Effects of Ayurveda interventions on acute pain and quality of life of a trigeminal neuralgia patient - A case report.

Classical trigeminal neuralgia (CTN) is a disease characterized by severe pain in the facial area related to the trigeminal nerve. CTN occurs due to neurovascular compression of the Trigeminal nerve presenting with recurrent pain episodes. This case reports the effect of Ayurveda interventions on CTN. Thirty-nine-year-old male patient with pain on the right side of the face for two years presented to the National Institute of Ayurveda, Hospital, Jaipur, Rajasthan, India. The pain was distributed on the right side of the upper lip, cheek, and chin. Paroxysms of pain appeared at the interval of 1-2 h and were lasting of 1-2 min. The case was diagnosed with the help of magnetic resonance imaging (MRI) as right-side classical trigeminal neuralgia due to indentation of the vascular loop of the right superior cerebellar artery. The patient had a treatment history of two years with allopathic medicine, and he sought Ayurveda treatment due to recurrence and excessive pain. The patient was given Ayurvedic interventions (oral medication, Nasya, Kavalagraha, and Gandusha) for three months. The improvement were observed on the visual analogue scale (VAS) for pain, hospital anxiety and depression scale (HADS), and Short Form -36 questionnaire (SF-36) for quality of life. After three months of the treatment, the VAS scale for pain and the HADS scale for anxiety and depression showed marked improvement. Improvement in all the domains of SF-36 was observed, with a total percentage improvement from 10.7% to 83.2%. Observations of this case highlight the usefulness of Ayurveda interventions, i.e., Oral medication, Nasya, Kavalagraha, and Gandusha, in reducing the acute paroxysms of pain in Classical TN and improving the quality of life of CTN patients.

Main title - Socio-economic effects on informal caregivers of long-term hospitalized adult patients: A cross-sectional study.

Introduction: A significant proportion of patients are being treated at hospitals in the government sector in Sri Lanka. Informal caregivers play a major role in taking care of hospitalized surgical patients while facing physical, social, and psychological challenges. Objective: To describe the socio-economic effects on informal caregivers of long-term hospitalized adult patients. Methods: A cross-sectional descriptive study was conducted among 202 informal caregivers of long-term hospitalized patients in a tertiary care hospital in Sri Lanka, using an interviewer-administered questionnaire. Sociodemographic assessment of both caregiver and care recipient, the health status of the care recipient, effects on social life, and economic aspect of informal caregiver were assessed. Results: Most of the caregivers were married (n=164, 81.2%), first degree relative of the care receiver (n=139, 68.8%), employed (n=115, 56.9%) and sole caregivers (n=130, 64.4%). Four out of 5 caregivers (n=181, 89.6%) showed moderate to severe socio-economic maladaptation. Increasing age (p=0.00), marital status (p=0.00) and sole caregiving (p=0.01) are significantly associated with the level of maladaptation. Conclusion: Moderate to severe levels of maladaptation is present among a substantial number of informal caregivers of long-term hospitalized patients. Sole caregiving is one of the contributing factors and can be addressed by adequate formal caregivers appointed by health care authorities or from voluntary services to minimize informal caregiver burnout.

Protocol for presurgical and anesthetic management of pheochromocytomas and sympathetic paragangliomas: a multidisciplinary approach.

OBJECTIVE: To offer a practical guide for the presurgical and anesthetic management of pheochromocytomas and sympathetic paragangliomas (PGLs). METHODS: This protocol was based on a comprehensive review of the literature and on our own multidisciplinary team's experience from managing pheochromocytoma and sympathetic PGLs at a referral center. RESULTS: Patients with pheochromocytomas and sympathetic paragangliomas (PGLs) may develop potentially life-threatening complications, especially during surgical procedures. A complete biochemical, radiological, genetic, and cardiological assessment is recommended in the preoperative stage as it provides an evaluation of the risk of surgical complications and malignancy, allowing individualization of the presurgical treatment. Treatment with α-blockade and proper volume expansion in the preoperative stage significantly reduces the perioperative morbidity. During surgery, the anesthesiologist should look for a deep anesthetic level that inhibits the cardiovascular effects of catecholamines to minimize the risk of intraoperative complications. CONCLUSIONS: An optimal presurgical evaluation of pheochromocytomas/ sympathetic PGL requires a multidisciplinary approach, including a complete hormonal, radiological, cardiac, genetic, and functioning evaluation in most cases. A proper preoperative evaluation in combination with strict blood pressure and heart rate control, and blood volume status optimization, will significantly reduce the risk of intraoperative and perioperative complications. In those patients who unfortunately develop intraoperative complications, the role of the anesthesiologist is essential since the selection of the appropriate management has a direct impact on morbimortality reduction.

Metal-organic frameworks as template for synthesis of Mn3+/Mn4+ mixed valence manganese cobaltites electrocatalysts for oxygen evolution reaction.

Cobalt-based oxides are among the most promising electrocatalysts for oxygen evolution reactions (OER). In this context, this work reports the synthesis of manganese-doped cobaltites using the Zeolitic-Imidazolate Frameworks 67 (ZIF-67) as template. The incorporation of manganese ions into ZIF-67 structure was evaluated in ethanol and methanol, in order to obtain the best synthetic route. Non-doped (ZIF-67C) and Mn-doped cobaltites (Mn/ZIF-67C(E) and Mn/ZIF-67C(M)) were obtained after thermal treatment at 350 °C. Structural and morphological properties were investigated and presence of Mn3+ and Mn4+ was confirmed by X-ray photoelectron spectroscopy (XPS) data and magnetization curves. The electrocatalytic activity in OER was investigated in alkaline medium for manganese cobaltites, and compared to the ZIF-67C. Overpotentials to generate a current of 10 mA cm-2 were 338 mV and 356 mV for Mn/ZIF-67C(E) and Mn/ZIF-67C(M), respectively. These results are superior to those found for similar materials in the literature. The material obtained in methanol (Mn/ZIF-67C(M)) presents lower overpotential, however, shows superior electrocatalytic performance for current density above 100 mA cm-2, therefore being an efficient electrode for commercial electrolysers.

Use of Ayurveda and Sri Lankan traditional medicine for healing shaft of humerus fracture following nonunion.

Sri Lanka comprises of a well-established traditional orthopedic treatment system. A 14 year old child had a compound fracture over shaft of humerus. The internal fixator Kirschner (k) wire was applied following allopathic treatment and after three weeks, it was removed as there was no healing of wound over fracture site. Patient was asked to follow orthopedic clinic but defaulted and presented to Ayurveda management. X-ray reports showed nonunion of the humerus. Initially, nonunion bone was immobilized for six months using bamboo splints. Prior to applying the splints, during every visit, herbal oil and herbal paste were applied. Subsequently up to six months, motor, sensory functions assessment and quality of life (QoL) assessment was done using Quality of Life of the International Osteoporosis Foundation (QLIOF) questionnaire. Initial power of wrist and fingers were graded 1 and in 6- months time, improved to grade 5. The difference in the QLIOF scores were analyzed using Wilcoxon signed rank test. There was a significant (p = 0.03) difference between the pre-treatment (14) and post-treatment (59) QLIOF scores. The anterior- posterior and lateral X-ray showed complete healing of the fracture. This report indicates that the methods and medicines in Ayurveda and traditional orthopedic system can successfully treat a nonunion of humerus fracture.

Characteristics and outcome of patients with newly diagnosed advanced or metastatic lung cancer admitted to intensive care units (ICUs).

BACKGROUND: Although patients with advanced or metastatic lung cancer have poor prognosis, admission to the ICU for management of life-threatening complications has increased over the years. Patients with newly diagnosed lung cancer appear as good candidates for ICU admission, but more robust information to assist decisions is lacking. The aim of our study was to evaluate the prognosis of newly diagnosed unresectable lung cancer patients. METHODS: A retrospective multicentric study analyzed the outcome of patients admitted to the ICU with a newly diagnosed lung cancer (diagnosis within the month) between 2010 and 2013. RESULTS: Out of the 100 patients, 30 had small cell lung cancer (SCLC) and 70 had non-small cell lung cancer. (Thirty patients had already been treated with oncologic treatments.) Mechanical ventilation (MV) was performed for 81 patients. Seventeen patients received emergency chemotherapy during their ICU stay. ICU, hospital, 3- and 6-month mortality were, respectively, 47, 60, 67 and 71%. Hospital mortality was 60% when invasive MV was used alone, 71% when MV and vasopressors were needed and 83% when MV, vasopressors and hemodialysis were required. In multivariate analysis, hospital mortality was associated with metastatic disease (OR 4.22 [1.4-12.4]; p = 0.008), need for invasive MV (OR 4.20 [1.11-16.2]; p = 0.030), while chemotherapy in ICU was associated with survival (OR 0.23, [0.07-0.81]; p = 0.020). CONCLUSION: This study shows that ICU management can be appropriate for selected newly diagnosed patients with advanced lung cancer, and chemotherapy might improve outcome for patients with SCLC admitted for cancer-related complications. Nevertheless, tumors' characteristics, numbers and types of organ dysfunction should be taken into account in the decisional process before admitting these patients in ICU.

Assessment of the outcome of Ayurvedic treatments for vertebral fracture with motor dysfunction.

Assessment of outcome following Ayurveda treatment protocol was done in a complicated case of spinal fracture with motor dysfunction and having a past history of Pott's disease. A 52-year-old man was suffering from motor dysfunction after a spinal fracture at D5/D6 level. The patient sought Ayurveda treatments because he did not gained any significant improvement according to mainstream medical treatments what he underwent for several years. According to Ayurveda, the patient was treated following immobilization, external and internal application of herbal preparations followed by physiotherapy. The outcome of the treatments were monitored by motor function assessment, quality of life assessment and computed tomography scan. Initial signs of improvement were observed just after 1 month of commencing Ayurveda treatments. Continuously following the treatments for 24-month duration, the patient was reverted back to his normal life. This complicated case of spinal fracture was successfully cured using Ayurveda treatment. Therefore, the observations made here would be useful for organizing a future clinical trial.

Combined interventions for mitigation of an influenza A (H1N1) 2009 outbreak in a physical training camp in Beijing, China.

OBJECTIVES: Many studies have suggested the effectiveness of single control measures in the containment and mitigation of pandemic influenza A (H1N1) 2009. The effects of combined interventions by multiple control measures in reducing the impact of an influenza A (H1N1) 2009 outbreak in a closed physical training camp in Beijing, China were evaluated. METHODS: Oseltamivir was prescribed for the treatment of confirmed cases and possible cases and as prophylaxis for all other participants in this training camp. Public health control measures were applied simultaneously, including the isolation of patients and possible cases, personal protection and hygiene, and social distancing measures. Symptom surveillance of all participants was initiated, and the actual attack rate was calculated. For comparison, the theoretical attack rate for this outbreak was projected using the Newton-Raphson numerical method. RESULTS: A total of 3256 persons were present at the physical training camp. During the outbreak, 405 (68.3%) possible cases and 26 (4.4%) confirmed cases were reported before the intervention and completed oseltamivir treatment; 162 (27.3%) possible cases were reported after the intervention and received part treatment and part prophylaxis. The other 2663 participants completed oseltamivir prophylaxis. Of the possible cases, 181 with fever ≥38.5°C were isolated. The actual attack rate for this outbreak of pandemic influenza A (H1N1) 2009 was 18.2%, which is much lower than the theoretical attack rate of 80% projected. CONCLUSIONS: Combined interventions of large-scale antiviral ring prophylaxis and treatment and public health control measures could be applied to reduce the magnitude of influenza A (H1N1) 2009 outbreaks in closed settings.

Cultivo de larvas de Ucides cordatus (LINNAEU, 1763) sob diferentes intensidades luminosas / Rearing of Ucides cordatus (LINNAEU, 1763) larvae under different light intensities

O caranguejo-uçá, Ucides cordatus, é uma espécie típica dos manguezais brasileiros e tem grande importância econômica para as populações litorâneas tradicionais. O presente trabalho investigou a influência da intensidade luminosa sobre a sobrevivência e a taxa de desenvolvimento larval de U. cordatus. Três intensidades luminosas foram avaliadas: claro - 710 lux, penumbra - 210 lux e escuro - 1 lux, em duas condições de cultivo, individual e coletivo. Houve diferenças significativas entre as taxas de sobrevivência das larvas zoea e as três intensidades luminosas avaliadas (p<0,05). As maiores taxas de ecdise para o estágio de megalopa foram obtidas no tratamento claro (42% nos cultivos coletivos e 30% nos cultivos individuais). No tratamento escuro, a metamorfose para megalopa foi de apenas 16% nos cultivos coletivos e de 7% nos cultivos individuais. Estes resultados indicam que a manutenção das larvas em baixas intensidades luminosas afeta negativamente a sobrevivência larval de U. cordatus...

Ucides cordatus is an edible crab species typical of Brazilian mangroves, and traditionally represents an important economic resource for many coastal populations. The present study investigated the influence of light intensity on the survival and rate of larval development of U. cordatus. Three different levels of luminosity were evaluated: 710 (Light), 210 Lux (Shaded) and 1 Lux (Dark), both in individual and collective cultivation conditions. Significant differences were found for survival of zoea larvae under the different light intensities (P<0.05). The greatest survival rates as well as rates of ecdysis to the megalopa stage were obtained under Light conditions (42% in collective cultures and 30% in individual cultures). In Dark conditions events of metamorphosis to megalopa stage was observed only in 16% of collective cultures and 7% of individual cultures. The result indicates that low light intensities may negatively affect larval survivorship during U. cordatus larval cultivations...

Intensive care in patients with lung cancer: a multinational study.

BACKGROUND: Detailed information about lung cancer patients requiring admission to intensive care units (ICUs) is mostly restricted to single-center studies. Our aim was to evaluate the clinical characteristics and outcomes of lung cancer patients admitted to ICUs. PATIENTS AND METHODS: Prospective multicenter study in 449 patients with lung cancer (small cell, n = 55; non-small cell, n = 394) admitted to 22 ICUs in six countries in Europe and South America during 2011. Multivariate Cox proportional hazards frailty models were built to identify characteristics associated with 30-day and 6-month mortality. RESULTS: Most of the patients (71%) had newly diagnosed cancer. Cancer-related complications occurred in 56% of patients; the most common was tumoral airway involvement (26%). Ventilatory support was required in 53% of patients. Overall hospital, 30-day, and 6-month mortality rates were 39%, 41%, and 55%, respectively. After adjustment for type of admission and early treatment-limitation decisions, determinants of mortality were organ dysfunction severity, poor performance status (PS), recurrent/progressive cancer, and cancer-related complications. Mortality rates were far lower in the patient subset with nonrecurrent/progressive cancer and a good PS, even those with sepsis, multiple organ dysfunctions, and need for ventilatory support. Mortality was also lower in high-volume centers. Poor PS predicted failure to receive the initially planned cancer treatment after hospital discharge. CONCLUSIONS: ICU admission was associated with meaningful survival in lung cancer patients with good PS and non-recurrent/progressive disease. Conversely, mortality rates were very high in patients not fit for anticancer treatment and poor PS. In this subgroup, palliative care may be the best option.

A comprehensive analysis of reassortment in influenza A virus.

Genetic reassortment plays a vital role in the evolution of the influenza virus and has historically been linked with the emergence of pandemic strains. Reassortment is believed to occur when a single host - typically swine - is simultaneously infected with multiple influenza strains. The reassorted viral strains with novel gene combinations tend to easily evade the immune system in other host species, satisfying the basic requirements of a virus with pandemic potential. Therefore, it is vital to continuously monitor the genetic content of circulating influenza strains and keep an eye out for new reassortants. We present a new approach to identify reassortants from large data sets of influenza whole genome nucleotide sequences and report the results of the first ever comprehensive search for reassortants of all published influenza A genomic data. 35 of the 52 well supported candidate reassortants we found are reported here for the first time while our analysis method offers new insight that enables us to draw a more detailed picture of the origin of some of the previously reported reassortants. A disproportionately high number (13/52) of the candidate reassortants found were the result of the introduction of novel hemagglutinin and/or neuraminidase genes into a previously circulating virus. The method described in this paper may contribute towards automating the task of routinely searching for reassortants among newly sequenced strains.

Swine to human transmission of reassortants of pandemic (H1N1) 2009 and endemic swine influenza viruses: Abstract.

To gain insight into the possible origin of a new reassortant influenza A virus between pandemic (H1N1) 2009 and endemic swine viruses that has jumped the species barrier and caused a few infections among humans in Indiana and Pennsylvania recently, we analyzed all full genome sequences related to this virus and report its evolutionary history, but failed to determine how the virus had emerged simultaneously in two geographically distinct areas.

Epidemiological assessment of continuing transmission of lymphatic filariasis in Samoa.

Ongoing transmission of lymphatic filariasis (LF) was assessed in five Samoan villages by measuring microfilaraemia (Mf), circulating filarial antigen (CFA) and antibody prevalence. Compared to the other villages, Fasitoo-Tai had a significantly higher Mf prevalence (3·2%), CFA prevalence (14·6%) and antibody prevalence in children (62·0%) (P<0·05). Puapua had a significantly lower CFA prevalence (2·5%), no detectable Mf-positive individuals and significantly low antibody prevalence in children (7·9%) (P<0·05). Siufaga, previously believed to be LF-free, recorded >1% CFA prevalence and a high antibody prevalence in children (46·6%). Overall, antibody prevalence in children appeared to reflect the transmission dynamics in the villages and, in Siufaga, identified an area of ongoing transmission. The Filariasis Cellabs Enzyme-Linked Immunosorbent Assay (CELISA), based on recombinant antigen Bm14, to detect antibodies, could potentially be a promising diagnostic tool for inclusion in future surveillance in the South Pacific.

Appearance of Drug Resistance-Associated Mutations in Human Immunodeficiency Virus Type 1 CRF01_AE Integrase Derived from Drug-Naive Thai Patients.

CRF01_AE is a major subtype of human immunodeficiency virus type 1 (HIV-1) circulating in Southeast Asia, including Thailand. We performed genotypic studies on HIV-1 CRF01_AE integrase derived from plasma samples from drug-naive Thai patients. Direct sequencing of amplified CRF01_AE integrase genes revealed that although no primary mutations associated with drug resistance to integrase inhibitors were detected, at least one secondary mutation was found in 96% of samples. Our results indicate that the impact of these mutations on the baseline drug susceptibility of CRF01_AE viruses to integrase inhibitors may need to be addressed prior to the introduction of these drugs in Southeast Asian countries, including Thailand.

Genotypic characterization of HIV type 1 env gp160 sequences from three regions in Thailand.

We report 25 env gp160 sequences from patients in three geographically distinct districts of Thailand, i.e., Lampang in the north, Trang in the south and Rayong in the east. One of these is a CRF01_AE/subtype B recombinant and the other 24 sequences are purely CRF01_AE. Very little interpopulation diversity was observed between the sequences from the three different geographic regions and from those previously reported by our laboratory from central Thailand. Potential N-linked glycosylation sites (PNLGs) were reasonably conserved among the 25 sequences: we found 15 highly conserved PNLGs on gp120 and 4 almost fully conserved PNLGs on gp41. Analysis of coreceptor tropism revealed that six of the isolates were dual tropic and the others were R5 tropic. We also examined a rare seven amino acid deletion found in one isolate at position 847-853 on gp41. These results may enhance our understanding of HIV-1 currently circulating in Thailand.

Impact of amino acid variations in Gag and protease of HIV type 1 CRF01_AE strains on drug susceptibility of virus to protease inhibitors.

BACKGROUND: Protease (PR) inhibitors (PIs) were designed against subtype B virus of human immunodeficiency virus type 1 (HIV-1), but believed to retain its activity against most of the other subtypes. CRF01_AE PR (AE-PR) contains background mutations that are presumed to alter the drug susceptibility of PR. In addition, amino acid variations found in HIV-1 Gag potentially affect the drug susceptibility or catalytic efficiency of PR. METHODS: We studied the impact of naturally occurring amino acid substitutions found in AE-PR and CRF01_AE Gag (AE-Gag) on the drug susceptibility of PR to 9 currently available PIs, using the pNL4-3-derived luciferase reporter virus containing AE-Gag and/or AE-PR genes derived from drug treatment-naïve, HIV-1-infected Thai patients. RESULTS: Sequencing analysis revealed that several mutations were detected in deduced amino acid sequences of AE-PR and AE-Gag genes, as compared to these genes of pNL4-3. Drug susceptibility tests revealed that AE-PR showed a variety of susceptibilities to 9 PIs compared with pNL4-3 PR. In addition, AE-Gag significantly reduced the drug susceptibility of AE-PR and pNL4-3 PR. CONCLUSION: Our results suggest that amino acid variations in AE-PR and AE-Gag play roles in determining the drug susceptibility of CRF01_AE viruses to PIs.