Clinical Profile and Renal Survival of Anti-Glomerular Basement Membrane Disease Patients: A Retrospective Case Series from Northern India.

Introduction: Anti-glomerular basement membrane (anti-GBM) disease is a rare organ-specific autoimmune disease. The overall and renal outcomes of patients have mostly been reported in small-sized cohorts. We aimed to study the clinical profile, overall survival, and renal survival of anti-glomerular basement membrane disease patients at our center. Methods: We conducted a retrospective analysis of the data regarding the clinical profile and renal survival of patients diagnosed with anti-GBM disease from October 2019 to March 2022, having a minimum follow-up of 12 months. Results: There were 15 patients in the study, with the mean age of presentation being 51.6 ± 13.7 years. The median duration of symptoms onset to the nephrologist opinion was 15 (10-23) days. The extrarenal manifestations were seen in the respiratory, otorhinolaryngological, and neurological systems. The mean serum anti-GBM titers were 154.5 (14.9-263.5) U/mL. Serum anti-GBM titers were present in 13/15 (86.6%) patients, and 12/13 (92.3%) patients had above the reference range. Anti-neutrophil cytoplasm antibody (ANCA) levels were assessed in 12/15 (80%) patients, and 9/12 (75%) had higher levels. Renal biopsy was available in 14 patients with more than 50% crescents. Along with crescents, necrotizing lesions, rupture of the Bowman's capsule, and granulomatous lesions were also seen. Among the initial therapies, the steroid pulse was given to 13 (86.6%) patients, whereas membrane plasmapheresis was given to 8 (53.3%) patients. Inj. cyclophosphamide and inj. rituximab were given to 8 (53.3%) and 4 (26.6%) patients, respectively. No difference was seen in clinical characteristics, renal biopsy features, treatment received, and outcomes with ANCA positivity except for age, where patients who were ANCA positive were older compared to patients who were ANCA negative. One-year renal and patient survival was seen in 4 (26.6%) and 6 (40%) patients, respectively. Conclusion: Most patients of anti-GBM disease have active sediments, raised creatinine, and non-specific symptomatology. There is poor renal and patient outcome as most patients present with advanced renal failure.

Outcome of Therapies for Membranous Glomerulonephritis During Three Waves of COVID Pandemic.

There is lack of clarity on immunosuppressive therapy in glomerular diseases and concomitant corona-virus infection. We retrospectively evaluated 36 patients with primary membranous nephropathy from January 2020 to December 2021 who had received immunosuppression during this period. Diagnosis of COVID-19 was made based on self-reported history of being COVID positive. History of hospitalization and oxygen therapy was noted. Four patients developed COVID-19 in this cohort, and all were infected only once. Two patients had asymptomatic disease and two were hospitalized for severe COVID-19 and had complete recovery. In immunocompromised patients, there is a high risk of infection. This observational study is an attempt to bridge the gap that immunosuppression can precipitate COVID-19 infection.

You stay home, but we can't: Invisible 'dirty' work as calling amid COVID-19 pandemic.

Research on calling has largely focused on its benefits for employees. This study contends that experiencing work as a moral duty based calling in invisible-dirty occupations can yield both favorable and unfavorable employee outcomes. Whether employees feel burdened or supported in their work and family roles depends on the demands and resources provided by the workplace. In a sample of 175 janitors at a large government hospital designated for treating COVID-19 patients in the national capital region of India, hypothesis testing results support that work calling is positively associated with both positive (job performance, subjective career success), and negative (work-family and family-work conflicts, burnout) outcomes. Further, job demands strengthen the relationship of work calling with work-family and family-work conflicts, and burnout, whereas, job resources augment the relationship between work calling and job performance, and subjective career success.

Reconfiguration of food grain supply network amidst COVID-19 outbreak: an emerging economy perspective.

The procurement of food grains from farmers is one of the biggest challenges under the COVID-19 outbreak due to country-wise lockdowns. The present study aims to reconfigure the existing food grain supply chain network. The study advances the extant literature by proposing a novel mathematical model that considers the government guidelines issued to procure food grains from farmers under the COVID-19 situation. The model includes personal distancing, a key parameter relevant in the COVID-19 crisis, and has remained unaddressed in the existing literature. The proposed model is tested in India. The effect of different parameters like personal distancing cost, carbon emission cost, fixed cost, and transportation cost is also investigated under a given set of procurement centers. Finally, the procurement schedule for each procurement center is generated, which is especially useful for managing its activities and is also helpful to farmers to streamline the process. Results indicate that the proposed model is highly effective under pandemic emergencies like the current COVID-19 crisis. Policymakers and the government will find this model helpful in drafting relevant policies regarding food grain procurement under emergencies such as the COVID-19 outbreak. The distribution segment of the supply chain network is not part of the present research work. In future studies, this part could be then added to the whole of the procurement process, and both procurement and distribution can be assessed together again.

Second-hand smoke exposure and its determinants among nonsmoking adolescents residing in slum areas of Bhubaneswar, India.

BACKGROUND: Second-hand exposure (SHS) is a significant public health problem and accounts for over 600,000 deaths among non smokers worldwide every year. The study aimed to estimate the prevalence and determinants of SHS exposure among nonsmoking adolescents residing in slum areas of Bhubaneswar, India. METHODS: Multistage cluster random sampling was used to select 259 nonsmoking adolescents from eleven slum areas. We used descriptive statistics to determine the prevalence of SHS exposure and inferential statistics using multivariable logistic regression model to identify factors associated with SHS exposure. RESULTS: Of the 259 adolescent participants, 67 (25.9%) were exposed to SHS inside home and 97 (37.5%) were exposed outside home. About 47.5% adolescents were exposed to anti-smoking media messages and 22.8% were unaware of the harmful effects of exposure to SHS. SHS exposure inside home was associated with smokeless tobacco use (adjusted odds ratio [aOR]: 10.64; 95% confidence interval (CI): 2.57-43.48), illiteracy of father (aOR: 5.40; 95% CI: 1.51-19.32), non-exposure to antismoking media messages (aOR: 3.53; 95% CI: 1.06-11.72), and absence of knowledge regarding harmful effects of SHS (aOR: 3.72; 95% CI: 1.15-12.05). Also, variables like male gender (aOR: 10.31; 95% CI: 4.50-23.81), smokeless tobacco use (aOR: 2.43; 95% CI: 1.05-5.65), illiteracy of father (aOR: 4.58; 95% CI: 1.23-17.14), and non-exposure to antismoking media messages (aOR: 4.04; 95% CI: 1.49-10.89) had increased SHS exposure outside home. CONCLUSION: The findings underscore the urgent need to implement comprehensive smoke-free policies to reduce SHS exposure among slum adolescents.

Diagnostic efficiency of methylene blue and lugol's iodine double staining method in oral leukoplakia in detecting dysplasia.

OBJECTIVES: Early detection of dysplasia in oral potentially malignant disorders (PMD) might facilitate screening for possible subsequent malignant transformation. Vital staining is a non-invasive clinical adjunct used for determining the biopsy site, which facilitates early detection of dysplastic changes in PMD. Some authors suggested that double staining method has superior results over staining with a single dye. AIM: The aim of the study was to evaluate the accuracy of in vivo staining with methylene blue (MB) and Lugol's iodine (LI) double staining method in comparison with MB staining alone. MATERIALS AND METHODS: Fifty patients of oral leukoplakia were recruited for the study. After obtaining written informed consent from the patients, the lesions were stained consecutively with 5% MB and 3% LI. The pattern of dye retention of MB alone, followed by MB and LI was noted. Incisional biopsy from the lesion was taken based on the retention of MB and the absence of staining of LI or by clinical judgement in case both stains were not retained. The clinical uptake of the stains was correlated with the degree of dysplasia on histopathological examination. RESULTS: Out of 50 subjects, MB was retained in 47 cases (94%), while 3 cases (6%) failed to retain the dye. However, out of 47 cases, 20 cases had dark blue stain and were considered as MB positive, while the rest 27 cases had pale blue stain and were considered to be negative for MB staining. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) of MB staining were 57.82%, 100%, 100%, 26.53% and 46%, respectively. After applying both stains, i.e., double staining method, the outline of the lesion was better defined. Out of 50 PMD cases, 3 patients retained only LI and showed no dysplasia. Out of 47 cases which showed dysplasia, 27 cases showed pale blue retention of MB (-) and also were negative for LI. The rest 20 cases were positive for MB but negative for LI. The sensitivity, specificity, PPV and NPV with double staining technique were 100%. CONCLUSION: The accuracy and reliability of double staining method was superior to MB staining. CLINICAL RELEVANCE: Increased accuracy of double staining method aids in better detection of dysplasia and is of great help to the clinician in deciding the nature of PMD in question.

Perceived Status and Care Practices among Complete Denture Wearers.

BACKGROUND: Oral health is neglected even today. This can be evidently seen in the low utilization rates and poor oral health status. Conventional dentures are the most common treatment option in the restoration of lost teeth. Without appropriate denture care practices, there is an elevated risk of developing a multitude of problems. The aim of this study was to assess the perceived status and care practices among complete denture wearers in Modern Dental College and Research Centre, Indore, Madhya Pradesh, India. MATERIALS AND METHODS: A cross-sectional study was conducted in the Department of Prosthodontics at the Modern Dental College and Research Centre, Indore, Madhya Pradesh, India. Patients with self-care optimum overall health who were using either single or full complete dentures for more than 1 year from the commencement of the study were requested to participate in the study. A total of 1000 study participants were given a self-administered questionnaire on their denture care practices followed by clinical examination of the denture status. Data were statistically analyzed using the Statistical Package for the Social Sciences software for Windows, version 20.0. RESULTS: Maximum denture wearers informed that they cleaned their dentures once a day, with brush and water, and had the habit of removing the dentures before sleeping at night. Almost 90% of the participants reported their denture status to be good or fair. Clinical examination revealed that slightly more than half of the participants had poor denture status. CONCLUSION: This study signifies the importance for improvement in patient oral health education and counseling with respect to the maintenance of dentures and upkeep of denture hygiene. It also emphasizes the need for educating patients on how to evaluate the status of their dentures.

Retailers' tobacco sales, profit margins, and promotional activities in slum areas of Bhubaneswar, India.

We conducted a cross-sectional study during January-June 2017 involving 70 tobacco retailers from 11 slums to learn about the tobacco retailers' practices of tobacco sales, their profit margins from these sales, and their promotional activities in slum areas of Bhubaneswar, India. Slum retailers were gaining a profit margin of ≥ 10% in selling 68% of cigarette brands and in all brands of bidi (smoked tobacco) and smokeless tobacco. Almost 50% of retailers were directly or indirectly advertising tobacco, and in 90% of retail shops, tobacco products were displayed in such a way that they could be seen from outside the shop. Nearly 25% of retailers were providing discounts; 33% were giving a gift or prize or free sample or coupon to customers on purchase of a tobacco product. Understanding retailers' concerns about tobacco sales, promotion, and strict enforcement of Indian "Cigarettes and Other Tobacco Products Act" regulations is critical for tobacco control in slums.

Patterns of geriatric anemia: A hospital-based observational study in North India.

BACKGROUND: Geriatric anemia is a global health problem because of its high prevalence and associated significant morbidity and mortality. AIM: The objectives of this study were to estimate the pattern of anemia in the elderly patients and the underlying etiology of anemia. RESEARCH DESIGN AND METHODS: This was a hospital-based prospective observational study, conducted in patients aged 60 years and above at PGIMER, Chandigarh, a tertiary care center of North India. Anemia is defined as hemoglobin level less than 13 g/dl in men and 12 g/dl in women. RESULTS: Among the 105 older patients with anemia, the mean value of hemoglobin was 8.8 ± 2.3 g/dl. The etiological distribution of anemia was iron deficiency in 26 patients (24.8%), chronic disease in 24 patients (22.9%), hematological disorders in 21 (20%), chronic kidney disease in 13 (12.4%), multifactorial in 8 (7.6%), vitamin B12 deficiency in 2 (1.9%), folate deficiency in 1 (0.9%), and hypothyroidism in 1 patient (0.9%). No etiology could be found in 9 patients (8.6%). 57.6% of the iron-deficient patients had upper gastrointestinal lesions and 30.7% had a nutritional cause. Common chronic diseases causing anemia were malignancy (36.6%) and liver disease (29.1%). The myelodysplastic syndrome was the commonest hematological disorder. 53.35% of the patients had normocytic anemia, 40% had microcytic anemia, and 6.6% had macrocytic anemia. CONCLUSIONS: In most of the cases, anemia in the elderly had a treatable cause. Thus, a thorough investigation including gastrointestinal endoscopy is warranted. Unexplained progressive or unresponsive anemia requires bone marrow examination.

Compliance with packaging and labelling rules for tobacco products marketed in slum areas of Bhubaneswar, India.

BACKGROUND: The Government of India has been issuing notifications regarding packaging and labelling rules for tobacco products since 2003 under the 'Cigarettes and Other Tobacco Products Act' (COTPA) guidelines. METHODS: The present cross-sectional study was carried out during November 2016 to March 2017 to assess the extent of compliance with the COTPA prescribed packaging and labelling rules for packages of tobacco products marketed in 11 slum areas of Bhubaneswar, India. From 81 retail outlets, 42 different brands of tobacco products were purchased which consisted of 23 in smoking form (17 brands of cigarette, 6 brands of bidi) and 19 in smokeless form (9 brands of gutkha, 4 brands of khaini and 6 brands of betel quid with tobacco). RESULTS: In most of the product packages, particularly in smokeless tobacco, the health warnings were not in compliance with the COTPA specifications. In a majority of the tobacco brands (69.0%), specified health warnings occupied less than the prescribed size of 85% of the principal display area of the package. Misleading descriptors and promotional messages were also present. CONCLUSION: The tobacco products marketed in Bhubaneswar slums were not in compliance with the packaging and labelling rules specified by COTPA. This underscores the need for strict implementation of COTPA guidelines and enforcement measures to assure full compliance.

Evaluation and Comparison between Formocresol and Sodium Hypochlorite as Pulpotomy Medicament: A Randomized Study.

INTRODUCTION: Pulpotomy is the most common treatment to preserve vitality of cariously exposed molars. Various pulpotomy medicaments used should be antimicrobial, should help in healing without damaging surrounding tissue, and should not affect eruption of permanent teeth. Thus, this study was conducted to evaluate and compare the clinical and radiographic outcomes of formocresol (FC) and sodium hypochlorite (NaOCl) in primary molars. The aim of this randomized study was to compare the clinical and radiographic success rate of FC and 5% NaOCl as a pulpotomy medicament in primary molars. MATERIALS AND METHODS: Forty children aged 4 to 9 years with primary carious molar were selected and randomly assigned into two groups: FC and NaOCl. Pulpotomy procedure was then performed followed by restoration with stainless steel crowns. Clinical and radiographic evaluation was done at an interval of 3 to 6 months. RESULTS: Clinical success rate at 3 and 6 months was 100% for both groups. Radiographic success rate for FC was 95% at 3 months and 90% at 6 months, whereas for NaOCl, it was 90% at 3 months and 85% at 6 months. CONCLUSION: Based on this study, result of 5% NaOCl and FC showed no significant difference in their success rate. Hence, NaOCl can be used as pulpotomy medicament; however, further clinical trials with long follow-up period are required. CLINICAL SIGNIFICANCE: Sodium hypochlorite is a potential clinical substitute of FC for vital pulpotomy treatment in primary teeth because of its exceptional biological compatibility and to evade carcinogenic effect of FC.

Development and characterization of morin hydrate loaded microemulsion for the management of Alzheimer's disease.

The aim of this study is to prepare and characterize intranasal delivery of morin hydrate loaded microemulsion for the management of Alzheimer's diseases. After intranasal delivery, brain and blood drug concentrations were found to be higher for optimized morin hydrate loaded microemulsion as compared to plain morin hydrate. Significant (P < 0.05) reduction in assessed pharmacodynamic parameters was observed after intranasal administration of morin hydrate loaded microemulsion as compared to sham control group. Daily chronic treatment with morin loaded microemulsion till the 21st day significantly increased the memory in wistar rats with STZ-induced dementia.

Effect of TENS on stimulation of saliva in postmenopausal women with or without oral dryness - An interventional study.

BACKGROUND: Decreased estrogen levels in postmenopausal women may cause an increase in oral symptoms including dry mouth, burning sensation of the mouth, and taste alterations. Management of salivary gland hypofunction by various modalities had been tried with variable results and associated side effects or discomfort. AIM: To evaluate the effects of transcutaneous electric nerve stimulation (TENS) on whole salivary flow rate in postmenopausal females with and without oral dryness. METHODS: Fifty postmenopausal women, based on their response to Xerostomia Inventory, were divided into 2 groups of 25 each; group 1 were postmenopausal women with oral dryness (PMD + OD) and group 2 were postmenopausal women without oral dryness (PMD - OD). Unstimulated whole saliva collection was done by low forced spitting method. External salivary stimulation of parotid gland by electrodes of TENS unit was done and sialometry was repeated. The salivary flow rates were compared within both groups before and after stimulation and between the two groups. RESULTS: The mean salivary flow rates at baseline were statistically significantly lower in the PMD + OD group than the PMD - OD group. There was a mean increase of 0.33 ml and 0.46 ml with TENS stimulation in PMD + OD and PMD - OD groups, respectively. CONCLUSION: Postmenopausal women with perception of oral dryness had lower salivary flow rates. 90% of the subjects, irrespective of oral dryness status, responded to TENS therapy. TENS stimulation resulted in a statistically significant increase in the quantity of whole saliva flow rate in postmenopausal women with or without oral dryness.