A randomized controlled trial evaluating a theory driven, complex intervention centered on task sharing and mobile health to improve selfcare and outcomes in heart failure - The PANACEA-HF RCT: Design and rationale.

Background: We developed a three-pronged complex intervention to improve selfcare and deliver whole person care for patients with heart failure, underpinned by the 'extant cycle' theory - a theory based on our formative work. Methods: This is a 3 centre, 2-arm, 1:1, open, adaptive stratified, randomized controlled trial. We included patients aged ≥ 18 years with heart failure, taking any of the key guideline directed medical treatments, with a history of or currently on a high ceiling diuretic. We excluded end stage renal disease, clinically diagnosed severe mental illness or cognitive dysfunction and having no caregivers. Interventions included, (i) trained hospital based lay health worker mediated assessment of patients' current selfcare behaviour, documenting barriers and facilitators and implementing a plan to 'transition' the patient toward optimal selfcare. (ii) m-health mediated remote monitoring and (iii) dose optimization through a 'physician supervisor'. Results: We recruited 301 patients between Jan 2021 and Jan 2022. Mean age was 59.8 (±11.7) years, with 195 (64.8 %) from rural or semi-urban areas and 67.1 % having intermediate to low health literacy. 190 (63.1 %) had an underlying ischemic cardiomyopathy. In the intervention arm, 142 (94.1 %) had a Selfcare in Heart Failure Index (SCHFI) score of ≤70, with significant barriers being 'lack of knowledge' 105 (34.5 %) and 'behavioural passivity' 23 (7.5 %). Conclusion: This is the first South Asian trial evaluating a complex intervention underpinned by behaviour change theory for whole person heart failure care. These learnings can be applied to heart failure patient care in other resource constrained health systems.

The use of concentrated growth factor in dental implantology: A systematic review.

In the era of evidence based dentistry, a well-documented consolidated data about improvements in dentistry is a necessity. Concentrated growth factor (CGF) is an emerging trend in periodontology and now in implant dentistry. Various studies have been published in the literature evaluating the effect of CGF on implant osseointegration, implant stability, survival rate, sinus augmentation, and peri-implant defects. However, no systematic review has yet been documented. The present systematic review, being first of its kind, aimed to evaluate the potential outcomes of employing CGF in implant treatment. A literature search was carried out in PubMed and Google scholar for articles published between 2001 and 2019, with various keywords such as "CGF," "dental implant," "bone regeneration," "CGF," and "osseointegration." The screening of studies was done according to PRISMA guidelines. A total of eleven studies were included in this review. Majority of the included studies pointed toward the beneficial effects of CGF in implant treatment. CGF was seen to promote osseointegration and enhance bone regeneration. Although more clinical studies are required to validate the potential merits of CGF in the long run, the preliminary results seem promising.

Innominate Vein Stenosis in Association with Ipsilateral Hyperdynamic Brachiobasilic Fistula Causing Ipsilateral Limb and Hemifacial Swelling.

A 34-year-old hypertensive woman with a hyperdynamic, left brachiobasilic dialysis fistula presented with a long history of throbbing in her head and swelling of the left side of the face. Tight stenosis of left brachiocephalic vein was found to be causing retrograde flow into the left jugular vein which normalized after dilatation and stenting with resolution of all the symptoms and patient is asymptomatic for 1 year.

Implant-supported overdentures.

Retention of the lower complete denture is always a question for the dentist and the patient because of the alveolar ridge resorption and many muscle attachments to the mandible. The treatment of edentulous patients using oral implants does not always permit the placement of an adequate number of implants for fixed prosthesis construction; the reasons are insufficient anatomical bone height of the alveolar ridge, health restrictions and financial limitations. Placement of two dental implants in the cuspid regions anterior to the mental foramina on either side will improve the retention and stability of complete dentures in edentulous patients. Implant-supported overdentures with ball and socket attachments are more successful, provide good retention, stability for the denture and improve comfort and confidence for the edentulous patient while speaking and masticating.

Chemical hair relaxers have adverse effects a myth or reality.

CONTEXT: Hair plays an important role in one's personality and builds confidence. Now-a-days, chemical hair relaxers are used very commonly in the society. We document the adverse effects reported by the sample that have used any one of the professional chemical hair relaxers. AIM: To study the adverse effects reported by the sample who underwent repeated chemical hair relaxing. SETTINGS AND DESIGN: Cross-sectional questionnaire based study done on a sample taken from a medical college and hospital campus in Mangalore. MATERIALS AND METHODS: The sample was restricted to females and to those who underwent it more than once. A questionnaire was given to a sample of 90, which matched our criteria. STATISTICAL ANALYSIS: SPSS software 17. RESULTS: Adverse effects reported by the sample after undergoing the procedure were found to be a high 95.56%, out of which the following are the common adverse effects reported; frizzy hair in 67%, dandruff in 61%, hair loss in 47%, thinning and weakening of hair in 40%, greying of hair 22%, and split ends in only 17%. CONCLUSIONS: Very few studies have been conducted on the adverse effects of hair straightening products in India. From our study, it can be stated that most of the samples had adverse effects, which was as high as 95.56%. Hence from the details elicited from this study, we can conclude that, usage of chemical hair relaxers does cause adverse effects and is "not a myth." Thus, it is necessary to make available a less harmful chemical hair relaxer to the society.

Foot eczema: the role of patch test in determining the causative agent using standard series.

Foot dermatitis refers to the predominant involvement of feet in the eczematous process. This study is undertaken to determine the clinical pattern and causative agent in foot eczema and to evaluate the role of patch testing in determining the causative agent of foot eczema. Data was collected from 50 patients with foot eczema, who attended the out-patient department. The patch test was performed using Indian standard series. Patch test was positive in 88% of the patients. The most common site affected was the dorsal aspect of the foot (48%) and scaly plaque was the predominant morphological pattern. The highest number of patients (24%) showed positive reactions to mercaptobenzothiazole (MBT) and the lowest (4%) to neomycin sulfate. Rubber and rubber chemicals have been reported worldwide to be the most common sensitizer causing foot eczema. Thus, patch test has a major role in finding out the cause of foot eczema.

Effect of oxidative stress in follicular fluid on the outcome of assisted reproductive procedures.

OBJECTIVE(S): To measure levels of lipid peroxidation (LPO) and total antioxidant capacity (TAC) in the follicular fluid from patients undergoing IVF and to examine the association among LPO and TAC and oocyte maturity, embryo quality, fertilization, cleavage, and pregnancy rates. DESIGN: Prospective study. SETTING: Tertiary care medical center. PATIENT(S): Forty-one patients undergoing IVF. INTERVENTION(S): Clear follicular fluid specimens were collected at oocyte retrieval. MAIN OUTCOME MEASURE(S): Follicular fluid LPO and TAC levels measured by the thiobarbituric acid and the chemiluminescence method, respectively. RESULT(S): The mean LPO level was 0.95 micromol malonaldehyde/L, and the mean TAC level was 819.16 Trolox equivalents. No correlation was seen among LPO or TAC levels and oocyte maturity, fertilization, cleavage, and embryo quality. The pregnancy rate was 31.7%. Pregnant patients were significantly younger than the patients who did not become pregnant (30.53 +/- 3.5 years vs. 34.32 +/- 3.98 years). After adjusting for age, a positive correlation was seen between pregnancy rate and LPO and between pregnancy rate and TAC. CONCLUSION(S): Both LPO and TAC levels were positively correlated with the pregnancy rate. Lipid peroxidation may be a good marker of metabolic activity within the follicle, and some amounts may be necessary to establish a pregnancy.

Double orifice mitral valve: report of 4 cases.

Double Orifice Mitral Valve (DOMV) is a rare congenital abnormality. Reports of 4 patients with DOMV are presented. As associated anomalies, one had ostium primum atrial septal defect (ASD). Second one had Ebstein's anomaly. Third one had grade IV tricuspid regurgitation, thickened tricuspid valve and right atrial mass. Fourth one had sinus venosus ASD. Echocardiography is the gold standard investigation. Surgical treatment depends upon the mitral valve function and associated anomalies.