Prevention starts here: effectiveness of substance abuse prevention module among adolescent students in Bengaluru - a quasi experimental study.

OBJECTIVES: This study aims to evaluate the effectiveness of a structured educational module on substance abuse prevention program among adolescents in enhancing their knowledge against substance abuse. METHODS: A quasi-experimental design was employed involving 120 students (mean age: 14.3±1.03 years, 59.2% boys) from two English medium schools. Participants were exposed to a structured module on substance abuse over a month. The study assessed changes in knowledge through pretest and post-test evaluations. Statistical analyses examined improvements in scores and the relationship between class of study and post-test knowledge scores. RESULTS: The intervention significantly improved students' knowledge about substance abuse (p<0.001) across all measured domains, genders, and classes, with the exception of the 7th class. A positive correlation was found between the class of study and post-test scores (Rs=0.288, p<0.001), indicating that higher classes were associated with greater improvements in knowledge. These findings suggest that the training effectively increased awareness and understanding of substance abuse among participants. CONCLUSIONS: The substance abuse prevention program successfully enhanced adolescents' knowledge and equipped them with resilience and coping strategies, thus reducing their vulnerability to peer pressure and substance abuse. Despite the lack of significant improvement in the 7th class, the overall positive outcomes underscore the importance of implementing such educational interventions to foster healthy development and well-being among students. Further research is encouraged to explore the specific barriers to effectiveness in younger classes and to refine program content accordingly.

Loop gain response to increased cerebral blood flow at high altitude.

PURPOSE: To compare loop gain (LG) before and during pharmacological increases in cerebral blood flow (CBF) at high altitude (HA). Loop gain (LG) describes stability of a negative-feedback control system; defining the magnitude of response to a disturbance, such as hyperpnea to an apnea in periodic breathing (PB). "Controller-gain" sensitivity from afferent peripheral (PCR) and central-chemoreceptors (CCR) plays a key role in perpetuating PB. Changes in CBF may have a critical role via effects on central chemo-sensitivity during sleep. METHODS: Polysomnography (PSG) was performed on volunteers after administration of I.V. Acetazolamide (ACZ-10mg/kg) + Dobutamine (DOB-2-5 µg/kg/min) to increase CBF (via Duplex-ultrasound). Central sleep apnea (CSA) was measured from NREM sleep. The duty ratio (DR) was calculated as ventilatory duration (s) divided by cycle duration (s) (hyperpnea/hyperpnea + apnea), LG = 2π/(2πDR-sin2πDR). RESULTS: A total of 11 volunteers were studied. Compared to placebo-control, ACZ/DOB showed a significant increase in the DR (0.79 ± 0.21 vs 0.52 ± 0.03, P = 0.002) and reduction in LG (1.90 ± 0.23 vs 1.29 ± 0.35, P = 0.0004). ACZ/DOB increased cardiac output (CO) (8.19 ± 2.06 vs 6.58 ± 1.56L/min, P = 0.02) and CBF (718 ± 120 vs 526 ± 110ml/min, P < 0.001). There was no significant change in arterial blood gases, minute ventilation (VE), or hypoxic ventilatory response (HVR). However, there was a reduction of hypercapnic ventilatory response (HCVR) by 29% (5.9 ± 2.7 vs 4.2 ± 2.8 L/min, P = 0.1). CONCLUSION: Pharmacological elevation in CBF significantly reduced LG and severity of CSA. We speculate the effect was on HCVR "controller gain," rather than "plant gain," because PaCO2 and VE were unchanged. An effect via reduced circulation time is unlikely, as the respiratory-cycle length did not change.

Alternating Facial Palsy- Decoding the Enigma.

Facial palsy is a neurological emergency with a wide spectrum of aetiologies. The term 'alternating facial palsy', a very rare presentation, refers to facial paralysis, the onset of which occurs at different points in time on both sides of the face. It can occur in systemic vasculitis, trauma, tumours and infectious diseases. We report the case of a middle-aged female who presented with complaints of alternating facial palsy and the diligent journey that we took to finally reach a diagnosis of Lyme neuroborreliosis.

Cervical Spine Magnetic Resonance Imaging Findings in Hirayama Disease.

Background Hirayama disease is an uncommon type of cervical cord myelopathy seen typically in young males due to trauma from flexion movements. This study aims to assess the clinical presentations and classify the extent of various cervical spine MRI findings for the local population. Methodology A retrospective study of 13 patients diagnosed with Hirayama disease on cervical MRI was performed from January 2017 to December 2022 at Dr. D. Y. Patil Medical College, Hospital and Research Center, Pune. Results Of the 13 patients, 12 (92%) were male, and one (8%) was female. Nine (69%) patients were in the 16-25-year age group, two (15%) were in the 26-35-year age group, and one (8%) each was in the 6-15-year and 66-75-year age groups. Upper limb weakness was the most common clinical symptom seen in 12 (92%) patients, followed by distal muscle atrophy in seven (54%) patients. Tremors in the hand were a rare symptom seen in two patients. Claw hand was an atypical symptom seen in one patient. On cervical MRI, all patients showed excessive forward shifting of the posterior dura on flexion, with resultant cord compression due to tightness of the dural sac. One (8%) patient had no signs of myelopathy, while 12 (92%) patients had developed chronic myelomalacia and showed abnormal cord hyperintensity and atrophy in the lower cervical cord. All 13 (100%) patients showed increased laminodural space on flexion; the mean thickness was 4.08 mm, with the minimum and maximum thickness being 2.4 mm and 6.7 mm, respectively. Classifying by length of the anterior bulging dura, one (8%) patient showed involvement of less than two vertebral body segments, eight (62%) patients showed involvement of two to four vertebral body segments, and four (30%) patients showed involvement of more than four vertebral body segments. Crescent-shaped post-contrast enhancement on flexion was seen in all eight (100%) patients who underwent a contrast study. Prominent epidural flow voids on flexion were seen in six (46%) patients. Conclusions Hirayama disease is an uncommon type of cervical myelopathy seen typically in juvenile males. The occult onset of distal upper limb weakness and atrophy during puberty, typical MRI features of lower cervical cord atrophy, and the presence of a crescent-shaped enhancing mass in the posterior epidural space are pathognomonic of the condition. A few atypical cases can also occur. Early diagnosis and treatment are crucial to avoiding serious dysfunction.

Do kinematic measures, added to clinical measures, better predict upper extremity motor impairments at three months post-stroke?

OBJECTIVE: Predicting post-stroke recovery through prediction models is crucial for choosing appropriate treatment options. However, the existing models predominantly incorporate clinical measures although measurement of movement quality using kinematic measures is essential for distinguishing various types of recovery. Thus, this study aimed at determining if, by considering varied aspects of recovery, adding kinematic measurements over clinical measures would better predict upper extremity (UE) motor impairments at three months post-stroke. MATERIALS AND METHODS: Eighty-nine stroke survivors (58.9 ± 11.8 years) were assessed for clinical predictors between 4 and 7 days, kinematic predictors within 1 month, and the impairment outcome of the Fugl Meyer Assessment of the UE (FM-UE) at three months post-stroke. Significant predictors (p<0.05) with a variation inflation factor (VIF) <10 were selected for model development. After performing further step-wise selection, three models incorporating clinical outcomes, kinematic measurements, and a combination of these two, respectively, were formulated. RESULTS: The clinical model (R2 = 0.70) included shoulder abduction finger extension (SAFE) scores, the National Institutes of Health Stroke Scale (NIHSS), and the Montreal Cognitive Assessment (MoCA). The kinematic model (R2 = 0.34) included total displacement, total time, and reaction time. The combined model (R2 = 0.72) comprised of SAFE score and shoulder flexion. All the models had a minimal mean squared error on cross validation, which indicated a good validity. CONCLUSION: The performance of clinical and combined prediction models for predicting three-month post-stroke UE motor recovery was nearly similar. However, in order to detect minimal changes over time and to understand all aspects of motor recovery, there is a need to add instrument-based kinematic measures.

Atypical hyperplasia of the breast: Clinical cases and management strategies.

Atypical hyperplasia of the breast is a histopathologic lesion identified incidentally on image-guided breast biopsy. It is associated with a substantial increase in lifetime risk for breast cancer. Clinicians should counsel women with atypical hyperplasia regarding risk-reducing strategies, which include preventive endocrine therapy options, enhanced surveillance imaging, and lifestyle modifications. In this review, we describe 5 different but common clinical case scenarios for atypical hyperplasia of the breast and review management strategies for each scenario.

Facilitating COVID recognition from X-rays with computer vision models and transfer learning.

Multimedia data plays an important role in medicine and healthcare since EHR (Electronic Health Records) entail complex images and videos for analyzing patient data. In this article, we hypothesize that transfer learning with computer vision can be adequately harnessed on such data, more specifically chest X-rays, to learn from a few images for assisting accurate, efficient recognition of COVID. While researchers have analyzed medical data (including COVID data) using computer vision models, the main contributions of our study entail the following. Firstly, we conduct transfer learning using a few images from publicly available big data on chest X-rays, suitably adapting computer vision models with data augmentation. Secondly, we aim to find the best fit models to solve this problem, adjusting the number of samples for training and validation to obtain the minimum number of samples with maximum accuracy. Thirdly, our results indicate that combining chest radiography with transfer learning has the potential to improve the accuracy and timeliness of radiological interpretations of COVID in a cost-effective manner. Finally, we outline applications of this work during COVID and its recovery phases with future issues for research and development. This research exemplifies the use of multimedia technology and machine learning in healthcare.

Case report on combined approach for delayed orbital floor repair.

"White-eyed blowout" fractures in pediatric patients can be presented with fewer clinical symptoms; therefore, immediate diagnosis and surgery is essential. In cases where early surgery was performed, rapid recovery and better postoperative outcomes were noted regardless of the configuration of fracture. In pediatric patients, due to changes in the orbital volume, autograft is recommended. Although there are different approaches to orbital floor, transantral approach provides enhanced illumination and accessibility to orbital floor. This case report portrays a pediatric case of white-eyed blow out fracture which went unnoticed for about 1 month and was managed at a later date. Combined mid-tarsal and transantral approaches using iliac crest graft was used to repair the orbital blow-out fracture.

The Impact of Osteitis on Quality of Life in Patients with Chronic Rhinosinusitis.

Introduction: Chronic rhinosinusitis (CRS) is a significant health problem worldwide with an estimated prevalence of 5-12% in the general population. Osteitis refers to inflammation of bone characterized by bone remodeling, neo-osteogenesis and thickening of adjacent mucosa. These changes are evidenced by specific radiological appearance on Computerized Tomography (CT) which may be localized or diffuse dependent on extent of disease. Osteitis act as a marker of severity in chronic rhinosinusitis and can significantly affect the patient's Quality of Life (QOL) proportional to its severity. Aim: To analyze the impact of osteitis on quality of life in patients with chronic rhinosinusitis as evidenced by pre-operative Sinonasal Outcome Test-22(SNOT-22) scores. Materials & Methods: 31 patients diagnosed to have chronic rhinosinusitis with co-existing osteitis were enrolled in this study based on computerized tomography scan Paranasal Sinuses (PNS) findings and graded as per the calculated Global Osteitis Scoring Scale. Accordingly, patients were categorised into those without significant osteitis, with mild, moderate and severe osteitis. Baseline quality of life in these patients was assessed using the Sinonasal Outcome Test-22 (SNOT-22) and its association with the severity of osteitis analysed. Results: There is a very strong correlation between severity of osteitis and quality of life in the study population based on the Sinonasal Outcome Test-22 scores (p = 0.000). The mean Global Osteitis score was 21.65 with standard deviation 5.66. Maximum score obtained was 38 and minimum score 14. Conclusion: • Osteitis has a significant impact on quality of life in patients with chronic rhinosinusitis. • Severity of osteitis has a direct relation to quality of life in chronic rhinosinusitis.

Hospitalisation outcomes in pneumococcal-vaccinated versus -unvaccinated patients with exacerbation of COPD: results from the HOPE COPD Study.

Background: Infectious exacerbations are crucial events that dictate the natural course of COPD patients. Pneumococcal vaccination has been shown to decrease incidence of community-acquired pneumonia in COPD patients. There is a paucity of data on outcomes of hospitalisation in pneumococcal-vaccinated COPD patients in comparison with unvaccinated subjects. The objectives of the present study were to evaluate the difference in hospitalisation outcomes in pneumococcal-vaccinated versus -unvaccinated COPD subjects hospitalised with acute exacerbation. Methods: This was a prospective analytical study on 120 subjects hospitalised with acute COPD exacerbation. 60 patients with prior pneumococcal vaccination and 60 unvaccinated patients were recruited. Outcomes of hospitalisation such as mortality rate, need for assisted ventilation, length of hospital stay, need for intensive care unit (ICU) care and length of ICU stay were collected and compared between two groups with appropriate statistical tools. Results: 60% of unvaccinated patients (36 out of 60) required assisted ventilation, whereas only 43.3% of vaccinated subjects (26 out of 60) needed assisted ventilation (p-value of 0.04). Most of the secondary outcomes were better in the vaccinated group. The mean±SD length of ICU stay in the vaccinated group was 0.67±1.11 days compared to 1.77±1.89 days in the unvaccinated group. The mean±SD length of hospital stay was 4.50±1.64 days and 5.47±2.03 days in the vaccinated and unvaccinated group, respectively (p-value of 0.005). Conclusions: COPD patients who have received prior pneumococcal vaccination have better outcomes when they are hospitalised for an acute exacerbation. Pneumococcal vaccination may be recommended for all patients with COPD who are at risk of hospitalisation with acute exacerbation.

Omorgus (Omorgus) khandesh (Coleoptera: Scarabaeoidea: Trogidae), a new species from India, along with an annotated catalogue of the Oriental and Palearctic species of the subgenus Omorgus Erichson, 1847.

A new species of keratin beetle from Western India, Omorgus (Omorgus) khandesh Strümpher & Kalawate, new species, is described and illustrated. The new species is morphologically most similar to O. (O.) rimulosus (Haaf, 1957). The latter is redescribed and illustrated to enable accurate recognition of both species. Based on this work the following taxonomic changes are proposed: Three species are transferred from the subgenus Afromorgus Scholtz, 1986 to the nominotypical subgenus: O. (O.) inclusus (Walker 1858), O. (O.) maissouri (Haaf, 1945a) and O. (O.) rimulosus (Haaf, 1957). Lastly, we include an annotated catalogue of the species of the nominotypical subgenus Omorgus known from the Oriental and Palaearctic regions.

Impact of salivary stimulation on tear film function in dry eye subjects.

Purpose: Dry eye is a common condition affecting people worldwide. It causes ocular discomfort by reducing the quality of vision and impacts daily activities. To overcome such ocular discomfort, artificial tears are used but it is difficult to use artificial tears every time to protect eyes from dryness. There is a need to explore other treatment options, which can be used during work hours. The aim was to study the effect of salivary stimulation on tear film functions among dry eye subjects. Methods: Thirty-three subjects were enrolled in this prospective experimental study. Tear film function tests such as tear break up time (TBUT), tear meniscus height (TMH), and Schirmer's I and II tests were conducted. For dry eye subjects, salivation was induced by giving a tamarind candy (a soft slightly sour tamarind pulp mixed with sugar) for 5 min. Tear film function tests were carried out within a few seconds (2 to 3 s) after finishing the candy and then after 30 and 60 min of the induction of salivation. The pre- and post-tear film function measurements were recorded and analyzed. Results: TBUT, TMH, and Schirmer's II tests showed statistically significant (P < 0.05) increase immediately and after 30 min of stimulation of salivation for all tests in both eyes. However, the difference was insignificant after 60 min of stimulation of salivation. Schirmer's I showed statistically significant changes in the left eye, but not in the right eye immediately after stimulation of salivation (P = 0.025). Conclusion: The quantity as well as the quality of tear film improved after the stimulation of salivation among dry eye subjects.

Neuroimaging Spectrum of Intracranial Lipomas.

BACKGROUND: Intracranial lipomas are rare congenital malformations at characteristic sites. Though largely asymptomatic, some cause significant morbidity. We are studying this for the local population.  Objectives: The purpose of this article is to analyze the spectrum of intracranial lipomas, determine their distribution at characteristic locations, and assess their associations.  Method: A retrospective study of 21 patients diagnosed with intracranial lipomas detected on CT and MRI performed between September 2017 and May 2022 at Dr. D.Y. Patil Medical College, Hospital & Research Center, Pune. RESULTS: Amongst the 21 patients with intracranial lipomas, the most common location was the pericallosal region seen in 11 patients (n = 11, 52.3%), of which nine were curvilinear type (n = 9), more common than tubular nodular type (n = 2). Other locations (n = 10, 47.7%) were found to be; quadrigeminal cistern in six patients (28.5%), cranial diploic space in two patients (9.5%), one each in interhemispheric falx (4.8%), and cribriform plate (4.8%). Associated anomalies were observed in three patients, which were fronto-ethmoidal encephalocele (n = 1), partial agenesis of the corpus callosum (n = 2), extension with a frontal subcutaneous lipoma (n = 1), and bilateral intraventricular extension (n = 1). Presenting symptoms were headache and dizziness (38.1%), seizures (19%), swelling on the forehead (9.5%), and other non-specific clinical symptoms (33.3%). CONCLUSION: Intracranial lipomas are rare congenital lesions that are usually asymptomatic and discovered incidentally. However, lipomas at interhemispheric locations can cause seizure disorders and some present with headaches and dizziness. Few have associations like communication with extracranial swellings and corpus callosum agenesis.

Daratumumab Use Prior to Kidney Transplant and T Cell-Mediated Rejection: A Case Report.

There is growing interest in daratumumab in the solid organ transplant realm owing to the potential immunomodulatory effects on CD38-expressing cells, primarily plasma cells, as they have a key role in antibody production. In particular there is interest in use of daratumumab for desensitization and potential treatment for antibody-mediated rejection. However, ongoing investigation with daratumumab has shown potential immunologic concerns in vitro, with a significant increase in populations of CD4-positive cytotoxic T cells and CD8-positive helper T cells in both peripheral blood and bone marrow that could lead to acute T cell-mediated rejection in the solid organ transplant patient. To date, there are no published reports of an association with daratumumab use and T cell-mediated rejection in vivo. In this case report we present what is to our knowledge the first documented case of an early severe T cell-mediated rejection in a low-immunologic-risk living-donor kidney transplant recipient who received daratumumab for multiple myeloma maintenance prior to transplant.

Postoperative Utilization of Opioids After Midurethral Sling Surgery: A Prospective Clinical Practice Study.

IMPORTANCE: This study was performed to understand opioid consumption after midurethral sling (MUS) procedures to provide surgeons with guidelines on appropriate prescription regimens. OBJECTIVE: This study aimed to evaluate postdischarge narcotic use (PDNU) after MUS surgery using a restrictive postdischarge opioid regimen. STUDY DESIGN: This prospective clinical practice study included women undergoing MUS surgery from December 2018 to October 2019. Patients were discharged with an electronic prescription for 5 tablets of an oral narcotic. Brief Pain Inventory (BPI) surveys were collected preoperatively. Patients answered questions regarding remaining number of opioid tablets, BPI scores, and patient satisfaction on day 1, week 1 (postoperative week [POW] 1), and 4-6 weeks (POW4-6) postoperatively. Electronic records were reviewed to determine narcotic refills. Primary outcome was PDNU measured in morphine milligram equivalents (MME). Secondary outcomes evaluated refill rate, BPI scores, and patient satisfaction. Standard statistical tests were applied. RESULTS: Fifty-six patients were included in the analysis. Total median (interquartile range) PDNU was 12.5 (0-37.5) MME at POW1 and 15.0 (0-37.5) MME at POW4-6, which is approximately equivalent to 2 oxycodone (5 mg) tablets. Eighteen patients (32.1%) took 0 narcotics postdischarge. Brief Pain Inventory scores showed that "worst pain" was highest on postoperative day 1 with a median (interquartile range) score of 6 (4-8). At the POW1 and POW4-6 mark, 94.3% and 92% of patients, respectively, were satisfied or extremely satisfied with their pain control. Seven patients (11.8%) required a refill. CONCLUSIONS: Most patients undergoing MUS surgery used no more than 2 oxycodone (5 mg) tablets during their 6-week postoperative course, with almost a third not requiring any narcotics. Low pain scores and high patient satisfaction rates were noted.

Drug Therapy in Cognitive Disorders and Its Effects on Oral Health.

Dementia and Alzheimer's disease are the two most characteristic cognitive disorders presenting numerous cognitive dysfunctions such as memory loss, functional impairment, speech impairment, and orientation problems. In India, there is an increased risk in the elderly population leading to the prevalence of Alzheimer's and dementia-related diseases. Therefore, it is not only general health care practitioners but also oral health care providers also play a major role in rehabilitating and treating this type of patient. So, it is necessary for oral health care providers to understand the pharmacologic agents used for the management of Alzheimer's and dementia-related diseases. This article gives an insight into the management of dementia and Alzheimer's disease and also an update on the drug therapies for AD and outlines their implications on oral health.

Implications of video chat use for young children's learning and social-emotional development: Learning words, taking turns, and fostering familial relationships.

Parents of young children use video chat differently than other screen media, paralleling expert recommendations (e.g., American Academy of Pediatrics Council on Communications and Media, 2016), which suggest that video chat, unlike other screen media, is acceptable for use by children under 18 months. Video chat is unique among screen media in that it permits contingent (time-sensitive and content-sensitive) social interactions. Contingent social interactions take place between a child and a partner (dyadic), with objects (triadic), and with multiple others (multi-party configurations), which critically underpin development in multiple domains. First, we review how contingent social interaction may underlie video chat's advantages in two domains: for learning (specifically learning new words) and for social-emotional development (specifically taking turns and fostering familial relationships). Second, we describe constraints on video chat use and how using chat with an active adult (co-viewing) may mitigate some of its limitations. Finally, we suggest future research directions that will clarify the potential advantages and impediments to the use of video chat by young children. This article is categorized under: Linguistics > Language Acquisition Psychology > Learning Cognitive Biology > Social Development.

Association Between Lifestyle Changes, Mammographic Breast Density, and Breast Cancer.

In screening for breast cancer (BC), mammographic breast density (MBD) is a powerful risk factor that increases breast carcinogenesis and synergistically reduces the sensitivity of mammography. It also reduces specificity of lesion identification, leading to recalls, additional testing, and delayed and later-stage diagnoses, which result in increased health care costs. These findings provide the foundation for dense breast notification laws and lead to the increase in patient and provider interest in MBD. However, unlike other risk factors for BC, MBD is dynamic through a woman's lifetime and is modifiable. Although MBD is known to change as a result of factors such as reproductive history and hormonal status, few conclusions have been reached for lifestyle factors such as alcohol, diet, physical activity, smoking, body mass index (BMI), and some commonly used medications. Our review examines the emerging evidence for the association of modifiable factors on MBD and the influence of MBD on BC risk. There are clear associations between alcohol use and menopausal hormone therapy and increased MBD. Physical activity and the Mediterranean diet lower the risk of BC without significant effect on MBD. Although high BMI and smoking are known risk factors for BC, they have been found to decrease MBD. The influence of several other factors, including caffeine intake, nonhormonal medications, and vitamins, on MBD is unclear. We recommend counseling patients on these modifiable risk factors and using this knowledge to help with informed decision making for tailored BC prevention strategies.