Community health volunteer for blood pressure control in rural people with stroke in India: Pilot randomised trial.

OBJECTIVE: To test the hypothesis that an Accredited social health activist (ASHA), a community health volunteer in a task-sharing model can help in sustained control of systolic blood pressure (BP) in rural people with Stroke and hypertension at 6 months follow up. METHODS: In this randomized trial two rural areas (Pakhowal and Sidhwan bet) with 70 and 94 villages respectively were screened for people with stroke and hypertension. They were assigned to either ASHA-assisted BP control in addition to standard-of-care (Pakhowal-intervention Group) or standard-of-care alone (Sidhwan bet- Control Group). Assessors blinded to intervention conducted the baseline and 6 months follow-up visits to measure risk factors in both the rural areas. RESULTS: A total of 140 people with stroke with mean age of 63.7 ± 11.5 years and 44.3% females were randomised. The baseline systolic BP was higher in the intervention group (n = 65,173.5 ± 22.9 mmHg) compared to the control group (n = 75,163 ± 18.7 mmHg, p = 0.004). The follow-up systolic BP was lower in the intervention group compared to the control group 145 ± 17.2 mmHg and 166.6 ± 25.7 mmHg respectively (p < 0.0001). According to the intention-to-treat analysis a total of 69.2% of patients in the intervention group achieved systolic BP control compared to 18.9% in the control group patients (OR 9, 95% CI 3.9-20.3; p < 0.0001). CONCLUSION: Task sharing with ASHA a community health volunteer can improve BP control in rural people with stroke and hypertension. They can also help in the adoption of healthy behaviour. CLINICAL TRIAL REGISTRATION NUMBER: ctri.nic.in, CTRI/2018/09/015709.

Radiological evaluation of lacrimal apparatus injury after functional endoscopic sinus surgery.

OBJECTIVE: To determine the incidence of nasolacrimal duct injury after functional endoscopic sinus surgery radiologically, using computed tomography. METHODS: Fifty patients of either sex who underwent functional endoscopic sinus surgery were evaluated for nasolacrimal duct injury by computed tomography. Computed tomography was conducted pre-operatively, and post-operatively at the end of four weeks, and nasolacrimal duct injury was analysed. RESULTS: The prevalence of nasolacrimal duct injury dehiscence was 1.16 per cent, with a similar incidence of 1.16 per cent for nasolacrimal duct injury post-operatively. However, no cases of symptomatic nasolacrimal duct injury were recorded. CONCLUSION: Computed tomography scan is an effective, non-invasive method to evaluate nasolacrimal duct injury following functional endoscopic sinus surgery, in accordance with evidence-based medicine.

A rare case of extra-nasopharyngeal angiofibroma of the septum in a female child.

BACKGROUND: Extra-nasopharyngeal angiofibroma is a rare but distinct clinical entity, different from juvenile angiofibroma. METHODS: This clinical record elucidates the only case of extra-nasopharyngeal angiofibroma arising from the septum in a female child, who presented with epistaxis. RESULTS: The histopathological diagnosis was confirmed by immunohistochemistry, and the case was managed surgically with no recurrence. CONCLUSION: In a female paediatric patient presenting with epistaxis, extra-nasopharyngeal angiofibroma (of the inferior turbinate) is a rare albeit important differential diagnosis, as it challenges the hormonal theory of angiofibroma aetiopathogenesis.

Role of circumferential subannular tympanoplasty in anterior and subtotal perforations.

OBJECTIVE: This study aimed to evaluate the surgical success of a modified inlay tympanoplasty technique, known as circumferential subannular tympanoplasty, for anterior and subtotal perforations. METHODS: This prospective study was performed in a tertiary care teaching hospital between October 2013 and April 2016. A total of 58 adult patients of both sexes with anterior or subtotal perforations underwent circumferential subannular tympanoplasty under local anaesthesia. In this technique, after tympanomeatal flap elevation, the temporalis fascia graft is placed directly onto the annulus instead of being tucked underneath the tympanic membrane remnant. Outcome data were graft uptake and hearing improvement. RESULTS: This technique had a surgical success rate of 97 per cent and led to significant hearing improvement. CONCLUSION: Circumferential subannular tympanoplasty has a definitive role in managing anterior and subtotal perforations.

Tympanoplasty: does dry or wet temporalis fascia graft matter?

OBJECTIVES: To evaluate the success rate of dry and wet temporalis fascia grafts in type I underlay tympanoplasty. METHODS: A prospective, randomised study was conducted. One hundred adult patients (males and females) with chronic suppurative otitis media (mucosal type) were divided into 2 groups of 50 each: one group underwent dry graft tympanoplasty and the other underwent wet graft tympanoplasty. Fibroblast count was calculated in dry and wet grafts. RESULTS: The dry graft and wet graft groups had overall surgical success rates of 82 and 90 per cent, respectively; this finding was not statistically significant. A statistically significant high fibroblast count was observed in wet grafts, but it did not correlate with surgical success. CONCLUSION: A dry or wet temporalis fascia graft does not influence the outcome of tympanoplasty type I.

Paediatric tympanoplasty: comparative study between patients aged 5-8 years and those aged over 14 years.

OBJECTIVE: To evaluate and analyse the success rate of tympanoplasty type I in paediatric patients aged 5 to 8 years compared to a control group (patients aged over 14 years). METHODS: In this prospective study, 60 patients (of either sex) with chronic suppurative otitis media inactive mucosal disease were divided into 2 groups (30 in each): group A comprised paediatric patients aged 5-8 years and group B consisted of older individuals aged over 14 years. All patients underwent tympanoplasty type I with an underlay technique using a temporalis fascia graft. RESULTS: Impressive surgical success rates of 87 and 90 per cent were recorded in groups A and B, respectively. Furthermore, audiological success rates of 69 and 78 per cent were achieved in groups A and B respectively. Statistical analysis of the data revealed that eustachian tube function had no impact on the outcome of tympanoplasty. CONCLUSION: Tympanoplasty type I performed in children aged five to eight years gives comparable results to those of older individuals.

Axillary hyperhidrosis: a 5-year review of treatment efficacy and recurrence rates using a new arthroscopic shaver technique.

BACKGROUND: Axillary hyperhidrosis is a chronic condition characterized by excess axillary perspiration. This results in considerable patient morbidity, with no consistently efficacious medical or surgical treatment method described in the literature. METHODS: All cases of axillary hyperhidrosis over a 5-year period were reviewed retrospectively. Data were gathered by a chart review and telephone interview. Inclusion criteria included primary hyperhidrosis, failed conservative therapy, no prior surgical therapy, surgical management using a new arthroscopic shaver technique (R.L.B.-S.), and 6 months of postoperative follow-up. The technique used was consistent between surgeons. Sweating severity was assessed using a subjective numerical rating scale ranging from 1 to 10. Patient demographics, symptom history, results, and complications were analyzed. RESULTS: Average follow-up for 50 patients meeting the inclusion criteria was 28 months. The subjective severity scale demonstrated severity of 9.8 of 10 preoperatively and 2.3 of 10 postoperatively. Three patients (6 percent) reported mild recurrence of symptoms (4.6 of 10), which was not severe enough to seek further treatment. The average follow-up of those patients was 18.5 months. An overall subjective satisfaction of 96 percent was found, with a treatment success rate of 94 percent. Complications were minimal and self-limiting. The average time away from employment was 3.9 days and the average surgical operating room time was 46 minutes. CONCLUSIONS: The authors' new arthroscopic shaver technique is efficacious, with no significant morbidity, a 96 percent satisfaction rate, a subjectively measured 75 percent reduction of sweat, and a recurrence rate of only 6 percent. For cases of primary hyperhidrosis affecting the axilla not amenable to conservative treatment, the authors recommend an arthroscopic shaver technique as the first-line treatment of choice.

Destructive aspergillosis.

The incidence of mycotic infections of paranasal sinuses is on the rise. Aspergillosis is the commonest fungal infection involving the nose and paranasal sinuses. This disease has a varied presentation ranging from the allergic form to the more deadly invasive or destructive form. Destructive fungal disease is almost regarded as synonymous with mucormycosis. The destructive potential of aspergillosis has not been highlighted in the medical literature. We here report a case of aspergillosis, which caused massive destruction of maxilla in an apparently healthy patient.

Orbital pneumatocele.

Air in the orbit is usually a result of trauma to the orbit but here we report a case of spontaneously occurring orbital Pneumatocele which followed about of sneezing and clearing of nose. The rare site communication at frontoethmoid junction is highlighted with relevant review of literature.

Desensitization of exposed root surfaces using a semilunar coronally positioned flap.

A definitive treatment is described for cervical dentinal sensitivity, featuring a semilunar coronally positioned flap to cover the denuded root surface. Many patients who complain of having sensitive teeth from exposed dentin secondary to gingival recession can be easily and conservatively treated with a semilunar flap procedure.

The prevalence of HIV in female sex workers in Manipur, India.

Data on STDs and sexual practices in commercial sex workers (CSWs) is in general limited in India. Manipur in north-east Indian has a high prevalence of HIV in injecting drug users but the rate in CSWs is not known. The site selected for the study was Moreh, on the Myanmar border of Manipur. One hundred blood samples were collected, 7 from migrants from Myanmar, the remainder from Manipuri women. The HIV seropositivity rate was 12% (95% CI = 5.6-18.4). The age of the women ranged from 15 to 42 (mean = 24.5 years, median 23.7 years). The proportion of HIV positives increased significantly with number of customers per day and number of years in the profession. The HIV prevalence among Injecting drug using CSWs was 9.4 times higher that among non-IDU CSWs. Vaginal discharge was strongly associated with HIV positivity. Effective intervention programmes among CSWs in Manipur to prevent further spread of HIV are strongly indicated by the results of this study.

Extended analysis of the region encompassing the PRM1-->PRM2-->TNP2 domain: genomic organization, evolution and gene identification.

The human male haploid expressed protamine 1 (PRM1)-->protamine 2 (PRM2)-->transition protein 2 (TNP2) locus comprises a coordinately regulated multigenic domain. This region of 16p13.13 has been used as a model to address how the organization of genes and genic domains within the human genome may influence tissue specific gene expression. Toward this goal, we have completed an extensive computational and biological analysis of the region encompassing the PRM1-->PRM2-->TNP2 domain. These analyses have revealed the likely genesis of this domain. Interestingly, the SOCS-1 gene and an hnRNPC-class pseudogene lies just 3' of this domain. Regions of nuclear matrix attachment also mark these newly identified genes.

MARs mission update.

Genes are organized as chromatin domains and positioned in the nucleus through regions of nuclear matrix association, termed MARs. Although well-studied, the mechanisms regulating expression of the beta-globin locus remain an enigma. Here, we show that certain MAR sequences of the beta-globin locus are conserved and reiterated throughout the genome in association with other genes of the hematopoietic lineage. Further, the density of the MARs within the beta-globin locus and the sharing of these sequences by the various members of this gene cluster suggest that they may provide critical gene regulatory components.

A matrix associated region localizes the human SOCS-1 gene to chromosome 16p13.13.

The MarFinder algorithm was applied to a newly sequenced segment of 16p13.13 abutting the 3' end of the human PRM1-->PRM2-->TNP2 locus. A candidate region of matrix attached was identified. Subsequent biophysical analysis showed that this region was attached to the somatic nuclear matrix. Nucleotide sequence analysis also revealed the presence of a CpG island. Data base queries showed that this region contained the SOCS-1 gene. Thus, the SOCS-1 gene is bounded by a somatic MAR and is just 3' of the spermatid-expressed PRM1-->PRM2-->TNP2 domain at position 16p13.13.

Mathematical model to predict regions of chromatin attachment to the nuclear matrix.

The potentiation and subsequent initiation of transcription are complex biological phenomena. The region of attachment of the chromatin fiber to the nuclear matrix, known as the matrix attachment region or scaffold attachment region (MAR or SAR), are thought to be requisite for the transcriptional regulation of the eukaryotic genome. As expressed sequences should be contained in these regions, it becomes significant to answer the following question: can these regions be identified from the primary sequence data alone and subsequently used as markers for expressed sequences? This paper represents an effort toward achieving this goal and describes a mathematical model for the detection of MARs. The location of matrix associated regions has been linked to a variety of sequence patterns. Consequently, a list of these patterns is compiled and represented as a set of decision rules using an AND-OR formulation. The DNA sequence was then searched for the presence of these patterns and a statistical significance was associated with the frequency of occurrence of the various patterns. Subsequently, a mathematical potential value,MAR-Potential, was assigned to a sequence region as the inverse proportion to the probability that the observed pattern population occurred at random. Such a MAR detection process was applied to the analysis of a variety of known MAR containing sequences. Regions of matrix association predicted by the software essentially correspond to those determined experimentally. The human T-cell receptor and the DNA sequence from the Drosophila bithorax region were also analyzed. This demonstrates the usefulness of the approach described as a means to direct experimental resources.

Effects of Boswellia serrata gum resin in patients with ulcerative colitis.

Ulcerative colitis is a chronic inflammatory disease of the colon where leukotrienes are suggested to play an important role for keeping inflammation active. Boswellic acids, the biologically active ingredients of the gum resin of Boswellia serrata (Sallai guggal), have been shown to be specific, nonredox and noncompetitive inhibitors of 5-lipoxygenase, the key enzyme of leukotriene biosynthesis. In patients suffering from ulcerative colitis grade II and III the effect of Boswellia serrata gum resin preparation (350 mg thrice daily for 6 weeks) on stool properties, histolopathology and scan microscopy of rectal biopsies, blood parameters including Hb, serum iron, calcium, phosphorus, proteins, total leukocytes and eosinophils was studied. Patients receiving sulfasalazine (1 g thrice daily) served as controls. All parameters tested improved after treatment with Boswellia serrata gum resin, the results being similar compared to controls: 82% out of treated patients went into remission; in case of sulfasalazine remission rate was 75%.

Computer-assisted search for sites of nuclear matrix attachment.

This communication describes a useful approach for assessing the significance of the occurrence of multiple motifs within defined segments of the genome. Regions of potential biological importance are identified using various sequence motifs, and then the results are displayed as their cumulative statistically weighted distribution. We illustrate the utility of this strategy to the search for known nuclear matrix-associated regions by its application to the human beta-globin and other loci.