Participatory asset mapping and photovoice interviews to scope cultural and community resources to reduce alcohol harm in Chitwan, Nepal

AIMS

To scope the breadth of existing cultural and community assets and how alcohol drinkers and community health workers perceived them in relation to reducing alcohol-related harm.

METHODS

The study was conducted in Chitwan, south-central Nepal, which has considerable alcohol problems. Participatory asset mapping was conducted using field notes, photography, and through engaging with communities to explore how community assets affect alcohol consumption. Semi-structured photovoice interviews were conducted with harmful/hazardous drinkers (AUDIT score 8 to 19) and community health workers. Purposive and snowball sampling were used to recruit participants. During interviews, participants used their photographs to reflect on how community assets influenced alcohol use. Thematic framework analysis was used to analyse the data.

RESULTS

We recruited 12 harmful/hazardous drinkers (3 females) and 6 health workers (2 females). The mean AUDIT score of the former was 12.17 (SD ±2.86). Thematic analysis of the photovoice interviews produced three themes: 'influences and impact of families and communities'; 'culture and spirituality'; and 'nature and the environment'. The community mapping produced five assets that promoted alcohol consumption: (1) availability; (2) advertising; (3) negative attitudes towards users; (4) festivals/gatherings; and (5) illiteracy/poverty. Six assets that discouraged consumption were: (1) legislation restricting use; (2) community organisations; (3) cultural/spiritual sites; (4) healthcare facilities; (5) family and communities; and (6) women's community groups. Those from certain ethnic groups consumed more alcohol, experienced more family discord, or felt stigmatised due to their drinking. Assets 'festivals/gatherings' and 'negative attitudes toward users' and the theme 'family and communities' concerned with relationships and community activities were perceived to both promote and reduce alcohol use.

CONCLUSIONS

This study provides new insight into a variety of cultural and community assets that promote and reduce alcohol use. The study identifies new possibilities to build on visual participatory and arts-based methods that have potential to be effectively implemented at scale.

Microplastics in environment: global concern, challenges, and controlling measures

Plastic pollution in various forms has emerged as the most severe environmental threat. Small plastic chunks, such as microplastics and nanoplastics derived from primary and secondary sources, are a major concern worldwide due to their adverse effects on the environment and public health. Several years have been spent developing robust spectroscopic techniques that should be considered top-notch; however, researchers are still trying to find efficient and straightforward methods for the analysis of microplastics but have yet to develop a viable solution. Because of the small size of these degraded plastics, they have been found in various species, from human brains to blood and digestive systems. Several pollution-controlling methods have been tested in recent years, and these methods are prominent and need to be developed. Bacterial degradation, sunlight-driven photocatalyst, fuels, and biodegradable plastics could be game-changers in future research on plastic pollution control. However, recent fledgling steps in controlling methods appear insufficient due to widespread contamination. As a result, proper regulation of environmental microplastics is a significant challenge, and the most equitable way to manage plastic pollution. Therefore, this paper discusses the current state of microplastics, some novel and well-known identification techniques, strategies for overcoming microplastic effects, and needed solutions to mitigate this planetary pollution. This review article, we believe, will fill a void in the field of plastic identification and pollution mitigation research.

Isolation and identification of aerobic bacteria and their antibiogram profile in catheter related bloodstream infection among the hemodialysis patient in a tertiary care hospital

Background: Catheter-related bloodstream infection (CRBSI) is quite evident in hemodialysis (HD) patients. The pattern of the isolates from the catheter tip as well as blood culture and their sensitivity against antibiotics varies and set a huge challenge for the physician for its management. Aims and Objectives: The present study was undertaken to isolate and identify, causative organism in CRBSI from the HD patient and to determine the antibiotic susceptibility profile of each isolate and determines the current trend. Materials and Methods: A total (n=101) patients admitted for HD in the nephrology unit of a tertiary care hospital with preexisting comorbidities such as diabetes and hypertension (HT) were recruited according to inclusion/exclusion criteria after obtaining written consent. Blood samples from peripheral blood vessel of suspected CRBSI patients were collected as well as the catheter tip was cut and collected in sterile test tube and transported to microbiology laboratory for isolation, identification, and antibiotic susceptibility test. Results: The HD catheter tip culture was found positive in 54 (53.46%) samples out of the total 101 samples. The distribution of catheter tip culture positive patients and their association with diabetes mellitus was highest at age group > 60 years with a p < 0.0001. The association between catheter tip culture positive and HT was also found significant with P<0.0001. After analysis of culture reports of HD catheter tip and peripheral blood, culture-positive reports were found in 15 (14.85%) patients as CRBSI. The distribution of CRBSI predominantly found in the age group of 41–50 years (33%) which was significant with P=0.004. The causative organisms for CRBSI were Gram negative under this study and multidrug resistant too. The only drug polymyxin B was 100% sensitive to Gram-negative organism whereas vancomycin and linezolid were 100% sensitive to Gram-positive organisms. Conclusion: Patients with kidney disease receiving HD with a central venous catheter experience high rates of bloodstream and catheter tip infection commonly in those suffering from diabetes, HT, and dyslipidemia. The causative organisms for CRBSI were mainly Gram negative with a concern over existence of multidrug resistance strain.

A Study on Evaluating the pattern of medicine use by patients undergoing dialysis in a tertiary care hospital of Eastern India

Background: Patients of end stage renal diseases on hemodialysis often suffer from multiple comorbidities leading to poly pharmacy which might lead to potential drug-drug interaction. Aims and Objectives: The aim of this study was to assess the pattern of medicines prescribed to patients undergoing dialysis in a tertiary care hospital. Materials and Methods: A cross-sectional observational study was conducted on patients admitted in dialysis unit to assess the pattern of drug use among them in a tertiary care hospital in eastern India from June to December 2019. With prior approval from the Institutional Ethics Committee the demographic details, biochemical and hematological parameters and details of medicine use were captured in a pre-designed, pre-validated form. The data were interpreted in mean, percentage, and diagrams using Microsoft Excel 2010. Results: Among the recruited patients (n=160), majority of them were homemakers (30.62%) and unemployed (30%), out of which 42.75% were male and 51.25% were female suffering from chronic kidney diseases (70.62%) and acute kidney injury (29.37%). The mean age of the study population was 46.7±16.35 years. The mean pre-dialyzed systolic and diastolic pressure (mm Hg) and pulse rate recorded was 140.56±21.94, 83.04± 13.29, and 81.97±5.51, respectively. Before hemodialysis, the mean hemoglobin level was 11.135±1.219 gm/dl, urea139.81±69.29 mg/dl, creatinine 6.48±3.77mg/dl, sodium 136.63±4.07mEq/L, and potassium 4.47± 1.00 mEq/L. Major comorbidities found associated with these patients were hypertension (68.75%), diabetes mellitus (52.5%), and hypothyroidism (11.87%). The commonly prescribed drugs were anti-hypertensive (73.8%), proton pump inhibitors mainly pantoprazole (68.1%), diuretic (86.2%), calcium supplements (74.3%), insulin (53.1%), and erythropoietin (49.3%). Average number of drugs administered per patient was 5.3±1.78. Conclusion: Patients in the dialysis unit are exposed to multiple drugs at a time due to their association with multiple comorbidities. Physician need to deal such patients very cautiously to avoid drug-drug interactions and adverse drug effects.

Comparison between esmolol and verapamil in attenuation of cardiovascular stress response to laryngoscopy and endotracheal intubation in elective surgery

Background: Cardiovascular stress due to reflex sympathetic over activity is a great concern during laryngoscopy and endotracheal intubation. Aims and Objectives: To compare the efficacy and safety of esmolol and verapamil for attenuation of hemodynamic effects (heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure) due to laryngoscopy and endotracheal intubation in elective surgical cases. Materials and Methods: A prospective, randomized, double blinded, controlled study was conducted on 60 patients divided equally into 30 each receiving esmolol (2 mg/kg body weight) and verapamil (0.1 mg/kg body weight) respectively. Heart rate, systolic and diastolic blood pressure and mean arterial pressure were recordedat pre-operative stage, after administration of the study drugs, immediately after intubation and at 1 ,3 ,5 minutes after intubation. Data collected were statistically analyzed. Results: The mean systolic blood pressure was lower in the esmolol group at all times of estimation compared with the verapamil group and the difference was at the time of intubation (p value <0.001).The mean diastolic blood pressure was lower in the esmolol group at all times of estimation compared to the verapamil group which was not statistically significant at any time of estimation. The mean arterial pressure was significantly lower at the time of immediately after intubation (p<0.001) in esmolol as compared to verapamil group. Adverse effects in both the study groups were insignificant. Conclusion: Esmololand Verapamil can effectively attenuate the cardiovascular stress to laryngoscopy and endotracheal intubation with the former appears to be a better alternative from efficacy and safety perspectives.

Surface acoustic wave assisted depinning of magnetic domain walls

We investigate the effects of high frequency strain on the depinning of magnetic domain walls in perpendicular anisotropy materials. Micron wide stripes of [Co(0.3 nm)/Pt(0.6 nm)]₅are patterned between a pair of identical inter-digital transducers that generate high frequency (114.8 MHz) standing surface acoustic waves. We use magneto-optical Kerr effect microscopy to characterize the thermally-assisted depinning of domain walls at defect sites within the strips. Our results show that the excitation of the domain walls with surface acoustic waves results in an increase in their depinning probabilities by approximately a factor of 10. Our data are consistent with a model in which the magnetoelastic anisotropies induced by the acoustic waves modulate the energy barriers that pin the domain walls. These results suggest an alternative route to domain wall depinning in thin films and nanostructures and are relevant to the development of racetrack memories, where domain wall pinning can result in reduced velocities and non-deterministic motion.

The Band-Gap Studies of Short-Period CdO/MgO Superlattices

Trends in the behavior of band gaps in short-period superlattices (SLs) composed of CdO and MgO layers were analyzed experimentally and theoretically for several thicknesses of CdO sublayers. The optical properties of the SLs were investigated by means of transmittance measurements at room temperature in the wavelength range 200-700 nm. The direct band gap of {CdO/MgO} SLs were tuned from 2.6 to 6 eV by varying the thickness of CdO from 1 to 12 monolayers while maintaining the same MgO layer thickness of 4 monolayers. Obtained values of direct and indirect band gaps are higher than those theoretically calculated by an ab initio method, but follow the same trend. X-ray measurements confirmed the presence of a rock salt structure in the SLs. Two oriented structures (111 and 100) grown on c- and r-oriented sapphire substrates were obtained. The measured lattice parameters increase with CdO layer thickness, and the experimental data are in agreement with the calculated results. This new kind of SL structure may be suitable for use in visible, UV and deep UV optoelectronics, especially because the energy gap can be precisely controlled over a wide range by modulating the sublayer thickness in the superlattices.

Neuroanatomy and behavior in mice with a haploinsufficiency of AT-rich interactive domain 1B (ARID1B) throughout development

BACKGROUND

One of the causal mechanisms underlying neurodevelopmental disorders (NDDs) is chromatin modification and the genes that regulate chromatin. AT-rich interactive domain 1B (ARID1B), a chromatin modifier, has been linked to autism spectrum disorder and to affect rare and inherited genetic variation in a broad set of NDDs.

METHODS

A novel preclinical mouse model of Arid1b deficiency was created and validated to characterize and define neuroanatomical, behavioral and transcriptional phenotypes. Neuroanatomy was assessed ex vivo in adult animals and in vivo longitudinally from birth to adulthood. Behavioral testing was also performed throughout development and tested all aspects of motor, learning, sociability, repetitive behaviors, seizure susceptibility, and general milestones delays.

RESULTS

We validated decreased Arid1b mRNA and protein in Arid1b+/- mice, with signatures of increased axonal and synaptic gene expression, decreased transcriptional regulator and RNA processing expression in adult Arid1b+/- cerebellum. During neonatal development, Arid1b+/- mice exhibited robust impairments in ultrasonic vocalizations (USVs) and metrics of developmental growth. In addition, a striking sex effect was observed neuroanatomically throughout development. Behaviorally, as adults, Arid1b+/- mice showed low motor skills in open field exploration and normal three-chambered approach. Arid1b+/- mice had learning and memory deficits in novel object recognition but not in visual discrimination and reversal touchscreen tasks. Social interactions in the male-female social dyad with USVs revealed social deficits on some but not all parameters. No repetitive behaviors were observed. Brains of adult Arid1b+/- mice had a smaller cerebellum and a larger hippocampus and corpus callosum. The corpus callosum increase seen here contrasts previous reports which highlight losses in corpus callosum volume in mice and humans.

LIMITATIONS

The behavior and neuroimaging analyses were done on separate cohorts of mice, which did not allow a direct correlation between the imaging and behavioral findings, and the transcriptomic analysis was exploratory, with no validation of altered expression beyond Arid1b.

CONCLUSIONS

This study represents a full validation and investigation of a novel model of Arid1b+/- haploinsufficiency throughout development and highlights the importance of examining both sexes throughout development in NDDs.

Plant growth-promoting endophytic bacteria augment growth and salinity tolerance in rice plants

Salt stress negatively affects growth and development of plants. However, it is hypothesized that plant growth-promoting endophytic bacteria can greatly alleviate the adverse effects of salinity and can promote growth and development of plants. In the present research, we aimed to isolate endophytic bacteria from halotolerant plants and evaluate their capacity for promoting crop plant growth. The bacterial endophytes were isolated from selected plants inhabiting sand dunes at Pohang beach, screened for plant growth-promoting traits and applied to rice seedlings under salt stress (NaCl; 150 mm). Out of 59 endophytic bacterial isolates, only six isolates, i.e. Curtobacterium oceanosedimentum SAK1, Curtobacterium luteum SAK2, Enterobacter ludwigii SAK5, Bacillus cereus SA1, Micrococcus yunnanensis SA2, Enterobacter tabaci SA3, resulted in a significant increase in the growth of Waito-C rice. The cultural filtrates of bacterial endophytes were tested for phytohormones, including indole-3-acetic acid, gibberellins and organic acids. Inoculation of the selected strains considerably reduced the amount of endogenous ABA in rice plants under NaCl stress, however, they increased GSH and sugar content. Similarly, these strains augmented the expression of flavin monooxygenase (OsYUCCA1) and auxin efflux carrier (OsPIN1) genes under salt stress. In conclusion, the pragmatic application of the above selected bacterial strains alleviated the adverse effects of NaCl stress and enhanced rice growth attributes by producing various phytohormones.

Effect of Yarcha Gumba (O sinensis) on Male Reproductive System in Rat

The present study was undertaken to assess the aphrodisiac effect of O sinensis. It was a pre-clinical experimental case-control study performed in the Department of Pharmacology, RG Kar Medical College, Kolkata, India; from February 2019 to March 2019 using Wister rat model. One group of rats was given the test drug suspension (10mg/kg body weight) and the control group animals received the same volume of vehicle devoid of drug orally for 10 days. Sexual behaviour of individual rats was studied on 9th day of treatment with oestrogenized female Wister rats. On 10th day of treatment the animals were sacrificed by decapitation. After collection of blood sera from each animal; serum LH, FSH, testosterone and nitric oxide were assessed. Histological assessment of testes was done. Improved sexual behaviour, hypertrophy of Leydig cells, significant increase in serum LH (1.248 vs. 1.448mIU/ml), FSH (0.324 vs. 0.413mIU/ml) testosterone (3.120 vs. 4.498ng/ml) and nitric oxide (0.01757 vs. 0.02690nM/ml) were noted. Elevated NO titre in animals treated with O sinensis extract might be the cause of good erection capacity and increased libido in them. Nevertheless, result of the present study points that the active principle of O sinensis also acts on LHRH receptors present in pituitary gonadotrophs evidenced by significant increase in serum LH and FSH and indicating great aphrodisiac property.

Antibacterial activities of the extracts, fractions and isolated compounds from Canarium patentinervium Miq. against bacterial clinical isolates

Background

Canarium patentinervium leaves are used by the local indigenous people of Malaysia for wound healing. The current study is undertaken to screen the comprehensive antibacterial activity of the leaves and barks extracts, fractions and isolated compounds from this plant. Bioassay guided fractionation was also undertaken to deeply evaluate the antibacterial activity of the water fraction of the leaves extract. This is to provide preliminary scientific evidence to the ethnopharmacology usage of this plant by investigating antibacterial properties of the plant and its isolated constituents.

Methods

Bio-assay guided fractionation and subsequent isolation of compounds using open column chromatography. The antibacterial activity against gram positive and gram negative ATCC strain and resistant clinical strains were evaluated using microtiter broth dilution method to determine minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and time-kill assay. The chemical structure of the isolated compounds from the water fraction of the ethanol extract of leaves was elucidated using Nuclear Magnetic Resonance (NMR).

Results

The ethanol extract of the leaves and barks showed antimicrobial activity against all four ATCC and eight clinical isolates. The ethanol extract of the leaves and the corresponding water fraction had good activity against MRSA S. aureus. (MIC: 250 μg/ml) and had bactericidal effect on eight of the clinical strains (MSSA,MRSA, oxacillin-resistant CONS, oxacillin-sensitive CONS, Enterococcus faecalis, Klebsiela species, Kleb pneumoniae ESBL and Candida parapsilosis). Further phytochemical investigation of the water fraction of the crude ethanol extract of leaves afforded compound 7 (hyperin) and compound 8 (cynaroside) that had bactericidal activity against tested bacterial species (MIC 50 μg/ml and 100 μg/ml). The two compounds were isolated from this genus for the first time.

Conclusions

These results may provide a rational support for the traditional use of Canarium patentinervium Miq. in infections and wound healing, since the antimicrobial compounds isolated were also present in the leaves extract.

Translational outcomes in a full gene deletion of ubiquitin protein ligase E3A rat model of Angelman syndrome

Angelman syndrome (AS) is a rare neurodevelopmental disorder characterized by developmental delay, impaired communication, motor deficits and ataxia, intellectual disabilities, microcephaly, and seizures. The genetic cause of AS is the loss of expression of UBE3A (ubiquitin protein ligase E6-AP) in the brain, typically due to a deletion of the maternal 15q11-q13 region. Previous studies have been performed using a mouse model with a deletion of a single exon of Ube3a. Since three splice variants of Ube3a exist, this has led to a lack of consistent reports and the theory that perhaps not all mouse studies were assessing the effects of an absence of all functional UBE3A. Herein, we report the generation and functional characterization of a novel model of Angelman syndrome by deleting the entire Ube3a gene in the rat. We validated that this resulted in the first comprehensive gene deletion rodent model. Ultrasonic vocalizations from newborn Ube3am-/p+ were reduced in the maternal inherited deletion group with no observable change in the Ube3am+/p- paternal transmission cohort. We also discovered Ube3am-/p+ exhibited delayed reflex development, motor deficits in rearing and fine motor skills, aberrant social communication, and impaired touchscreen learning and memory in young adults. These behavioral deficits were large in effect size and easily apparent in the larger rodent species. Low social communication was detected using a playback task that is unique to rats. Structural imaging illustrated decreased brain volume in Ube3am-/p+ and a variety of intriguing neuroanatomical phenotypes while Ube3am+/p- did not exhibit altered neuroanatomy. Our report identifies, for the first time, unique AS relevant functional phenotypes and anatomical markers as preclinical outcomes to test various strategies for gene and molecular therapies in AS.

Diagnostic diversities of Clear Fluid encountered during Fine needle aspiration cytology with an analysis of various variables

Background: Incidental finding of clear fluid during fine needle aspiration (FNA) is not rare in day to day practice of cytology. Though clear in appearance, cells obtained from it may yield a diverse diagnosis ranging from an inconclusive opinion to a malignant lesion. So, clear fluid is not non-significant always; lack of proper processing and examination may prove fatal to a patient. Aim: To evaluate the diverse diagnosis of clear fluid. Materials and methods: During a period of three years, hundred and seven cases which yielded clear fluid during FNAC from different parts of the body were studied. Direct and indirect smears (wherever applicable) was prepared, stained and examined microscopically. Results: Of these 107 cases of clear fluid, Male: Female ratio was 1: 1.6. Maximum cases - 55 (51.40%) was found in the age group 21 to 40 years. Trunk held the most number of lesions - 54 cases (50.46%). FNA results were interpreted as inconclusive in 19 cases (17.76%), benign in 84 cases (78.50%), suspicious in 01 case (0.93%) and malignant in 03 cases (2.80%). Epidermal cyst was the most common benign lesion - 16 cases (14.95%). Malignant lesions found were papillary carcinoma of thyroid, carcinoma of breast and metastatic squamous cell carcinoma – one case each. Conclusion: Our study emphasizes on the importance of proper examination of clear fluid as it may prove helpful in an undiagnosed case of malignancy and it may also improvise the learning of young pathologists. Bangladesh Journal of Medical Science Vol.18(4) 2019 p.753-755

Effectiveness of daily rinsing of alfalfa sprouts with aqueous chlorine dioxide and ozonated water on the growth of Listeria monocytogenes during sprouting

Alfalfa sprouts have been implicated in multiple foodborne disease outbreaks. This study evaluated the growth of Listeria monocytogenes during sprouting of alfalfa seeds and the effectiveness of daily chlorine dioxide & ozone rinsing in controlling the growth. Alfalfa seeds inoculated with L. monocytogenes were sprouted for 5 days (25°C) with a daily aqueous ClO₂ (3 ppm, 10 min) or ozone water (2 ppm, 5 min) rinse. Neither treatment significantly reduced the growth of L. monocytogenes on sprouting alfalfa seeds. The initial level of L. monocytogenes was 3·44 ± 0·27, which increased to c. 7·0 log CFU per g following 3 days of sprouting. There was no significant difference in the bacterial population between the treatment schemes. Bacterial distribution in roots (7·63 ± 0·511 log CFU per g), stems (7·51 ± 0·511 log CFU per g) and leaves (7·41 ± 0·511 log CFU per g) were similar after 5 days. Spent sanitizers had significantly lower levels of bacterial populations compared to the spent distilled water control. The results indicated that sprouting process provides a favourable condition for the growth of L. monocytogenes and the sanitizer treatment alone may not be able to reduce food safety risks. SIGNIFICANCE AND IMPACT OF THE STUDY: Sprouts are high-risk foods. Consumption of raw sprouts is frequently associated with foodborne disease outbreaks. Optimum sprouting procedure involves soaking seeds in water followed by daily water rinsing to maintain a moist environment that is also favourable for the growth of pathogenic micro-organisms. The present study emphasized the potential food safety risks during sprouting and the effect of applying daily sanitizer rinsing in the place of water rinsing to reduce those risks. The finding of this study may be useful in the development of pre-harvest and post-harvest risk management strategies.

Neutrophil-lymphocyte Ratio and C-reactive Protein Level in Patients with Major Depressive Disorder Before and After Pharmacotherapy

BACKGROUND

Neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) level are useful biomarkers of inflammation. This study aimed to assess NLR and CRP level in patients with major depressive disorder before and after pharmacotherapy to determine whether NLR or CRP could be used as biomarkers of severity of major depression and whether there was any sex difference.

METHODOLOGY

Patients with major depression who received no pharmacotherapy 1 month prior to the study were included. Their haemoglobin, total white blood cell count, neutrophil and lymphocyte counts, NLR, and CRP levels were evaluated at baseline and 12 weeks post pharmacotherapy, as were the Montgomery Asberg Rating Scale for Depression, the Scale for Impact of Suicidality Management and Assessment and Planning of Care (SIS-MAP), and the Clinical Global Impression Scale - Severity.

RESULTS

24 male and 26 female patients were included. At 12 weeks after pharmacotherapy, males had a higher haemoglobin level (p = 0.025), higher total white blood cell count (p = 0.018), and lower percentage of neutrophils (p = 0.019) than females. There was no sex difference in NLR or CRP. From baseline to 12 weeks, males had no significant change in any blood parameter, but females had a significantly greater increase in the percentage of neutrophils (p = 0.0001) and decrease in the percentage of lymphocytes (p = 0.012), resulting in a significantly increased NLR (p = 0.001). Both males and females had significant improvement on all 3 scales (p < 0.001). At 12 weeks, in males, the increase in NLR positively correlated with CRP as well as the Montgomery-Asberg Depression Rating Scale and the SIS-MAP, but not the Clinical Global Impression-Severity Scale. In females, the increase in NLR did not correlate with CRP or any of the scales.

CONCLUSION

In female patients, the NLR increased in response to antidepressant therapy while CRP remained unchanged. This indicated that inflammation has a role in the pathogenesis of major depression.

Impact of regulatory spin of pioglitazone on prescription of antidiabetic drugs among physicians in India: A multicentre questionnaire-based observational study

Background & objectives:

Pioglitazone was suspended for manufacture and sale by the Indian drug regulator in June 2013 due to its association with urinary bladder carcinoma, which was revoked within a short period (July 2013). The present questionnaire-based nationwide study was conducted to assess its impact on prescribing behaviour of physicians in India.

Methods:

Between December 2013 and March 2014, a validated questionnaire was administered to physicians practicing diabetes across 25 centres in India. Seven hundred and forty questionnaires fulfilling the minimum quality criteria were included in the final analysis.

Results:

Four hundred and sixteen (56.2%) physicians prescribed pioglitazone. Of these, 281 used it in less than the recommended dose of 15 mg/day. Most physicians (94.3%) were aware of recent regulatory events. However, only 333 (44.8%) changed their prescribing pattern. Seventeen of the 416 (4.1%) physicians who prescribed pioglitazone admitted having come across at least one type 2 diabetes mellitus patient (T2DM) who had urinary bladder carcinoma, and of these 13 said that it was in patients who took pioglitazone for a duration of more than two years. Only 7.8 per cent of physicians (n=58) categorically advocated banning pioglitazone, and the rest opined for its continuation or generating more evidence before decision could be taken regarding its use in T2DM.

Interpretation & conclusions:

Majority of the physicians though were aware of the regulatory changes with regard to pioglitazone, but their prescribing patterns were not changed for this drug. However, it was being used at lower than the recommended dose. There is a need for generating more evidence through improved pharmacovigilance activities and large-scale population-based prospective studies regarding the safety issues of pioglitazone, so as to make effectual risk-benefit analysis for its continual use in T2DM.

Polypharmacy and comorbidity status in the treatment of type 2 diabetic patients attending a tertiary care hospital: An observational and questionnaire-based study

Purpose/Aim:

Diabetes mellitus is associated with several comorbid conditions. Thus, often, diabetic patients are prescribed multiple drugs. Although multiple drugs help to combat various diseases, they also increase the propensity of drug interactions and adverse drug reactions. The present study thus tried to evaluate the comorbid conditions and concurrent medications associated with type 2 diabetic patients. It also aimed to address patient compliance for the medications provided to them.

Materials and Methods:

This was a cross-sectional observational study conducted for 2 months – January–February 2017. Data were collected from prescriptions of the patients and also by interviewing the willing patients, attending the Diabetic Clinic of R. G. Kar Medical College, Kolkata, India.

Results:

During the study period, 150 patients were interviewed and their prescriptions were studied. Out of 150 patients, 69 (46%) were males and 81 (54%) were females. The mean age of the study population was 51.5 (±0.78) years. The present study evaluated that 83.3% (125) of the study population suffered from at least one comorbid conditions, the most common being hyperlipidemia (70.7%) and hypertension (47.3%). The average number of drugs prescribed is 4.72 (±0.11) per prescription. Metformin was prescribed to 96% of the patients. The concurrent medications recommended included hypolipidemics (72%), antihypertensives (68%), drugs for peptic ulcer (34.7%), and antiplatelets (10.7%).

Conclusion:

The present study thus concluded that diabetic patients suffer from a number of comorbid conditions, most commonly, cardiovascular problems. The comorbidity increased with the age. The level of polypharmacy was also high, thereby increasing the pill burden for the patients.

Invasion of alien plant species and their impact on different ecosystems of Panchase Area, Nepal

The aggressiveness of invasive alien plant species has been amidst the changing climate, which has necessitated further research in this area. The impact of invasive alien plant species in the Panchase area of Nepal was assessed through the forest resource assessment and other methodologies such as, household survey, group discussion, direct field observation, participatory cluster mapping, quadrat sampling, laboratory analysis, and GIS mapping. A total of nine major invasive species, in which Ageratum houstonianum and Ageratina adenophora were found spread throughout the ecosystem. The invasion was fueled by anthropogenic disturbances such as leaving the agricultural lands, fallow and degradation of habitat. As a consequence, native species such as Artemisia indica and Urtica dioica were outcompeted mostly in the fringes of fallow lands, agricultural lands and in the disturbed sites. The intrusion was, however, less in the forest area, implying that community-managed dense canopy forests are less susceptible to invasion and routine management can offset the negative effects of invasion. Even though many negative consequences of the invasion were observed in the study sites, the possibility of the economically exploiting the biomass of invasive alien plant species for generating income locally was noticed.Banko Janakari, Vol. 27, No. 1, page: 31-42

Oleanolic acid from antifilarial triterpene saponins of Dipterocarpus zeylanicus induces oxidative stress and apoptosis in filarial parasite Setaria digitata in vitro

Absence of a drug that kills adult filarial parasites remains the major challenge in eliminating human lymphatic filariasis (LF); the second leading cause of long-term and permanent disability. Thus, the discovery of novel antifilarial natural products with potent adulticidal activity is an urgent need. In the present study, methanol extracts of leaves, bark and winged seeds of Dipterocarpus zeylanicus (Dipterocarpaceae) were investigated for macro and microfilaricidal activity. Two antifilarial triterpene saponins were isolated from winged seed extracts by bioactivity guided chromatographic separation and identified using Nuclear Magnetic Resonance and mass spectroscopic analysis as oleanolic acid 3-O-β-D- glucopyranoside (1) (IC50 = 20.54 μM for adult worms, 19.71 μM for microfilariae ) and oleanolic acid 3-O-α-L-arabinopyranoside (2) (IC50 = 29.02 μM for adult worms, 25.99 μM for microfilariae). Acid hydrolysis of both compounds yielded oleanolic acid (3) which was non or least toxic to human peripheral blood mono nuclear cells (Selectivity index = >10) while retaining similar macrofilaricidal (IC50 = 38.4 μM) and microfilaricidal (IC50 = 35.6 μM) activities. In adult female worms treated with 50 and 100 μM doses of oleanolic acid, condensation of nuclear DNA, apoptotic body formation and tissue damage was observed by using Hoechst 33342 staining, TUNEL assay and Hematoxylin and Eosin staining respectively. A dose dependent increase in caspase 3/CED3 activity and decrease in total protein content were also observed in these parasites. A dose dependant DNA fragmentation was observed in adult parasites and microfilariae. Decreased levels of reduced glutathione (GSH) and elevated levels of glutathione S transferase (GST), superoxide dismutase (SOD) and reactive oxygen species (ROS) were also observed in parasites treated with oleanolic acid indicating an oxidative stress mediated apoptotic event. Compound 3/oleanolic acid was thus identified as a potent and safe antifilarial compound in vitro.

A Study on Association between Common Haematological Parameters and Disease Activity in Rheumatoid Arthritis

INTRODUCTION

Rheumatoid Arthritis (RA) is a chronic systemic inflammatory disease where assessment of disease activity is essential for management of patient. Currently, many composite scoring systems are used for evaluation of disease activity but they are mainly clinical-based. As several haematological parameters are altered due to systemic inflammatory process in RA, this study was intended to evaluate role of common haematological parameters to assess disease activity in RA.

AIM

To find out the association of disease activity of Rheumatoid Arthritis (RA) with platelet count, Mean Platelet Volume (MPV) and Haemoglobin (Hb) level so that these cost-effective haematological parameters can be used as additional factors to assess disease activity.

MATERIALS AND METHODS

This hospital based cross-sectional study was done on newly diagnosed patients of RA along with age and sex matched healthy control population. Patients suffering from malignancies, renal failure, diabetes mellitus or RA patients on drug therapy were excluded. Clinically, disease activity of RA was measured using DAS 28-3 Score (Modified Disease Activity Score using three variables- tender joint count, swollen joint count and ESR). Haematological parameters were measured by automated cell counter.

RESULTS

Total 80 cases were selected (60 female and 20 male). 48 patients with high disease activity (DAS 28-3>5.1) were labelled as Group-A and 32 with low to moderate disease activity (DAS 28-3 ≤5.1) as Group- B. Mean platelet count of patients of group A and group B were 4.53 lac/cmm and 2.17 lac/cmm respectively (p <0.001). MPV mean in group A and B were 11.86 fl and 10.19 fl respectively (p <0.001). Mean Hb (g/dl) was 10.05 and 12.25 for group A and B respectively (p=0.001) for male patients while in females it was 10.12 and 11.91 for group A and B, respectively (p=0.003). Mean platelet count and MPV in control population were 2.07 lac/cmm and 9.4 fl, respectively while mean Hb (g/dl) was 13.31 (male) and 12.01 (female).

CONCLUSION

In our study it was observed that Hb is significantly lower in patients with high disease activity whereas platelet count and MPV are significantly higher with high disease activity compared to patients with low to moderate disease activity.

The Epidemiology of Chronic Venous Diseases

Objective:

To review the prevalence of and risk factors for varicose veins, chronic venous insufficiency (CVI) and venous leg ulcers.

Data sources:

MEDLINE was searched for the terms prevalence and varicose veins, chronic venous insufficiency, or venous leg ulcers.

Study selection:

The extant world literature (1966–1999) with a minimum of an available English abstract was collected. Ninety-nine studies were reviewed.

Data extraction:

Data were extracted on prevalence of diseases of the veins in the lower limb, age and gender of the subject populations, and other risk factors for those diseases examined by the original researchers.

Data synthesis:

The two most prominent risk factors for venous disease are increasing age and female gender. Additional risk factors for venous disease with at least some documentation in the literature include dietary patterns, obesity, physical activity, standing occupations, constrictive clothing, connective tissue laxity, and hormonal differences, including pregnancy. Family history is also a prominent risk factor, suggesting a genetic component.

Conclusions:

Varicose veins are found more commonly in women, and with increased age. The increase with age is linear, suggesting a constant incidence and cumulative prevalence. CVI is also more common in women and increases with age, but data are limited. Venous leg ulcers are much less common than varicose veins or CVI and show less of a female preponderance, but increase exponentially with age, suggesting a true increasing incidence with age.

Perception, awareness and practice of research-oriented medical education among undergraduate students of a medical college in Kolkata, West Bengal

BACKGROUND

The addition of research-oriented medical education (ROME) to the existing curriculum could promote logical thinking, rapid literature search and a better understanding of research methodology. Creation of research temperament could lead to innovations in healthcare. We assessed the perception, awareness and practice of ROME among undergraduate students.

METHODS

We conducted a cross-sectional survey among 234 students of R.G. Kar Medical College, Kolkata selected by the simple random sampling technique. Data were collected using a pre-designed, pre-tested, validated questionnaire by direct interviews.

RESULTS

The mean (SD) perception score was 44.2 (5.03). Students from outside West Bengal (p=0.05), women (p=0.03) and students whose parents were doctors (p=0.01) had significantly higher scores. Students in the second and fourth semesters had a better perception than those in the sixth and eighth semesters. Awareness of research fellowships granted to undergraduate students such as the Indian Council of Medical Research-Short-term studentship (ICMR-STS) was low among the second semester students (13.9%), but more than half (59.3%) of the students in the eighth semester were aware (difference across semesters, p<0.001). Awareness about journals, conferences and 'research bodies promoting student research' was low. Students in the senior semesters spent more time on research (6th semester 72.2% and 8th semester 88.9%) than those in the junior semesters (2nd: 66.7% and 4th: 77.8%; difference across semesters, p=0.03). About 3% of students participated in extracurricular research and/or had presented work at a conference.

CONCLUSION

There is a good perception about the need for research but a lack of awareness of the why and how, as well as hardly any practice of ROME among medical students of this medical college.

Ayurpharmacoepidemiology en Route to Safeguarding Safety and Efficacy of Ayurvedic Drugs in Global Outlook

Ayurpharmacoepidemiology is a new field developed by synergy of the fields of clinical pharmacology, epidemiology, and ayurveda. It will use the effects of ayurvedic medicinal products on large populations to describe and analyze the practices, evaluate the safety and efficacy, and carry out medicoeconomic evaluations. Good pharmacoepidemiology practices in ayurveda is projected to assist with issues of ayurpharmacoepidemiologic research. The embraced good pharmacoepidemiology practices guideline in this viewpoint will be able to provide valuable evidence about the health effects of ayurvedic herbs/drugs and consider different fields like pharmacovigilance, pharmacoeconomics, and drug discovery with ayurvedic reverse pharmacology approach, also pass out significant data for further basic sciences study in ayurveda biology, ayurgenomics, ayurnutrigenomics, and systems biology. Several unanswered questions about ayurvedic drug use and informed interventions or policies that can be addressed by informatics database, which will eventually demonstrate the credibility and rationality of ayurceuticals in the future.

Antidiabetic and antioxidant activity of Rhizophora mucronata leaves (Indian sundarban mangrove): An in vitro and in vivo study

Background:

Rhizophora mucronata is a salt-tolerant true mangrove which is widely distributed in Indian mangrove forest and traditionally used to treat diabetes and other health ailments.

Aim:

The aim of this study is to elucidate the role of Indian variety of R. mucronata leaves on glucose impairing metabolism during diabetes by in vitro and in vivo methods.

Materials and Methods:

The ethanolic fraction of R. mucronata leaves extract (RHE) was assessed for DPPH (1,1-diphenyl-2-picrylhydrazyl) radical scavenging and in vitro anti-diabetic action through α-amylase and α-glucosidase activity assessment. Oral glucose tolerance test (OGTT) and insulin sensitivity test (IST) were assessed and their counteraction with RHE (100 and 200 mg/kg, p.o) and glibenclamide (10 mg/kg, p.o) in streptozotocin (STZ) (50 mg/kg, intravenous) induced hyperglycemic rats were also monitored for 28 days. The data were analyzed statistically using t-test.

Results:

RHE dose-dependently inhibited α-amylase and α-glucosidase enzymes and lowered the area under the curve (AUC) for glucose on both OGTT and IST. RHE also significantly (p < 0.01) controlled glycemic index and thereby reducing diabetic complications as assessed by lipid profiles, atherogenic index, and coronary index in STZ rats.

Conclusion:

RHE at doses of 100 and 200 mg/kg/day for 28 days provided a significant decrease in diabetes complications and metabolic impairment.

A questionnaire-based survey to ascertain the views of clinicians regarding rational use of antibiotics in teaching hospitals of Kolkata

Objectives:

The objective was to assess the views of clinicians in teaching hospitals of Kolkata regarding the use of antibiotics in their own hospitals, focusing on perceived misuse, reasons behind such misuse and feasible remedial measures.

Materials and Methods:

A total of 200 clinicians from core clinical disciplines was approached in six teaching hospitals of Kolkata through purposive sampling. A structured, validated questionnaire adopted from published studies and modified to suit the responding population was completed by consenting respondents through face-to-face interaction with a single interviewer. Respondents were free to leave out questions they did not wish to answer.

Results:

Among 130 participating clinicians (65% of approached), all felt that antibiotic misuse occurs in various hospital settings; 72 (55.4% of the respondents) felt it was a frequent occurrence and needed major rectification. Cough and cold (78.5%), fever (65.4%), and diarrhea (62.3%) were perceived to be the commonest conditions of antibiotic misuse. About half (50.76%) felt that oral preparations were more misused compared to injectable or topical ones. Among oral antibiotics, co-amoxiclav (66.9%) and cefpodoxime (63.07%) whereas among parenteral ones, ceftriaxone and other third generation cephalosporins (74.6%) followed by piperacillin-tazobactam (61.5%) were selected as the most misused ones. Deficient training in rational use of medicines (70.7%) and absence of institutional antibiotic policy (67.7%) were listed as the two most important predisposing factors. Training of medical students and interns in rational antibiotic use (78.5%), implementation of antibiotic policy (76.9%), improvement in microbiology support (70.7%), and regular surveillance on this issue (64.6%) were cited as the principal remedial measures.

Conclusions:

Clinicians acknowledge that the misuse of antibiotics is an important problem in their hospitals. A system of clinical audit of antibiotic usage, improved microbiology support and implementation of antibiotic policy can help to promote rational use of antimicrobial agents.

Detection of arecoline by simple high-performance thin-layer chromatographic method in Indian nontobacco pan masala

Chewing the habit of blended pan masala containing areca nut with or without tobacco is a common practice in the Indian subcontinent. Arecoline, a pyridine alkaloid presence in areca nut alarmed for oral carcinogenesis and strictly prohibited in the western world. However, in India using blended pan masala is very popular among young and old individuals. In this context, we aimed to detect arecoline in Indian blended nontobacco pan masala sold in Kolkata using a simple densitometric high-performance thin-layer chromatographic (HPTLC) method and for alarming their use in common people. Eleven popularly Indian blended nontobacco pan masala were collected from the territory of Kolkata and isolated arecoline, following solvent extraction method derived for pyridine alkaloid. The quantitative analysis of arecoline was measured using automated software-based HPTLC instruments and validated the method according to International Conference on Harmonization guidelines. Arecoline was detected in all 11 blended nontobacco pan masala samples in a range of minimum 130 to maximum 415 μg/g dry samples. Arecoline is hazardous carcinogenic compound, so the use of Indian blended nontobacco pan masala should be restricted. Further, the method was found suitable for routine quantitative analysis of arecoline in areca nut containing substances.

Acute Pulmonary Embolism after Cesarean Section

Pregnancy is a well-known state of hypercoagubality, increasing the risk of venous thromboembolism (VTE). It is more common with cesarean delivery than vaginal delivery. Pulmonary Embolism (PE) is under diagnosed during pregnancy and postpartum period as majority of signs and symptoms of PE are non-specific. We describe a case of 35-yearold obese female who suffered a syncopal attack following caesarean delivery and was diagnosed to have pulmonary embolism. A high index of suspicion is required for the timely diagnosis and treatment of PE as most of the signs and symptoms of PE are nonspecific. It is important to consider VTE prophylaxis especially in patients with risk factors.

Ayurveda in changing scenario of diabetes management for developing safe and effective treatment choices for the future

Ayurveda described diabetes mellitus (DM) as Madhumeha. This ancient evidence-based system of medicine enumerated various herbs and formulations for its management, which needs scientific validation. Whereas translational "bedside to bench" approach in biomedical research is an upcoming concept, its application in traditional and complementary medicine can be interesting. The intersecting concepts in the field Ayurveda and translational research needs "omics" approach. The Ayurvedic biology concepts about DM have its close relations with present systems biology approach. Metabolic changes causing tissue damage connected with genetic and immunological irregularities leading to insulin resistance coincide with ancient knowledge. Combinatorial therapy according to Prakriti type as elucidated by Ayurgenomics should be carried on for further research. "Bedside to bench" approaches in research utilizing metabolomics and pharmacogenomics approach can be a major step towards changing the therapeutic strategy towards diabetes. Prameha which is described as the pre-diabetic state is a novel concept in Ayurvedic etiopathogenesis, while metabolomic parameters like lipid level in urine can be a thrust area of research to have a pre-diabetic screening method in high-risk populations. This tradition-guided research paradigm can open up novel opportunities in traditional knowledge-inspired systems biology and drug discovery against diabetes.

Quality of life and treatment satisfaction observed among Indians with diabetes foot ulcers undergoing ayurvedic adjunct therapy

The purpose of the study was to assess the health-related quality of life and treatment satisfaction of diabetes patients (n = 36) with foot ulcers undergoing insulin and ayurvedic adjunct therapy. Retrospective hospital based cross-sectional design considered patients with diabetes foot ulcers undergoing 4-week treatment with insulin and ayurvedic combinatorial therapy. The Audit of Diabetes Dependent Quality of Life Questionnaire and Diabetes Treatment Satisfaction Questionnaire were completed for the assessment. The mean duration of diabetes among participants was 9.32 ± 5.3 years. Assessment of Diabetes Treatment Satisfaction Questionnaire (total treatment satisfaction) score was found to be 26.0139 ± 5.20369, and Audit of Diabetes Dependent Quality of Life Questionnaire (average weighted impact) score was -3.0819 ± 1.83003. Relationship with diabetes complications showed that Audit of Diabetes Dependent Quality of Life Questionnaire score (P = .383) had no relationship, but Diabetes Treatment Satisfaction Questionnaire score (P = .039) showed significance. Integrated approaches for diabetes foot ulcer management with insulin and ayurvedic management have a favorable impact on patient-perceived quality of life.

Study of Proper use of Inhalational Devices by Bronchial Asthma or COPD Patients Attending a Tertiary Care Hospital

OBJECTIVE

To examine the frequency of proper use of inhalation devices and influence of age and training on it.

MATERIALS AND METHODS

One hundred and five subjects of bronchial asthma and Chronic Obstructive Pulmonary Disease (COPD); aged between 18 to 75 y (mean ± SD; 46 ± 28.55) were studied. Subjects were enrolled over a period of three months. Data like weight, height and concomitant medications were recorded. It was an observational and questionnaire based study. Parameters were chosen to demonstrate the inhalational technique, errors committed in different steps of use & nature of medical, paramedical, nursing personals and others imparting training for use of inhaler device and time devoted for it.

RESULTS

Of total 105 patients, 31 were using dry powdered inhalers (DPI), 50 on metered dose inhalers (MDI), and 24 on MDI with spacer devices. Among study population 83.81% were trained by healthcare professionals (doctors, nurse, pharmacists, paramedical or representatives of Pharmaceutical companies) and 16.19% are trained by general people. Among the MDI users (n=50) only 6%, 16.12% among the DPI users, 20.8%, among MDI with spacer users could use inhalers correctly. At 95% confidence limit there was significance of errors committed between DPI and MDI users (difference of SE is 2.56) and between spacer and MDI users (difference of SE 2.92). There was no difference found in regard of frequency of errors committed in taking different devices according to patient's socioeconomic, educational background and trainer.

CONCLUSION

It was concluded that use of MDI with spacer most convenient method. Doctors often did not have sufficient time to train patients regarding proper technique of inhaler use. With ever increasing and widespread use of inhalers patients' education is becoming more important. Proper training will surely make these drugs more effective and cost benefit ratio more favourable.

Evaluation of Phytochemical Screening and Anti Inflammatory Activity of Leaves and Stem of Mikania scandens (L.) Wild

Background:

The greatest disadvantage in the presently available potent synthetic anti-inflammatory drugs lies in their toxicity and reappearance of symptoms after discontinuation. Hence, people are returning to the natural products with the hope of safety and security. Several species of Mikania have been reported to have anti-inflammatory properties.

Aim:

The present study aims to assess the anti-inflammatory activity of the ethanolic extract of the leaves and stem of Mikania scandensin vivo and in vitro.

Materials and Methods:

The in vitro bioassay consisted of assaying the effect of the extracts against denaturation of protein (egg albumin) and measuring the absorbance. In vivo anti-inflammatory activity was checked by measuring the percentage inhibition of carrageenan-induced rat paw edema after oral administration of the extracts to male Wistar rats.

Results:

The plant extracts revealed the presence of tannins, alkaloids, steroids and flavonoids in both the leaf and stem extracts. The in vitro study of leaf extracts of M. scandens demonstrated that at 16000 μg/ml concentration a better anti-inflammatory activity was exhibited which is more than the stem extracts. Similarly in the in vivo study, carrageenan induced inflammation was significantly antagonized by M. scandens leaf extract, with inhibition of 50% at 1000 mg/kg.

Conclusion:

The ethanolic extract of both leaf and stem of M. scandens showed potent anti-inflammatory activity. In comparison the leaf extract found to be more potent in both the conditions in vivo and in vitro, comparing with the standard drug diclofenac sodium and traditional control rumalaya perhaps due to the presence of phytochemicals like alkaloids and flavonoids in the plant.

Histologic and morphometric study of human placenta in gestational diabetes mellitus

AIMS

The aim was to study morphometry, site of umbilical cord insertion and histological changes in placentae of women with gestational diabetes mellitus and compare the results with those of normal pregnancies and observe the perinatal outcome.

METHODS

It was an observational, correlational study of 130 placenta specimens collected from labour room and operation theatre of Department of Gynaecology & Obstetrics, Institute of Post Graduate Medical Education and Research, Kolkata. The subjects were mothers who attended antenatal clinic of the hospital regularly and delivered their babies in the same hospital. Cases were selected randomly, and divided in two groups: group A consisted of mothers having normal, uncomplicated pregnancy, group B consisted of mothers whose pregnancies were complicated by gestational diabetes mellitus. Morphometry, site of umbilical cord insertion and histological changes in placentae of all women were recorded. Perinatal outcome of the cases were also registered. The statistical methods used were chi-square test and Mann-Whitney U test.

RESULTS

It was observed that the placentae of diabetic mothers were significantly bigger in size, weight, volume, area, thickness, diameter and circumference than those of normal mothers. Also, in diabetic mothers, there was significant increase in villous oedema, fibrin deposition, calcification and congestion of blood vessels. These placental changes were significantly correlated with birth weights of babies. Out of 70 mothers in Group B, 65 had live births, 5 had stillborn babies.

CONCLUSIONS

Placentae of women with GDM showed several changes that may be associated with impaired functioning, leading to bad perinatal outcome.

Exploratory Study on the Ayurvedic Therapeutic Management of Cerebral Palsy in Children at a Tertiary Care Hospital of Karnataka, India

Cerebral palsy (CP) is the leading cause of childhood disability affecting cognitive function and developments in approximately 1.5 to 3 cases per 1000 live births. Based on Ayurvedic therapeutic principles, CP patients were subjected to Abhyanga (massage) with Moorchita Tila Taila (processed sesame oil) and Svedana (fomentation) with Shastikashali Pinda Sveda (fomentation with bolus of drugs prepared with boiled rice). Study group received Mustadi Rajayapana Basti (enema with herbal decoction) and Baladi Yoga (a poly-herbo-mineral formulation), while the placebo group received Godhuma Vati (tablet prepared with wheat powder) and saline water as enema. Treatment with Mustadi Rajayapana Basti and Baladi Yoga improved the activities of daily life by 8.79%, gross motor functions by 19.76%, and fine motor functions 15.05%, and mental functions like memory retention got improved by 15.43%. The placebo group showed an improvement of 0.21% in daily life activities, 2.8% in gross motor, and 2.4% in fine motor functions. Mustadi Rajayapana Basti and Baladi Yoga proved to be more supportive in improving the motor activities and gross behavioral pattern. Further clinical trials are required to evaluate and validate the maximum effect of the combination therapy in a large sample with repetition of the courses for longer duration.

Stenotrophomonas, Mycobacterium, and Streptomyces in home dust and air: associations with moldiness and other home/family characteristics

Respiratory illnesses have been linked to children's exposures to water-damaged homes. Therefore, understanding the microbiome in water-damaged homes is critical to preventing these illnesses. Few studies have quantified bacterial contamination, especially specific species, in water-damaged homes. We collected air and dust samples in twenty-one low-mold homes and twenty-one high-mold homes. The concentrations of three bacteria/genera, Stenotrophomonas maltophilia, Streptomyces sp., and Mycobacterium sp., were measured in air and dust samples using quantitative PCR (QPCR). The concentrations of the bacteria measured in the air samples were not associated with any specific home characteristic based on multiple regression models. However, higher concentrations of S. maltophilia in the dust samples were associated with water damage, that is, with higher floor surface moisture and higher concentrations of moisture-related mold species. The concentrations of Streptomyces and Mycobacterium sp. had similar patterns and may be partially determined by human and animal occupants and outdoor sources of these bacteria.