Quality of comprehensive assessment among severely ill TB patients referred after triaging in southern India.

To reduce TB deaths, Tamil Nadu, a southern Indian state, implemented the first state-wide differentiated TB care strategy starting April 2022. Triage-positive severely ill patients are prioritised for comprehensive assessment and inpatient care. Routine program data during October-December 2022 revealed that documentation of total score after comprehensive assessment was available in only 39%, possibly indicating poor quality of comprehensive assessment. We confirmed this using operational research. The case record form to record comprehensive assessment was used only in 26% and among these, the completeness and correctness in filling out the form were sub-optimal. There is a clear need to enhance the quality of comprehensive assessments.

Depuis avril 2022, le Tamil Nadu, un État du sud de l'Inde, a mis en œuvre la première stratégie de soins différenciés pour la TB à l'échelle de l'État afin de réduire le nombre de décès dus à la TB. Les personnes gravement malades ayant obtenu un résultat positif au triage sont prioritaires pour une évaluation complète et des soins hospitaliers. Les données du programme de routine entre octobre et décembre 2022 ont révélé que la documentation du score total après l'évaluation complète n'était disponible que dans 39% des cas, ce qui pourrait indiquer une mauvaise qualité de l'évaluation complète. Nous l'avons confirmé par le biais d'une recherche opérationnelle. Le formulaire de dossier pour enregistrer l'évaluation complète n'a été utilisé que dans 26% des cas et, parmi ceux-ci, l'exhaustivité et l'exactitude du remplissage du formulaire n'étaient pas optimales. Il est manifestement nécessaire d'améliorer la qualité de l'évaluation complète.

Surgical management of oculomotor nerve palsy: a comparison of lateral rectus deactivation combined with either medial rectus resection or medial rectus fixation to the medial palpebral ligament.

PURPOSE: To analyze and compare the outcome of two different surgical procedures in patients with complete oculomotor nerve palsy with large-angle exotropia. METHODS: The medical records of patients with total oculomotor nerve palsy and large-angle exotropia operated on at a single center from January 2006 to June 2020 were reviewed retrospectively. One group underwent lateral rectus deactivation with medial rectus resection (resection group); the other group underwent lateral rectus deactivation with medial rectus fixation to the medial palpebral ligament (fixation group). Surgical outcomes on the first postoperative day and at 6 months postoperatively were analyzed, including alignment and postoperative complications. All statistical analyses were performed using STATA version 14. A P value of <0.05 was considered significant. RESULTS: A total of 35 patients were included. There was a trend toward greater surgical success in the fixation group (93%) than in the resection group (65%), but these results were not statistically significant. Postoperative exotropic drifts were noted in both the procedures but tended to be more with patients in the resection group. Postoperative complications were noted only in the fixation group. CONCLUSIONS: Lateral rectus deactivation with medial rectus fixation to the medial palpebral ligament requires more time and greater surgical expertise but appears to better prevent postoperative exotropic drift compared with lateral rectus deactivation combined with medial rectus resection.

Micro and nano plastics in food: A review on the strategies for identification, isolation, and mitigation through photocatalysis, and health risk assessment.

Over the past few years, it has become increasingly evident that microplastic pollutant heavily contaminates water sources, posing a potential threat to both human and wildlife. These plastic pollutants do not get degraded efficiently by natural processes and the existing traditional treatment methods are incapable of fully eradicating them. In this regard, degradation of microplastic contaminants through photocatalytic methods has emerged as a powerful technique. Unfortunately, only a limited number of investigations have been reported in the field of photocatalytic degradation of microplastics. This comprehensive assessment focuses on the detailed analysis of the latest cutting edge engineered technologies aimed at efficiently separating, identifying microplastic contaminants present in food samples and degrading them through photocatalysis. Moreover, detailed information on various instrumental techniques that can be adopted to analyze the isolated micro sized plastic particles has been discussed. The assessment and degradation of these micro contaminants through photocatalytic methods is still in juvenile stage and there are lot of rooms to be explored. The need for profound contemplation on methods to degrade them through photocatalytic approaches as well as their possible health risks to humans motivated us to bring out this review.

Utility of in-house and commercial PCR assay in diagnosis of Covid-19 associated mucormycoss in an emergency setting in a tertiary care center.

Introduction. Invasive mucormycosis (IM) is a potentially fatal infection caused by fungi of the order Mucorales. Histopathology, culture, and radiology are the mainstays of diagnosis, but they are not sufficiently sensitive, resulting in delayed diagnosis and intervention. Recent studies have shown that PCR-based techniques can be a promising way to diagnose IM.Hypothesis/Gap Statement. Early diagnosis of fungal infections using molecular diagnostic techniques can improve patient outcomes, especially in invasive mucormycosis.Aim. The aim of this study was to evaluate the utility of our in-house mould-specific real time PCR assay (qPCR) in comparison with the commercially available real time PCR (MucorGenius PCR), for the early diagnosis of mucormycosis in tissue samples from patients with suspicion of invasive mucormycosis (IM). This in-house assay can detect and distinguish three clinically relevant mould species, e.g. Aspergillus spp., Mucorales and Fusarium spp. in a single reaction with only one pair of primers, without the need for sequencing.Methodology. We enrolled 313 tissue samples from 193 patients with suspected IM in this prospective study. All cases were classified using EORTC/MSGERC guidelines. All samples were tested using traditional methods, in-house qPCR, and MucorGenius PCR.Results. Using direct microscopy as a gold standard, the overall sensitivity and specificity of in-house qPCR for detection of IM was 92.46% and 80% respectively, while that of the MucorGenius PCR was 66.67% and 90% respectively. However, co-infection of IM and IA adversely affected the performance of MucorGenius PCR in detection of IM.The in-house PCR detected Aspergillus spp. in 14 cases and Fusarium spp. in 4 cases which showed clinical and radiological features of fungal sinusitis. The in-house qPCR also performed better in detecting possible cases of IM. This aids early diagnosis and appropriate treatment to improve patient outcomes.Conclusion. Because the in-house PCR is not only sensitive and specific, but also entirely based on SYBR Green for detection of targets, it is less expensive than probe-based assays and can be used on a regular basis for the diagnosis of IM in resource-constrained settings. It can be used to distinguish between mucormycosis and fungal sinusitis caused by Aspergillus and Fusarium in high-risk patients, as well as to accurately detect Mucorales in fungal co-infection cases.

Seasonal distribution of microplastics in surface waters of the Northern Indian Ocean.

Seven expeditions were carried out during pre-monsoon, monsoon and post monsoon in 2018-2019 for marine plastic collection in surface waters of Northern Indian Ocean. PE and PP (83 %) is the dominant type of polymer found in the surface waters. Colored particles account for 67 % of all particles, with fibre/line accounting for 86 %. The average (Mean ± SD) microplastics concentration in the Northern Indian Ocean during pre-monsoon is 15,200 ± 7999 no./km2, Monsoon is 18,223 ± 14,725 no./km2 and post monsoon is 72,381 ± 77,692 no./km2. BoB during pre-monsoon and post monsoon the microplastic concentration remains same except in the northern BoB this change is caused due to weak winds. Microplastics concentration varied both spatially, temporal and heterogeneity in nature. These differences are caused by effect of wind and seasonal reversal of currents. Microplastics collected in the anticyclonic eddy are 129,000 no./km2.

Independent and combined impact of texture manipulation on oral processing behaviours among faster and slower eaters.

Background: Food texture can moderate eating rate and ad libitum energy intake. Many foods are combined with condiments when consumed and the texture and eating properties differ considerably between condiments and carrier foods. Little is known about how combinations of textures impact oral processing or whether these differences are affected by individual eating-styles. Objective: We investigated the impact of texture parameters (unit size, thickness, hardness and lubrication) on oral processing behaviours for carrots and rice-crackers, and tested whether these behaviours differ between 'faster' and 'slower' eaters. Method: Seventy participants (34 males, 26.0 ± 5.4 years, BMI = 21.5 ± 1.7 kg m-2) consumed 24 weight-matched carrot samples varying in unit size (large/medium/small), thickness (thick/thin), hardness (hard/soft) and lubrication (with/without mayonnaise). In a second step, participants consumed 8 weight-matched cracker samples varying in unit size (large/small), hardness (hard/soft) and lubrication (with/without mayonnaise). Sample consumption was video-recorded for post hoc behavioural annotation to derive specific oral processing behaviours. Participants were divided into 'faster' or 'slower' eater groups using a post hoc median split based on eating rate of raw carrot. Results: Across texture parameters, hardness had the largest influence (p < 0.001) on eating rate for both carrots and crackers. The independent texture differences for carrot ranked from most to least impact on eating rate was hardness > thickness > lubrication > unit size. For crackers, the rank order of eating rate was hardness > lubrication > unit size. Harder carrot samples with decreased unit size and reduced thickness combined had a larger synergistic effect in reducing eating rate (p < 0.001) than manipulation of any single texture parameter alone. Reducing the unit size of crackers while increasing hardness without lubrication combined (p = 0.015) to produce the largest reduction in eating rate. There were no significant differences between fast and slow eaters on their oral processing behaviours across texture manipulations. Conclusions: Combinations of texture manipulations have the largest impact in moderating oral processing behaviours, and this is consistent across 'faster' and 'slower' eaters. Changing food-texture presents an effective strategy to guide reformulation of product sensory properties to better regulate eating rate and energy intake, regardless of an individual's natural eating-style.

The impact of distance cataract surgical wet laboratory training on cataract surgical competency of ophthalmology residents.

BACKGROUND: This study assessed the impact of distance cataract surgical wet laboratory training on surgical competency of ophthalmology residents at a tertiary-level ophthalmic training center in Trujillo, Peru. METHODS: Three five-week distance wet lab courses were administered through Cybersight, Orbis International's telemedicine platform. Weekly lectures and demonstrations addressed specific steps in phacoemulsification surgery. Each lecture had two accompanying wet lab assignments, which residents completed and recorded in their institution's wet lab and uploaded to Cybersight for grading. Competency was assessed through anonymous grading of pre- and post-training surgical simulation videos, masked as to which occurred before and after training, using a standardized competency rubric adapted from the Ophthalmology Surgical Competency Assessment Rubric (OSCAR, scale of 0-32). Day one best-corrected post-operative visual acuity (BVCA) was assessed in the operative eye on the initial consecutive 4-6 surgeries conducted by the residents as per the norms of their residency training. An anonymous post-training satisfaction survey was administered to trainees'. RESULTS: In total, 21 ophthalmic residents participated in the courses, submitting a total of 210 surgical videos. Trainees' average competency score increased 6.95 points (95%CI [4.28, 9.62], SD = 5.01, p < 0.0001, two sample t-test) from 19.3 (95%CI [17.2, 21.5], SD = 4.04) to 26.3 (95%CI [24.2, 28.3], SD = 3.93). Visual acuity for 92% of post-training resident surgeries (n = 100) was ≥20/60, meeting the World Health Organization's criterion for good quality. CONCLUSIONS: Structured distance wet lab courses in phacoemulsification resulted in significantly improved cataract surgical skills. This model could be applicable to locations where there are obstacles to traditional in-person training, such as the current COVID-19 pandemic.

Retrospective analysis of visual outcomes in retropupillary iris-suture-fixated rigid intraocular lens in a tertiary eye center in southern India.

PURPOSE: To report clinical outcomes of retropupillary iris-suture-fixated rigid intraocular lens (IFIOL) SETTING: Tertiary care ophthalmic hospital DESIGN: Retrospective study METHODS: This study included all eyes undergoing IFIOL with a minimum follow-up of 6 months between April 2017 and January 2019. Patients with preexisting anterior or posterior segment pathologies causing defective vision, uveitis or history of previous intraocular surgeries with exception of cataract surgery were excluded from the study. Data were retrieved from electronic medical records, and we documented demographics, history, position of cataractous lens or IOL, primary/secondary surgery and its complications. Postoperative visual acuity, pupillary response, diplopia, centration of IOL, inflammation were also recorded at the baseline visit and at 1 month, 3 months and 6 months postoperatively. RESULTS: One hundred and ten eyes of 110 patients that underwent IFIOL were evaluated. Twenty-two patients (20%) underwent primary IFIOL, whereas 67 (60.9%) patients had secondary IFIOL. In 18 patients (16.36%), IFIOL was done to reposition decentered/dislocated IOLs. At the final follow-up, there was a significant improvement in corrected distance visual acuity (CDVA) with 87 patients (79.09%) achieving CDVA of 6/12 or better. IFIOL was stable and centered in 101 eyes (91.81%). Two patients (1.81%) had intraoperative complications. Postoperative iritis was seen in 7 patients (6.36%), and 4 patients (3.63%) had rise in IOP. CONCLUSION: This is a safe, reliable, reproducible technique for aphakia rehabilitation and decentered IOL stabilization with good clinical outcome, especially in a limited resource setting.

Effectiveness of school dental health education on the oral health status and knowledge of children: A systematic review.

OBJECTIVE: To evaluate the effectiveness of school dental health education on the oral health status, oral health-related knowledge, and practice behavior of 6-12-year-old children. METHODS: Hand search and electronic search based on the keywords on school dental health education in seven search engines till 2017 identified 7434 articles. Trials involving school-based dental health education with a minimum follow-up period of 6 months were screened. Risk of bias assessment was done independently by two authors. RESULTS: Among the 18 articles which fulfilled the eligibility criteria, six were randomized controlled trials (RCTs) and 12 were non-RCTs. Quality assessment showed that 12 trials had a low risk of bias. Oral health-related knowledge improved in children. Oral health-related practice behaviors such as frequency and duration of brushing improved. Use of fluoridated toothpaste was increased. Plaque scores and gingival bleeding scores reduced. CONCLUSION: School dental health education had a positive impact on the oral health status, knowledge, and practice behavior of children. There is a definite need for high-quality RCTs analyzing the effectiveness of school dental health education on specific oral health outcomes.

A cohort study assessing the sustainable long-term effectiveness of a childhood-obesity intervention in China.

BACKGROUND: Obesity has become a global epidemic, with substantial impacts on children's health. Numerous intervention studies for the prevention of obesity in children have been conducted during the most recent decade, but very few have evaluated the long-term and sustainable effectiveness of such prevention efforts. METHODS: We conducted a follow-up study during September 2015 and September 2017, based upon a previous 3-year cluster randomized-controlled study (RCT) for a comprehensive childhood-obesity intervention in 14 primary schools in Shanghai, China. A total of 929 students were enrolled in the study. Generalized estimating equation approaches were applied to analyse student's body mass index (BMI), BMI z-score at baseline and three annual long-term follow-ups. RESULTS: Three years after the end of the RCT study, the odds of developing obesity and the odds of developing obesity or overweight in the intervention group were both lower than in the control group among girls [OR(obesity) = 0.299, p = 0.010 and OR (overweight/obesity) = 0.493, p = 0.013]; the odds of developing obesity or overweight in the intervention group was lower than in the control group among boys (OR = 0.369, p = 0.017). Compared with the baseline, the BMI z-scores in the intervention group were lower than those in the control group for both normal-weight students (-0.027) and overweight or obese students (-0.074). CONCLUSIONS: The 3-year RCT showed significant and reliable long-term effects on preventing childhood obesity, particularly among girls.

Assessing the role of access and price on the consumption of fruits and vegetables across New York City using agent-based modeling.

Most residents in New York City (NYC) do not consume sufficient fruits and vegetables every day. Difficulties with access and high prices of fruits and vegetables in some neighborhoods contribute to different consumption patterns across NYC neighborhoods. We developed an agent-based model (ABM) to predict dietary behaviors of individuals at the borough and neighborhood levels. Model parameters were estimated from the 2014 NYC Community Health Survey, United States Census data, and the literature. We simulated six hypothetical interventions designed to improve access and reduce the price of fruits and vegetables. We found that all interventions would lead to increases in fruit and vegetable consumption but the results vary substantially across boroughs and neighborhoods. For example, a 10% increase in the number of fruit/vegetable vendors combined with a 10% decrease in the prices of fruits and vegetables would lead to a median increase of 2.28% (range: 0.65%-4.92%) in the consumption of fruits and vegetables, depending on neighborhood. We also found that the impact of increasing the number of vendors on fruit/vegetable consumption is more pronounced in unhealthier local food environments while the impact of reducing prices on fruits/vegetable consumption is more pronounced in neighborhoods with low levels of education. An agent-based model of dietary behaviors that takes into account neighborhood context has the potential to inform how fruit/vegetable access and pricing strategies may specifically work in tandem to increase the consumption of fruits and vegetables at the local level.

Antemortem dental records versus individual identification.

BACKGROUND: Forensic odontology plays a pivotal role in the identification of victims in mass disasters utilizing "preserved dental records" or "ante-mortem records" available with the general dental practitioners. Identification of a deceased individual by comparing antemortem and postmortem records is more reliable and easier as compared to other methods. However, in India, the practice of maintaining dental case record requires additional emphasis. AIM: The aim of the present study is to assess the knowledge, attitude, and practices of dental practitioners in South India regarding awareness and importance of maintaining patient's dental records. SETTINGS AND DESIGN: A descriptive questionnaire study was conducted among the alumni of the dental institution over a period of 3 months. The alumni who passed out from 2000 to 2015 were included in the study. MATERIALS AND METHODS: A structured questionnaire containing 24 questions regarding the knowledge, attitude, and practice of maintaining clinical case records was prepared and validated. Data were collected from 543 dental practitioners from various parts of South India who were the alumni of the dental institution. STATISTICAL ANALYSIS: The data were summarized and analyzed using the statistical software Statistical Package for the Social Sciences. The descriptive analysis was done in percentages, and the results were tabulated. RESULTS: Overall, 58.39% of dentists were found to be maintaining records promptly, and 84.6% dentists have knowledge about forensic odontology, but only 8.4% of dentists have helped the government agencies during mass disasters. CONCLUSION: This study reveals that the need of the hour is to change the attitude and to cultivate interest among practicing dentists regarding dental record maintenance which can tremendously help in the deceased individual identification process.

Expansion Of Telestroke Services Improves Quality Of Care Provided In Super Rural Areas.

Telestroke is a telemedicine intervention that facilitates communication between stroke centers and lower-resourced facilities to optimize acute stroke management. Using administrative claims data, we assessed trends in telestroke use among fee-for-service Medicare beneficiaries with acute ischemic stroke and the association between providing telestroke services and intravenous tissue plasminogen activator (IV tPA) and mechanical thrombectomy use, mortality, and medical expenditures, by urban versus rural county of residence in the period 2008-15. The proportion of ischemic stroke cases receiving telestroke increased from 0.4 to 3.8 per 1,000 cases, with usage highest among younger, male, non-Hispanic white, and patients in rural or super rural areas (super rural is the bottom quartile of rural areas. Compared with patients receiving usual care, those receiving telestroke had greater IV tPA and mechanical thrombectomy use regardless of county type, while those in super rural counties had lower thirty-day all-cause mortality. Despite increased telestroke use, rural patients remained less likely than urban patients to receive IV tPA. The findings suggest that telestroke service expansion efforts have increased, especially in rural and super rural counties, and have improved outcomes.

Preventive Dental Checkups and Their Association With Access to Usual Source of Care Among Rural and Urban Adult Residents.

PURPOSE: This study aimed to assess the relationship between rural or urban residence and having a usual source of care (USC), and the utilization of preventive dental checkups among adults. METHODS: Cross-sectional analysis was conducted using data from the Medical Expenditure Panel Survey 2012. We performed a logit regression on the relationship between rural and urban residence, having a USC, and having at least 1 dental checkup in the past year, adjusting for sociodemographic characteristics and health status. FINDINGS: After controlling for covariates, rural adult residents had significantly lower odds of having at least 1 dental checkup per year compared to their urban counterparts (odds ratio [OR] = 0.73, 95% confidence interval [CI]: 0.62-0.86, P < .001). Additionally, individuals with a USC had higher odds of having at least 1 dental checkup per year (OR = 1.76, 95% CI: 1.59-1.95, P < .001). Among both rural and urban residents, having a USC was significantly associated with an 11% (95% CI = 9%-13%) increase in the probability of having a preventive dental checkup within a year. CONCLUSIONS: Individuals with a USC were more likely to obtain a preventive dental visit, with similar effects in rural and urban settings. We attributed the lower odds of having a checkup in rural regions to the lower density of oral health care providers in these areas. Integration of rural oral health care into primary care may help mitigate the challenges due to a shortage of oral health care providers in rural areas.

Improving Cancer Risk Awareness Including Obesity as a Risk Factor for Cancer in a Small U.S. Community.

Obesity is a risk for certain types of cancer; however, awareness of obesity as a risk factor for cancer is low. This study evaluated increases in cancer risk awareness, including obesity as a risk factor for cancer, from a quasi-experimental intervention that provided educational materials and community reinforcement for healthy living. The study uses data on participant's awareness of cancer risk factors along with sociodemographic variables collected from in-person surveys (N = 863) at baseline (June 2011) and post intervention (June 2012). The average awareness that overweight and obesity are risk factors for cancer was low (35 %) compared to chewing tobacco (92 %), using tanning bed (73 %), and sunburn (97 %) at baseline. The intervention significantly increased participants' awareness that overweight and obesity are risk factors for cancer. Based on regression analysis, the unadjusted intervention effect on cancer risk awareness was significant: 0.392 ± 0.165 (p value = 0.020) for matched participants and 0.282 ± 0.125 (p value = 0.024) for community participants. The adjusted intervention effect was significant in the matched participants (0.528 ± 0.189, p value = 0.006). Education, income, gender, and age had a significant impact on cancer risk awareness for the community participants. The results show that community intervention that incorporates community reinforcement can have the desired effect regardless of differences at participant level. Such interventions could be used to prevent cancer risk in communities that are at high risk.

Effect of a bcl-2 transgene on production and localization of precursor B cells in mouse bone marrow.

Many B cell precursors die while differentiating in mouse bone marrow. To ascertain the mechanisms involved in this process, populations of B lineage cells and their tissue localization were analyzed in bone marrow of transgenic mice overexpressing the apoptosis inhibitor, Bcl-2. Immunofluorescence labeling and mitotic arrest were used to quantitate the number and proliferative activity of mu- pro-B cells (terminal deoxynucleotidyl transferase [TdT]+B220-, TdT+B220+, and TdT-B220+); pre-B cells (cmu+); and B cells (smu+). Mature B cells (IgM+IgD+) were increased 16- to 20-fold. In addition, immature B lymphocytes (IgM+IgD-/low), representing newly formed cells, were increased three- to sixfold, whereas pre-B cells and late pro-B cells were increased 30 to 60% in production rate. Earlier pro-B cells expressing TdT were unaffected. In spleen, both mature and immature B cells were greatly increased, but cells of precursor phenotype were few and TdT+ cells were absent. The in vivo location of B cells was examined by autoradiography using light and electron microscopy after intravenous injection of 125I-labeled antibodies. B lineage cells (B220+) were increased throughout bone marrow, often within dilated venous sinusoids, particularly in subosteal regions. Many intravascular and perisinusoidal cells were IgDhigh mature B lymphocytes. In contrast, many other IgM+ and IgDlow immature B lymphocytes clustered extravascularly around the central venous sinus. Plasma cells with distended endoplasmic reticulum were numerous. These findings provide evidence that, in addition to expanding the recirculating pool of B cells entering bone marrow from the blood stream, high levels of Bcl-2 can inhibit some of the apoptosis occurring during B cell differentiation, thereby expanding populations of B lymphopoietic precursor cells within the bone marrow parenchyma.

Apoptosis and macrophage-mediated cell deletion in the regulation of B lymphopoiesis in mouse bone marrow.

Studies of cell population dynamics and microenvironmental organization of B lymphopoiesis in the bone marrow of normal mice and in various genetically modified states have shown that cell loss, involving processes of apoptosis and macrophage-mediated cell deletion, is a prominent feature of the primary genesis of B lymphocytes. Balanced against the influence of proliferative stimulants, the programmed death of precursor B cells provides a quantitative control, determining the magnitude of the final output of functional B lymphocytes to the peripheral immune system. The cell loss mechanisms can be readily set in motion by external or systemic influences, making the B-cell output particularly vulnerable to suppression by ionizing irradiation, stress or other systemic mediators. In addition, however, cell loss exerts an important quality control in the formation of the primary B-cell repertoire. The combination of apoptosis and macrophage-mediated deletion, acting at successive stages of B-cell differentiation, efficiently eliminates many precursors having non-productive Ig gene rearrangements, cell cycle dysregulations, and certain autoreactive Ig specificities. Outstanding areas of further work abound. Important questions concern the nature of mechanisms which underlie the processes of B-cell apoptosis and macrophage deletion in bone marrow, the microenvironmental signals involved in B-cell life or death decisions and genetic factors which may override these B-cell culling mechanisms. The answers will be relevant to problems of autoimmune disease, humoral immunodeficiency and B-cell neoplasia.