Prevalence of Oral Manifestations in COVID-19-Diagnosed Patients at a Tertiary Care Hospital in Kerala.

Background: COVID-19, a pandemic since 2019, is still causing significant healthcare burden across the world. Although the disease primarily presents with respiratory symptoms, a multitude of signs and symptoms may be manifested elsewhere in the body. Aim: This study was to estimate the prevalence of oral manifestations in COVID-19 diagnosed patients and thereby understand the effects of corona virus disease on oral health. Materials & methods: A total of 472 patients were evaluated using a questionnaire and further examined visually using a mouth mirror and a light source.The patients were evaluated for erythema, ulcers, macule, papule, vescicles, bullae or any other abnormal changes within the oral cavity. Results: 103 patients (21%) were found to have oral lesions and 41 (39.8%) of them presented with palatal enanthem which was macular in nature. Candidiasis was noted in 19 (18.4%) patients, ulcer in 4 (3.8%), mucositis in 5 (4.8%), angular cheilitis in 3 (2.9%), white coating on tongue in 25 (24.2%) & depapillated tongue with glossitis in 6 (5.8%). Multivariate analysis was done using logistic regression.Tobacco chewing, malignancies and altered taste sensation were found to be independently associated with oral lesions. Conclusion: The study thus confirms the presence of oral lesions in diagnosed COVID-19 patients prompting healthcare professionals on a multidisciplinary approach towards this novel disease.

Investigation of magnetic exchange interactions in Cr-dopedCa0.5Sr0.5RuO3.

The value of Curie temperature (TC) and resistivity forCa0.5Sr0.5Ru1-xCrxO3are found to increase with increase inxfrom 0 to 0.1. TheTCincreases from 38 K to 107 K. In this work, we investigate the increment using spin polarised density functional theory. The compounds exhibit Griffiths phase. Our results show that to understand the behaviour of the increase inTC, it is important to consider not only the competing super exchange and super-super exchange interactions between Ru/Cr-Ru/Cr ion pairs but also the increment in the value of the magnetic moment due to the localized character of the dopant (Cr) ion. Our results suggest that the increased resistivity with Cr doping could be due to increased scattering rate and strong on-site coulomb repulsion due to Cr doping. It is also important to note that the behaviour ofTCwith the Ru-O-Ru bond angle is not in line with the functional form reported for ferrites, chromites and some ferromagnetic oxides. We believe that our results will be helpful in further exploring the origin of magnetism and transport on Cr doping in perovskite ruthenates.

Structural and physical properties of Ni1-xVxalloys around and away from quantum critical point.

We investigate the room temperature structure (global and local), temperature dependent magnetic and transport behaviour of Ni1-xVx(0⩽x⩽0.13) alloys. Our Energy Dispersive Analysis of x-rays results show that the prepared compositions are stoichiometric. With increase in V doping, the compounds exhibit a quantum phase transition aroundxc= 0.12, where the ferromagnetic phase is suppressed. Our results show that all the compounds stabilize in face centred cubic structure at RT and the lattice parameter shows unusual behaviour close toxc. The magnetic and heat capacity studies show signature of Griffiths phase on either side ofxc. From 25 K to the lowest collected temperature, we observe a linear T dependence of resistivity atx = 0.1 and aroundxc, which is separated by a Fermi-liquid region aroundx = 0.106. This suggests that the origin of the transport behaviour is different around the quantum critical point and away from it. Our Ni K-edge x-ray Absorption Spectroscopy results show that there is a significant reduction in the first coordination number around Ni central atom on doping. Further, with doping, there is distortion in the first coordination shell around Ni. This suggests, with V doping, the local structure around Ni is different from the global structure as obtained from the x-ray Diffraction results. Interestingly, with doping, we observe a direct connection between the extent of distortion at RT and the magnetic disorder obtained at 2 K. We believe our results will motivate the scientific community to further study the interplay between the structural disorder and quantum fluctuations with temperature at the local level.

Disability among Leprosy Patients in the Lustrum 2016-2020: Retrospective Study from a Tertiary Care Centre in Southern Kerala.

Background: The stigma surrounding leprosy in the community is due to grade 2 disability (G2D). The current global leprosy project aims towards a 90% reduction in G2D by 2030. This research was done to estimate the proportion of leprosy patients who had G2D at the time of diagnosis and to identify the clinical and demographic factors that predicted G2D. Materials and Methods: Design -Hospital-based retrospective cross-sectional study. The outcome variable was G2D and the determinants were demographic and clinical characteristics. Results: G2D was seen in 22.3% and G1D in 17.5%. The M:F ratio of G2D was 5:1. G2D was highest in the hands (62.1%), followed by the feet (59.4%), and the eyes (16.2%). The claw hand was the most common deformity in the hand and the plantar ulcer was the most common deformity in the feet. Age >45 (OR 2.27, 95% CI 1.1-4.8), males (OR 3.3,95% CI 1.3-8.5), multibacillary type (OR 6.95,95% CI 1.6-30.6), pure neuritic type (OR 3.6,95% CI 1.1-12.3), and thickened nerves (OR 14.3, 95% CI 1.9-108.7) were the significant determinants. Conclusion: Being male, being older than 45, having multibacillary leprosy, having pure neuritic leprosy, and having a thicker nerve trunk predicted G2D. Training primary care health workers in recognising the subtle early symptoms and raising community awareness are the need of the hour. Frequent leprosy case detection programmes should be held to identify undiagnosed cases.

Brugada syndrome unmasked by dengue fever.

Key Clinical Message: Understanding the circumstances, leading to unmasking of hidden Brugada syndrome is essential for the practicing clinician and the patients so that they are informed adequately to seek prompt medical attention. Abstract: Brugada syndrome is a genetic arrhythmia syndrome characterized by a coved type of ST-segment elevation in the ECG. The patients are usually asymptomatic, with unmasking of the disease under certain conditions. We are reporting the case of a patient diagnosed with Brugada syndrome, which was unmasked during an attack of dengue fever.

Pseudogap in BaPbxBi1‒xO3(x = 0.7, 0.75 and 1.0).

In this work, we have investigated the crystal and electronic structure of the orthorhombic phase of BaPbxBi1-xO3(BPBO) forx = 0.7 (BPBO70), 0.75 (BPBO75) and 1.0 (BPO), using temperature dependent x-ray diffraction measurements, photoemission spectroscopy, and electronic structure calculations. Our results show the importance of particle size and strain in governing superconductivity. Interestingly, the temperature evolution of the structural parameters in the case of BPBO70 is similar to that of BPBO75 but the magnitude of the change is diminished. The BPBO75 and BPO compounds exhibit metallic nature, which is corroborated by the core level studies. The electronic structure calculations in conjunction with the core level studies suggest that oxygen vacancies play an important role for metallicity observed in the end compound. The exponent to the spectral line shape close to the Fermi level suggests the origin of pseudogap to be due to other contributions in addition to disorder in the case of BPBO70 and BPO. The core level studies also show that as one goes fromx = 0.70 to 1.0, there occurs chemical potential shift towards the valence band suggesting hole doping. Our results open the venue to further study these compounds as a function of particle size, nature of carriers for its transport behaviour, electronic structure belowTC, composition at the grain boundaries and microscopic origin of pseudogap in the non-superconducting phase. We believe that our results call for a revision of the temperature-doping phase diagram of BPBO to include the pseudogap phase.

Isolation and characterization of a lectin-like chitinase from the hepatopancreas of freshwater prawn, Macrobrachium rosenbergii.

A lectin was isolated from the hepatopancreas of freshwater prawn, Macrobrachium rosenbergii by affinity chromatography using mucin-sepharose matrix. The purity of the isolated lectin was confirmed in native gradient PAGE that showed a single protein band of ∼37.9 kDa. In SDS-PAGE also one band of ∼43.3 kDa molecular weight was observed that indicated the protein to be a monomer. The band from the SDS-PAGE gel was identified through mass spectrometry as chitinase 1. The purified chitinase (50 µg/ml) hemagglutinated rabbit RBCs and, mucin and glucose inhibited hemagglutination with minimum concentrations of 0.1 mg/ml and 100 mM, respectively. Bacterial agglutination with Gram -ve Vibrio harveyi, Aeromonas sobria and Escherichia coli was also observed by this protein. Thus, chitinase 1 showed lectin-like properties besides its chitin hydrolytic activity. In western blot with hepatopancreas sample, rabbit antiserum against chitinase 1 cross-reacted to two additional proteins namely, chitinase 1C and obstructor E (a chitin-binding protein, CBP), besides its specific reactivity. An indirect ELISA was developed with the antiserum to quantify chitinases/CBP in hepatopancreas and serum samples of M. rosenbergii. The assay was used in samples from juvenile prawns following V. harveyi challenge. At 72 h post-challenge, significantly higher levels of chitinases/CBP were quantified in the hepatopancreas of the challenged group (1.8 ± 0.2 mg/g tissue) compared to the control (1.2 ± 0.1 mg/g tissue). This study suggests that the chitinase 1 protein with lectin-like properties is possibly induced at the protein level and can be putatively involved in the innate immune response of M. rosenbergii.

Orbital hybridisation effects in B2 phase Cr doped Co2MnAl.

We investigate here the magnetic, transport, local structural and electronic properties of Co2Mn1-xCrxAl (x= 0, 0.05, 0.1 and 0.2). Our results show that all the compounds stabilise in B2 phase and are ferromagnets. The results reveal disorder at the structural and magnetic levels. X-ray absorption near edge structure (XANES) analysis reveal signature of antisite disorder between Mn and Al atoms with equal ratio. The electronic structure calculations suggest enhancement in the half metallicity, localisation of electrons at the Fermi level and an increment in density of states with doping. The combined results of electronic structure calculations and XANES studies suggest transfer of electrons to the Co site. The results of high temperature resistivity measurements suggest the conduction electrons are undergoing transition from delocalisation to weak localisation to activated behaviour with Cr doping. The extended x-ray absorption spectroscopic analysis shows that the local structure around Mn atom is different from the global structure as obtained from the x-ray diffraction results. The behaviour of the edge region is in line with the trend as obtained from the compositional analysis. We observe link between the hybridisation of 3dlike states at the Mn, Cr sites with that at the Co site and the transport properties. This could help in understanding the unusual decrement in the lattice parameter with doping. These results reveal the role of local structure in understanding the physical properties of such systems.

Lattice effects on the physical properties of half-doped perovskite ruthenates.

We investigate the unusual phase transitions in SrRuO3and Sr0.5Ca0.5Ru1-xCrxO3(x = 0, 0.05 and 0.1) employing x-ray diffraction, resistivity, magnetic studies and x-ray photoemission spectroscopy. Our results show the compounds undergo a crossover from itinerant ferromagnetism to localized ferromagnetism. The combined studies suggest Ru and Cr be in the 4+ valence state. A Griffith phase and an enhancement in Curie temperature (Tc) from 38 K to 107 K are observed with Cr doping. A shift in the chemical potential towards the valence band is observed with Cr doping. In the metallic samples, interestingly, a direct link between the resistivity and orthorhombic strain is observed. We also observe a connection between orthorhombic strain andTcin all the samples. Detailed studies in this direction will be helpful to choose suitable substrate materials for thin-film/device fabrication and hence manoeuvre its properties. In the non-metallic samples, the resistivity is mainly governed due to disorder, electron-electron correlation effects and a reduction in the number of electrons at the Fermi level. The value of the resistivity for the 5% Cr doped sample suggests semi-metallic behaviour. Understanding its nature in detail using electron spectroscopic techniques could unravel the possibility of its utility in high-mobility transistors at room temperature and its combined property with ferromagnetism will be helpful in making spintronic devices.

Characterization of a Lipopolysaccharide- and Beta-1,3-Glucan Binding Protein (LGBP) from the Hepatopancreas of Freshwater Prawn, Macrobrachium rosenbergii, Possessing Lectin-Like Activity.

The study focuses on the isolation, characterization, and expression analysis of a lectin from the hepatopancreas of Macrobrachium rosenbergii. The protein was isolated by affinity chromatography on a melibiose-agarose column. The molecular weight of the native protein was found to be ~120 kDa which consists of a single polypeptide of ~39.5 kDa. On mass spectrometric analysis, the protein was identified as lipopolysaccharide- and beta-1,3-glucan binding protein (LGBP). LGBP showed hemagglutination with rabbit RBC like a lectin and its carbohydrate-binding specificity was determined by the hemagglutination inhibition test. The protein also showed antibacterial activity against two Gram-negative bacteria Vibrio harveyi and Aeromonas sobria, and one Gram positive bacteria Bacillus cereus in the disc diffusion test. Rabbit antiserum was raised against the purified LGBP and used to develop a sandwich ELISA system for quantitation of the protein in hepatopancreas and serum samples of M. rosenbergii. The expression of the LGBP transcripts in muscle, hepatopancreas, and gill tissues from M. rosenbergii juveniles at 72 h post-challenge of V. harveyi was not modulated as noticed in qPCR analysis. However, significant increases in the concentrations of LGBP protein in hepatopancreas (5.23 ± 0.45 against 3.43 ± 0.43 mg/g tissue in control) and serum (1.08 ± 0.14 against 0.61 ± 0.08 µg/ml in control) were observed in the challenged group of prawns in ELISA suggesting its putative role against bacterial infections. The study for the first time characterized the native LGBP of M. rosenbergii showing a multifunctional role in immunity.

A patient presenting with early syphilis and features of general paralysis of insane - An interesting case report in the 21st century!

A 66-year-old unemployed unmarried male with known men sex men activity since the age of 20 years presented with an erythematous well-defined ulcer on the lower lip and multiple discrete papulo-squamous lesions on the palms, soles, and scrotum. The patient was also in dysphoric mood with grandiose ideas with normal higher function. Knee and ankle jerk reflexes were absent and there was impaired tandem walking. Venereal Disease Research Laboratory (VDRL) and treponema pallidum hemagglutination assay were positive. Cerebrospinal fluid-VDRL was positive with grossly elevated proteins and glucose. HIV test was negative. Magnetic resonance imaging scan of the brain was normal. We made a diagnosis of neurosphilis - General paralysis of insane (GPI) with co-existing early syphilis. The patient was started on crystalline penicillin for 14 days after which there was significant improvement in behavior. We are reporting a rare case of GPI with early syphilis.

Evidence of lattice strain as a precursor to superconductivity in BaPb0.75Bi0.25O3.

In this work, we have investigated the precursor effects to superconductivity in BaPb0.75Bi0.25O3using temperature dependent resistivity, x-ray diffraction technique and photoemission spectroscopy. The present compound exhibits superconductivity around 11 K (TC). The synthesis procedure adopted is much simpler as compared to the procedure available in the literature. In the temperature range (10 K-25 K) i.e. aboveTC, our results show an increase in both the orthorhombic and tetragonal strain. The well screened features observed in Bi and Pb 4f7/2core levels are indicative of the metallic nature of the sample. The compound exhibits finite intensity at the Fermi level at 300 K and this intensity decreases with decrease in temperature and develops into a pseudogap; the energy dependence of the spectral density of states suggests disordered metallic state. Furthermore, our band structure calculations reveal that the structural transition upon Pb doping results in the closing of the band gap at the Fermi level.

Dietary brewer's spent yeast enhances growth, hematological parameters, and innate immune responses at reducing fishmeal concentration in the diet of climbing perch, Anabas testudineus fingerlings.

A 60-day feeding trial was conducted to optimally reduce the fishmeal level in climbing perch (Anabas testudineus) fingerling diet using a dietary brewer's spent yeast biomass (BSY) based diet. In this study, five isonitrogenous (35% CP) and isocaloric (19.15 MJ/Kg) feeds were prepared by replacing 0 (BSY0), 25% (BSY25), 50% (BSY50), 75% (BSY75) and 100% (BSY100) of fishmeal protein using BSY protein. A total of 225 numbers of uniform-sized climbing perch fingerlings (3.29 ± 0.09 g) were randomly stocked in the 15 rectangular FRP (Fiber-reinforced plastic) tanks (150 L capacity). The experimental fish were fed twice daily at 4% BW for the first fortnight and later reduced to 3% BW based on satiation. At the end of the feeding trial, the weight gain (WG) of fish increased with the increasing BSY incorporation rates corresponding to fishmeal content and peaked at 77.88%, and beyond that, WG decreased. Food conversion ratios decreased as dietary BSY levels increased and peaked at 76.28%. All other growth and feed utilization parameters followed a similar trend of weight gain. Hepatosomatic index (HSI) and viscerosomatic index (VSI), A:G ratio, serum catalase activity, and monocytes were unaffected and the total serum protein, albumin, globulin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), respiratory burst activity, lysozyme levels, myeloperoxidase activity, hemoglobulin, red blood cells, white blood cells, neutrophils, eosinophils, lymphocytes, and gut protease activities were increased significantly (P < 0.05) with the increasing replacement levels and peaked between 25 and 75%. The serum SOD activity and total platelets were decreased, whereas the serum uric acid and gut amylase activities were increased significantly to the increasing levels of FM replacement in the diets (P < 0.05). Among treatments, the BSY100 resulted in an overall poor growth response combined with relatively reduced values in nearly all biochemical parameters. The whole-body composition was nearly unaffected. The integrated biomarker response of various biochemical indicators from the different treatments has shown that the 50% fishmeal protein can be optimally replaced by BSY, which would cause an 18% reduction in the Economic conversion ratio (ECR) and -270.28 gCO2e- reduction in carbon footprint value per kg of climbing perch fingerlings production.

Synthesis and structural link to the electronic and magneto-transport properties of spin-orbit Mott insulator Sr2IrO4.

We investigate the effect of sample preparation conditions on the link between the structural and physical properties of polycrystalline spin-orbit Mott insulator, Sr2IrO4. The samples were prepared in two batches. With the first batch prepared as per the commonly adopted procedure in literature and the second batch prepared adopting the same procedure as the first batch but with an additional annealing in vacuum. Interestingly, our results show that without change in the value of the Curie temperature (TC), there occurs increase in the value of magnetization, resistivity, magneto-resistance (MR) and an increase in temperature range of stabilization of the canted antiferromagnetic structure. The temperature behaviour of the difference in the irreversible magnetization between the samples is in line with the difference in the Ir-O-Ir in-plane bond angle. At low temperatures, the conduction mechanism in the first batch of the sample is mainly governed by disorder while in the case of the other sample it is of Arrhenius type. The magneto-transport results have shown its strong link with the disorder and structural results. Although the nature and mechanism of the disorder needs to be investigated further, the present results throw light on the role of disorder and its connectivity between the structure and physical properties to understand its complex behaviours.

Prevalence and antimicrobial susceptibility profiles of non-typhoidal Salmonella isolated from chickens in Rajshahi, Bangladesh.

Salmonellosis in poultry is an important disease that seriously impedes the development of the poultry industry. The increased resistance to antimicrobials against Salmonella has been a major public health concern worldwide. We conducted a study from January to June 2016 in and around the Rajshahi district of Bangladesh on the commercial chicken to isolate, identify and characterize poultry-specific Salmonella, to assess the potential risk factors and to determine the antimicrobial resistance pattern of the isolates. The overall prevalence of Salmonella enterica was 41% (49/120) [95% CI: 31.95%-50.17%] with 41.7% in broiler chicken (25/60) [95% CI: 29.06%-55.12%] and 40% in layer chicken (24/60, 40%) [95% CI: 27.56%-53.46%]. Samples collected from Rajshahi city (OR = 1.37, 95% CI: 0.50-3.73) and Puthia Upazila (OR = 1.51, 95% CI: 0.56-4.12) were more likely to be positive for Salmonella than Charghat Upazila. Salmonella detection was 1.3 times higher in chicken, providing loose feed than those provided ready feed. All the isolates fermented dextrose, maltose and mannitol with the production of acid and gas, but did not ferment sucrose and lactose. The isolates showed catalase, MR, citrate utilization test and TSI agar test positive, but indole and V-P tests negative. Salmonella isolates were sensitive to ciprofloxacin (90%), gentamycin (80%), amoxicillin (75%), streptomycin (70%), ampicillin (45%) and sulfamethoxazole-trimethoprim (45%), whereas highly resistant to penicillin (100%) and nalidixic acid (100%) followed by sulfamethoxazole-trimethoprim (55%), ampicillin (40%) and amoxicillin (25%). Salmonella enterica is endemic in commercial chicken production in Bangladesh with high prevalence. A considerable proportion of Salmonella isolates was found to be resistant to the majority of the common antimicrobial drugs. A good biosecurity system could be effective for the reduction of Salmonella. It is necessary to obtain universal commitments to establish prudent antibiotic use policies.

Effect of hormonal stimulation on captive broodstock maturation, induced breeding and spawning performance of striped snakehead, Channa striata (Bloch, 1793).

In the present study, there was assessment of effects of gonadotropin treatments on broodstock maturation, induced breeding, and spawning outcomes of striped snakehead in captivity. The striped snakehead (n = 128) were equally distributed in four concrete tanks (15 m2) and hormone implants (500 IU human chorionic gonadotropin (hCG)/kg body weight) were inserted intramuscularly and striped snakehead broodstock administered this treatment were confined in two tanks and striped snakehead of a non-implanted group were confined in two tanks. The hormone implanted striped snakehead had a greater (P < 0.05) gonadosomatic index (GSI) and oocyte diameter in comparison to non-implanted striped snakehead. In a subsequent experiment, hCG and carp pituitary homogenate (CPH) were evaluated for inducing breeding. Dosages of hCG used were, 2,000 (TH1), 3000 (TH2), and 4000 (TH3) IU hCG/kg body weight of females. Dosages of CPH were, 20 (TP1), 30 (TP2), and 40 (TP3) mg CPH/kg body weight of females. Males were administered 0.75 of the dosage administered to females. The values for reproductive variables were estimated. Fertilization (89.0 ±â€¯3.0 %) and hatching (92.0 ±â€¯1.0 %) rates were greater (P < 0.05) in the TH1 group of implanted striped snakehead. Relative fecundity (19,023 ±â€¯2211), as well as fertilization (96.2 ±â€¯2.4 %), and hatching (96.6 ±â€¯1.7 %) rates were greater in the TP2 group of the implanted striped snakehead. The results from the present study indicate broodstock treated with gonadotropins had greater spawning outcomes which might facilitate mass scale breeding and fertilized egg as well as juvenile production of striped snakehead in captivity.

Lectin-Like Activity of Hemocyanin in Freshwater Prawn, Macrobrachium rosenbergii.

Lectins are proteins that bind to the carbohydrate moieties on surface of bacteria, erythrocytes and other cells of invertebrates causing agglutination and mediate in recognition of foreign substances. In the present study, we isolated and characterized a lectin molecule present in the hemolymph of Macrobrachium rosenbergii, an important cultured freshwater prawn. Lectin in serum samples of adult prawns was assessed through hemagglutination (HA) test using rabbit RBC that showed a titre ranging from 16 to 64. This serum hemagglutinin was confirmed as a C-type lectin based on its dependency on calcium ions towards binding to rabbit RBCs. The hemagglutinin was also found to be stable at the pH range of 5.0-10.0 and temperature range of 10-40 °C. Of various sugars and glycoproteins tested in hemagglutination inhibition assay, the serum lectin was found specific only to N-acetylneuraminic acid and fetuin with respective minimum inhibitory concentrations at 50 mM and 0.31 mg/ml. Further, the lectin was purified by affinity chromatography on rabbit erythrocyte stroma, which showed hemagglutination with rabbit RBC. In electrophoretic analyses, the purified lectin showed one band with molecular weight of ~ 427 kDa in native gradient PAGE, and its two constituent polypeptide chains of ~ 81 and ~ 73 kDa in SDS-PAGE. These polypeptides were analysed in MALDI-TOF/TOF mass spectrometry and identified as hemocyanins. It was hence, concluded that hemocyanin in M. rosenbergii possesses lectin-like activity.

Caries Risk Assessment and Referral Tool (CRA-RT)-A novel risk scoring system for early childhood caries in community settings.

OBJECTIVE: To develop a brief and simple, easy-to-administer, culturally sensitive, reliable and valid risk scoring system for early childhood caries based only on behavioural and other nonclinical risk factors. The purpose was to allow risk scoring by child care providers without clinical examination in order to guide dental referral in a community setting. METHODS: A cross-sectional study using stratified multistage cluster sampling was conducted among 559 preschool children and their mothers in Anganwadi centres and Preprimary schools in Thiruvananthapuram district, Kerala, India. All steps in the development of a new tool were carried out. Exploratory factor analysis and principal component analysis with Varimax rotation were employed for item reduction. Reliability and validity assessments were also performed. Past caries experience was recorded as dmft scores and the validity hypothesis of higher dmft scores in children with higher caries risk scores was also verified as an additional measure of construct validity. RESULTS: The newly developed Caries Risk Assessment and Referral Tool (CRA-RT) is presented as a unidimensional, 11-item, discriminative tool which showed high test-retest reliability (ICC = 0.8), high inter-rater reliability (ICC = 0.8) and acceptable internal consistency (Cronbach's alpha = 0.6). Face, content and construct validity have been demonstrated. Children with higher CRA-RT scores were having higher dmft scores, and it provided an additional evidence for the construct validity of the tool. CONCLUSION: CRA-RT is a simple, valid and reliable novel risk scoring system for ECC, to be used in a nondental, nonmedical setting. The proposed tool contains those behavioural risk or protective factors, the presence or absence of which could be assessed by interviewing the mother. The quick and the easy risk scoring pattern with a cut-off score can guide the dental referral of preschool children by child care providers in a community setting.

Multimodal Intervention Approach Reduces Catheter-associated Urinary Tract Infections in a Rural Tertiary Care Center.

OBJECTIVE: To compare the catheter-associated urinary tract infections (CAUTI) standardized infection rate (SIR) before and after implementation of a multimodal intervention approach in a rural tertiary hospital. DESIGN: Before-after analysis of a multimodal intervention to evaluate primary outcomes of the incidence of inpatient CAUTI, the SIR for CAUTI, and number of urinary catheter days. SETTING: All inpatient departments of a rural 504-bed tertiary care facility in the Midwest. PARTICIPANTS: Patients admitted for in-patient care. INTERVENTIONS: A multimodal intervention composed of: (a) physician and nurse education, (b) modification of progress note templates and daily provider reminders for the clinical necessity of catheters, (c) implementing established best practices for eliminating CAUTIs, (d) advocating for alternative toileting options, and (e) promoting aseptic techniques for insertion and removal of catheters. SIR, CAUTI, and the number of urinary catheter days were obtained before and after implementation of the multimodal intervention in 2015 and 2017, respectively. RESULTS: After a one-year timeframe of intervention, CAUTI event rates decreased, and SIR for CAUTI was reduced by 60.2% (from 1.524 to 0.607) with P value<0.05. Urinary catheter days were also reduced from 16,195 in 2015 to 13,348 in 2017 (17.6% reduction) with P value <0.05. CONCLUSIONS: Incidence of CAUTIs were significantly reduced with a team effort involving infection control, physician and nursing education, modification of progress note and templates and daily provider reminders for the clinical necessity of catheters and appropriate usage of urinary catheter with corresponding reduction in urinary catheter days.