Effectiveness of Nicotine Replacement Therapy on Smoking Cessation and Reduction Among Pulmonary Tuberculosis Patients - A Randomized Controlled Trial.

Background': India is ranked second in the world in terms of tobacco use and tops the list of eight high-burden countries that account for two-thirds of the new tuberculosis (TB) cases globally. As tobacco smoking among TB patients is associated with unsuccessful TB treatment outcomes, effective smoking cessation interventions for TB patients is essential to combat this double pandemic. Aim: The study determined the effectiveness of nicotine replacement therapy (NRT) on smoking reduction and cessation among pulmonary TB patients. Settings and Design: The study included 300 pulmonary TB patients undergoing antitubercular treatment in government health care centers of Dakshina Kannada district in southern India. Materials and Methods: The participants in this two-armed, single-blinded, placebo-controlled, block-randomized trial were divided equally (n = 150) for experimental arm (brief advice + NRT) and control arm (brief advice + placebo). The total duration of treatment and follow-up was 6 months. Unadjusted relative risk (URR) and adjusted relative risk (ARR) were calculated for treatment outcomes at 95% confidence interval (CI). Generalized linear regression analysis was performed upon variables with P value less than 0.2. Results: After 6 months of intervention including follow up, there was a significant reduction in self-reported smoking (ARR = 1.08, 95% CI 1.01-1.17, P = 0.03) in the experimental arm compared with the control arm. Biochemically verified smoking abstinence was not significantly different between the two arms (ARR = 1.01, 95% CI 0.72-1.38, P = 0.97). Conclusion: The study showed statistically significant effectiveness of NRT for self-reported smoking reduction.

Effectiveness of brief counseling (5As): Antenatal tobacco cessation support program among pregnant women availing antenatal care.

Introduction: It is likely that a pregnant woman is more motivated and receptive to accepting healthy habits and practices if talked about the benefits to the fetus. When explained about the harmful effects of tobacco on the health of the baby, the mother can be encouraged to modify her tobacco consumption habits and work toward quitting tobacco. Aim: Our aim was to study the effectiveness of brief counseling (5As)-Antenatal Tobacco Cessation Support Program among pregnant women availing antenatal care (ANC). Methodology: A quasi-randomized study design was used to conduct the study. The participants were identified by screening during ANC visits, and women consuming tobacco were subjected to detailed history taking and very brief counseling with the help of 5A's framework. Results: We found that Mishri was the commonest form of tobacco consumed by these women. Around 93.33% of the women consume Mishri, followed by 6.66% of women consuming chewing tobacco. The method of brief counseling made an impact in the cessation of tobacco consumption in 13.37% of the study subjects. Conclusion: We conclude that the use of brief counseling and motivational interviewing is feasible in most settings without inhibiting the other important aspects of ANC or disrupting the patient flow.

Feasibility, acceptability, and preliminary efficacy of yoga to improve maternal mental health and immune function during the COVID-19 crisis (Yoga-M2 trial): a pilot randomized controlled trial.

Introduction: Women are vulnerable during pregnancy as they experience multiple physical and psychological problems which can lead to stress and poor quality of life ultimately affecting the development of the fetus and their health during and after pregnancy. Prior evidence suggests that prenatal yoga can improve maternal health and well-being and can have a beneficial effect on immune system functioning. To date, no study has been conducted in a rural, low-resource setting in India to assess the feasibility, acceptability, and preliminary efficacy of a yoga-based intervention on perceived stress, quality of life, pro-inflammatory biomarkers, and symptoms of upper respiratory tract infections. Methods: To address this gap and assess whether a yoga-based intervention could improve maternal mental health and immunity during the COVID-19 crisis (Yoga-M2 trial), a single-blind individual randomized parallel group-controlled pilot trial with a 1:1 allocation ratio was implemented. We randomly allocated 51 adult pregnant women, with gestational age between 12-24 weeks in the Yoga-M2 arm (n = 25) or the enhanced usual care arm (EUC) (n = 26). Feasibility and acceptability were assessed using the process data and In-Depth Interviews (IDIs) with the trial participants and yoga instructors. Multiple linear regression was used to compare follow-up scores for quantitative outcomes. Results: A three-month follow-up assessment was completed for 48 out of 51 participants (94.12%). We did not find any statistically significant difference between both arms in total Perceived Stress Scale scores, quality of life (Eq-5D-5L index), and serum C Reactive Protein levels at the three-month follow-up assessment. The critical barriers to practicing yoga were lack of knowledge about the benefits of yoga, lack of 'felt need' to practice yoga, lack of time to practice, lack of space, lack of transport, and lack of peer group to practice yoga. Despite this, women who regularly practiced yoga described the benefits and factors which motivated them to practice regularly. Discussion: The learnings from this trial will help design the explanatory trial in the future and the study findings can also be used by the primary health care system to deliver yoga-based interventions in the newly created health and wellness centers. Trial registration: This trial was prospectively registered with the Clinical Trials Registry of India on 25 January 2022. https://www.ctri.nic.in/Clinicaltrials/showallp.php?mid1=65173&EncHid=&userName=CTRI/2022/01/039701. Trial registration number: CTRI/2022/01/039701.

Study of exit survey and awareness program analysis on tobacco cessation counselling amongst the health care professionals of the tertiary care.

Introduction: Tobacco addiction in the rural community is very high, where we require efforts to break this addiction. Our aim was to find out the impact of awareness program on the current status of counselling on cessation of use of tobacco by the healthcare workers in various OPDs of PRH, Loni. Material and Methods: All patients visiting any of the OPD of Pravara satisfying the stated inclusion and exclusion criteria were included in the study. We conducted awareness survey amongst the health care professionals on tobacco cessation counselling. Results: In our study, 423 patients (79.2%) were not enquired regarding tobacco use by doctor to the patients, while 111 patients (20.8%) were asked for the same. Of the 111 patients who were enquired about tobacco use, 35 patients (31.5%) were given support for tobacco cessation. Thus overall (out of 534 patients), only 6.17% received support for tobacco cessation. Of these patients, most were given verbal counselling (13, 2.43%), followed by prescription of Nicotine replacement therapy in the form of nicotine gum (8, 1.5%) and one patient (0.19%) referred to the Tobacco Cessation center. Eleven patients (2.1%) did not recall the support provided. Conclusion: There is an urgent need for awareness among health care professionals in order to investigate, consult and stop smoking cessation. Our research strongly identifies an opportunity to significantly increase access to tobacco control services in rural India.

Comparative evaluation of penetration of sealers in dentinal tubules using passive ultrasonic irrigation and Erbium: yttrium-aluminum-garnet laser - A confocal laser scanning microscope study.

Context: Smear layer clearance and sealer penetration into dentinal tubules play a crucial role in root canal treatment. Hence, efficient irrigation is a crucial component of the root canal debridement. This in vitro study's objective was to assess the effectiveness of passive ultrasonic activation and Erbium: yttrium-aluminum-garnet (Er: YAG) laser-activated irrigation on irrigation solution penetration and sealer penetration into dentinal tubules. Aims: The aim of this study was to evaluate and compare the dentinal tubule penetration of epoxy resin-based sealer and bioceramic sealer after ultrasonic agitation and Er: YAG laser activation of the irrigant. Settings and Design: This was an in vitro study. Materials and Methods: Extracted tooth samples (n = 42) into 06 groups (Group A-F) with 7 samples in each group. Postobturation transverse section was made and assessed under a confocal laser scanning microscope for the total dentinal tubule penetration area and recorded as the mean apical, middle, and coronal penetration. Statistical Analysis: One-way analysis of variance test, followed by post hoc was used. Results: The intergroup comparison showed that Group E and Group F have significantly more penetration as compared to the controls and ultrasonic irrigation, P < 0.001 and P < 0.01, respectively. Conclusions: Er: YAG laser with AH plus sealer has the highest penetration in all the sections of tooth, followed by CeraSeal sealer.

Yoga to improve maternal mental health and immune function during the COVID-19 crisis (Yoga-M 2 trial): study protocol for a pilot randomized controlled trial.

Background: Mental health of women is adversely affected during pregnancy. A huge proportion of pregnant women suffer from stress and depression which negatively impacts birthweight and neuro-cognitive development of the fetus. The current crisis due to the COVID-19 pandemic further adds to the stressful situation. Yoga practiced during pregnancy has beneficial effects on improving stress and depression and preliminary evidence suggests that yoga-based interventions can improve immunity. This study aims to examine the feasibility, acceptability, and preliminary efficacy of a Yoga-based intervention for maternal Mental health and i Mmunity (Yoga-M 2) in a rural community in India.     Methods: The study design will be a single-blind individual randomized parallel group-controlled pilot trial with 1:1 allocation ratio. Adult pregnant women, with gestational age between 12-24 weeks will be randomly allocated to either the Yoga-M 2 group or the Enhanced Usual Care (EUC) group. Participants in the Yoga-M 2 arm will attend weekly group yoga sessions for 12 weeks and will be encouraged to practice yoga at home. In the EUC arm, participants will receive a single session of health education. Eligibility of the participants, recruitment, retention-in-care, and study completion rates will be estimated and feasibility of delivering Yoga-M 2 and acceptability of this intervention by the participants will be assessed. Change in the scores of the Perceived Stress Scale (PSS), EuroQoL 5 Dimensions Score (EQ-5D-5L), Wisconsin Upper Respiratory Symptom Severity Scale (WURSS-21), and serum C-Reactive Protein at three-months post-randomization will be used to assess preliminary efficacy.   Discussion: The key outputs of this trial will be a structured intervention manual and evidence about the feasibility, acceptability, and preliminary efficacy of the intervention, establishing the foundation to undertake an explanatory randomized controlled trial to assess efficacy and cost-effectiveness of Yoga-M 2 intervention.  Trial registration: CTRI/2022/01/039701. Prospectively registered with the Clinical Trials Registry of India on 25 January 2022.

Antidiabetic and antihyperlipidemic effects of crude fractions and isolated compound from Striga orobanchioides Benth on streptozotocin induced diabetic rats.

BACKGROUND: Striga orobanchioides Benth is a traditionally used Ayurvedic medicinal plant for the treatment of diabetes. Scientific validation of the claim is studied in this research. The significant bioactivity of the plant components is obligatory for its use in medicine. OBJECTIVE: The present work is to extract bioactive fractions and chemicals, biological activity of the chemicals and to identify potentially bioactive compound(s) from ethanolic extract of the plant. MATERIALS AND METHODS: Ethanolic extract of the authenticated plant was fractionated and subjected to in vitro and in vivo antidiabetic and antihyperlipidemic activity. In vitro α-amylase and α-glucosidase enzyme activity was carried out on digestive enzyme. Streptozotocin (STZ) induced diabetes mellitus in rats model was preferred for in vivo activity where antidiabetic parameters body weight, urine volume, blood glucose level, glycosylated hemoglobin, serum insulin, liver glycogen and lipid profile as an antihypertensive parameters were assessed. Isolation of bioactive compounds was carried out by chromatographic techniques and identification of the compound was done by FTIR, Mass spectrometry and NMR spectroscopy. The molecular docking study with α-amylase, α-glucosidase, dipeptidyl peptidase-IV (DPP-IV), glucokinase (GK) as diabetic markers and on 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) and Niemann-Pick C1-Like 1 (NPC1L1) was carried out. RESULTS: Ethyl acetate-methanol fraction of the ethanol extract showed presence of pentacyclic triterpenoids (81.5% w/w) in GC-HRMS study. Spectroscopic analysis of the isolated compound revealed presence betulin. In vitro antidiabetic activity pointed out robust inhibition of the digestive enzymes by the fractions known as bioactive fraction and betulin. Betulin at a dose of 40 mg/kg treated group showed significant improvement of diabetic conditions. The gene expression studies revealed that betulin in 40 mg/kg dose has positive effects for carbohydrate metabolism in liver, lowers the hepatic inflammation and increases insulin secretion. The plant compound demonstrated significant inhibitory potential on α-amylase, α-glucosidase, DPP-IV and GK enzymes in silico. CONCLUSION: The biological study reveals that betulin could dominate the succession of diabetes in dose dependent manner. The plant and specifically Betulin exerts a significant antidiabetic and antihyperlipidemic effects that are more possibly through stimulation of insulin secretion, increase in PPAR-α level with an increase in GRIA2 mRNA expression.

Is the medical teacher's mental health neglected? Effects of perceived student attitudes and behaviors on mental health and lifestyle of teachers in a rural university of western Maharashtra in India.

BACKGROUND: A medical teacher is a practitioner, teacher, trainer, and researcher all at once. There are very few studies assessing stress among medical teachers. With landmark policy changes, disruption and ongoing pandemic, looking at the mental health of medical teachers assumes greater importance. METHODS: A cross-sectional study was carried out in the teaching faculty of medical, dental, nursing, and physiotherapy colleges affiliated within a rural medical university in western Maharashtra. A convenience sample of 100 teachers was taken and a self-report questionnaire was used to collect data from the teachers. Stress was measured by the Perceived Stress Scale. RESULTS: Low stress scores (0-13) were seen in 43% of teachers, 55% had moderate stress scores (14-26), and 2% had high stress scores (27-40). Teaching was reported as a stressor by only 8%, whereas administrative work, lifestyle, family responsibilities, finances, patient care, professional jealousy, competition, and frequently changing norms were more commonly reported stressors. The overt focus on entrance test preparation, over-reliance on mobile phones, short attention span, poor listening skills, lack of interpersonal skills, lack of initiative to acquire clinical skills, lack of punctuality, and transactional nature toward learning were some of the perceived faults in the attitude of medical students as reported by the teachers. CONCLUSION: Teachers are coping with changing trends in technology and attitude of students toward learning and shoulder a multitude of responsibilities while creating doctors and healthcare professionals of the future. Attention needs to be paid to their health.