Efficacy and Safety of Stomatab Capsules® in Improving Oral Health in Recurrent Aphthous Stomatitis: An Open-labeled Clinical Study

Background: Recurrent aphthous stomatitis (RAS) is a common ulcerative disease of the oral mucosa, which is difficult to treat. In Ayurveda, several medicinal plants have been evaluated for their anti-inflammatory and antioxidant effects in many oral diseases as an alternative for modern medicines. Method: A study with open-label, non-comparative single-arm design was conducted to evaluate the efficacy of “Stomatab” capsules in improving oral health in 30 subjects with RAS. The secondary objectives were to assess the improvement in oral health and tolerability of the herbal formulation. Subjects were instructed to take one capsule thrice daily after meals for 14 days. Patients were evaluated at three assessment points: screening and baseline (Visit 1, Day 0) with follow-ups done at Visit 2 (Day 5 ± 2) and Visit 3 at the end of the study (Day 14 ± 2). Results: There was a significant reduction in the mean ulcer size from 3.66 ± 1.27 mm (V1) to 0.64 ± 0.78 (V3). The mean number of ulcers reduced from 1.97 ± 0.72 (V1) to 0.90 ± 0.66 (V3). Significant improvement in ulcer-related symptoms of pain (Ruja), burning sensation (Daha) and redness (Raktavarnata) was noted. The total ulcer symptom scores decreased from 7.67 ± 2.38 (V1) to 0.63 ± 0.56 (V3). No side effects were reported by the study participants. Conclusion: These results show that the polyherbal formulation “Stomatab” capsule is safe and effective for the treatment of RAS.

A telepathology based screening tool for COVID-19 by leveraging morphological changes related to leukocytes in peripheral blood smears

As we approach the aftermath of a global pandemic caused by Severe Acute Respiratory Syndrome-Corona Virus (SARS-CoV-2), the importance of quickly developing rapid screening tests has become very clear from the point of view of containment and also saving lives. Here, we present an explorative study to develop a telepathology-based screening tool using peripheral blood smears (PBS) to identify Coronavirus Disease (COVID-19)-positive cases from a group of 138 patients with flu-like symptoms, consisting of 82 positive and 56 negative samples. Stained blood smear slides were imaged using an automated slide scanner (AI 100) and the images uploaded to the cloud were analyzed by a pathologist to generate semi-quantitative leukocyte morphology-related data. These telepathology data were compared with the data generated from manual microscopy of the same set of smear slides and also the same pathologist. Besides good correlation between the data from telepathology and manual microscopy, we were able to achieve a sensitivity and specificity of 0.83 and 0.71, respectively, for identifying positive and negative COVID-19 cases using a six-parameter combination associated with leukocyte morphology. The morphological features included plasmacytoid cells, neutrophil dysplastic promyelocyte, neutrophil blast-like cells, apoptotic cells, smudged neutrophil, and neutrophil-to-immature granulocyte ratio. Although Polymerase Chain Reaction (PCR) and antibody tests have a superior performance, the PBS-based telepathology tool presented here has the potential to be an interim screening tool in resource-limited settings in underdeveloped and developing countries.

Diagnostic accuracy of hysteroscopy in relation to histopathology in patients with abnormal uterine bleeding at a tertiary care centre

Background: : Judicious use of hysteroscopy to manage abnormal uterine bleeding (AUB) adds a new dimension in handling this perplexing problem. Hysteroscopy combined with histological examination is the new “Gold Standard” for evaluating a case of abnormal uterine bleeding Objectives: To study Diagnostic accuracy of hysteroscopy in relation to histopathology in patients with abnormal uterine bleeding Methods: A hospital based diagnostic accuracy study was carried out among 100 women with abnormal uterine bleeding. All patients underwent the procedure of hysteroscopy. Samples were collected in all patients for histopathology confirmation of the hysteroscopy findings. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated for hysteroscopy in comparison to gold standard histopathology. Results: Majority of the women belonged to 40-49 years (41%). Majority (37%) reported after one year of occurrence of the symptoms. Majority (54%) had menorrhagia. Hysteroscopy was found to be having good sensitivity and specificity in comparison to gold standard histopathology. Sensitivity=97.7%; specificity=78.5%, positive predictive value=78.1%; negative predictive value=97.7%; diagnostic accuracy=87% for hysteroscopy in comparison to histopathology. Conclusion: Hysteroscopy is simple to perform and provides direct visualization of the uterus cavity and the endo-cervical canal. In abnormal uterine bleeding, quick and safe diagnosis is possible by hysteroscopy. In cases of endometrial polyp and sub mucous myoma which are pedunculated structures, diagnostic accuracy is greater with hysteroscopy and can be treated during the procedure itself. Thus, Hysteroscopic guided biopsy and histopathology is considered as new “Gold Standard” in diagnosis and often treatment of abnormal uterine bleeding.

Cultural, morphological and molecular diversity of Ustilaginoidea virens (Cooke) Tak. isolates causing false smut of rice in different agroclimatic regions of Karnataka

The ascomycete fungal pathogen Ustilaginoidea virens (Cooke) Takahshi cause false smut in rice and considerable yield loss. In this study, we collected isolates of U. virens from the rice growing ecosystems of Karnataka and characterized for cultural, morphological and molecular characters. The isolates of the fungus on Potato Sucrose Agar media exhibited distinct colonies with colony growth ranging from 21.50 mm (Uv-20) to 70.00 mm (Uv-15). The colony colour appeared as whitish to yellowish with varied growth pattern from flat, raised flat to fluffy and raised fluffy colonies with sectoring in Uv-1, Uv-3, Uv-6 and Uv-9 isolates. The isolates of U. virens also showed variation in the morphology of spores, where the conidia were globose, irregularly round to elliptical and warty on the surface with spore radius ranging from 2.91 to 5.36 ?m. The scanning electron microscopy revealed hyaline globose to irregularly rounded ornamented chlamydospores with prominent spines. Besides cultural and morphological characters, molecular identification of false smut isolates was confirmed through ITS sequencing which showed 91 to 99 per cent identity with U. virens in NCBI-BLAST analysis. Dendrogram constructed using ITS sequence data broadly separated the isolates into two major clusters with divergence among clusters. This ITS (internal transcribed spacer) sequencing of isolates should help better understanding of the phylogenetic relationships among these isolates.

Risk Factors for Catheter-Associated Urinary Tract Infections (CA-UTI) in the Pediatric Intensive Care Unit

Objective: To describe the occurrence, microbiology, and risk factors of catheterassociated urinary tract infections (CA-UTI) in critically ill children. Methods: We conducted a review of hospital records for CA-UTI in the pediatric intensive care unit (PICU) over a 7- year period (2014-2020). Results: 62 CA-UTI cases (48% boys, median (IQR) age 36 (12,96 month) were identified during the study period with occurrence rate of 7.2/1000 catheter-days. The most common organisms were Escherichia coli (32.4%) and Enterococcus faecalis (30.6%). Using a multivariate logistic regression analysis, the significant associated variables for CA-UTI were duration of catheter drainage (a OR (95% CI) 1.14, (1.03,1.27), P=-0.009), PICU stay (aOR (95% CI) 1.13 (1.05,1.21) (P<0.001), and hospital stay (aOR (95% CI): 1.03 (1.01,1.06), P=0.015). Conclusion: CA-UTI is not an uncommon nosocomial infection in PICU. The risk increases with increasing duration of catheter drainage, and hospital or PICU stay.

A study of changes in Mean Ocular Perfusion Pressure and Intra-Ocular Pressure among pa?ents undergoing hemodialysis

Background:During hemodialysis there is decrease in both systolic blood pressure (SBP) and diastolic blood pressure (DBP) and hence Mean Arterial Pressure (MAP) due to decrease in body fluid volume. Due to reduc?on in MAP there is decrease in Mean Ocular Perfusion Pressure (MOPP) and also there is increase in IOP during dialysis. Objec?ve:To study changes in MOPP and IOP among pa?ents undergoing hemodialysis Methods:An observa?onal study was carried out among 100 pa?ents undergoing hemodialysis Under asep?c condi?on, Proparacaine eye drops were ins?lled in both eyes, IOP was measured by Schiotz Indenta?on Tonometer 30 min before, during hemodialysis and 30 min a?er hemodialysis in supine posi?on. Tonometer was sterilized by Isopropyl alcohol and was washed with normal saline before using on next pa?ent. Systolic and diastolic blood pressure were measured by using sphygmomanometer 30 min before, during and 30 min a?er hemodialysis. Results:The varia?ons in the SBP, DBP and MAP before, during and a?er hemodialysis were not sta?s?cally significant (p>0.05). There was significant differences for IOP between before, during and a?er hemodialysis and same for MOPP except before and 30 min a?er hemodialysis (p < 0.0001). Conclusion:Significant fluctua?ons were seen from the present study in the intra-ocular pressure and mean ocular perfusion pressure during, before and a?er hemodialysis.

V for vitamin, inverted V for lack of it: A rare case of subacute combined degeneration of cord with bladder symptoms and associated multiple Tarlov cysts

Subacute degeneration of cord (SACD) is a rare presentation of a common disease and it should be kept in mind when the patient develops symptoms of peripheral neuropathy. This is a case of a 65-year-old male who presented with pins and needles sensation of bilateral hands and feet and with difficulty in voiding. Neurological examination showed large fiber neuropathy with an exaggerated knee jerk, absent ankle jerk, extensor plantar, and a positive Romberg’s sign. Routine laboratory investigations showed low hemoglobin and low vitamin B12 levels. Magnetic resonance imaging of the spinal cord showed a hyperintense lesion in the posterior aspect of the cervical cord with a classical “inverted V” sign on the axial section which is suggestive of SACD. Coincidentally, there were multiple Tarlov cysts present. Finally, the patient improved with vitamin B12 injections. This case is unique as an association of SACD with Tarlov cysts with a classical inverted V sign has not been reported according to the literature.

Outcome of transcutaneous retrobulbar injection of liposomal amphotericin B in post-COVID-19 rhino-orbito-cerebral mucormycosis: Our experience

Purpose: To assess the outcome and response of transcutaneous retrobulbar injection of amphotericin B (TRAMB) in post?coronavirus disease of 2019 (COVID?19) rhino?orbito?cerebral mucormycosis (ROCM) and to establish a scoring system in guiding treatment modalities. Methods: An interventional, prospective study was done on 82 eyes of post?COVID?19 ROCM from May 2021 to July 2021. A comprehensive multi?departmental evaluation along with detailed ophthalmic examination, laboratory investigations, and radiological examination was done. Scoring points were given to each symptom, sign, and radiological features of orbit and the total score was taken. Based on these scores, severity of disease was grouped into A, B, and C corresponding to mild, moderate, and severe orbital ROCM. One milliliter of reconstituted liposomal amphotericin B was given to all patients every alternate day as three doses. Efficacy of these injections was assessed in all groups, even though other treatment modalities like orbital debridement and exenteration were considered for moderate and severe cases. Patients were followed up for a period of 8 weeks. Results: Out of 82 eyes, symptomatic improvement was seen in a major proportion (72%) of patients. A statistically significant improvement in scores was noted in group A (93% improved) with a P value of 0.002, while 68.4% showed improvement in group B (P?value? 0.0001). Group C with severe disease showed minimal improvement in post?injection scores of 41% (P?value 0.086), necessitating surgical intervention. No serious adverse effect of the drug or procedure was noted. Conclusion: Significant improvement in scores of groups A and B highlights TRAMB as an effective and safe treatment modality in mild to moderate ROCM. It is an effective adjunct in severe cases, along with other interventions. Also, the scoring system helps in assessing the severity and guiding in management strategies.

“Fever clinic duty” during Covid-19: through the eyes of a preclinical doctor–teacher

In this narrative, a teacher of physiology writes about her shifts at an out-patient fever clinic during the Covid-19 pandemic. Apart from describing the author’s own struggle during her return to a clinician’s role, the narrative reveals the anxieties, fears, challenges and stigma faced by patients and the pressures on the healthcare team in a pandemic situation.

ELECTROPHORETIC SEPARATION OF INDUCIBLE PROTEINS IN MAIZE SEEDLINGS UNDER FUNGICIDE TREATMENT

The aim of the experiment was to study the effect of a various concentrations of a systemic fungicide, metalaxyl on the expression of new proteins during early germination of maize. The study was conducted for 7 days. Our investigation showed the appearance of induced proteins ranging from 100-110kDa, 44kDa, 30kDa and 18-25kDa on different days of observation and different concentration of metalaxyl treatment, which is in line with the ?ndings in various abiotic stresses

Oro-facial Manifestations, Oral Health Status and Treatment Needs in Transfusion Dependent Children With β-thalassemia Major: A Cross-sectional Study

@#Introduction: β-Thalassemia is genetic disorder which clinically presents as anaemia due to decreased production of beta-chains of haemoglobin molecule. Literature on oro-facial manifestations, oral health status is sparse and inconclusive in the β-thalassemia major patients (TM). Methods: This cross-sectional study was done to assess oro-facial manifestations of β-Thalassemia. 31 TM patients in the age group of 6-18 years were clinically examined and oro-facial manifestations were recorded. Oral health status including oral hygiene status, dental caries, gingival status of these TM children was compared with 42 healthy children. The mean values were compared using Student’s t-test. Treatment needs of both the groups were recorded using WHO oral health assessment form. Results: Lip incompetence (38.75%) and maxillary protrusion (19.35%) were most common oro-facial manifestations of Thalassemia major. Mean OHI-S score for TM and healthy children were comparable 1.73 ± 1.10 and 1.36 ±1.17 respectively (p=.178) but mean GI score for TM was higher than healthy children, 1.42±.39 and .94±.51 respectively (p<.05). Mean DMFT scores for TM and healthy children were 1.5±1.8 and 1.2±2.1 respectively (p=.578). Treatment needs was relatively higher among TM children with 58% of these children requiring one surface filling. Conclusion: Lip incompetence followed by maxillary protrusion were most common oro-facial manifestations of Thalassemia major. There is no significant association between oral hygiene and dental caries with Thalassemia major. However, thalassemia major is associated with gingivitis. Treatment requirement was relatively higher among TM children with one surface filling being the commonest need.

Clinical study of urinary incontinence in women at a tertiary care centre

Background: Urinary Incontinence is often underreported, undiagnosed and untreated. Though the prevalence increases with age it can occur even in younger age women. Validated questionnaires are available to establish the association of risk factors and diagnose the type of incontinence. Objective: To study risk factors and the impact of Urinary Incontinence on quality of life in women. Methods: Descriptive Cross-Sectional study was carried out among 230 women with symptoms of urinary incontinence. ICIQ-FLUTS a brief and psychometrically robust patient-completed questionnaire for evaluating female lower urinary tract symptoms and impact on quality of life (QoL) was used. The data was analysed using proportions. Results: Most commonly affected age group was 41-50 years (42%). Storage phase symptoms were seen in 78.6% women, and Incontinence was seen in 36.08% women. Stress incontinence was commonest (55.65%) with an average bothersome score of 3.1/10. Moderate to severe degree of Stress Incontinence with a score >5/10 was seen in 15.65% of women. Frequency incontinence was seen in 33.47% of respondents. Average bothersome score of stress and urge incontinence was 3.1/10. They showed as average score of 1.36 and 1.44 respectively. Nocturia was commonest symptom in storage phase symptoms (78.69%). Urgency and Frequency was noted in 55.65% and 50.43% of women respectively. Intermittency was the commonest in voiding phase symptoms seen in 19.56% with an average score of 1.44/4. Conclusion: Stress urinary incontinence was the most common type of urinary incontinence. Urinary incontinency significantly affected the quality of life of women.

The use of negative-pressure wound therapy over a cultured epithelial autograft for full-thickness wounds secondary to purpura fulminans in an infant

Purpura fulminans is a serious condition that can result in severe morbidity in the pediatric population. Although autologous skin grafts remain the gold standard for the coverage of partial- to full-thickness wounds, they have several limitations in pediatric patients, including the lack of planar donor sites, the risk of hemodynamic instability, and the limited graft thickness. In Singapore, an in-house skin culture laboratory has been available since 2005 for the use of cultured epithelial autografts (CEAs), especially in burn wounds. However, due to the fragility of CEAs, negative-pressure wound therapy (NPWT) dressings have been rarely used with CEAs. With several modifications, we report a successful case of NPWT applied over a CEA in an infant who sustained 30% total body surface area full-thickness wounds over the anterior abdomen, flank, and upper thigh secondary to purpura fulminans. We also describe the advantages of using NPWT dressing over a CEA, particularly in pediatric patients.

The use of negative-pressure wound therapy over a cultured epithelial autograft for full-thickness wounds secondary to purpura fulminans in an infant

Purpura fulminans is a serious condition that can result in severe morbidity in the pediatric population. Although autologous skin grafts remain the gold standard for the coverage of partial- to full-thickness wounds, they have several limitations in pediatric patients, including the lack of planar donor sites, the risk of hemodynamic instability, and the limited graft thickness. In Singapore, an in-house skin culture laboratory has been available since 2005 for the use of cultured epithelial autografts (CEAs), especially in burn wounds. However, due to the fragility of CEAs, negative-pressure wound therapy (NPWT) dressings have been rarely used with CEAs. With several modifications, we report a successful case of NPWT applied over a CEA in an infant who sustained 30% total body surface area full-thickness wounds over the anterior abdomen, flank, and upper thigh secondary to purpura fulminans. We also describe the advantages of using NPWT dressing over a CEA, particularly in pediatric patients.

Dermoscopy of Dilated Pore of Winer

Summary@#Dilated pore of Winer is a benign adnexal tumour of follicular differentiation. It has typical clinical feature of asymptomatic, solitary enlarged pore with a keratin plug. Dermoscopy offers further assistance in diagnosis. In this case on dermoscopy, well defined lamellated central blackish area arranged in concentric circles, surrounded by a bluish grey halo was seen with a rim of hyperpigmentation.

A Study Assessing the Practices and Motivation for Seeking Tattoo Removal

Background@#As the number of patients getting tattooed is increasing, so is the number of patients seeking removal of tattoos. The primary objective of this study was to assess the reasons as to why patients got tattoos and also seek tattoo removal. The secondary objective was to study the demographics and the knowledge they had regarding tattoo removal.@*Methods@#A cross sectional study was done among 250 consecutive patients who attended the Dermatology centre seeking tattoo removal. A questionnaire was used to fill in the details.@*Results@#167 males and 83 females were included in the study. Majority of patients were in the age group of 21 to 30 years (43.8%) followed by 31-40 years (26.7%). 56.6% of patients had got tattoos in the third decade and 35.1% in the second decade. 52.6% of those seeking tattoo removal had got their tattoos from amateur artists, village fairs or roadside tattoo shops. 45.8% did not have a specific reason for getting a tattoo and were decorative tattoos. 34.7% had names of their beloved or family members. 29.5% were seeking removal for professional reasons and 23.1% due to changes in relationship status.@*Conclusion@#Patients seek tattoo removal mainly for professional reasons, changes in personal relationships when they have name tattoo and due to complications. Most of the patients were in the third decade of life. It is important to educate school going children ang youngsters regarding the permanent nature of tattoo and its complications.

A Case of Isolated Trichorrhexis Nodosa and Trichoscopic Images

Summary@#Trichorrhexis nodosa (TN) is a hair shaft disorder characterized by fragile hair with nodes on the hair shaft. Here we report a case of aquired localised trichorrhexis nodosa and describe the importance of noninvasive tools like trichoscopy and light microscopy in the diagnosis of an isolated TN.

Role of a Nurse in COVID-19 Pandemic.

The role of nurse changes as the health care is needed in the hospitals, society or community. Nurses are providing essential health care services throughout the health care system. In response to COVID-19 pandemic, the role of nurse changes to care or respond to the needs of the patients, their families and their caregivers. They also should take part in policies making, doing procedures and taking care of necessary supply of the material and equipment in the hospitals. All over the world nurses are demonstrating their kindness, care, courage, values and professional responsibility as nursing personnel. Prior to the COVID-19 pandemic in many institutions / organizations, there was a focus on nurses, mental health, physical health and wellbeing such as workload, anxiety, anger, irritability, burnout etc. They have to follow the rules, regulations, ethics and standard of nursing. However, while working in the isolation units or intensive care unit with COVID-19 patients, the nurse has to decide how much quality care they can provide to the patients while taking care of themselves. Hospital authorities have the responsibility to provide optimal work environments for all staff involved in the care of COVID-19 patients and health care professionals must follow the protocols that protect their ethical rights as a health care professional. In a 2018 policy brief, the American Nurses Association, said “nurse leaders are the key to preventing and containing widespread illnesses. They have the skills and education to develop coordinated global networking and properly identifying of infectious diseases”.

Tuberculosis: a great masquerader

Central nervous system tuberculosis caused by Mycobacterium tuberculosis is the most severe form of tuberculosis, accounting for 1% of all TB cases. Intracranial tuberculosis can present as Tuberculous meningitis, Tuberculous encephalopathy, Tuberculous vasculitis, CNS tuberculomas and Tuberculous brain abscess. Here authors present a case of a 10-year-old girl who presented with insidious onset of early morning vomiting, excessive sleepiness with classical neuroimaging findings of intracranial tuberculosis. Authors emphasise that intracranial tuberculoma should be considered in the differential diagnosis of any intracranial space-occupying lesion with or without pulmonary involvement.

Evaluation of Signs of Inflammation that Can Kill score in predicting mortality in an urban tertiary care centre for children in South India

Background: Mortality in critically ill children is maximum in the first 24 hours. Need of the hour is a rapid clinical scoring system that predicts mortality on admission. This study aims at using the Signs of Inflammation that Can Kill (SICK) score in a tertiary care pediatric hospital in India, to evaluate its usefulness in predicting mortality on admission.Methods: The study design is a hospital based prospective study for evaluation of diagnostic test for a duration of one year.' The assessment using SICK score was done on arrival prior to initiation of treatment for children admitted through the emergency room and paediatric ward. The variables of SICK score - temperature, heart rate, respiratory rate, systolic BP, oxygen saturation, CRT, sensorium by AVPU scale were measured using standard guidelines.Results: The study includes a population of 369 children. Children between 1 month to 12 years were included in the study. Out of 369 children studied 24 died. The mortality in the study is 6.5%. The area under the ROC curve is 0.94, which indicates the scores based on regression could predict mortality in 94% subjects correctly. Further a score of 2.5 showed maximum discrimination with a sensitivity of 87.5% and specificity of 87.2%.Conclusions: The assessment of SICK score in the population will provide objective measure of severity of illness on admission, prediction of mortality, early triage of patients, effective allocation of resources and personnel, enables early intervention, which helps in reducing mortality.