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Purpose: Glaucoma is the second leading cause of blindness worldwide, affecting more than 64 million people aged 40–80. The best way to manage primary open?angle glaucoma (POAG) is by lowering the intraocular pressure (IOP). Netarsudil is a Rho kinase inhibitor, the only class of antiglaucoma medications that reorganizes the extracellular matrix to improve the aqueous outflow through the trabecular pathway. Methods: An open?label, real?world, multicentric, observation?based 3?month study was performed for assessing the safety and ocular hypotensive efficacy of netarsudil ophthalmic solution (0.02% w/v) in patients with elevated IOP. Patients were given netarsudil ophthalmic solution (0.02% w/v) as a first?line therapy. Diurnal IOP measurements, best?corrected visual acuity, and adverse event assessments were recorded at each of the five visits (Day?1: screening day and first dosing day; subsequent observations were taken at 2 weeks, 4 weeks, 6 weeks, and 3 months). Results: Four hundred and sixty?nine patients from 39 centers throughout India completed the study. The mean IOP at baseline of the affected eyes was 24.84 ± 6.39 mmHg (mean ± standard deviation). After the first dose, the IOP was measured after 2, 4, and 6 weeks, with the final measurement taken at 3 months. The percentage reduction in IOP in glaucoma patients after 3 months of once?daily netarsudil 0.02% w/v solution use was 33.34%. The adverse effects experienced by patients were not severe in the majority of cases. Some adverse effects observed were redness, irritation, itching, and others, but only a small number of patients experienced severe reactions, as reported in a decreasing order: redness > irritation > watering > itching > stinging > blurring. Conclusion: We found that netarsudil 0.02% w/v solution monotherapy when used as the first?line treatment in primary open?angle glaucoma and ocular hypertension was both safe and effective.
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Objective: To assess the feasibility of measurement of retinal arteriovenous (AV) ratio using a smartphone, we performed a comparative evaluation with fundus camera imaging and coronary SYNTAX score. Method: Successive coronary artery disease (CAD) patients who underwent coronary angiography were recruited for smartphone retinal imaging. Following pupillary dilatation, fundus camera images and smartphone photography were performed. Video images were captured with a smartphone, edited and analysed. Retinal artery and vein size at 0.5 and 1 disc diameter (DD) were measured using DICOM software by two independent observers. Another observer calculated SYNTAX score. Results: Analysable smartphone images were available in 91 (89.2%) of 102 patients. Tobacco use was found in 26%, hypertension in 54%, diabetes in 55%, and high LDL cholesterol in 50%. Median and 25e75 interquartile range (IQR) AV ratio at 0.5 and 1.0 DD, respectively, with smartphone were 0.48 (0.45e0.52) and 0.47 (0.45e0.52) and fundus camera were 0.48 (0.44e0.53) and 0.48 (0.45e0.53) (Spearman's correlation 0.80 and 0.79, p < 0.001). Coronary single vessel disease was in 21%, double vessel in 16%, triple vessel in 55%, normal angiogram in 8%, and median SYNTAX score was 18.0 (8.0e25.0). There was an inverse correlation of SYNTAX score with smartphone-derived AV ratio at 0.5 and 1.0 DD (rho _x0001_0.27,p ¼ 0.007 and _x0001_0.26,p ¼ 0.009) as well as with fundus camera (rho _x0001_0.37 and _x0001_0.38, p < 0.001). Trend-analysis showed an inverse association of smartphone AV ratio with increasing CAD (ptrend <0.001). Conclusions: Smartphone-based retinal AV imaging is feasible and comparable to fundus-camera imaging. There is a significant inverse correlation with coronary angiographic severity
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Secondary prevention in coronary heart disease is the prevention of occurrence of recurrent coronary events after clinical diagnosis. High level of adherence to secondary prevention interventions, especially aggressive lifestyle changes and pharmacotherapy can lead to significant decline in recurrent coronary events. Both international and Indian studies have reported low adherence to such therapies. Evidencebased useful interventions include regular physical activity, yoga, intake of healthy diet, smoking and tobacco use cessation and weight management. Pharmacotherapeutic interventions useful are antiplatelet therapy, target oriented lipid lowering therapy with statins, beta blockers and angiotensin converting enzyme inhibitors in patients with impaired left ventricular function. Hypertension and diabetes management with control to targets is important. Novel strategies include use of anticoagulants, anti-inflammatory drugs, and triglyceride lowering for residual risk. Physician and patient level interventions using multifaceted educational, socioeconomic and technological innovations are important to promote life-long adherence to these strategies
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Background & aims: Premature coronary artery disease (CAD) is endemic in India. We performed a study to identify risk factors, clinical presentation, angiographic findings and interventions in premature CAD. Methods: Successive patients who underwent percutaneous intervention (PCI) were enrolled from January 2018 to June 2021. Premature CAD was defined as women 45-59 y and men 40-54 y and very premature as women <45 y and men <40 y. Descriptive statistics are presented. Univariate odds ratio (OR) and 95% confidence intervals (95%CI) were calculated to identify differences in various groups. Results: 4672 patients (women 936, men 3736) were enrolled. Premature CAD was in 1238 (26.5%; women 31.9%; men 25.1%) and very premature in 212 (4.5%; women 6.5%, men 4.0%). In premature and very premature vs non-premature CAD, OR (95%CI) for high cholesterol _x0001_200 mg/dl [women 1.52(1.03 e2.25) and 1.59(0.79e3.20); men 1.73(1.38e2.17) and 1.92(1.22e3.03)], non-HDL cholesterol _x0001_130 mg/dl [women 1.84(1.35e2.52) and 1.32(0.72e2.42); men 1.69(1.43e1.90) and 1.67(1.17e2.34)], LDL cholesterol [men 1.10(0.95e1.25) and 1.04(0.77e1.41)], and tobacco [women 1.40(0.84e2.35) and 2.14(0.95e4.82); men 1.63(1.34e1.98) and 1.27(0.81e1.97)] were higher while hypertension, diabetes and chronic kidney disease were more in non-premature(p < 0.05). Presentation as STEMI was marginally more in women with premature [1.13(0.85e1.51)] and very premature [1.29(0.75e2.22)] CAD and was significantly higher in men [1.35(1.16e1.56) and 1.79(1.29e2.49)]. Location and extent of CAD were not different. Conclusions: In India, a third of CAD patients presenting for coronary intervention have premature disease. Important risk factors are high total and non-HDL cholesterol and tobacco (men) with greater presentation as STEMI. Extent and type of CAD are similar to non-premature CAD indicating severe disease.
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The diagnosis of congenital pseudarthrosis of the tibia (CPT) in pediatric age group is difficult (1), particularly if the patient had repeated trauma and was mismanaged.[2,3] The etiology of congenital pseudarthrosis is unknown. Mostly patient presents with neurofibromatosis.[4] Most of cases have defect on anterolateral angulation. Most effective treatment option for CPT is surgery. Surgical methods like Ilizarov technique, intramedullary fixation, and grafting [5] with combination of two or three types surgeries. However, Ilizarov ring fixation is the most effective treatment option. Every surgery should include correction of deformity, bone remodeling, limb lengthening, and complete removal of the lesion. Many patients developed deformity and degenerative arthritis of knee and ankle joints. Unfortunately, operation can’t differ according to the nature of disease history and pathology.[1] As such cases should undergo Ilizarov ring fixation. Most common complication was refracture. Therefore, an effective, safe and practical treatment method that minimizes the residual challenges after healing and accomplishes the multiple goals of treatment is needed.
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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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Purpose: The purpose of the study was tocompare measurements of maxillary occlusal cant obtained through facebow transfer and through lateral cephalogram.Method:40 subjects were included in this study according to inclusion and exclusion criteria and divided into two groups: dentulous and edentulous. For edentulous subjects, all the steps of complete denture fabrication were carried out and finished dentures weredelivered. Alginate impressions were now made for all the subjects (with complete denture worn in edentulous cases) for both upper and lower arches. The study was conducted in two parts. Facebow transfer was done next and casts were mounted. In first partof the study, sagittal inclination was measured after facebow transfer. After mounting of the casts, four points were marked to measure the inclination of the occlusal plane. In second part, cephalometric evaluation of occlusal plane and Frankfurt horizontal plane was carried out. Angle between Frankfurt horizontal plane and the occlusal plane was maxillary occlusal cant. which was evaluated by tracing.Paired t test was used to compare mean facebow values and lateral ceph values in edentulous subjects. Intergroup comparison between lateral ceph and mean facebow values between dentulous and edentulous subjects was evaluated using independent t test.Results:Facebow measurements gave comparatively higher values in both dentulous and edentulous patients and are subjected to less variation as compared to the lateral cephalogram values p<0.0001.Conclusion:The occlusal plane angle of lateral cephalogram was found to be significantly different from angle obtained through facebow transfe
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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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Objectives We evaluated trends in hypertension prevalence, awareness, treatment and control in an Indian urban population over 25 years. Trends were projected to year 2030 to determine attainment of World Health Organization (WHO) Global Monitoring Framework targets. Methods Adult participants (n = 7440, men 4237, women 3203) enrolled in successive population based studies in Jaipur, India from years 1991 to 2015 were evaluated for hypertension prevalence, awareness, treatment and control. The studies were performed in years 1991–93 (n = 2212), 1999–01 (n = 1123), 2003–04 (n = 458), 2006–07 (n = 1127), 2009–10 (n = 739) and 2012–15 (n = 1781). Descriptive statistics are reported. We used logarithmic forecasting to year 2030 and compared outcomes to WHO target of 25% lower prevalence and >50% control. Results The age-adjusted hypertension prevalence (%) among adults in successive studies increased from 29.5, 30.2, 36.5, 42.1, 34.4 to 36.1 (R2 = 0.41). Increasing trends were observed for hypertension awareness (13, 44, 49, 44, 49, 56; R2 = 0.63); treatment in all (9, 22, 38, 34, 41, 36; R2 = 0.68) and aware hypertensives (61, 66, 77, 79, 70, 64; R2 = 0.46); and control in all (2, 14, 13, 18, 21, 21; R2 = 0.82), aware (12, 33, 27, 46, 37, 37; R2 = 0.54) and treated (9, 20, 21, 48, 36, 49; R2 = 0.80) hypertensive participants. Projections to year 2030 show increases in prevalence to 44% (95% CI 43–45), awareness to 82% (81–83), treatment to 62% (61–63), and control to 36% (35–37). Conclusion Hypertension prevalence, awareness, treatment and control rates are increasing among urban populations in India. Better awareness is associated with greater control. The rates of increase are off-target for WHO Global Monitoring Framework and UN Sustainable Development Goals.
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Non-communicable diseases are important causes of mortality and morbidity in India. Data from the Registrar General of India, World Health Organization and Global Burden of Disease (GBD) Study have reported that cardiovascular diseases (CVD) are the most important causes of death and disability. Age-adjusted mortality from these conditions has increased by 31% in last 25 years. Case-control studies have reported that hypertension is most important risk factor for CVD in India. GBD Study has estimated that hypertension led to 1.6 million deaths and 33.9 million disability-adjusted life years in 2015 and is most important cause of disease burden in India. Intensive public health effort is required to increase its awareness, treatment and control. UN Sustainable Development Goals highlight the importance of high rates of hypertension control for achieving target of 1/3 reduction in non-communicable disease mortality by 2030. It is estimated that better hypertension control can prevent 400–500,000 premature deaths in India.
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Primary congenital glaucoma usually presents as enlarged and hazy cornea at birth or early childhood. The diagnosis is based on a thorough clinical examination under anesthesia. Most cases require surgical intervention as the definitive treatment. In very rare instances, primary congenital glaucoma may arrest and resolve spontaneously. We describe a case of spontaneously arrested and resolved primary congenital glaucoma in a 37‑year‑old male presenting with large cornea, Haab’s striae, and normal intraocular pressure in one eye. Such a case has not been previously described from the Indian subcontinent.
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As the economy matures, it is important for the government to ensure that growth becomes more inclusive. An inclusive financial system facilitates efficient allocation of productive resources and thus can potentially reduce the cost of capital. In addition, use of proper financial services can significantly improve the day to-day management of finances. Financial inclusion ensures delivery of banking services and credit at affordable cost to the various sections of disadvantaged and low income groups.The paper primarily looked to find out the extent and spread of financial inclusion in India. Since the study is based on macro level parameters such as number of bank branches and number of Automated Teller Machines (ATMs) and availing of banking services by Indians, the secondary data readily available from database of Reserve Bank of India (RBI), National Sample Survey Organization (NSSO),World Bank & other establishments of Indian government were used.We noted that financial exclusion in terms of access to credit from formal institutions is high for small and marginal farmers and some social groups. Driving away rural and urban poverty in India can help in achieving inclusive growth. Financial institutions and government together can bring the most awaited change of almost 100% inclusion.
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Background & objectives: It was hypothesized that both thrombogenic and atherogenic factors may be responsible for premature coronary heart disease (CHD) in young Indians. A case-control study was performed to determine cardiovascular risk factors in young patients with CHD in India. Methods: Successive consenting patients <55 yr with an acute coronary event or recent diagnosis of CHD were enrolled (cases, n=165). Age- and gender-matched subjects with no clinical evidence of CHD were recruited as controls (n=199). Demographic, anthropometric, clinical, haematological, and biochemical data were obtained in both groups. Univariate and multivariate logistic regression were performed to identify important risk factors. Results: In cases vs. controls mean systolic BP, diastolic BP, platelet counts, LDL cholesterol, non-HDL cholesterol, triglycerides, and fibrinogen were higher and HDL cholesterol lower (P<0.001). The presence of current smoking, low fruit and vegetables intake, high fat intake, hypertension, diabetes, low HDL cholesterol, and high LDL cholesterol, total:HDL ratio, fibrinogen and homocysteine was significantly higher in cases (P<0.05). Multivariate logistic regression analysis (age adjusted odds ratio, 95% confidence intervals) revealed that smoking (19.41, 6.82-55.25), high fat intake (1.66, 1.08-2.56), low fruit and vegetables intake (1.99, 1.11-3.59), hypertension (8.95, 5.42-14.79), high LDL cholesterol [2.49 (1.62-3.84)], low HDL cholesterol (10.32, 6.30-16.91), high triglycerides (3.62, 2.35-5.59) high total:HDL cholesterol (3.87, 2.35-5.59), high fibrinogen (2.87, 1.81-4.55) and high homocysteine (10.54, 3.11-35.78) were significant. Interpretation & conclusions: Our results showed that thrombotic (smoking, low fruit/vegetables intake, fibrinogen, homocysteine) as well as atherosclerotic (hypertension, high fat diet, dyslipidaemia) risk factors were important in premature CHD. Multipronged prevention strategies are needed in young Indian subjects.