Economic burden of acute myeloid leukemia on patients in a resource-limited tertiary hospital in the Philippines

ABSTRACT Introduction: The remission induction treatment for acute myeloid leukemia (AML) has remained unchanged in the resource-limited setting in the Philippines. AML treatment consists of induction chemotherapy followed by high dose consolidation chemotherapy or allogeneic hematopoietic stem cell transplantation. In the Philippines, the Filipino household bears the burden of health care cost of hospitalization expenditure. Insights into the treatment costs becomes an essential requirement as these guides the allocation of resources to scheme health programs. Method: This study involved a retrospective cohort analysis of AML patients who underwent treatment for AML. Review of the statements of account per admission per patient during treatment for remission induction, consolidation, relapsed and refractory disease and best supportive care from 2017 to 2019. Of the 251 eligible patients, 190 patients were included. Result: The mean healthcare expenditure for remission induction chemotherapy (Phase 1) was US $2, 504.78 (Php 125,239.29). While 3 to 4 cycles of consolidation chemotherapy cost an average of US $3,222.72 (Php 162,103.20). For patients who had relapsed and refractory disease, an additional mean cost of US $3,163.32 (Php 159,115.28) and US $2, 914.72 (Php 146,610.55) were incurred, respectively. The average cost of palliative care was US $1,687.00 (Php 84,856.59). Conclusion: The cost of chemotherapy and other therapeutics bear most of the weight of the direct healthcare cost. The cost of AML treatment represents a significant economic burden for patients and the institution. The cost increases as patients proceed through subsequent lines of treatment for induction failure. Existing subsidy for health insurance benefits could still be improved for appropriate source allocation of resources.

Posterior segment involvement in systemic lupus erythematosus – A series from South India

Purpose: To report the spectrum of posterior segment manifestations and visual outcomes in a large series of patients with systemic lupus erythematosus (SLE). Methods: Retrospective study at a tertiary referral eye center in south India between 2016 and 2022. Results: Charts of 109 patients diagnosed to have SLE were retrieved from our medical database. Only nine cases of SLE (8.25%) had posterior segment involvement. The male: female ratio was 1:8. The mean age was 28 years. Unilaterality was the most common presentation in eight cases (88.89%). Lupus nephritis was the most common systemic presentation in five cases (55.56%). Antiphospholipid antibodies (APLA) positivity was seen in two cases (22.22%). Ocular manifestations included microangiopathy (cotton wool spots) in one case, occlusive retinal vasculitis with cotton wool spots in four cases (five eyes), optic disc edema with combined venous and arterial occlusion (one case), central retinal vein occlusion with cotton wool spots and hemorrhages (one case), macular edema (four cases), posterior scleritis with optic disc edema and exudative retinal detachment in the posterior pole (one case), and tubercular choroidal granuloma (one case). Treatment included systemic steroids, hydroxychloroquine sulfate (HCQS), and immunosuppression in all cases, blood thinners in two cases, and laser photocoagulation in four cases. HCQS?related retinal toxicity was not seen in any of the 109 cases. Ocular manifestation was the initial presentation of SLE in one case. Visual outcome was poor in three cases. Conclusion: Presence of posterior segment findings in cases with SLE may suggest a severe systemic disease. Early detection and aggressive treatment result in better visual outcomes. Ophthalmologists could play a vital role in guiding systemic therapy.

STABILITY TOLERANCE OF SUNFLOWER OIL -IN-WATER EMULSION EMULSIFIED BY SOYA LECITHIN FOR FOOD GRADE ACIDS

Oil-in-water emulsion has promised values in food, pharmaceutical, drug, cosmetic and allied industries. The stable emulsion with long shelf life increases its utility. Many avouring agents are used to increase shelf life as preservative or commercial value. Food grade acids are used to in the emulsion preparation which enhances the taste or avour. The present study focuses the usage of acetic acid, phosphoric acid and oxalic acid. The emulsions for different acids are prepared ranging concentration from 0.001 to 0.003M using lecithin as emulsier and sunower oil. Experiments were done to study organoleptic properties with respect to basicity and dissociation constant values. The colour of the primary emulsion was creamy white and sustainable for acetic acid emulsion to 28 day at experimental temperature 10, 25 and 40 0C. Oxalic acid is recorded a low pH value 1.88 for 0.003 M emulsion solution in compare with acetic acid (3.63) and phosphoric acid (2.32).The relative conductance measurement for oxalic acid shows a very high value 5.6mS to acetic acid 0.257mS and phosphoric acid 0.247 mS. The rst dissociation constant value 5.6x10-2 of oxalic acid is larger relatively compare to phosphoric acid 7.5 x 10-3 and acetic acid 1.8 x10-5. Basicity of acids increases from acetic acid (mono basic), oxalic acid (dibasic) to phosphoric acid (tri-basic).These results strongly supports that basicity and dissociation constant values of acids conspicuously inuence the stability of the emulsion. Higher value of dissociation constant value and basicity, lower the stability of the emulsion.

COVID-19 Pandemic and the Role of Control Room in the Tertiary Care Hospital

COVID-19 has been labeled a serious public health emergency globally. Due to its high infectivity it has led to an increased burden to the Medical Fraternity as well as the Government. Therefore, the need for preparedness as well as conventional intervention strategies became integral during such health emergencies. To monitor the implementation of proper activities and to manage the patient load with adequate safety of the staff, COVID control rooms were established in the hospital premises. The main objective of the Control Room is risk mitigation, planning strategies, alleviating concerns and addressing issues associated with the health emergency across the hospital and further delegating the information to the higher authorities and the Ministry. Hereby in this review we have tried to summarize the administrative structure, functions and limitations of the 24x7 Control Room established in Tertiary Care Hospital, New Delhi.

The association of hyperglycemia with the development of infectious complications in adult Filipino patients with acute lymphoblastic leukemia

Abstract Introduction Hyperglycemia occurs in Acute Lymphoblastic Leukemia (ALL) due to chemotherapeutic agents and may be stress-induced. Given the potential impact of hyperglycemia on the clinical outcomes of ALL patients, we sought to determine the association of hyperglycemia with the development of infectious complications. Methods This is a retrospective cohort involving adult Filipino ALL patients admitted at a tertiary referral center. Patients were stratified according to blood glucose levels and infections were classified into microbiologically and clinically defined infections. Logistic regression was performed to determine whether hyperglycemia was associated with the development of infectious complications. Results Of the 174 patients admitted for ALL, only 76 patients (44%) underwent blood glucose monitoring and were thus included in this study. Hyperglycemia was observed in 64 patients (84.21%). Infectious complications were seen in 56 patients (73.68%), of whom 37 patients (48.68%) had microbiologically defined infections and 19 (25%) had clinically defined infections. The respiratory tract was the most common site of infection and gram-negative bacteria were the predominant isolates. Hyperglycemia significantly increased the likelihood of infectious complications, particularly at blood glucose levels ≥ 200 mg/dL. Conclusion Hyperglycemia is associated with an increased likelihood of infectious complications in Filipino ALL patients. With sepsis being one of the main causes of mortality in this population, our study provides compelling evidence for us to consider routine blood glucose monitoring in order to manage and potentially decrease the occurrence of infections in these patients.

POST-COVID COMPLICATIONS IN PATIENTS ADMITTED TO A TERTIARY CARE HOSPITAL IN NORTHERN INDIA: A PROSPECTIVE STUDY

Background CORONAVIRUS disease 2019 (COVID-19) is a viral infectious disease caused by the single-stranded, enveloped RNA virus, severe acute respiratory syndrome coronavirus-2 (SARS COV-2). Though Covid-19 is an acute viral infection predominantly affecting the respiratory system, it has short-term, long-term metabolism and endocrine complications. Being a global pandemic with a high rate of recovery, it is expected to have many long-term metabolic complications in a vast number of covid-19 survivors. We aimed to find out the post covid complications in patients discha Objective: rged from SARI ward AIIMS Bathinda, Punjab. Design: Settings: Prospective observational study OPD and telemedicine consultation of the patients admitted to the tertiary hospital Material and Methods: - A prospective study was done on 244 patients with COVID -19 RAT, and RTPCR Positive patients were done. Patients were followed up in OPD and by telemedicine for post covid complications. Main outcome measures: The main outcome measures were measured in terms of mortality as well as morbidity. Morbidity was evaluated in terms of the complications developing after covid or persistence of the complications developed during the covid. All the patients who were admitted Sample size: to our tertiary Centre were followed for post covid complications. Result: - Out of 244 patients that were analyzed, 22% died during the disease, and 78% survived. Out of the patient who survived 64.8% developed post covid complications. 35.8% complained of fatigue, 10.5% developed headache, 8.9% developed body aches, 3.2% had a persistent cough, 1.6% had a sore throat and 1.1% had gastrointestinal symptoms. Conclusion: - In this population-based study large no. of patients suffer from long-term residual effects afterward-CoV-2 infection such as fatigue, cough, headache, dyspnea, and decline in quality of the eye. With a large range majority of people infected all over the world, our findings emphasize the need for timely planning of resources and patient care. Multidisciplinary collaboration is essential to provide integrated outpatient care for the survival of acute COVID-19. Limitation: Small sample size

BRCA1 promoter methylation & its immunohistochemical correlation in sporadic breast cancer

Background & objectives: Studies have shown that apart from hereditary breast carcinomas, breast cancer susceptibility gene 1 (BRCA1) mutations conferring to its loss are seen in sporadic breast carcinomas (SBC) as well. The aim of the present study was to assess BRCA1 methylation in females presenting at King George’s Medical University, Lucknow, with SBC by both immunohistochemistry (IHC) and methylation PCR with respect to hormonal profile and various morphological prognostic parameters. The primary objective was to look for the association between BRCA1 protein expression and DNA promoter methylation. Methods: 81 mastectomy specimens from SBC of invasive breast carcinoma (no special type) were included in this study. After a detailed morphological assessment, formalin fixed paraffin embedded tissue from a representative tumour area was selected for BRCA1 IHC by heat-mediated antigen retrieval under high pH and DNA extraction and further bisulphate treatment. BRCA1 was studied for methylation by methylated and unmethylated PCR-specific primers. Results: BRCA1 promoter methylation was present in 42/81 (51.9%) participants, with significant BRCA1 protein loss (72.7%; P=0.002). A significant association between BRCA1 loss and hormonal profile was found (P=0.001); maximum in triple negative breast carcinoma (TNBC) (72%; 18/25). Most of the TNBC also harboured methylation (68%). Although not significant grade II and III tumours, lymph vascular invasion, ductal carcinoma in situ, and nodal metastasis (?3) were seen in a higher percentage in methylated tumours. Mortality in SBC was significantly associated with BRCA1 loss (30.3%; P=0.024). Interpretation & conclusions: Study results highlight the concept of “BRCAness” in SBC as well. Hence, we can confer that identification of BRCA1 loss in SBC can make it a perfect candidate for poly ADP- ribose polymerase inhibitors or cisplatin-based therapy like hereditary ones.

Quality assurance of malaria rapid diagnostic tests: An aid in malaria elimination

Background & objectives: India targets malaria elimination by 2030 in a phased manner, so malaria’s assured diagnosis is crucial. Introduction of rapid diagnostic kits in India in 2010 has revolutionized malaria surveillance. The storage temperature of rapid diagnostic tests (RDTs), kit components and handling in transportations impact the results of RDTs. Therefore, quality assurance (QA) is required before it reaches end-users. The Indian Council of Medical Research-National Institute of Malaria Research (ICMR-NIMR) has a World Health Organization (WHO) recognized lot-testing laboratory facility to assure the quality of RDTs. Methods: The ICMR-NIMR receives RDTs from different manufacturing companies as well as various agencies such as National and State Programmes and Central Medical Services Society. The WHO standard protocol is followed to conduct all the tests, including long-term and post-dispatch testing. Results: A total of 323 lots tested during January 2014-March 2021 were received from different agencies. Amongst them, 299 lots passed the quality of test and 24 failed. In long-term testing, 179 lots were tested and only nine failed. A total of 7741 RDTs were received from end-users for post-dispatch testing of which 7540 qualified the QA test with a score of 97.4 per cent. Interpretation & conclusions: RDTs received for quality testing showed compliance with QA evaluation of malaria RDTs based on the protocol recommended by the WHO. However, continuous monitoring of the quality of RDTs is required under QA programme. Quality-assured RDTs have a major role, especially in areas where low parasitaemia of parasites persists.

Comparative analysis of craniofacial asymmetry in subjects with and without symptoms of temporomandibular joint disorders: a cross-sectional study

Objectives@#The aim of the study was to quantify and compare craniofacial asymmetry in subjects with and without symptoms of temporomandibular joint disorders (TMDs). @*Materials and Methods@#A total of 126 adult subjects were categorized into two groups (63 with a TMDs and 63 without a TMDs), based on detection of symptoms using the Temporomandibular Joint Disorder-Diagnostic Index (TMD-DI) questionnaire. Posteroanterior cephalograms of each subject were traced manually and 17 linear and angular measurements were analyzed. Craniofacial asymmetry was quantified by calculating the asymmetry index (AI) of bilateral parameters for both groups. @*Results@#Intra- and intergroup comparisons were analyzed using independent t-test and Mann–Whitney U test, respectively, with a P<0.05 considered statistically significant. An AI for each linear and angular bilateral parameter was calculated; higher asymmetry was found in TMD-positive patients compared with TMD-negative patients. An intergroup comparison of AIs found highly significant differences for the parameters of antegonial notch to horizontal plane distance, jugular point to horizontal plane distance, antegonial notch to menton distance, antegonial notch to vertical plane distance, condylion to vertical plane distance, and angle formed by vertical plane, O point and antegonial notch. Significant deviation of the menton distance from the facial midline was also evident. @*Conclusion@#Greater facial asymmetry was seen in the TMD-positive group compared with the TMD-negative group. The mandibular region was characterized by asymmetries of greater magnitude compared with the maxilla. Patients with facial asymmetry often require management of temporomandibular joint (TMJ) pathology to achieve a stable, functional, and esthetic result. Ignoring the TMJ during treatment or failing to provide proper management of the TMJ and performing only orthognathic surgery may result in worsening of TMJ-associated symptoms (jaw dysfunction and pain) and re-occurrence of asymmetry and malocclusion. Assessments of facial asymmetry should take into account TMJ disorders to improve diagnostic accuracy and treatment outcomes.

Ayurvedic Management of Artavakshaya w.s.r. to Polycystic Ovarian Syndrome: A Case Report

Normal menstrual cycle is a crucial physiological phenomenon for maintaining woman’s health during reproductive years. Nowadays, menstrual disarrayed are the main reasons for gynecological consultations worldwide owed to faulty dietary habits and lifestyle. Oligomenorrhea is one among all menstrual disorders with a prevalence of 13.5% in general population and is characterized by irregular, inconsistent menstrual blood flow. In Ayurveda it can be correlated with Artavakshaya due to their strong symptom equality. Prevalence of Artavakshaya is rising in present gynecological practice which may leads to terrifying sequel of infertility. In modern science, only hormonal preparations are used as treatment strategies but only offer short term symptomatic management. Methodology: A female patient of 17 years of age came to OPD of National Institute of Ayurveda, Jaipur, on 29/01/2022 with chief complaints of irregular (delayed) menses with prolonged interval of 4-5 months since last 1 year along with USG findings of Bilateral Polycystic Ovarian Disease with simple Ovarian cyst in left Ovary. In this case study, patient was treated with some oral Ayurvedic preparation for 2 consecutive cycles having Strotoshodhak, Kapha- Vatashamak, and Vataanulomaka properties. Result: Patient had her menstruation regularly with normal duration during and after treatment.

A Study On Consumer Behavior While Selecting A Hotel For Meal In Nashik City

This article reviews the hospitality industry. The study is focused on influencing factors on consumer buying behaviour while selecting a hotel for dinner/lunch purposes. This paper aims to study consumer decision-making processes or thought processes while choosing any hotel for the meal. Different parameters like hotel services influence the choice of hotel selection, received information, personal preferences, etc. This study concentrated on all things consumer is concerned about and why. The cluster is made based on the likability of the customer, interest of customer which includes (Hospitality, Service, Hygiene, Quality, and Ambience, Experiences of other Customers, Infrastructure, and Hotel Location etc.) why and how people select any hotel that gives an idea about the attitude of the customer and his behaviour. Consumer behaviour changes concerning needs and priorities in the selection of hotels. Therefore it is an attempt to understand consumer buying behaviour and factors influencing choice/selection of hotels by consumers in Nashik city.

Diagnosis, Treatment and Prevention of Nutritional Anemia in Children: Recommendations of the Joint Committee of Pediatric HematologyOncology Chapter and Pediatric and Adolescent Nutrition Society of the Indian Academy of Pediatrics

Justification: Anemia in children is a significant public health problem in our country. Comprehensive National Nutrition Survey 2016-18 provides evidence that more than 50% of childhood anemia is due to an underlying nutritional deficiency. The National Family Health Survey-5 has reported an increase in the prevalence of anemia in the under-five age group from 59% to 67.1% over the last 5 years. Clearly, the existing public health programs to decrease the prevalence of anemia have not shown the desired results. Hence, there is a need to develop nationally acceptable guidelines for the diagnosis, treatment and prevention of nutritional anemia. Objective: To review the available literature and collate evidence-based observations to formulate guidelines for diagnosis, treatment and prevention of nutritional anemia in children. Process: These guidelines have been developed by the experts from the Pediatric Hematology-Oncology Chapter and the Pediatric and Adolescent Nutrition (PAN) Society of the Indian Academy of Pediatrics (IAP). Key areas were identified as: epidemiology, nomenclature and definitions, etiology and diagnosis of iron deficiency anemia (IDA), treatment of IDA, etiology and diagnosis of vitamin B12 and/or folic acid deficiency, treatment of vitamin B12 and/or folic acid deficiency anemia and prevention of nutritional anemia. Each of these key areas were reviewed by at least 2 to 3 experts. Four virtual meetings were held in November, 2021 and all the key issues were deliberated upon. Based on review and inputs received during meetings, draft recommendations were prepared. After this, a writing group was constituted which prepared the draft guidelines. The draft was circulated and approved by all the expert group members. Recommendations: We recommend use of World Health Organization (WHO) cut-off hemoglobin levels to define anemia in children and adolescents. Most cases suspected to have IDA can be started on treatment based on a compatible history, physical examination and hemogram report. Serum ferritin assay is recommended for the confirmation of the diagnosis of IDA. Most cases of IDA can be managed with oral iron therapy using 2-3 mg/kg elemental iron daily. The presence of macro-ovalocytes and hypersegmented neutrophils, along with an elevated mean corpuscular volume (MCV), should raise the suspicion of underlying vitamin B12 (cobalamin) or folic acid deficiency. Estimation of serum vitamin B12 and folate level are advisable in children with macrocytic anemia prior to starting treatment. When serum vitamin B12 and folate levels are unavailable, patients should be treated using both drugs. Vitamin B12 should preferably be started 10-14 days ahead of oral folic acid to avoid precipitating neurological symptoms. Children with macrocytic anemia in whom a quick response to treatment is required, such as those with pancytopenia, severe anemia, developmental delay and infantile tremor syndrome, should be managed using parenteral vitamin B12. Children with vitamin B12 deficiency having mild or moderate anemia may be managed using oral vitamin B12 preparations. After completing therapy for nutritional anemia, all infants and children should be advised to continue prophylactic iron-folic acid (IFA) supplementation as prescribed under Anemia Mukt Bharat guidelines. For prevention of anemia, in addition to age-appropriate IFA prophylaxis, routine screening of infants for anemia at 9 months during immunization visit is recommended.

The hematologic profile of Filipino HIV-infected individuals and its association with CD4 counts

ABSTRACT Introduction: Hematologic abnormalities are common in HIV and involve all blood cell lineages. A study on cytopenias, as correlated with disease progression, can be valuable in resource-limited settings. This study aimed to determine the hematologic profile of HIV patients and its association with CD4 count and antiretroviral (ARV) treatment. Methods: This is a retrospective cohort study involving adult Filipino HIV patients with complete blood count (CBC) and CD4 count determinations prior to the initiation of ARV treatment and after ≥6 months of ARV treatment. Logistic regression was performed to determine the association between cytopenias and a CD4 count <200 cells/μL. Results: The study included 302 patients. Anemia was the most common cytopenia. Anemia and leukopenia were associated with an increased likelihood of having a CD4 count <200 cells/μL in ARV-naïve patients. In ARV-treated patients, leukopenia was associated with an increased probability of having a CD4 count <200 cells/μL. An increase in hemoglobin, white blood cell (WBC) and platelet counts was observed after ≥6 months of ARV treatment. Conclusion: Anemia and leukopenia can be used as markers of immune status in HIV-infected individuals and improvement in the CBC parameters can be used to assess response to ARV treatment. Routine monitoring of hematologic parameters is recommended.

Conceptual Study of Ama and its Manifestation in Various Diseases

Like the theories of Tridosha, Sapta Dhatu, and Trimalas, the concept of Agni and Ama are very unique conceived in Ayurvedic texts. The concept of Ama encompasses an almost whole spectrum of diseases mentioned in Ayurveda. In the Ayurvedic view, nearly all diseases have their origin in Ama dosha. In Ayurveda, the word Ama and Pakva are very important to understand the theories of pathology and treatment according to Ayurveda. The success or failure of the Ayurvedic Physician in treatment depends upon the understanding of two conditions, Sama and Nirama- immature and mature. In Ama dosha langhan or fasting is the general form of treatment. Even medicine is forbidden in acute conditions. As the Jathragni is already weak and struggling to digest Ama, it can’t digest the medicine, another newcomer. The interaction of Doshas, food, and medicine may cause even fatal results.

Variations in Innervation Pattern to Dorsum of Foot by Medial Dorsal Cutaneous Nerve, Intermediate Dorsal Cutaneous Nerve, Lateral Dorsal Cutaneous Nerve with Surgical and Clinical Correlations: A Cadaveric Dissection Based Study

The complete reconstruction of any soft tissue defect includes even the sensory recovery which is very significant aspect pertaining to prognosis. Superficial nerves in the vicinity of the vascular axis can be considered as vascular relays and neuroskin grafts can be constructed on them. Variations in innervation to various part of the dorsum of the foot by this nerve should be kept in mind while making these grafts. Authors dissected 50 formalinized cadaveric feet and studied normal anatomy and variations in origin, course, branching pattern, communications, and any other variations in medial, intermediate and lateral dorsal cutaneous nerve. The intermediate dorsal cutaneous nerve was innervating larger area of the skin around 3rd and 4th web spaces in 60% of cadaveric feet. The 2nd web space was innervated by medial dorsal cutaneous nerve in 92% of cadaveric feet. In 52% of cadaveric feet communicating branches were found between intermediate dorsal cutaneous nerve and lateral dorsal cutaneous nerve. In 63% cadaveric feet communicating branches were found between medial dorsal cutaneous nerve and branch of deep peroneal nerve to 2nd web space. The mean distance between lateral malleolus and intermediate dorsal cutaneous nerve was 4.05cm. These all observations can provide anatomical basis at the time of preparing medial dorsal cutaneous nerve flaps and intermediate dorsal cutaneous nerve flaps and also can minimize morbidity at donor site.

Effect of atropine 0.01% on progression of myopia

Purpose: Myopia is the most common type of refractive error and the leading cause of functional visual loss. Increased risk of myopic maculopathy, retinal detachment, glaucoma and cataract has been seen with a myopia of as low as ?1D. This study was done to determine the effect of atropine 0.01% eye drops on the progression of myopia in children >5 years. Methods: This was a single?blind, prospective, randomized case–control study which included children of 5–15 years with myopia of >2D and were divided into treatment group (group 1) and placebo group (group 2). Children under treatment group were treated with application of 0.01% atropine at night. Children with history of any ocular surgery, chronic ophthalmic illness, squint and amblyopia were excluded from the study. The follow?up for myopia progression was done for two years. Results: This study showed a significant difference in increase of spherical equivalent and axial length among treatment and placebo groups after a duration of two years. Total duration of follow up was twenty?four months. Mean increase in axial length of group 1 and 2 was 0.115 mm and 0.32 mm, respectively. Mean increase in refraction of groups 1 and 2 was ?0.30 D and ?0.88 D, respectively, showing significant change in axial length and refraction (P < 0.0001). Conclusion: This study supports the use of atropine 0.01% eye drops in reducing the progression of myopia.

Evaluation of Serum and Gingival Crevicular Fluid Levels of Vitamin D Binding Protein in Subjects with Clinically Healthy Periodontium and Chronic Periodontitis: A Clinico Bio-Chemical Study

Background: Advances in oral and periodontal disease diagnostic research are moving towards methods wherein periodontal risk can be identified and quantified by objective measures such as bio?markers. Given the roles of vitamin D binding protein (DBP) in modulating the immune response and in the transport of vitamin D, it is hypothesised that quantitative changes of vitamin DBP are associated with periodontal disease. Aim: The aim of the current study is to measure DBP levels in serum and gingival crevicular fluid (GCF) of patients with generalised chronic periodontitis, in comparison to healthy controls. Materials and Methods: The present cross?sectional clinico?bio?chemical study includes 30 systemically healthy subjects with 15 periodontally healthy and 15 chronic periodontitis subjects who were recruited from the out?patient Department of Periodontics. GCF and blood samples were collected from all the patients. DBP estimation was performed in both the samples using a commercially available ELISA kit. Results: Serum and GCF DBP levels in chronic periodontitis subjects were significantly higher when compared to the periodontally healthy group. There were no significant correlations found among serum and GCF DBP levels with gender and increasing age in both the groups. An increase in disease severity measured by the increase in probing pocket depth and clinical attachment loss did not show correlation with the GCF and serum DBP levels in the chronic periodontitis group. Conclusion: Based on the findings of the present study, increased serum and GCF DBP levels in chronic periodontitis seem to be a probable marker for identifying ongoing periodontal destruction.

Results of fusional vergence therapy in managing consecutive esotropia: A case series

Purpose: To analyze the efficacy of fusional vergence therapy (FVT) in management of consecutive esotropia with diplopia after intermittent exotropia (IXT) surgery. The current study is carried on how FVT affects the duration of treatment, sensory fusion, and exotropic drift. Methods: This was a retrospective study for the medical record of 11 patients with consecutive esotropia after IXT surgery of 543 patients over the period of 5 year, with mean surgery age of 9.5 (range: 4–33 y). FVT was planned after minimum 6 weeks of surgery and was considered for maximum 24 weeks. Patients underwent a combination of office-based and home-based FVT. Successful outcome of therapy was considered where diplopia resolves in free space and achieves sensory fusion, stereopsis with no manifest deviation. Results: Record of 543 patients who had horizontal muscle surgery for IXT were identified and reviewed. Records of 11 patients who showed consecutive esotropia of 10 prism diopter (PD) or more with normal retinal correspondence, with or without diplopia complaint, after 6 week of surgery and had undergone vision therapy management were reviewed. A successful outcome of binocular single vision with good sensory and motor fusion with no manifest deviation or prism requirement was achieved with in the mean duration of 4.8 month of therapy. With a mean duration of 4 weeks of therapy, the mean angle of deviation reduced by 53% for distance (17 PD to 8 PD) and 27% for near (11 PD to 8 PD) and mean stereopsis improvement by 80% with 94% patients demonstrating sensory fusion on Bagolini test and 94% of patients having no symptoms of diplopia or squint. Conclusion: With nonsurgical management involving refractive error correction, FVT, and prism, consecutive esotropia was resolved in 74% cases. Management of consecutive esotropia with FVT can result in satisfactory sensory fusion and successful motor alignment.

Utility of a real?time fluorescence imaging device in guiding antibiotic treatment in superficial skin infections

The prescription of antibiotics empirically without confirmation of an infective etiology is on the rise. Administration of appropriate antibiotics can be guided by real-time fluorescence imaging using a point-of-care device. These composite images show the presence, type and the burden of infection. The time saved by this method over microbiological testing, especially in resource-poor settings, can lead to a paradigm shift in treatment by facilitating prompt and adequate antimicrobial therapy, surgical debridement as well as follow-up. Thumbnail sketches of a series of four cases highlighting different scenarios in which a fluorescent imaging device utilizing artificial intelligence and machine learning was found useful is presented in this report.

Pattern Of Nicotine Use And Dependence In Psychiatric Patients Study

Background: Tobacco use is an epidemic known as “the brown plague” affec?ng one billion lives in the 21st century and 80% in developing countries. Prevalence of smoking is especially high in pa?ents with psychiatric illness with an ongoing debate over which comes first. Studies about nico?ne consump?on in psychiatric pa?ents are few from developing countries. Hence, this study is designed to iden?fy socio-demographic and diagnos?c correlates of nico?ne use. Aims and Objec?ves:- To es?mate the pa?ern of nico?ne use and determine the associa?on between sociodemographic profile, onset of nico?ne use, it’s use as a coping mechanism, psychological associa?on with nico?ne use in psychologically ill pa?ents. Material and methods:- A cross-sec?onal study including 101 pa?ents with nico?ne use and psychiatric illness were administered a semi structured ques?onnaire, Fagerstrom Test for Nico?ne Dependence(FTND) and nico?ne dependence syndrome scale. Data analyzed with mean, standard devia?on, chi- square, ANOVA Results:-Nico?ne use was more common in middle age group with alcohol dependence followed by depression. Nico?ne use was not associated with background, socioeconomic status, gender. Majority tried to quit for health but what kept them with nico?ne were drive, stereotypy, con?nuity, priority. Conclusions:- Nico?ne is a commonly abused substance in psychiatric pa?ents without a clear demarca?on about the cause effect rela?onship. The exis?ng study gives few insights into reasons for nico?ne intake which was more so among the produc?ve age group. Hence, there is a need for further research about psychotropic drug interac?ons with nico?ne use and focus on integra?on of nico?ne cessa?on into treatment of other psychiatric disorders rather than separate deaddic?on clinics to alleviate the illness burden.