: The response rate was 74.2% (187/252). Fifty-one (26%) centers were teaching centers; 18% centers performed more than 1000 cases annually. Crystalloid solution was the most common priming solution used. Twenty-three percent centers used corticosteroids routinely; methylprednisone was the most commonly used agent. The cardioplegia solution used by most responders was the one available commercially containing high potassium St. Thomas solution (55%), followed by Del Nido cardioplegia (33%). Majority of the responders used nasopharyngeal site to monitor intraoperative patient temperature. Antifibrinolytics were commonly used only in patients who were at high risk for bleeding by 51% of responders, while yet, another 39% used them routinely, and 11% never did. About 59% of the centers insist on only fresh blood (<7 days old) when blood transfusion was indicated. The facility to use vaporizer on CPB was available in 62% of the centers. All the teaching centers or high volume centers in India had access to transesophageal echocardiography probe and echo machine, with 51% using them routinely and 38% using them at least sometimes. Conclusions: There is a wide heterogeneity in CPB management protocols among various Indian cardiac surgery centers. The survey suggests that adherence to evidence-based and internationally accepted practices appears to be more prevalent in centers that have ongoing teaching programs and/or have high volumes, strengthening the need to devise guidelines by appropriate body to help bring in uniformity in CPB management to ensure patient safety and high quality of clinical care for best outcomes.
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The presence of dynamic left ventricular outflow tract obstruction (LVOTO) can complicate the postoperative course of patients undergoing surgical aortic valve replacement (AVR). The phenomenon of LVOTO is a consequence of an interplay of various pathoanatomic mechanisms. The prevailing cardiovascular milieu dictates the hemodynamic significance of the resultant LVOTO in addition to the anatomical risk factors. A thorough understanding of the predisposing factors, mechanism, and hemodynamic sequel of the obstruction is pivotal in managing these cases. A comprehensive echocardiographic examination aids in risk prediction, diagnosis, severity characterization, and follow-up of management efficacy in the setting of postoperative LVOTO. The armamentarium of management modalities includes conservative (medical) and surgical options. A stepwise approach should be formulated based on the physiological and anatomical substrates predisposing to LVOTO. The index phenomenon occurs more frequently than appreciated and should be considered when the post-AVR patients exhibit hemodynamic instability unresponsive to conventional supportive measures. The present article provides an overview of various peculiarities of this under-recognized phenomenon in the context of the perioperative management of patients undergoing AVR.