Lessons from the Pandemic and Healthcare Service Delivery for the Senior Citizens

Background : The healthcare delivery system is an important indicator of the quality of life in a society. The advent of the Corona Virus pandemic led to an unfortunate and unforeseen disruption in the healthcare services Globally. The older persons were impacted on multiple counts including limitations in healthcare service availability, access and social marginalization. As we gain more insight into the full impact of the Pandemic on the health quality indicators and look to resume Medical service delivery in Postpandemic times, it’s important to ensure that the older population is not neglected. Discussions : Small transitions in the delivery models but larger modifications in the mind-set may be needed to provide continued, effective and seamless healthcare services to the older Indian population. Planned interventions at each level of the system can ensure a smooth transition into the modified systems. Integration of modern telecommunication technology into the medical practice and extensive research in the area can make telemedicine a more accessible and acceptable option to the elderly patients with chronic ailments. The full extent of the impact of the Pandemic on healthcare will be revealed in the coming times requiring constant adaptation of each element of the system to cope with it.

Efficacy Of Low Dose Doxycycline In The Treatment Of Periodontal Disease - A Systematic Review

Background:Periodontal instrumentation is accessible to a certain limit, as subgingival calculus is difficult to remove completely in cases of deep pockets and furcation defects. Host modulating agents aim to inhibit arachidonic acid pathways, modulate MMPs, bone remodeling, and regulate immune and inflammatory responses. This systematic review aimsto find the effects of Low Dose Doxycycline (LDD) as local drug delivery systems and sub-antimicrobial dose doxycycline for the treatment of periodontal disease.Material And Methods:Electronic database searched were: Pubmed, Medline, Scopous and Ebsco was performed using MeSH terms: low dose doxycycline, subantimicrobial dose doxycycline, chemically modified doxycycline, doxycycline, doxycycline hyclate, atridox and periostat. Articles published between years 2008-2019 were reviewed. Result:A Systematic review methodology was followedand database searching was done which yields 422 records. Records from year 2008 –2019 were taken into consideration. After inclusion and exclusion accordingly, A total of 10 studies were systematically reviewed. Non surgical or surgical periodontal therapy is more effective in reducing periodontal disease when low dose doxycycline is used as an adjunct either locally or systematically delivered. Conclusion:Subantimicrobial Dose Doxycycline (SDD) is commonly accepted as a host response modifier and it Subantimicrobial Dose Doxycycline (SDD) which down regulates the activity of MMPs. Also, doxycycline provides long-term post-treatment effects. Based in the inference drawn from this systematic review, non surgical or surgical periodontal therapy is more effective in reducing periodontal disease when low dose doxycycline is used as an adjunct, delivered either locally or systematically.

Barriers To Seeking Dental Treatments

Oral health is one of the important factors in maintaining general well-being of an individual. Both the dental health professional and the patient are responsible for preventing the patient from accessing dental health care advice leading to the subsequent failure of treatment and worsening oral health. This review aims to identify and suggest various methods to resolve the causes that prevents the patient from accessing the dental health facility.

Role Of Periodontal Therapy On Glycemic Control-A Systematic Review

Background:Periodontitis is a term used to describe an inflammatory process ,which is initiated by the plaque biofilm that leads to the loss of periodontal attachment from adjacent alveolar bone and surface of root ultimately results in tooth loss. Although, periodontitis is bacterial infection associated with gram negative anaerobes, in recent years,a two-way correlation has been postulated between periodontitis and diabetes mellitus. It has been found that periodontal diseases may increase the severity in subjects exhibiting diabetes mellitus. Aim:The aim of the present study was role of periodontal therapy on glycemiccontrol-a systematic review. Material And Methods:A Systematic review of clinical trials assessing the relationship between DM and chronic periodontitis. Electronic search based on internet sites (From2009-2019) by MEDLINE,PubMed,Google Scholar and SCOPUSwere used.Result:On basis of this systemic review it can be concluded that non-surgical periodontal therapy is advantageous in clinical parameters and serum HbA1c levels in chronic periodontitis patients suffering from diabetes mellitus. Conclusion:Recent evidence and literature suggests that there exists a strong interconnection between DM and chronic periodontitis.Diabetic patients with periodontal disease have two chronic conditions, of which may affect each other, and require regular professionalevaluations, patient education and consistent educational reinforcement by health care providers both medical and dental.

Effect Of Photodynamic Therapy In The Management Of Periodontal Disease - A Systematic Review

Background:Periodontitis is multifactorial disease which is initiated with plaque formation that will initiate an inflammatory response which can cause destruction of tissues & tooth supporting structure. If left untreated it will cause gingival recession and bone destruction which will lead to tooth mobility. Sometimes it is difficult to eliminate periodontal pathogens completely from deepest areas of periodontal pockets, to overcome these issues photodynamic therapy (PDT) was used as it is local non-invasive treatment modality without any side effects. Aim:The aim of present study was to investigate the effectiveness of Photodynamic Therapy (PDT) as an Adjunct To Scaling & Root Planing in the managementOf Periodontal Disease. Material And Methods:Literature was searched systemically and studies were identified based on the-PICO (Glossary of Evidence Based Terms 2007). Electronic database search of Pubmed, Google scholar, Medline and scopus was performed using (MESH) terms-Photodynamictherapy,periodontitis, microbiological assessment. Articles published between year 2009-2019 were reviewed. Patient treated with SRP alone on one side and other side with SRP+ PDT. Recording of Clinical parameters like PPD,CAL,BOP,PS,GR were done from baseline to 3,6 month. Microbiological and biochemical analysis were also evaluated to check level of RANKL/OPG, IL-1?, TNF-?, Aggregatibacter actenomycetocomitans, Porphyromonas gingivalis, Tanerella forsythia Conclusion::A large evidence suggest that PDT when used along with SRP resulted in significantimprovement in clinical parameters.Significant improvement in biochemical parameters such as IL-1? , Tnf-? , RANKL/OPG were also seen after periodontal therapy along with PDT when compared with SRP alone.

Functional Outcome of Open Latarjet Procedure in NonAthletic Middle-Aged Patie

@#Introduction: The movement and steadiness of the shoulder joint is due to both the dynamic and static stabilisers. Recurrent anterior shoulder instability is common due to the Bankart lesion or the Hill Sachs lesion. The bone loss and soft tissue failure due to these lesions causing instability is well compensated by Latarjet procedure which acts by triple blocking effect of the bone graft, the sling effect of the conjoint tendon of subscapularis and the ligament of the coracoacromial ligament stump. Materials and methods: Middle-aged patients with recurrent anterior shoulder dislocation and a mid-range instability on clinical assessment with an isolated glenoid bone loss of 20% or Bankart lesion with engaging Hill Sachs lesion were selected for the study. The surgical procedure included a subscapularis split to expose the glenoid. The coracoid graft harvested was prefixed with Kirschner wires and placed flush over the glenoid ensuring no medial or lateral overhang and fixed with 4.0mm cancellous screws with the washer. The functional outcome was measured with the ROWE score and ASES score and the movements were evaluated. Results: A total of 24 patients fulfilled the inclusion criteria. Post-operatively at final follow-up, the mean ROWE score was 97.08 ±8.45 and the mean ASES score was 94.4±9.10. One patient had screw breakage as a complication and another had restriction of movement which was managed with physiotherapy. Conclusion: Open Latarjet is an effective procedure for recurrent anterior shoulder instability in non-athletic middleaged patients as a excellent functional outcome was achieved with this technique. We therefore recommend open Latarjet as an alternative to arthroscopic treatment in developing countries where patient affordability and the availability of the resources are the issues.

A Review From Historical To Current-Celastrus Paniculatus

Celastrus paniculatus is commonly known as “Malkangani”, widely distributed in the Maldives, Australia, China, Cambodia, Malaysia, Taiwan, Nepal, Thailand as well as in the Pacific Islands and all over India mainly Maharashtra, Orissa and Andaman and Nicobar group of Islands on an altitude of 1800m. It climbs up to over 10m. The leaves are ovate or elliptic in shape with dentate margin. Seeds are ellipsoid or ovoid, yellowish-brown in color and grow inside the capsules. Celastrus paniculatus (Malkangni) is used in Ayurveda as a nervine tonic, tranquilizer and diuretic and in rheumatism, gout, leprosy and asthma. Different Parts of Celastrus paniculatus after extraction and fractionation give different active constituents such as sesquiterpene esters-malkanguinol, malkangunin, sesquiterpene alkaloids-celapanin, celapanigin, alkaloids-celastrine, paniculatine, fatty acids-oleic acid, palmittic acid, linoleic acid and stearic acid, crystalline substance tetracasanol and sterol. Different pharmacological activities are anti-rheumatic, anti-fungal, nootropic activity, antimalarial activity, anti spermatogenic effect, anti-anxiety and anti-atherosclerotic effect. In the present review, our target is to search, bring together and compile the data of Celastrus paniculatus, which have less side effects and very valuable for the treatment of rheumatism. Related information is procured from various scientific publications using online, seek out engines such as Google scholar, Pubmed and Science Direct. A total of 200 articles was reviewed out of which 55 articles are selected to review for the description of the plant, parts used, chemical constituents, traditional uses and for reported activities.

Comparative Study to Evaluate Efficacy, Safety and Quality of Life of Metoprolol and Telmisartan versus Metoprolol and Ramipril in Patients of Hypertension

Background: Hypertension(HTN) is a major cardiovascular disease and is a major worldwide clinical problem. The prevalence of hypertension increases in urban and rural areas. The treatment of hypertension began in the 1960s with oral diuretics. The other modalities of treatment of hypertension are beta – blockers, calcium-channel blockers, alphareceptors blockers, ACE inhibitors and ARBs. The better compliance occurs with single-pill combination, and may be even double or even triple pill combination therapy should be used. Also quality of life was improved better with Metoprolol and Telmisartan as compared with Metoprolol and Ramipril. Quality of life was assessed by SF -36 Quiestionnare. Objective: To compare the effect of Metoprolol and Telmisartan versus Metoprolol and Ramipril on BP and quality of life in patients of hypertension. Material and Methods: In this prospective, open, randomized, parallel group, comparative study, 80 patients of hypertension attending the Cardiology Outpatient Department, Govt. Medical College & Rajindra Hospital, Patiala were recruited. This randomized comparative study was done on 80 patients for 4 months. Quality of Life: In my project of Quality of life, I had taken total 80 patients and the patients were divided into two groups and 40 patients each of Metoprolol and Ramipril versus Metoprolol and Telmisartan. To assess quality of life questionnaire SF-36 was administered to the patients. Results: There was a marked decrease in SBP and DBP with the use of Metoprolol and Telmisartan than Metoprolol and Ramipril. There was also no change in demographic parameters. There was significant improvement in the quality of life with Metoprolol and Telmisartan. Conclusion: Metoprolol and Telmisartan was a better choice than Metoprolol and Ramipril in treating hypertension as this combination causes more reduction in BP and little effect on HR.

Spectral domain optical coherence tomography evaluation of macular changes in Eales disease

Purpose: The purpose of the study was to describe macular changes in treatment-naïve eyes with Eales disease using spectral domain optical coherence tomography (SD-OCT). Methods: A cross-sectional study was done on 79 eyes of 66 patients with Eales disease. Best-corrected visual acuity (BCVA), slit-lamp biomicroscopy (SLB), indirect ophthalmoscopy, fundus fluorescein angiography (FFA), and quantitative (central macular thickness [CMT]) and qualitative analysis on SD-OCT were performed. Results: Forty-six (58.2%) eyes had macular involvement as assessed with SD-OCT, while in 33 (41.8%) eyes, macula was not affected. Macular edema was the most common feature when macula was affected followed by epiretinal membrane. Mean CMT was higher (315.3 ± 102.3 ?m) in eyes with macular involvement than those without it (243.8 ± 19.3 ?m). Eyes with active vasculitis involving larger vessels and neovascularization had greater chance of macular involvement. SLB and FFA alone missed 28.3% and 50% eyes with macular abnormalities on SD-OCT, respectively. Conclusion: While the clinical description of Eales disease points mainly to a peripheral location, macular involvement can be commonly picked up when SD-OCT is used. Macular involvement when present is associated with a poorer BCVA.

Prevalence of multidrug-resistant tuberculosis among Category II pulmonary tuberculosis patients.

Background & objectives: Multidrug-resistant tuberculosis (MDR-TB) has emerged as a significant global health concern. The most important risk factor for the development of MDR-TB is previous anti-tuberculosis therapy. Category II pulmonary TB includes those patients who had failed previous TB treatment, relapsed after treatment, or defaulted during previous treatment. We carried out this study to ascertain the prevalence of MDR-TB among category II pulmonary TB patients. Methods: This was a cross-sectional, descriptive study involving category II pulmonary TB patients diagnosed between 2005 and 2008. All sputum-positive category II TB cases were subjected to mycobacterial culture and drug-susceptibility testing (DST). MDR-TB was defined as TB caused by bacilli showing resistance to at least isoniazid and rifampicin. Results: A total of 196 cases of sputum-positive category II pulmonary tuberculosis patients were included. Of these, 40 patients (20.4%) had MDR-TB. The mean age of MDR-TB patients was 33.25 ± 12.04 yr; 9 patients (22.5%) were female. Thirty six patients showed resistance to rifampicin and isoniazid; while 4 patients showed resistance to rifampicin, isoniazid and streptomycin. The prevalence of MDR-TB among category-II pulmonary tuberculosis patients was 20.4 per cent. Interpretation & conclusions : The prevalence of MDR-TB in category II TB patients was significant. However, nation-wide and State-wide representative data on prevalence of MDR-TB are lacking. We stress the importance of continuous monitoring of drug resistance trends, in order to assess the efficacy of current interventions and their impact on the TB epidemic.

Prevalence of multidrug-resistant tuberculosis among newly diagnosed cases of sputum-positive pulmonary tuberculosis.

Background & objectives: The prevalence of multidrug-resistant tuberculosis (MDR-TB) is increasing throughout the world. Although previous treatment for TB is the most important risk factor for development of MDR-TB, treatment-naïve patients are also at risk due to either spontaneous mutations or transmission of drug-resistant strains. We sought to ascertain the prevalence of MDR-TB among new cases of sputum-positive pulmonary TB. Methods: This was a prospective, observational study involving newly diagnosed cases of sputum-positive pulmonary tuberculosis diagnosed between 2008 and 2009 carried out in New Delhi, India. All sputum-positive TB cases were subjected to mycobacterial culture and first-line drug-susceptibility testing (DST). MDR-TB was defined as TB caused by bacilli showing resistance to at least isoniazid and rifampicin. Results: A total of 218 cases of sputum-positive pulmonary tuberculosis were enrolled between 2008 and 2009. Of these, 41 cases had negative mycobacterial cultures and DST was carried out in 177 cases. The mean age of the patients was 27.8 ± 10.2 yr; 59 patients (27%) were female. All patients tested negative for HIV infection. Out of 177 cases, two cases of MDR-TB were detected. Thus, the prevalence of MDR-TB among newly diagnosed pulmonary tuberculosis patients was 1.1 per cent. Interpretation & conclusions: MDR-TB prevalence is low among new cases of sputum-positive pulmonary TB treated at primary care level in Delhi. Nation-wide and State-wide representative data on prevalence of MDR-TB are lacking. Efforts should be directed towards continued surveillance for MDR-TB among newly diagnosed TB cases.

Antioxidant levels in blood and seminal plasma and their impact on sperm parameters in infertile men.

Excess reactive oxygen species (ROS) beyond the scavenging capacity of antioxidants leads to DNA damage and oxidation of lipoprotein components at the cellular and subcellular level. The oxidative stress (OS) adversely affects sperm function by altering membrane fluidity, permeability and impairs sperm functional competence. In the present study, the OS status in seminal plasma and blood serum in infertile men and its relationship with spermatozoa parameters have been investigated. Four groups of infertile men viz., oligozoospermic (n = 15), asthenozoospermic (n = 17), teratozoospermic (n = 19), and oligoasthenoteratozoospermic (n = 9), and healthy fertile controls (n = 40) have been analyzed for superoxide dismutase (SOD), catalase (CAT), glutathione (GSH) and malondialdehyde (MDA) in seminal plasma and blood serum. Significant correlation between blood serum SOD and sperm count has been observed in patients (p = 0.018) and controls (p = 0.021). Similarly, significant correlation between blood serum GSH and sperm progressive motility in patients (p = 0.036) and controls (p = 0.029) is observed. The low seminal MDA is associated with increase in sperm progressive motility in patients (p = 0.039) and controls (p = 0.028). Positive correlation is found between increased seminal MDA levels and abnormal sperm morphology in both patients and controls (r = 0.523, p = 0.029; r = 0.612, p = 0.034 respectively). Correlations between blood SOD and sperm count and between blood GSH levels and progressive motility suggest that these can be important biochemical markers in assaying the sperm count and motility. A negative correlation of motility with seminal MDA indicates that sperm membrane lipid peroxidation affects the fluidity and thus mobility of sperm axoneme. This affects functional competence of the sperm and acts like a biological safeguard. The results of the present study suggest the prospects of using the blood serum and seminal plasma antioxidants as a valuable tool to evaluate the sperm reproductive capacity and functional competence.

High frequency of loss of allelic integrity at Wilms' tumor suppressor gene-1 locus in advanced breast tumors associated with aggressiveness of the tumor.

Background: The product of Wilms' tumor suppressor gene (WT1), a nuclear transcription factor, regulates the expression of the insulin-like growth factor (IGF) and transforming growth factor (TGF) systems, both of which are implicated in breast tumorigenesis and are known to facilitate angiogenesis. In the present study, WT1 allelic integrity was examined by Loss of Heterozygosity (LOH) studies in infiltrating breast carcinoma (n=60), ductal carcinoma in situ (DCIS) (n=10) and benign breast disease (n=5) patients, to determine its possible association with tumor progression. Methods: LOH at the WT1 locus (11p13) as determined by PCR-RFLP for Hinf1 restriction site and was subsequently examined for its association with intratumoral expression of various growth factors i.e. TGF-β1, IGF-II, IGF-1R and angiogenesis (VEGF and Intratumoral micro-vessel density) in breast carcinoma. Results: Six of 22 (27.2%) genetically heterozygous of infiltrating breast carcinoma and 1 of 4 DCIS cases showed loss of one allele at WT1 locus. Histologically, the tumors with LOH at WT1 were Intraductal carcinoma (IDC) and were of grade II and III. There was no correlation in the appearance of LOH at WT1 locus with age, tumor stage, menopausal status, chemotherapy status and lymph node metastasis. The expression of factor IGF-II and its receptor, IGF-1R was significantly higher in carcinoma having LOH at WT1 locus. A positive correlation was observed between the TGF-β1, VEGF expression and IMD scores in infiltrating carcinoma. Conclusions: The current study indicates that the high frequency of loss of allelic integrity at Wilms' tumor suppressor gene-1 locus in high-graded breast tumors is associated with aggressiveness of the tumor.