Inherited epidermolysis bullosa dystrophica and squamous cell carcinoma- A case report

Epidermolysis bullosa dystrophica (EBD) is an inherited disease of the structural proteins in the upper dermis, characterized by blister formation at the site of trauma followed by scarring. Skin fragility and blistering are the hallmarks of this disease. Cutaneous squamous cell carcinoma (cSCC) is a dreadful complication in the epidermolysis bullosa (EB) patients and common cause of death. The recent advances in distinct tumor microenvironment explain the aggressive nature of SCC in recessive Recessive Dystrophic Epidermolysis Bullosa (RDEB) patients and the use of collagen VII re-expression as a possible therapeutic measure. Regular follow-up is a must in preventing complications.

Development and Validation of a Bedside Dengue Severity Score for Predicting Severe Dengue in Children

Objective: To develop and validate a bedside dengue severity score in children less than 12 years for predicting severe dengue disease. Methods: We carried out an analysis of data on the clinical and laboratory parameters of patients with confirmed dengue, hospitalized in October, 2019 at our center. A comprehensive patient’s score was developed. Predictive models for severity were built using a forward step-wise method. This model was validated on the data of 312 children with dengue admitted during September- October, 2021. Results: Severe dengue was predicted by the dengue severity score with a sensitivity of 86.75% (95% CI 77.52%-93.19%), specificity of 98.25% (95% CI 95.56-99.52%), a positive predictive value of 95.34% (95% CI 92.18%-97.26%) and a negative predictive value of 94.74% (95% CI 87.16%-97.95%). The overall predictive accuracy was 95.2% (95% CI 92.19%- 97.28%). Conclusion: The proposed bedside dengue severity scoring system was found to have good validity. Validating the score in different settings and patient populations is suggested.

Clinical Profile and Short-Term Outcome of Children with Acute SARS-CoV-2 Infection During the First and Second Waves of the Pandemic

Objectives To compare the clinical profle and short-term outcome of children admitted with acute SARS-CoV-2 infection during the frst and second waves of the Coronavirus Disease (COVID-19). Methods This retrospective study was conducted in a tertiary care setting. A retrospective medical record review of all pediatric patients admitted with confrmed SARS-CoV-2 infection between March 2020 and September 2021 was conducted. Patients’ demographic data, pre-existing comorbidities, mode of presentation, and clinical course in the hospital were noted. The outcome measures were in-hospital mortality, need for intensive care, and invasive mechanical ventilation, duration of ICU, and hospital stay. Results One thousand and twenty-four children were recruited, 592 of the frst wave and 432 of the second wave. In the second wave, more children were admitted with respiratory distress (OR=3.38) and neurological manifestations (OR=4.61). There was a higher requirement of intensive care (OR=4.2) and invasive mechanical ventilation (OR=4.17). In-hospital mortality of the second wave was also increased (1.4% vs. 0.1%), but the diference was not statistically signifcant. Children with neurological comorbidities (OR=8.73), malnutrition (OR=3.01), and preterm babies (OR=6.8) were associated with severe COVID. Conclusion The clinical profle of the second wave of COVID-19 in children was diferent from the frst wave, with more respiratory distress and neurological manifestations at presentation. In the second wave, a signifcant increase in the incidence of severe infections requiring ICU care was observed.

Consensus Statement of the Neurodevelopmental Pediatrics Chapter of Indian Academy of Pediatrics (IAP) on the Management of Children With Down Syndrome

Justification: The diagnosis of Down syndrome (DS) is easily made clinically but the management is multi-disciplinary and life-long. There is no standard protocol available for its management in India. Process: A committee was formed under the Indian Academy of Pediatrics (IAP) chapter of Neuro developmental pediatrics consisting of 20 experts working in the related field. The various aspects of the condition were discussed and allotted to the concerned experts related for preparing the guidelines. The material received was collated to form a set of guidelines, which were reviewed by the committee, and a consensus statement made. The guidelines were then approved by the chapter, and by the IAP. Objectives: To define the condition and to look into the various aspects of antenatal and postnatal diagnosis. To explain briefly about the involvement of the various systems that are involved and formulate recommendations for management. To recommend early and sustained interventional therapies to enable children with DS lead an independent life. Recommendations: The stress on bio-psycho-social strategy for the management of children with DS is reiterated, and the need for a medical, social and rights model is recommended after each section. The age-wise recommendations are also highlighted in addition to the recommendations under each system.

Metabolic Bone Disease in Children With Transfusion-Dependent Thalassemia

Objective: This study aimed to detect metabolic bone disease and endocrinopathies in a cohort of patients with transfusion-dependent thalassemia (TDT). Methods: This prospective study was conducted between March 2020 - August 2021. Children with TDT older than 5 years, receiving regular blood transfusion, underwent comprehensive endocrine and metabolic bone disease evaluation, which included screening for short stature, delayed puberty, diabetes mellitus, hypothyroidism, adrenal insufficiency and hypoparathyroidism. Children older than 10 years also underwent. X-ray of thoracolumbar spine, and dual energy X-ray absorptiometry (DXA) scanning. Results: Out of 37 patients (19 males), with mean (SD) age 15 (6) years, hypogonadism was the commonest endocrine deficiency seen in 15 (62%), followed by short stature, abnormal glucose metabolism, subclinical adrenal insufficiency, hypothyroidism, and hypoparathyroidism. Vitamin D insufficiency/deficiency was seen in 12 (60%) and hypocalcemia in 2 patients. Low bone mass was seen in 8, and osteoporosis, as evidenced by vertebral fractures, in 4 patients. Of the four patients with vertebral fracture, three were aged ?18 years, one was symptomatic, two each had grade 1 and grade 2 fractures, one had multiple vertebral fractures, and all four had hypogonadism and multiple endocrine deficiencies. Conclusion: Vertebral fractures occur even in the second decade among patients with TDT, and are often associated with endocrinopathies, most commonly hypogonadism. Early screening and prevention of vertebral fractures is necessary.

Semilunar Vestibular Incision Technique for Treatment of Multiple Gingival Recession in Maxillary Teeth - An Evaluative Study

Background: Recession is a mucogingival condition affecting teeth causing hypersensitivity. Although many techniques are there for recession coverage, semilunar vestibular incision technique (SVIT) is a novel procedure for management of multiple gingival recession in maxillary teeth. Aim: To evaluate the efficacy of root coverage in maxillary teeth with multiple gingival recession using SVIT. Methodology: Twenty systemically healthy patients were recruited with Miller’s class I and II gingival recessions in maxillary teeth. Parameters such as recession height (RH), recession weight (RW), avascular surface area (ASA), width of keratinized gingiva (WKG), width of attached gingiva (WAG), and clinical attachment level (CAL) were measured at baseline three and six months post?surgery. Results: The outcome measures were statistically significant at baseline, three and six months. A reduction of 86% was achieved in terms of RH and RW. Gain in WKG and WAG as achieved at six?month follow?up was 31.5% and 55%, respectively. An 87% decrease in ASA was obtained and reduction in CAL was 82.4%. Between three and six months there was a significant increase in WAG. Conclusion: SVIT results in improved measures of attached gingiva on six?month follow?up.

A Comparative Pharmaceutical Study on Tiladi Churna and Tiladi Granules

Bhaishajya Kalpana- the pharmaceutical science of Ayurveda mainly deals with the planning and preparation of medicines. As per Ayurveda, an ideal drug is that one which can process into different forms. Though Ayurveda claims that no material is incapable of being utilized as medicine, none of them can be employed in the form in which they are available because they are not appetizing or easily absorbed by the human system. In this modern era, society prefers medicines which are more palatable, available, less dose and with more shelf life. In this view, as per the need of time, there is a need to modify the classical formulations in order to improve its characters and to make more acceptable. In this present study, Tiladi churna, a pure herbal formulation having minimum ingredients and its granules were prepared in departmental pharmacy. Churna Kalpana is considered as an Upakalpana of Kalka Kalpana which is one among the basic Panchavidha Kashaya Kalpana mentioned in classical texts while Khanda Kalpana or granules are the preparations added after 20th century which have more palatability and acceptance. Here both Tiladi Churna and granules were then compared to determine the efficiency in terms of method, duration of preparation and also in terms of organoleptic and physical parameters

A review on phyto-nanotechnology for therapy of alzheimer’s disease

Alzheimer’s disease (AD) is a common chronic neurodegenerative disease (ND) that is mainly investigated nowadays because of its increased incidence and burden on the elderly population. It leads to atrophy of the brain. Clinical features of AD include loss of memory with impaired cognition and behaviour, which leads to mood instability and death. Aggregation of beta-amyloid protein(A?) and neurofibrillary tangles within the neuronal cells are the accepted pathophysiological process of AD. Studies have demonstrated that medicinal plants and herbs could improve memory and cognitive function affected by AD. The bioavailability of active herbal components is affected by rapid metabolism, less permeability, and decreased stability within the CNS. Many studies have reported that the application of nanotechnology to plant extracts enhances the efficacy of extracts. Adding herbal extracts into the nanoparticle system could improve the action of extracts, promote the sustained release of bioactive components, decrease the required dose, and lower the side effects. Using published articles from trustworthy resources like PubMed, Google Scholar, Research Gate, Web of Science, and Wiley Online Library, with keywords like "natural products," "Alzheimer's disease," and "nanotechnology," herein we reviewed and summarized recent nano-drug delivery treatment strategies for AD using natural products.

Synthesis, spectral characterization, anti-bacterial, cytotoxic evaluation and docking studies of new urea and thiourea derivatives

Isoniazid is one of the main API’s used in the combination treatment of tuberculosis recommended by the WHO. Urea and its derivatives are an important class of heterocyclic compounds that possess a wide range of therapeutic and pharmacological properties, while thiourea is an organosulphur compound in that it resembles urea except that the atom oxygen has been replaced by a Sulphur atom, but the properties of urea and thiourea are significantly different. The current work concerns the synthesis of a new class of urea and thiourea derivatives of isoniazid with various isocyanates and isothiocyanates in the presence of trimethylamine. The IR and NMR spectral data were performed for the urea and thiourea derivatives of the compounds [(3c & 3f) & (3d & 3e)], respectively. Molecular docking studies of the compounds (3a-h) revealed the binding mode involved in the active site of DNA gyrase. The synthesized urea and thiourea derivatives of isoniazid with various isocyanates and isothiocyanates were tested for their antibacterial activity against gram-positive and gram-negative bacteria using the “disc diffusion method”. Of all compounds tested, the urea derivatives (3a &3d), the thiourea derivatives (3e & 3g) showed more potent activity than the other compounds. The MTT assay revealed concentration dependent cytotoxic effects over a concentration range 25-200 µg/mL.

Community voices around COVID-19 vaccine in Chennai, India: A qualitative exploration during early phase of vaccine rollout

Background & objectives: Globally, vaccination is considered as an important public health strategy to mitigate the impact of the COVID-19 pandemic. The purpose of the current study was to conduct an in-depth inquiry to explore perceptions of community members around COVID-19 vaccines in the southern city of Chennai, Tamil Nadu. This was conducted during the early phase of the vaccine rollout programme in India. Methods: A qualitative investigation was conducted between January-February 2021 through in-depth interviews. Healthcare workers, religious leaders, community influencers, local administrators and representatives of marginalized communities were included. The key informant interview guides and probes explored five domains; (i) vaccine availability, (ii) trust in COVID-19 vaccines, (iii) vaccine-related concerns, (iv) health/risk balance and (v) vaccine prioritization. Transcripted interviews were coded using a thematic approach and analyzed manually as well as with the help of ATLAS.ti 9 software. Results: Eagerness to receive COVID-19 vaccines amongst some of the respondents was linked with freedom from fear, possible restoration of normalcy, protection of family and ability to travel and work abroad. Concerns around threat of emergence of new variants, damage caused by such viral mutants and trust in policymakers were other facilitatory influencers for vaccine uptake. On the other hand, doubts surrounding safety and fear of side effects of COVID-19 vaccine were the feeders to vaccine hesitancy. Lack of accurate information, sensational media reports and rumours exacerbated this fear and provoked anxiety among people. Apprehensions around COVID-19 vaccine in the wake of its rapid development and approval for use and reluctance to take it during the declining phase of the epidemic were identified as other inhibitory factors. Participants underlined the importance of having responsive communication strategies in place focussing on vaccine safety. Making vaccines available to people free of cost and ensuring wider access were other programmatic suggestions. Interpretation & conclusions: In conclusion, our study findings suggest that it is essential to remain engaged with communities and execute evidence-based information dissemination strategy about the safety and efficacy of the vaccines. We identified that it is also imperative to sensitize and train media professionals on how to report side effects related to vaccines. Responsive communication strategies will thus have the potential to serve as a key public health approach pertaining to future pandemic preparedness as well as to manage the demands of clinical and public health issues in an ongoing pandemic situation.

Evaluation of the efficacy of plaque reduction and gingival health among 6-12 years old school children before and after a short term daily intake of probiotic lozenge - A comparative study

Context: Probiotics are defined as live microorganisms which when delivered in adequate amounts provides health benefit in the host. Dietary supplements like lozenge seem to be the easy and acceptable vehicle for ingestion of probiotics in young children. Aim: To assess the efficacy of probiotics in plaque reduction and gingival health among 6?12 years school children before and after short term daily intake of Probiotic lozenge. Settings and Design: This Comparative study was conducted among 60 children in the age group 6–12 years. Thirty children in experimental group; who were given lozenge containing probiotic bacteria twice daily, one in the morning and another in the evening after brushing for one month. The placebo lozenge group also followed the same protocol. Statistical Analysis Used: SPSS version 21. Results: The Probiotic lozenge group was found to have statistically significant reduction in plaque scores when compared to that of the placebo group with P < 0.001 and there was also a significant improvement in gingival health. Conclusion: An effective reduction in plaque accumulation and gingival inflammation was found with the use of probiotic lozenges and hence proved the therapeutic value of the same.

Hereditary neuropathies: Genetics and utility of nerve biopsy

Peripheral neuropathy is one of the most common neurological conditions of the nervous system. Hereditary neuropathies (HNs) form an important group with varying degrees of severity, causing a significant disease burden. Accurate diagnosis is essential for management, counseling, and preventing unnecessary extended workups for acquired etiologies and inappropriate treatment. Several hereditary neuropathies have characteristic or diagnostic histologic findings; however, in the era of molecular diagnostics, the role of nerve biopsy in the diagnosis of hereditary neuropathy has reduced significantly. Nevertheless, in sporadic cases, cases without a clear family history, clinical mimics, cases with rare mutations, and genetic variants of unknown significance, a nerve biopsy can confirm the diagnosis, provide an unexpected diagnosis, or direct a targeted molecular testing. HN may be non-syndromic, affecting predominantly the peripheral nervous system or syndromic where it is a part of more widespread neurological or multisystem involvement. This review summarizes the microscopic pathological features in a nerve biopsy in some of the more commonly encountered inherited peripheral neuropathies highlighting their utility in selected cases.

Effect of Supplementation of Vitamin C and Thiamine on the Outcome in Sepsis: South East Asian Region

Introduction: The global burden of sepsis is overwhelming and novel therapeutic agents is the need of the hour. The present study was designed to understand the role of Malondialdehyde as a marker of the oxidative stress in sepsis, as well as the effect of supplementation of Vitamin C and Thiamine in patients of sepsis. Methods: 80 patients of sepsis were randomly divided into 4 groups of 20 each. Twenty age-sex matched healthy volunteers were chosen as controls. The first group received Vitamin C, the second group received Thiamine, the third group received both and the fourth group received neither. Vitamin C (2g 8 hourly) and Thiamine (200 mg 12 hourly) were given intravenously for five days. The outcome was recorded in terms of mortality in the various groups as well as by the improvement in SOFA scores (?SOFA). The serum levels of Vitamin C, Thiamine and Malondialdehyde were estimated. Results: Among the 80 patients, 17 (21%) were in septic shock. The mortality rate was 10% overall, and 47% among patients of septic shock. No additional mortality benefit was observed in the groups supplemented with Vitamin C and Thiamine. However, the ?SOFA score in patients who received both Vitamin C and Thiamine was significantly higher as compared to the other groups. The mean malondialdehyde level was higher in patients of sepsis (1.81±1.18 ?mol/l) as compared with healthy controls (0.78 ± 0.36 ?mol/l). The Vitamin C level and Thiamine level (estimated indirectly by TPP effect), at presentation were 5.14±4.19 ng/ml and 52.99±28.45 % in patients of sepsis, which was significantly lower than that in healthy controls, in whom the levels were 14.64±5.51 ng/ml and 27.55±13.67% respectively. Conclusion: Vitamin C and Thiamine supplementation is a cost-effective approach with a good safety profile. Additional studies including a larger population is required to study the mortality benefits and reaffirm our findings.

Carbohydrate profiling & glycaemic indices of selected traditional Indian foods

Background & objectives: Consumption of high glycaemic index (GI) food is associated with a high risk for diabetes. There is a felt need to understand the GI of common Indian traditional foods using standard GI protocols. The present study was aimed to analyse the carbohydrate profile of common traditional Indian food preparation and to determine their GI using standardized protocols. Methods: Twelve food preparations made of millets, wheat, maize and pulses were evaluated for nutrient composition including detailed carbohydrate profiling and tested for GI in healthy volunteers using standard methodology. Capillary blood glucose responses for the test foods containing 50 g available carbohydrates were recorded and compared to the reference food (50 g glucose). GI was calculated from the incremental area under the curve (IUAC) for the test and reference foods. Results: Available carbohydrate content of the food preparations ranged between 13.6 and 49.4 g per cent. Maize roti showed the highest total dietary fibre (7.5 g%). White chick pea ‘sundal’ showed highest resistant starch content (3.95 g%). Amongst the 12 test foods, five fell in the high GI category (finger millet balls, sorghum, pearl millet and maize roti), four in the medium GI category (sorghum idli, wheat dosa, methi roti and adai) and three in the low GI category (broken wheat upma, white peas sundal and white chick peas sundal). Interpretation & conclusions: Merely being a whole grain-based food does not qualify for a lower GI. The method of processing, food structural integrity and preparation could influence the GI. The type and quality of fibre are important than the quantity of fibre alone. Judicious planning of accompaniments using low GI legumes may favourably modify the glycaemic response to high GI foods in a meal.

Ectodermal dysplasia: A case report

Ectodermal dysplasia (ED) is a rare group of inherited disorders with defects in the development of one or more tissues derived from primary embryonic ectodermal derivatives. The inclusion of ED does not include all ectodermal derivatives and is manifested with a defect in skin, hair, teeth, and eccrine glands. Dry skin, frontal bossing, scanty eyebrows, and hair follicles are common features seen in these patients. The patient may suffer from high fever due to the absence of eccrine glands. Intraoral findings include a partial or complete absence of teeth with generalized spacing. It can be inherited or caused by a genetic mutation, and it can also happen without a family history. This case report presents a 12-year-old female child with hypohidrotic ED involving a multidisciplinary approach in ED that was beneficial both physiologically and psychologically is discussed in this case report.

Evaluation of Lung Volume and Effect of Vital Staining as Motivation to Quit Tobacco among Nicotine Dependents of Kanpur, India

Abstract Objective: To quantify and compare respiratory functions and further screen the oral mucosa of tobacco and non-tobacco users. Material and Methods: First control group, non-tobacco users (n=55); Second group, smokers' group (n=168) who currently smoked cigarettes; Third group smokeless/chewing type, tobacco group (n=81); Fourth group, both smokeless and smoking type tobacco users (n=46). Fagerstrom Test for Nicotine Dependences (FTND) and Fagerström Test for Nicotine Dependence-Smokeless Tobacco (FTND-ST) instruments were used to assess nicotine dependence. Subsequently, spirometry and Toluidine Blue (TB) vital staining were performed. Chi-squared and one-way analysis of variance (ANOVA) were used for statistical analysis. Results: Fagerstrom test resulted in 48.8% of subjects with low dependency, followed by an increase in nicotine dependency from low to moderate (29.2%), moderate (15.6%), and highly dependent (6.4%) groups. All respiratory function tests and oral screening confirmed significant changes amongst tobacco and non-tobacco users. The forced vital capacity of non-smoker group was significantly different from other tobacco users' group (p<0.05). Conclusion: Early effects of tobacco use can lead to complications with the respiratory system and oral cavity. Such data can be used to delineate the harm of tobacco and should be used to urge individuals to evade the utilization of tobacco (AU).

Expression of Toll-like receptors 3, 7, 9 and cytokines in feline infectious peritonitis virus-infected CRFK cells and feline peripheral monocytes

Background@#The role of Toll-like receptors (TLRs) in a feline infectious peritonitis virus (FIPV) infection is not completely understood. @*Objectives@#This study examined the expression of TLR3, TLR7, TLR9, tumor necrosis factoralpha (TNF-α), interferon (IFN)-β, and interleukin (IL)-10 upon an FIPV infection in CrandellReese feline kidney (CRFK) cells and feline monocytes. @*Methods@#CRFK cells and monocytes from feline coronavirus (FCoV)-seronegative cats and FCoV-seropositive cats were infected with type II FIPV-79-1146. At four, 12, and 24 hours postinfection (hpi), the expression of TLR3, TLR7, TLR9, TNF-α, IFN-β, and IL-10, and the viral load were measured using reverse transcription quantitative polymerase chain reaction. Viral protein production was confirmed using immunofluorescence. @*Results@#FIPV-infected CRFK showed the upregulation of TLR9, TNF-α, and IFN-βexpression between 4 and 24 hpi. Uninfected monocytes from FCoV-seropositive cats showed lower TLR3 and TLR9 expression but higher TLR7 expression compared to uninfected monocytes from FCoV-seronegative cats. FIPV-infected monocytes from FCoV-seropositive cats downregulated TLR7 and TNF-α expression between 4 and 24 hpi, and 4 and 12 hpi, respectively. IFN-β was upregulated early in FIPV-infected monocytes from FCoV-seropositive cats, with a significant difference observed at 12 hpi compared to FCoV-seronegative cats.The viral load in the CRFK and FIPV-infected monocytes in both cohorts of cats was similar over time.ConclusionTLR7 may be the key TLR involved in evading the innate response against inhibiting TNF-α production. Distinct TLR expression profiles between FCoVseronegative and FCoV-seropositive cats were observed. The associated TLR that plays a role in the induction of IFN-β needs to be explored further.

A Study on Anthropometric Measurements of Lower end of IndianFemora

Background: The knee joint is a complex, compound synovial joint, providing hinge movements useful to give stability and support to body weight. Com The present study may be useful to orthopeditians and surgeons to select the accurate size of the prosthesis during knee arthroplasty surgeries.mon knee problems happen due to injuries and diseases of the knee. To the best of my knowledge, the anthropometric measurement on the lower end of the femur is not available for Madhya Pradesh population. The present study aims to measure various parameters of femoral condyles and intercondylar area which would be useful in the placement of the femoral compartment of knee prosthesis. Subjects and Methods: To conduct the Present study a total of 65 human dried femora were measured in the department of Anatomy, IMCH & RC, Indore, MP. Parameters & measurements recorded at the lower end of the femur were Anteroposterior & transverse diameters of medial and lateral condyles, intercondylar notch depth, width & bicondylar width. Results will be analyzed with the help of statistical calculations. Conclusion

Sources of Oral Health Information and its Relationship on Knowledge Among Indian Adolescents

ABSTRACT Objective: To assess the current level of oral health knowledge and identify information sources among adolescents in Bhubaneswar, India. Material and Methods: A cross-sectional examination was conducted among 1330 adolescents aged 13 to 15 years enrolled in 24 randomly selected government and private schools in Bhubaneswar. A specially designed self-administered questionnaire was used to collect the responses. Chi-square test with a level of significance set at 5% was used for statistical analysis. Results: Parents (55%) followed by media (18%) were the major sources of oral health information among the study population, which was statistically not significant in relation to gender and school type. Many subjects (95.3%) perceived sweets could cause tooth decay; however, this was statistically significant only among school type (p<0.05). Around (45%) knew about fluoride and only 36% properly identified fluoride's action as preventing cavities. This was statistically significant among both gender and school type (p<0.05). Seventy-five percent of students effectively distinguished gum disease symptoms, which was significant only with gender (p<0.05). Around 55% identified that oral habits have an influence on oral health, which showed significance among gender (p<0.05). Conclusion: Children oral health knowledge was not satisfactory, highlighting the need to utilize parents, schoolteachers and media to provide oral health education. It's essential for designing and implementing a person-centered care model in dentistry.