Antiretroviral drug use and the risk of falls in people living with HIV: a systematic review and meta-analysis.

Objective: The risk of falls in people living with HIV (PLHIVs) on antiretroviral therapy (ART) has received little attention in the literature. The aim of the meta-analysis is to quantify the association between fall risk and various categories of drugs used in ART. Material and Methods: PubMed, Google Scholar, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to January 2023. Any observational study or controlled trial that reported on the relationship of at least one antiretroviral drug with falls in PLHIVs was included. Data on the frequency of single fallers, multiple fallers (≥2 falls), and non-fallers were extracted and studied for each drug and drug category. The pooled results were reported as an odds ratio (OR) with a 95% confidence interval (CI). Results: A total of five observational studies (51 675 participants) were included out of 414 articles obtained through a literature review. Stavudine use was found to be associated with an increased risk of single falls in PLHIVs (OR: 1.69, 95% CI: 1.08-2.66, P=0.02). However, efavirenz (OR: 0.82, 95% CI=0.76-0.89, P<0.001) and zidovudine (OR: 0.82, 95% CI=0.77-0.92, P<0.001) were found protective against the single falls. Didanosine had no significant association with fall risk (OR: 1.23, 95% CI: 0.78-1.93, P=0.37). Likewise, protease inhibitors, integrase inhibitors, nucleoside reverse transcriptase inhibitors, and non-nucleoside reverse transcriptase inhibitors were discovered to have no significant association with fall risk. Conclusion: Most drug categories of ART have no significant association with the risk of falls in PLHIVs. However, certain drugs, such as didanosine and stavudine, which have the inherent effect of causing balance deficits and neuropathy, should be used cautiously.

Assessment of Prognosis of Dental Implants in Diabetic Patients: A Clinical Study.

Background: To evaluate the prospects for dental implants in people with diabetes. Materials and Methods: Thirty patients in all were enrolled. The age range was from 40 to 60. Out of 30, 8 men and 22 women were present. HbA1c values were calculated. HbA1c levels and the ratio of problems to implant numbers were shown to be correlated. Data were gathered. Software called SPSS was used to analyses the results. Results: Thirty patients in all were enrolled. In follow-up cases, the stratification levels of HbA1c were investigated. The implant failure rate in 8.0-8.9 was 90.91%, with 2 implants failing. The survival rate in 11.0-11.9 was 75%. Others had a 100% success rate. Conclusion: Patients with diabetes have higher implant survival rates and fewer problems.

Adrenal adenoma associated with raised metanephrine level: A case report.

INTRODUCTION AND IMPORTANCE: Adrenal adenomas are benign neoplasms of the adrenal cortex which can be functional or non-functional. The functional tumors manifest as Cushing syndrome. Rarely, they are associated with high levels of metanephrine due to pheochromocytoma. Here, we report an extremely rare case of adrenal adenoma associated with raised metanephrine, but no histopathological evidence of medullary changes. CASE PRESENTATION: A 30-year female with diabetes, hypothyroidism, and hypertension was admitted for resistant hypertension, severe refractory hypokalemia, decreased sleep, fearfulness, anxiety, and palpitation. Facial puffiness, ecchymoses on upper and lower limbs, and bilateral pedal edema were present. Laboratory investigation revealed raised 24-hour-urine cortisol (52.5 µmol/dL) and metanephrine (56.00 µmol/24 h), very low ACTH (<5.0 pg/mL), and negative dexamethasone suppression test. MRI brain findings were normal. CT scan of the abdomen revealed a well-defined soft tissue lesion in the right adrenal gland and diffuse osteopenia vertebrae. Hence, diagnosis of Cushing Syndrome secondary to adrenal adenoma, and pheochromocytoma was made, and laparoscopic adrenalectomy was done under pheochromocytoma protocol. The patient improved dramatically, thereafter. Histopathological findings showed adrenocortical adenoma only; no evidence of pheochromocytoma was found. CLINICAL DISCUSSION: We came across many articles reporting adrenal adenoma associated with high levels of metanephrine due to co-existing pheochromocytomas either in the ipsilateral or contralateral adrenal gland. But, in our case, the adrenal adenoma was associated with high metanephrine levels with no histopathologic features of pheochromocytoma. CONCLUSION: Cushing syndrome due to Cortisol secreting Adrenal adenoma can be associated with biochemical and clinical features suggestive of Pheochromocytoma which could resolve after adrenalectomy.

Complete small intestinal obstruction due to band formation in low-grade appendiceal mucinous neoplasm: A rare case report and literature review.

INTRODUCTION: Intestinal obstruction due to external compression is a rare condition, and those caused by appendiceal neoplasms like low-grade appendiceal mucinous neoplasms are extremely rare. PRESENTATION OF CASE: A 67-year-old post-menopausal female, with no history of prior abdominal surgery, presented to the emergency room with constipation for 2 days, and peri-umbilical pain and non-projectile bilious vomiting for 19 h. There was mild abdominal distension and diffuse tenderness. After ultrasonography and Computed Tomography (CT) of the abdomen and pelvis, a provisional diagnosis of complete small bowel obstruction secondary to perforated mucinous neoplasm of the appendix was made. An emergency exploratory laparotomy was performed followed by ileo-cecal resection and ileocolic anastomosis. Intraoperative findings revealed bands extending from the appendix to the ileum forming a closed loop with gangrenous spots in the distal ileum and ascitic fluid with mucin. Later, histopathological examination findings were consistent with low-grade appendiceal mucinous neoplasm (LAMN). DISCUSSION: We reviewed three cases of intestinal obstruction, caused by compression from a LAMN, including the presented case. Preoperative diagnosis of the cause of small intestinal obstruction on CT is sometimes challenging. Hence, in patients with intestinal obstruction with a transition point in the right lower quadrant of the abdomen on CT, a high index of suspicion for an appendiceal etiology is required. CONCLUSION: LAMN with an associated band should be considered as one of the differential diagnoses in the patient presenting with symptoms of complete small intestinal obstruction without prior abdominal surgery.

Assessment of Pattern of Oral Prosthetic Treatment and Prevalence of Oral Diseases in Edentulous Patients in North Indian Population: A Cross-sectional Study.

BACKGROUND: The present study was undertaken for assessing the pattern of oral prosthetic treatment and prevalence of dental diseases in edentulous patients in North Indian population. MATERIALS AND METHODS: A survey was carried out in North Indian population, and screening of the edentulous patients was done. Five hundred edentulous patients were enrolled. Complete oral and general examination was carried out. Pro forma was framed, and clinical details were recorded. Using mouth mirror and explorer, complete oral examination was carried out. Demographic profile was also evaluated. Prosthetic rehabilitation pattern of all the participants was also recorded. RESULTS: Complete removable denture and removable partial denture were method of rehabilitation in 28% and 31% of the participants. Dental implant-supported complete denture was used in 8% of the patients, whereas dental implant-supported overdenture was used in 33% of the participants. Ulcerative lesions were present in 5% of the patients, whereas oral leukoplakia was present in 4% of the patients. Oral lichen planus and torus were present in 2% and 1% of the patients. CONCLUSION: Majority of the geriatric patients prefer having removable denture. Furthermore, due to nutritional deficiency associated with geriatric age, oral leukoplakia and ulcerative lesions are more common in them.

Management of interstitial lung diseases: A consensus statement of the Indian Chest Society (ICS) and National College of Chest Physicians (NCCP).

BACKGROUND: Interstitial lung disease (ILD) is a complex and heterogeneous group of acute and chronic lung diseases of several known and unknown causes. While clinical practice guidelines (CPG) for idiopathic pulmonary fibrosis (IPF) have been recently updated, CPG for ILD other than IPF are needed. METHODS: A working group of multidisciplinary clinicians familiar with clinical management of ILD (pulmonologists, radiologist, pathologist, and rheumatologist) and three epidemiologists selected by the leaderships of Indian Chest Society and National College of Chest Physicians, India, posed questions to address the clinically relevant situation. A systematic search was performed on PubMed, Embase, and Cochrane databases. A modified GRADE approach was used to grade the evidence. The working group discussed the evidence and reached a consensus of opinions for each question following face-to-face discussions. RESULTS: Statements have been made for each specific question and the grade of evidence has been provided after performing a systematic review of literature. For most of the questions addressed, the available evidence was insufficient and of low to very low quality. The consensus of the opinions of the working group has been presented as statements for the questions and not as an evidence-based CPG for the management of ILD. CONCLUSION: This document provides the guidelines made by consensus of opinions among experts following discussion of systematic review of evidence pertaining to the specific questions for management of ILD other than IPF. It is hoped that this document will help the clinician understand the accumulated evidence and help better management of idiopathic and nonidiopathic interstitial pneumonias.

Management of interstitial lung diseases: A consensus statement of the Indian Chest Society (ICS) and National College of Chest Physicians (NCCP)

Interstitial lung disease (ILD) is a complex and heterogeneous group of acute and chronic lung diseases of several known and unknown causes. While clinical practice guidelines (CPG) for idiopathic pulmonary fibrosis (IPF) have been recently updated, CPG for ILD other than IPF are needed. Methods: A working group of multidisciplinary clinicians familiar with clinical management of ILD (pulmonologists, radiologist, pathologist, and rheumatologist) and three epidemiologists selected by the leaderships of Indian Chest Society and National College of Chest Physicians, India, posed questions to address the clinically relevant situation. A systematic search was performed on PubMed, Embase, and Cochrane databases. A modified GRADE approach was used to grade the evidence. The working group discussed the evidence and reached a consensus of opinions for each question following face-to-face discussions. Results: Statements have been made for each specific question and the grade of evidence has been provided after performing a systematic review of literature. For most of the questions addressed, the available evidence was insufficient and of low to very low quality. The consensus of the opinions of the working group has been presented as statements for the questions and not as an evidence-based CPG for the management of ILD. Conclusion: This document provides the guidelines made by consensus of opinions among experts following discussion of systematic review of evidence pertaining to the specific questions for management of ILD other than IPF. It is hoped that this document will help the clinician understand the accumulated evidence and help better management of idiopathic and nonidiopathic interstitial pneumonias.

Similarity of referents influences the learning of phonological word forms: Evidence from concurrent word learning.

Although it is well accepted that various components of words (e.g., phonological word forms, and semantics) interact with each other during processing, it is less clear whether semantics and phonology interact with each other during word learning in the sense of affecting each other's learning. This study employed three behavioral experiments as well as computational simulations to shed light on this issue by examining whether semantic similarity, operationalized as visual referent similarity, influences the learning of phonological word forms. Experiment 1 demonstrated an effect that would typically be interpreted as an effect of similarity on phonological learning, employing the commonly used naming task. We discuss how such results are confounded by at-test competition effects that can arise directly from the explicit presentation of similar referents, or indirectly from their re-activation even without explicit presentation. Experiments 2 and 3 used a stem completion test and a recognition from mispronunciation test to control for direct effects of competition, and still found effects of similarity on performance. A neural network model of word learning simulated the behavioral results, with analysis of the model confirming a genuine effect of referent similarity on phonological learning even when controlling for both direct and indirect at-test similarity effects. Together these results provide converging evidence that phonological word form learning is affected by referent similarity, suggesting that semantics and phonology interact with each other during learning.

Squat-to-stand test in functional assessment of stable chronic obstructive pulmonary disease patients.

BACKGROUND: Assessment of functional status is vital for proper therapy and rehabilitation programs in chronic obstructive pulmonary disease (COPD) patients. Traditionally, 6 min walk test (6MWT) has been used but it by itself may not reflect the total functional status in these patients as it poorly correlates to the disease severity. A sit-to-stand test (STST) has been proposed as a better alternative to 6MWT but to test their ability to stand from the squatting position, i.e., a squat-to-stand test (SqTST) will be more appropriate in rural patients. MATERIAL AND METHODS: All patients, diagnosed to have stable COPD, after exclusion of asthma and other respiratory or nonrespiratory diseases were evaluated by applying 6MWT, STST, and SqTST in them. Data so obtained were statistically analyzed. RESULTS: Ninety patients and twenty healthy controls were studied. Sixteen, 24, 23, and 27 of the patients were classed as COPD risk category A, B, C, and D, respectively. The mean post bronchodilator forced expiratory volume in 1st second (PB FEV1) and body mass index (BMI) were significantly lower in category D as compared to the rest. The cutoff values for 6MWT, STST, and SqTST were derived as 184M, 11, and 07, respectively. 6MWT correlates poorly to disease severity (P = 0.109) but there was a strong correlation between disease severity and SqTST and STST (P = 0.000). CONCLUSION: SqTST is a feasible and effective tool to assess functional status of COPD patients residing in rural areas. BMI is an important surrogate marker of the functional status in these patients.

Evaluation of the Role of Music as a Nonpharmacological Technique in Management of Child Patients.

INTRODUCTION: Behavior management and reducing anxiety and pain are very important for success of treatment. Hence, apart from pharmacological management, such as conscious sedation, nonpharmacological interventions like music play a significant role. This study aims to evaluate the effects of music in reducing anxiety, pain, and behavior management. MATERIALS AND METHODS: This study was conducted at the Department of Pedodontics in 2015. It consisted of 60 patients, age ranging from 3 to 7 years, who required dental treatment with local anesthesia. They were divided into three groups of 20 each. Group I consisted of upbeat music distraction group. Group II consisted of relaxing music distraction group. Group III consisted of control group. We scheduled the treatment in two visits. We used Venham picture test, North Carolina behavior rating scale, and visual analog scale test for the study. Baseline heart rate was also recorded. RESULTS: No significant differences were found among the three groups based on three scales used in the study. CONCLUSION: Management of child patient in dental clinic is a challenge for clinician. Apart from various pharmacological techniques, management of pediatric patients using audio music distraction has been introduced. However, music did not produce a reduction in pain, anxiety, or disruptive behavior. CLINICAL SIGNIFICANCE: Various pharmacological techniques are present for the management of pediatric patients. Apart from it, there is need of introducing nonpharmacological techniques to reduce pain, anxiety, and to alter behavior of child. By this study, we have tried to evaluate the usefulness of music in child management.

Add-on prednisolone in the management of cervical lymph node tuberculosis.

Studies defining role of systemic steroids in routine management of cervical lymph node tuberculosis (CLNTB) are too few and inconclusive. The present study was carried out to define the role of add-on prednisolone in the management of CLNTB. Patients of CLNTB were randomized into two groups. Group I patients received DOTS Category I treatment along with prednisolone 1mg/kg for first 4 weeks and then tapered down. Group II patients received DOTS Category I treatment along with placebo. Patients were kept under close follow up for 6 months. Response to therapy and adverse drug reactions, if any, were recorded. A total of 120 patients completed the study protocol. The two groups were similar with respect to age, sex, smoking, alcoholism, and clinical profile (p>0.5). At 2 months, 54 out of 60 patients in Group I showed symptom relief when compared with 44 out of 60 patients in Group II (p<0.001). Abscess, sinus, and/or appearance of new lymph node/s were noted in 3 and 13 patients in Group I and Group II, respectively (p<0.001). Complete resolution was seen in 57 patients in Group I when compared with only 40 patients of Group II and sequel in form of residual LN was noted in three patients of Group I when compared with 20 in Group II (p<0.001). Gastrointestinal side effects were reported by higher number of patients in Group I but skin rashes and joint pain were fewer when compared with Group II (p>0.05). All the adverse reactions were transient and amenable to symptomatic treatment.

Resurvey of symptomatics of the Jaipur district population and suggestion for alternative diagnostic criteria of asthma for epidemiological surveys.

INTRODUCTION: The prevalence of asthma in Jaipur district of Rajasthan was reported as 0.96% in an earlier survey. It was far below the national average of 2.38%. It was reasoned then that this could be due to under diagnosis of asthma in the Jaipur population. MATERIAL AND METHODS: A resurvey of the symptomatics, not diagnosed as asthma at time of the original survey was, therefore, undertaken. The resurvey data were analysed and those who now fulfilled the twin criteria for diagnosis of asthma, as used in the original survey, were diagnosed as having asthma. The original data of these newly diagnosed asthma patients were reanalyzed in search for an alternative diagnostic criterion. RESULTS: Of the 382 symptomatics, 344 (90%) could be resurveyed and of them, 85 now fulfilled the twin diagnostic criteria for asthma. The reanalysis of the original survey data of these patients revealed that presence of shortness of breath (SOB) had the highest sensitivity, the presence of allergic symptoms in self or the family had the highest specificity and the presence of wheezing had the highest odds ratio (OR) for diagnosing asthma. Further, the OR for diagnosing asthma increased further and was highest with the presence of SOB and 2 additional symptoms. With the use of the "symptom criteria" for diagnosis of asthma i.e. the presence of SOB with 2 additional symptoms, it would have been possible to diagnose majority of the missed cases at the time of the original survey itself. CONCLUSIONS: Based on this study data it can be concluded that (a) the twin criteria for diagnosing asthma as used in earlier surveys led to under diagnosis of asthma and (b) the use of symptom criteria alone effectively checks the problem of under diagnosis of asthma. The symptom criteria are being suggested as an alternative method for use in future epidemiological surveys on asthma.

A comparative study of itraconazole in various dose schedules in the treatment of pulmonary aspergilloma in treated patients of pulmonary tuberculosis.

INTRODUCTION: The optimal dose, duration, and efficacy of itraconazole in Indian patients of pulmonary aspergilloma (PA) are not clearly defined. Therefore, a study was carried out, to resolve these issues in diagnosed cases of PA complicating old treated patients of pulmonary tuberculosis. MATERIALS AND METHODS: The study patients randomly received itraconazole either in a fixed dose schedule of 200 mg (group I), 200 mg twice daily (group II) or a variable dose schedule (group III), for 12 months. All the patients were followed up for the entire duration of the study for clinical, radiological, and immunological response. The side effects were recorded as and when reported by the patients and managed symptomatically. RESULTS: A total of 60 patients were enrolled, 20, in each group. There were no intergroup differences with regard to age, sex, body weight, smoking status, alcohol intake, symptoms, Potassium hydroxide (KOH) mount, fungal culture, pattern of radiological lesions or anti-aspergillus antibodies (anti-Asp-Ab) titers. The radiological response was poor in group I patients, as compared to the other groups, at two months (P < 0.05). The dose of itraconazole was increased in five of the patients in group I due to poor response. A higher number of group II patients suffered side effects and the dose of itraconazole had to be decreased in three of these patients, but none of the patients on a variable dose schedule required a change in dose schedule. CONCLUSION: Thus, a weight-based variable dose schedule of itraconazole was found to be a more effective and safer modality in the management of PA than a fixed dose schedule.

Concentration of Fluoride in Cow's and Buffalo's Milk in Relation to Varying Levels of Fluoride Concentration in Drinking Water of Mathura City in India- A Pilot Study.

AIM: To estimate fluoride concentration in drinking water, cow's milk and buffalo's milk and to correlate the concentration of fluoride in cow's milk and buffalo's milk with varying levels of fluoride concentration in drinking water. MATERIALS AND METHODS: Ten households having both cows and buffalo's were selected by convenience in each of the 3 zones (below optimum fluoride <0.7 ppm (parts per million), optimum fluoride 0.7-1.2 ppm and above optimum fluoride areas > 1.2 ppm). From these selected households, 200 ml of fresh milk of both cows and buffaloes was collected along with 200 ml of drinking water for estimation of fluoride concentration by using a fluoride ion selective electrode method. The data was analysed using SPSS, version 11.5 for windows. RESULTS: The mean fluoride concentration of drinking water, cow's milk and buffalo's milk in three different fluoride zones was 0.89±0.39, 0.09±0.07, 0.09±0.08 respectively. Pearson's correlation found a statistically significant correlation between fluoride concentrations in cow's and buffalo's milk with varying levels of fluoride concentration in drinking water in zone B and zone C. However, this correlation was not statistically significant in zone A. CONCLUSION: With an increase in fluoride concentration in drinking water there was an increase in concentration of fluoride in cow's and buffalo's milk. We conclude that this association is seen in conjunction to not only a single factor but rather due to culmination of several other aspects. So, there is a need to elucidate the other factors that might be contributing to this increase and dental fluorosis.

A comparative evaluation of static frictional resistance using various methods of ligation at different time intervals: an in vitro study.

Aim. To compare and evaluate the static frictional resistance offered by the four different types of ligation methods in both dry and wet conditions and at different durations when immersed in artificial saliva. Material and Methods. Alastik Easy to Tie modules, Super Slick Mini Stix elastomeric modules, Power "O" modules, and 0.009(″) Stainless Steel ligatures were used to compare the static friction using maxillary canine and premolar Preadjusted Edgewise brackets with 0.022(″) × 0.028(″) slot and 0.019(″) × 0.025(″) stainless steel wires. Results. The mean frictional resistance for Alastik modules was the lowest and that of Stainless Steel ligatures was found to be highest among the four groups compared and the difference among the four groups was statistically significant (P < 0.005). The mean static frictional resistance in all groups under dry conditions was lower than that under wet conditions. No statistical significant differences were found when the groups were compared at different time periods of immersion in artificial saliva. Conclusion. This study concludes that the Alastik modules showed the lowest mean static frictional forces compared to any other ligation method, though no significant difference was found for different time periods of immersion in the artificial saliva.

Value of past clinical history in differentiating bronchial asthma from COPD in male smokers presenting with SOB and fixed airway obstruction.

OBJECTIVE: Differentiating asthma from chronic obstructive pulmonary disease (COPD) is difficult. Steroid trial may be of help but has several pitfalls. The present study aims to assess the value of past clinical profile of asthma and its differential diagnosis from COPD in male smokers and thereby to formulate clinical parameters to diagnose bronchial asthma in such patients. PATIENTS AND METHODS: Male smokers who reported at the Respiratory Medicine Department of the National Institute of Medical Sciences (NIMS) Hospital, Jaipur, (India), with shortness of breath (SOB) and showing less than 12% postbronchodilator bronchial reversibility (BR) on spirometry were recruited. These patients were given oral prednisolone 1 mg/kg for two weeks. Post steroid (PS) spirometry was performed to ascertain BR. The past clinical history was recorded and analyzed to determine if it is of any use in differentiating asthma from COPD. RESULT: Out of 104 patients, four were lost to follow up, 52 were diagnosed as bronchial asthma, and the remaining 48 as COPD. It was revealed that past history of (H/O) seasonal variation, wheezing, eye allergy, nasal allergy, dust allergy, skin allergy, and family H/O asthma/allergy were positive in 50, 40, 34, 30, 18, 14, and 12 asthma patients as compared to 10, 8, 2, 4, 6, 0, and 0 in 48 COPD patients (P < 0.001). The odds ratio (OR) for diagnosing asthma was highest for the presence of any other two symptoms/variables, besides SOB, in the past (OR = 275, P < 0.0001). CONCLUSION: Past clinical history is of immense value in differentiating asthma from COPD in male smokers presenting with SOB and fixed airway obstruction.

Isolated pauci-immune pulmonary capillaritis.

A young house wife presented with low grade fever, cough, haemoptysis and SOB of unknown aetiology for 40 days duration. Respiratory system examination revealed diffuse crepts and rhonchi. Other organ system examination did not reveal any abnormality. X-ray chest PA view and CT thorax showed diffuse bilateral necrotising nodular lesions of various sizes with small pleural effusion. She also had low resting oxygen saturation with falling haematocrit. Her Serum was week positive for p-ANCA and negative for MPO-ANCA. Bronchoscopy revealed continuous bloody aspirates. We could not isolate any organisms in any of the specimens from her and she was unresponsive to any of the antibiotics either. Based on the clinical, laboratory data, radiological features and positive outcome to pulse therapy of methylprednisolone and cyclophosphamide, she was diagnosed as a case of IPIPC.