Post-tonsillectomy Hemorrhage in Patients Receiving Ketorolac Analgesic.

Background Ketorolac, the non-steroidal anti-inflammatory drug, is thought to have less sedation as well as postoperative nausea and vomiting in comparison to opioids, but with higher risk of post-tonsillectomy hemorrhage as reported in some of the literatures. There is no consensus till date in the use of ketorolac in the management of pain following tonsil and adenoid related surgeries. Objective To find out the incidence of hemorrhage following tonsil and adenoid related surgeries in patients receiving ketorolac in postoperative period. Method This is a retrospective chart review of patients undergoing tonsil and adenoid related surgeries who had received ketorolac during April, 2013 to May, 2019 at department of ENT-HNS, Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal. Post-tonsillectomy hemorrhage rate was calculated in pediatric and adult patients. Result During the study period, 103 patients (male - 50 and female - 53) received ketorolac in postoperative period. Tonsillectomy and adenotonsillectomy were performed in 71and 32 patients respectively. Forty-five patients were < 18 years whereas 58 were ≥ 18 years. Most common indication for surgery was recurrent tonsillitis (66/103) followed by adenotonsillar hypertrophy (31/103). Post-tonsillectomy hemorrhage was observed in 15 patients; among them, four out 45 were < 18 years and 11 out of 58 ≥ 18 years. All five patients out of 15, who required surgical intervention for post-tonsillectomy hemorrhage, were ≥ 18 years and were operated for recurrent tonsillitis. Rest of the patients (10/15) were managed conservatively. None of the patients required blood transfusion. Conclusion Ketorolac is not associated with increased risk of post-tonsillectomy hemorrhage in children and can safely be administered. Whereas in adults, recurrent tonsillitis being the most common indication for tonsillectomy, it should be used cautiously.

Economic burden of limited English proficiency: A prevalence-based cost of illness study of its direct, indirect, and intangible costs.

Aims: The primary objective of the present study was to evaluate the economic burden of limited English proficiency (LEP) by estimating its direct, indirect, and intangible costs. A secondary objective was to assess the impact of variables on the economic burden. Design and Setting: A cross-sectional single-arm descriptive study conducted in a learning disability clinic in a public medical college in Mumbai. Subjects and Methods: The study cases (aged ≥8 years and ≤18 years) were recruited by non-probability sampling. A structured questionnaire was used to interview the parent to collect data related to direct and indirect costs. Intangible cost data were collected by documenting the willingness-to-pay value using the contingent valuation technique. Statistical Analysis Used: A multivariate regression model was used to assess the impact of predictor variables on the costs. Results: The direct, indirect, and intangible costs due to LEP were Indian Rupees (INR) 826,736, 3,828,220, and 1,906,300, respectively. Indirect costs comprised 82.2% of the total costs. Expenditure on tuition and remedial education comprised 39.86% and 14.08% of the indirect and direct costs, respectively. The average annual learning disability clinic costs were INR 2,169,146. The average annual total costs per student were INR 42,102. Higher socioeconomic status was predictive of increased "indirect costs", "total costs", and "intangible costs." Conclusion: LEP is a cost-intensive condition (indirect > intangible > direct costs). Non-medical costs are the costliest component of direct costs. Parental loss of earnings is the costliest component of indirect costs.

Parental-perceived health-related quality of life of school students with borderline intellectual functioning: A cross-sectional questionnaire-based study in Mumbai, Maharashtra, India.

Background and Objectives: Students with borderline intellectual functioning ("slow learners") underperform in all school subjects. The primary objective of this study was to evaluate the parental-perceived health-related quality of life (HRQoL) of these students. Its secondary objective was to analyze the impact of sociodemographic variables on their HRQoL. Settings and Design: Cross-sectional single-arm questionnaire-based study was conducted in the learning disability clinic in a public medical college in Mumbai. Subjects and Methods: One hundred parents of slow learners aged 8 to 16 years were recruited by non-probability sampling. Their HRQoL scores were measured using the English DISABKIDS chronic generic module parent (proxy) long-version ("DCGM-37-P") instrument. Statistical Analysis: Multiple regression analysis was carried out for determining the "independent" impact that sociodemographic variables had on a poor facet and total score outcomes. Results: Clinically significant deficits were detected in 4 facets, namely: small deficit in "social inclusion"; medium deficits in "independence", "emotion", and "social exclusion"; and large deficit in "total score". Multivariate analysis revealed that: (i) being an only child predicted a poor "emotion" and "social exclusion" facet score outcomes (P = 0.039 and P = 0.024, respectively); (ii) being a female predicted a poor "social inclusion" facet score outcome (P = 0.022); and, (iii) studying in a single-gender school predicted a poor "limitation" facet score outcome (P = 0.020). Conclusions: Parents of slow learners perceive their psychosocial and total HRQoL to be significantly compromised. There is a need to evaluate the HRQoL of slow learners so that optimum rehabilitation can be facilitated.

Are fireworks a significant episodic source of brown carbon?

We hypothesize that firework events involving the combustion of charcoal fuel, organic binders, metal salts, and cellulose-based wrapping material could be significant transient sources of aerosol brown carbon (BrC). To test this, we couple high time-resolution (1 min) measurements of black carbon (BC) and BrC absorption from a 7-wavelength aethalometer with time-integrated (12-24 h) measurements of filter extracts, i.e., UV-visible, fluorescence, and Fourier-transformed infrared (FT-IR) signatures of BrC, total and water-soluble organic carbon (OC and WSOC), ionic species, and firework tracer metals during a sampling campaign covering the Diwali fireworks episode in India. In sharp contrast to BC, BrC absorption shows a distinct and considerable rise of 2-4 times during the Diwali period, especially during the hours of peak firework activity, as compared to the background. Fluorescence profiles suggest enrichment of humic-like substances (HULIS) in the firework plume, while the enhancement of BrC absorption in the 400-500 nm range suggests the presence of nitroaromatic compounds (NACs). Considerable contributions of WSOC and secondary organics to OC (44.1% and 31.2%, respectively) and of the water-soluble fraction of BrC to total BrC absorption (71.0%) during the Diwali period point toward an atmospherically processed, polar signature of firework-related BrC, which is further confirmed by FT-IR profiles. This aqueous BrC exerts a short-lived but strong effect on atmospheric forcing (12.0% vis-à-vis BC in the UV spectrum), which could affect tropospheric chemistry via UV attenuation and lead to a stabilization of the post-Diwali atmosphere, resulting in enhanced pollutant build-up and exposure.

Brown carbon aerosols in the Indo-Gangetic Plain outflow: insights from excitation emission matrix (EEM) fluorescence spectroscopy.

We report the first characterization of the aerosol brown carbon (BrC) composition in the Indian context using excitation emission matrix (EEM) fluorescence spectroscopy coupled with parallel factor (PARAFAC) analysis. We find that biomass burning (BB)-dominated wintertime aerosols in the Indo-Gangetic Plain (IGP) outflow are characterized by two humic-like (HULIS) (C1_aq and C2_aq) and one protein-like/fossil fuel-derived (C3_aq) component for aqueous-extractable BrC (BrCaq), and by one humic-like (C1_me) and one protein-like (C2_me) component for methanol-extractable BrC (BrCme). Strong correlations of the BB tracer nss-K+ with C1_aq and C2_aq (r = 0.75-0.84, p < 0.01) and C1_me (r = 0.77, p < 0.01) point towards the BB-dominated IGP outflow as the major source. This is also supported by the analysis of fluorescence indices, which suggest extensive humification of BB emissions during atmospheric transport. The HULIS components correlate significantly with BrC absorption (r = 0.85-0.94, p < 0.01), and contribute substantially to the BrC relative radiative forcing of 13-24% vis-à-vis elemental carbon (EC). There is strong evidence that the abundant BB-derived NOX leads to NO3- formation in the IGP plume and drives the formation of water-soluble nitroaromatics (NACs) that constrain BrCaq light absorption (r = 0.56, p < 0.01) to a considerable degree. Overall, the study uncovers complex atmospheric processing of the IGP outflow in winter, which has important implications for regional climate.

Optical properties of aerosol brown carbon (BrC) in the eastern Indo-Gangetic Plain.

We report here measurements of aerosol black carbon (BC) and aqueous and methanol-extractable brown carbon (BrCaq and BrCme) from a receptor location in the eastern Indo-Gangetic Plain (IGP) under two aerosol regimes: the photochemistry-dominated summer and biomass burning (BB) dominated post-monsoon. We couple time-resolved measurements of BC and aerosol light absorption coefficients (babs) with time-integrated analysis of BrC UV-Vis and fluorescence characteristics, along with measurements of total and water-soluble organic carbon (OC and WSOC), and ionic species (NH4+, K+, NO3-). In the BB regime, BC and its BB-derived fraction (BCBB) increased by factors of 3-4 over summertime values. In comparison, babs_365_aq and babs_365_me (absorption coefficients of BrCaq and BrCme at 365 nm) increased by a factor of 5 (9.7 ± 7.8 vs 2.1 ± 1.4 Mm-1) and 2.5 (17.2 ± 9.0 vs 6.9 ± 2.9 Mm-1), respectively, in the BB period over summer, and were highly correlated (r = 0.82-0.87; p < 0.01) with the BB-tracer nssK+. The wavelength dependence of babs_BrC (Ångstrom exponent: 5.9-6.2) and the presence of characteristic fluorescence peaks at 420-430 nm suggested presence of humic-like substances (HULIS) in the aged BB aerosol, while significant association between BrCaq and NO3- (r = 0.73; p < 0.01) possibly indicated formation of water-soluble nitroaromatic compounds. BrCaq contributed 55% to total BrC absorption at 300-400 nm while that for the water-insoluble component (WI-BrC) increased from 41% at 340 nm to ~60% at 550 nm, suggesting formation of water-insoluble polycyclic aromatic hydrocarbons (PAHs) and/or N-PAHs. Mass absorption efficiencies at 365 nm (MAE365) of BrCaq and BrCme in the BB regime (0.95 ± 0.45 and 1.17 ± 0.78 m2 g-1, respectively) were in line with values expected from photobleaching of BB source emissions after transport to the eastern IGP. Overall, BrCaq and BrCme were significant components of light absorbing aerosol in the BB regime, with contributions of 9 ± 5% and 16 ± 7%, respectively, to radiative forcing vis-à-vis BC in the 300-400 nm range.

Boron nitride nanomaterials: biocompatibility and bio-applications.

Boron nitride has structural characteristics similar to carbon 2D materials (graphene and its derivatives) and its layered structure has been exploited to form different nanostructures such as nanohorns, nanotubes, nanoparticles and nanosheets. Unlike graphene and other carbon based 2D materials, boron nitride has a higher chemical stability. Owing to these properties, boron nitride has been used in different applications as a filler, lubricant and as a protective coating. Boron nitride has also been applied in the biomedical field to some extent, but far less than other 2D carbon materials. This review explores the potential of boron nitride for biomedical applications where the focus is on boron nitride biocompatibility in vivo and in vitro, its applicability as a coating material/composite and its anti-bacterial properties. Geometry, material processing and the type of biological analysis appear to be relevant parameters in assessing boron nitride bio-compatibility. Engineering of both these variables and the coating would open the door for some applications in the medical field for boron nitride, such as drug delivery, imaging and cell stimulation.

Hospital-based Surveillance of Rotavirus Diarrhea among Under- five Children in Chandigarh.

In a prospective hospital-based surveillance of 958 under five children admitted with acute gastroenteritis in Chandigarh (May 2011 to July 2012), 239 stool samples were collected. Rotavirus antigen was detected in 18.8% of samples by reverse transcriptase polymerase chain reaction. Genotypes G1P[8] (53.3%), G12P[6] (15.6%) were prevalent, and G3 not detected.

A Rare Case of Bilateral Aspergillomas in a Patient of Ankylosing Spondylitis.

Pulmonary involvement by Aspergillus sp. mainly includes allergic bronchopulmonary aspergillosis, aspergilloma, and invasive aspergillosis. Aspergilloma (Fungal ball) is the most common form of aspergillous pulmonary involvement, which occurs in preexisting pulmonary cavities, especially secondary to pulmonary tuberculosis. Ankylosing spondylitis is a rare cause of upper lobe fibro-cavitary lesions in pulmonary parenchyma. It may also lead to development of fungal balls in pulmonary cavities. Most common presentation is mild to massive hemoptysis; dyspnoea, chronic cough, expectoration may be other presentation; even the patient may remain asymptomatic. Intaracavitary mobile mass is a valuable sign for fungal ball, best detected by computed tomography (CT) scan of thorax. Lobectomy is the treatment of choice to stop the hemoptysis, if the general condition of the patient is fit; otherwise associated co-morbidities complicate the post-operative scenario. In this situation, bronchial artery embolization may be used as a temporary measure to control hemoptysis. Here, we report a case of bilateral aspergillomas within the cavities located in upper lobes of both lungs in a 74 years old male who was suffering from ankylosing spondylitis for last 42 years.

Clinical evaluation of purified Shilajit on testosterone levels in healthy volunteers.

Purified Shilajit, an Ayurvedic rasayana, was evaluated in healthy volunteers of age between 45 and 55 years for its effect on male androgenic hormone viz. testosterone in a randomised, double-blind, placebo-controlled clinical study at a dose of 250 mg twice a day. Treatment with Shilajit for consecutive 90 days revealed that it has significantly (P < 0.05) increased total testosterone, free testosterone and dehydroepiandrosterone (DHEAS) compared with placebo. Gonadotropic hormones (LH and FSH) levels were well maintained.

Effect of multi-nutrient insufficiency on markers of one carbon metabolism in young women: response to a methionine load.

BACKGROUND/OBJECTIVES: Multi-nutrient insufficiencies as a consequence of nutritional and economic factors are common in India and other developing countries. We have examined the impact of multi-nutrient insufficiency on markers of one carbon (1C) metabolism in the blood, and response to a methionine load in clinically healthy young women. SUBJECTS/METHODS: Young women from Pune, India (n=10) and Cleveland, USA (n=13) were studied. Blood samples were obtained in the basal state and following an oral methionine load (50 mg/kg of body weight in orange juice). Plasma concentrations of vitamin B12, folate and B6 were measured in the basal state. The effect of methionine load on the levels of methionine, total homocysteine, cysteine, glutathione and amino acids was examined. RESULTS: Indian women were significantly shorter and lighter compared with the American women and had lower plasma concentration of vitamins B12, folate and B6, essential amino acids and glutathione, but higher concentration of total homocysteine. The homocysteine response to methionine load was higher in Indian women. The plasma concentrations of glycine and serine increased in the Indian women after methionine (in juice) load. A significant negative correlation between plasma B6 and homocysteine (r= -0.70), and plasma folate and glycine and serine levels were observed in the Indian group (P<0.05) but not in the American group. CONCLUSIONS: Multi-nutrient insufficiency in the Indian women caused unique changes in markers of whole body protein and 1C metabolism. These data would be useful in developing nutrient intervention strategies.

Singular Value Decomposition of Optically-Mapped Cardiac Rotors and Fibrillatory Activity.

Our progress of understanding how cellular and structural factors contribute to the arrhythmia is hampered in part because of controversies whether a fibrillating heart is driven by a single, several, or multiple number of sources, and whether they are focal or reentrant, and how to localize them. Here we demonstrate how a novel usage of the neutral singular value decomposition (SVD) method enables the extraction of the governing spatial and temporal modes of excitation from a rotor and fibrillatory waves. Those modes highlight patterns and regions of organization in the midst of the otherwise seemingly-randomly propagating excitation waves. We apply the method to experimental models of cardiac fibrillation in rabbit hearts. We show that the SVD analysis is able to enhance the classification of the heart electrical patterns into regions harboring drivers in the form of fast reentrant activity and other regions of by-standing activity. This enhancement is accomplished without any prior assumptions regarding the spatial, temporal or spectral properties of those drivers. The analysis corroborates that the dominant mode has the highest activation rate and further reveals a new feature: A transfer of modes from the driving to the passive regions resulting in a partial reaction of the passive region to the driving region.

Radiobiological evaluation of intensity modulated radiation therapy treatments of patients with head and neck cancer: A dual-institutional study.

In clinical practice, evaluation of clinical efficacy of treatment planning stems from the radiation oncologist's experience in accurately targeting tumors, while keeping minimal toxicity to various organs at risk (OAR) involved. A more objective, quantitative method may be raised by using radiobiological models. The purpose of this work is to evaluate the potential correlation of OAR-related toxicities to its radiobiologically estimated parameters in simultaneously integrated boost (SIB) intensity modulated radiation therapy (IMRT) plans of patients with head and neck tumors at two institutions. Lyman model for normal tissue complication probability (NTCP) and the Poisson model for tumor control probability (TCP) models were used in the Histogram Analysis in Radiation Therapy (HART) analysis. In this study, 33 patients with oropharyngeal primaries in the head and neck region were used to establish the correlation between NTCP values of (a) bilateral parotids with clinically observed rates of xerostomia, (b) esophagus with dysphagia, and (c) larynx with dysphagia. The results of the study indicated a strong correlation between the severity of xerostomia and dysphagia with Lyman NTCP of bilateral parotids and esophagus, respectively, but not with the larynx. In patients without complications, NTCP values of these organs were negligible. Using appropriate radiobiological models, the presence of a moderate to strong correlation between the severities of complications with NTCP of selected OARs suggested that the clinical outcome could be estimated prior to treatment.

Estimation of Stature from Arm Span in Medical Students of Maharashtra, India.

BACKGROUND: Stature can be estimated from body parameters in dead and mutilated bodies using regression equation or multiplication factor. However, regression equations and multiplication factors are specific for the region only and can't be used in all population. AIM: To formulate regression equation and multiplication factor for the estimation of stature from arm span (AS) for a region in Maharashtra, India. SUBJECTS AND METHODS: It was a cross-sectional study, did over a period of 2 years, from October 2011 to September 2013. Four hundred students of three Government medical colleges of Maharashtra, aged 18-24 years were enrolled in the study. Stature and AS were measured and subjected to statistical analysis. Unpaired t-test and simple linear regression were used. RESULTS: Stature and AS of 400 medical students (219 males and 181 females) were measured. Subjects were divided into six groups depending upon age. Simple regression equation and multiplication factor for male and female and for each age group were derived for estimation of stature. We found correlation coefficient (R) of 0.89 in male and 0.90 in female using simple regression, which shows strong correlation between stature and AS. CONCLUSION: Mean stature and AS of male were more than female with statistical significance. Stature can be accurately estimated from AS using simple regression equation or multiplication factor.

Identification of anti-biofilm components in Withania somnifera and their effect on virulence of Streptococcus mutans biofilms.

AIMS: The aim of this study was to identify components of the Withania somnifera that could show anti-virulence activity against Streptococcus mutans biofilms. METHODS AND RESULTS: The anti-acidogenic activity of fractions separated from W. somnifera was compared, and then the most active anti-acidogenic fraction was chemically characterized using gas chromatography-mass spectroscopy. The effect of the identified components on the acidogenicity, aciduricity and extracellular polymeric substances (EPS) formation of S. mutans UA159 biofilms was evaluated. The change in accumulation and acidogenicity of S. mutans UA159 biofilms by periodic treatments (10 min per treatment) with the identified components was also investigated. Of the fractions, n-hexane fraction showed the strongest anti-acidogenic activity and was mainly composed of palmitic, linoleic and oleic acids. Of the identified components, linoleic and oleic acids strongly affected the acid production rate, F-ATPase activity and EPS formation of the biofilms. Periodic treatment with linoleic and oleic acids during biofilm formation also inhibited the biofilm accumulation and acid production rate of the biofilms without killing the biofilm bacteria. CONCLUSIONS: These results suggest that linoleic and oleic acids may be effective agents for restraining virulence of S. mutans biofilms. SIGNIFICANCE AND IMPACT OF THE STUDY: Linoleic and oleic acids may be promising agents for controlling virulence of cariogenic biofilms and subsequent dental caries formation.

Effect of brief cetylpyridinium chloride treatments during early and mature cariogenic biofilm formation.

OBJECTIVES: The aim of this study was to investigate the antibiofilm activity of brief cetylpyridinium chloride (CPC) treatments during early and mature Streptococcus mutans biofilm formation. METHODS: Streptococcus mutans biofilms were formed on saliva-coated hydroxyapatite disks. The biofilms were treated with CPC twice daily (1 min/treatment) from 0 to 50 h or from 48 to 98 h. Acidogenicity, dry weight, viability, and water-insoluble extracellular polysaccharides of the biofilms were analyzed. Confocal laser scanning microscopy (CLSM) images were obtained to confirm the antibiofilm activity during mature biofilm formation and to evaluate the relationship between treatment time and the antibiofilm activity. RESULTS: CPC showed complete antibiofilm activity during early biofilm formation at 0.025% to 0.1%. During mature biofilm formation, CPC inhibited dry weight, viability, and acidogenicity at 0.075% and 0.1%. CLSM images showed an increase in dead cells at 0.075% and 0.1% CPC. The antibiofilm activity during mature biofilm formation increased as the concentration of CPC increased. Images from the CLSM study also showed that antibiofilm activity increased as treatment time increased. CONCLUSION: Our findings suggest that brief CPC treatments have strong anti-S. mutans biofilm activity. The antibiofilm activity was dependent on the stage of biofilm formation, CPC concentration, and treatment time.

Re-irradiation in head and neck cancers: an Indian tertiary cancer centre experience.

OBJECTIVE: To explore the treatment outcomes of patients treated with re-irradiation for recurrent or second primary head and neck cancer. METHOD: An analysis was performed of 79 head and neck cancer patients who underwent re-irradiation for second primaries or recurrent disease from January 1999 to December 2011. RESULTS: Median time from previous radiation to re-irradiation for second primary or recurrence was 53.6 months (range, 2.7-454.7 months). Median age at diagnosis of first primary was 54 years. Median re-irradiation dose was 45 Gy (range, 45-60 Gy). Acute grade 3 or worse toxicity was seen in 30 per cent of patients. Median progression-free survival for recurrent disease was 15.0 months (95 per cent confidence interval, 8.33-21.66). The following factors had a statistically significant, positive impact on progression-free survival: patient age of less than 50 years (median progression-free survival was 29.43, vs 13.9 months for those aged 50 years or older; p = 0.004) and disease-free interval of 2 years or more (median progression-free survival was 51.66, vs 13.9 months for those with less than 2 years disease-free interval). CONCLUSION: Re-irradiation of second primaries or recurrences of head and neck cancers with moderate radiation doses yields acceptable progression-free survival and morbidity rates.

Immunohistochemical assessment of proliferating cell nuclear antigen protein expression in plaque, reticular and erosive types of oral lichen planus.

BACKGROUND: Proliferating cell nuclear antigen (PCNA) is a nuclear protein synthesized in the late G1 and S-phase of the cell cycle. Immunodetection of this protein represents a useful marker of the proliferation status of lesions. AIMS: The aim of this study is to evaluate the immunohistochemical expression of PCNA in oral lichen planus (OLP) and to assess the PCNA expression in a different layer of epithelium in different types of OLP. SUBJECTS AND METHODS: A total of 96 cases of histologically proven OLP, 32 cases each of erosive, reticular and plaque type were selected. Two sections were taken from each one for H and E. Other sections were stained according to super sensitive polymer horseradish peroxidase method for identifying PCNA expression. RESULTS: Of the three types of OLP, erosive type showed higher expression of PCNA (average 66.8%, minimum of 55% and maximum of 80.3%) followed by reticular (average 37.7%, minimum of 26% and maximum of 47%) and plaque type (average 17%, minimum of 5% and maximum of 25%) indicating increased proliferative activity. The erosive type also showed higher expression of PCNA in all the layers of epithelium followed by reticular and plaque type. CONCLUSION: PCNA is a good marker to indicate proliferation status of disease. Out of three types, erosive type possess more proliferative ratio, chances of malignant changes is more in this type.