Naturopathic Interventions for Reduction of Perceived Pain in Patients Suffering from Arthritis: A Systematic Review and Meta-Analysis

Arthritis affects millions of lives with its pervasive effects on physical health and quality of life. Addressing the complexities of managing symptoms such as swelling, inflammation, and pain requires prolonged treatment. Naturopathy is a treatment method that enhances the body's innate ability to restore optimal health through a holistic approach including natural products and lifestyle modifications. This systematic review addresses the intersection of naturopathy and arthritis treatment to provide current evidence about its potential benefits. Four databases (PubMed, AYUSH Research Portal, Web of Science, and Google Scholar) were searched with the keywords "Naturopathy" AND "Arthritis". Randomized, non-randomized, and cross-over studies in English were included. Studies reporting perceived pain using a visual analogue scale (VAS) were selected for meta-analysis. A total of 15 studies were included in the systematic review. The studies were from Denmark, Egypt, France, Hungary, Israel, Italy, Spain, and Turkey, and the study periods ranged from 1992 to 2017. They suggested that naturopathic treatment modalities like exercise, mud compress, sand bath, or hydrotherapy may be used in addition to conventional modes of treatment for added benefit. There was a diversity of naturopathic treatment modalities and outcome evaluation methods. Most studies used mud compress or mud baths with reported improvement of symptoms. The meta-analysis of 10 studies (11 sets of data) showed a significant improvement in pain measured by VAS. The studies included in the review have a high level of heterogenicity. There is a need for more studies and uniform assessment methods with standardization of interventions for robust evidence. More clinical trials from countries where naturopathy is approved treatment modalities are needed.

Cancer care and economic burden-A narrative review

Cancer care poses a significant economic burden in India, where noncommunicable diseases contribute to a large number of deaths and disability-adjusted life-years. Despite economic growth, equitable wealth distribution remains a challenge, leading to inequalities in healthcare access. India's healthcare system is primarily privatized, financed through out-of-pocket expenditure (OOPE), and lacks coverage for a majority of the population. As a result, individuals without financial means face catastrophic health consequences when seeking necessary healthcare. OOPE in India's healthcare system is a major concern, with medicines accounting for a significant portion of expenses, followed by diagnostic tests and consultation fees. Nonmedical expenses also contribute to the financial burden. Cancer care specifically faces substantial financial challenges, with high treatment costs, reduced workforce participation, and the need for distress financing. Cancer-related OOPE is predominantly borne by patients and their families, leading to significant financial strain. The lack of comprehensive health insurance coverage and limited access to publicly funded healthcare services exacerbate the problem. Catastrophic health expenditure (CHE) in cancer care is prevalent, pushing households into financial distress and potentially impoverishment. Efforts have been made to address this issue, such as increasing public spending on healthcare and implementing health insurance schemes. However, challenges remain in ensuring their effectiveness and reach. The role of family care physicians is crucial in supporting patients and their families during catastrophic health expenditures related to cancer-related palliative care. They coordinate care, provide advocacy, emotional support, symptom management, and facilitate end-of-life discussions. Comprehensive measures are needed to strengthen healthcare infrastructure, improve access to affordable cancer care, enhance health insurance coverage, and implement supportive measures for cancer patients. Additionally, promoting preventive measures and early detection can help reduce the need for expensive treatments and decrease the risk of catastrophic health expenditures.

Thermal, dielectric, mechanical and structural behavior of 2-amino 4-methylpyridinium 4-nitrophenolate 4-nitrophenol bulk single crystal

Applications in both science and industry have received increased attention as a result of bulk single crystals with particular orientations. However, due to the instability of organic crystals at high temperatures and stress, there is an interest in growing good-quality bulk single crystals with stable thermal and mechanical properties. Here, the 2-amino 4-methylpyridinium 4-nitrophenolate 4-nitrophenol (2A4MPPP) crystal was prepared employing a single-wall ampoule and the vertical Bridgman technique. Structure and functional groups were determined by XRD, NMR, and FTIR studies. More importantly, detailed thermal and kinetic properties such as activation energy, frequency factor, rate constant, and Avrami exponent are discussed. The mechanical stability and dielectric studies are also demonstrated for the title compound. According to the single crystal XRD investigation, 2A4MPPP is a member of the orthorhombic crystal system with the Pna21 space group. Through the TGA and DTA analyses, it was confirmed that the compound starts to melt at 98 °C and complete melting occurs at 103.3 °C. The dielectric experiments reveal the crystal's poor dielectric constant and high-frequency dielectric loss. Vickers microhardness investigations show that grown 2A4MPPP belongs to the soft materials group. As a result of these findings, the 2A4MPPP crystal should be well suited for usage in thermomechanical, microelectronic, optical communications, and nonlinear optical applications.

Effect of alternate nostril breathing exercises on cardiorespiratory function- a systematic review

Introduction- Alternate nostril breathing has positively affected the cardio-respiratory system. This review aimed to compile information on the effects of alternate nostril breathing on cardiorespiratory function. Method– Databases such as PubMed, Medline, Scopus, Cochrane, and Google Scholar were systematically searched to review current evidence of randomized control trials (RCT) on alternate nostril breathing over the past two decades. Out of 89 articles, six were chosen for the final data extraction based on the inclusion and exclusion criteria. Results- All of the final included studies demonstrated a significant improvement in respiratory endurance and functioning and a high heart rate variability (HRV) that mostly has a parasympathetic effect. Conclusion- Alternate nostril breathing shows promising results in reducing stress, improving cardiovascular and respiratory function, and reducing complications of pulmonary problems in the future.

Spatial-temporal lipidomics profile of acute myocardial injury

Background

Lipidome disturbance has long been recognized to occur after myocardial infarction (MI). Accumulation of excessive fatty acids induces production of reactive oxygen species and consequently deteriorates cardiac injury in MI. However, the spatial and temporal lipid profile in the heart following ischemic injury remains unknown.

Purpose

We aim to uncover the temporal-spatial lipidome profile of the heart following ischemia reperfusion (I/R) injury and identify circulating lipids released from injured myocardium that are potentially useful for diagnosis of ischemic heart disease.

Methods

C57/BL6 mice were subjected to 30 min myocardial ischemia followed by removal of the ligature to establish reperfusion injury. Porcine I/R injury was induced by 105 min myocardial ischemia followed by reperfusion. Human plasma was obtained from 143 post-MI patients. Myocardial lipid profiles were generated by matrix-assisted laser desorption/ionization (MALDI) mass spectrometry imaging (MALDI-MSI) in different regions (infarct, remote and peri-infarct) at different time points. Moreover, the lipids in the heart and plasma were analysed by LC-MS/MS.

Results

We observed a drastic alteration in the lipidome with distinct spatial-temporal features in the injured heart by both MALDI-MSI and LC-MS/MS. In the infarct heart tissue, as revealed by LC-MS/MS, we observed an elevation of glycerolipids that peaked at 3 hours after I/R, and a sustained elevation of phospholipids and sphingolipids up to 3 days. Similar alternations in lipid profile was observed but much weaker in the remote and peri-infarct heart tissue compared to the infarct tissue. Among those lipids, PC 32:0 detected by MALDI-MSI highly overlapped CD68 staining at a single-cell level, showing a strong correlation of PC 32:0 with macrophage infiltration in mouse hearts (R2=0.93, p<0.0001). A similar increase of PC 32:0 in the infarct area was also observed in porcine hearts following I/R injury. Surprisingly, plasma levels of PC 32:0 in the mice decreased after I/R injury. In humans, plasma levels of PC 32:0 in post-MI patients were lower than that in healthy individuals (p=0.03). Further analysis demonstrated that plasma levels of PC 32:0 determined within 72 hours after percutaneous coronary intervention were negatively correlated with the 6-month post-MI cardiac ejection fraction in patients (R2=0.08, p<0.001).

Conclusions

A temporal-spatial lipidome profile was established in heart injury by synergizing LC-MS/MS and mass spectrometry imaging. PC 32:0 levels are positively correlated with myocardial macrophage infiltration but negatively correlated with cardiac function in cardiac I/R injury. Our findings indicate that PC 32:0 is a potential biomarker for cardiac injury and the inflammatory status in the injured heart.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Singapore Ministry of Health's National Medical Research Council

A systematic review on the guidelines for nutritional assessment for head and neck cancer patients managed by surgery

There are a number of guidelines to assess the nutrition status of cancer cases. None of these guidelines are specifically head and neck cancer related; except for the European guidelines. This article reviews the different guidelines in nutrition for cancer cases and also their drawbacks.

Scleredema adultorum of Buschke associated with hypothyroidism and liver cirrhosis

Scleredema adultorum of Buschke is a rare disorder of the connective tissue, involving the skin. Here, we present a 61-year-old male, who is a known case of compensated liver cirrhosis with a past history of being treated for autoimmune thyrotoxicosis, who presented with complaints of alopecia, skin tightening, dry skin, pruritus, and woody indurated plaques on the skin of the upper back, shoulder, and arms. Skin biopsy of the arm revealed the characteristic features of scleredema. He was extensively evaluated for known literature-cited causes of scleredema, and the work up revealed a negative result. He was also found to be hypothyroid on presentation. Hence, we present a case of scleredema occurring in a patient with hypothyroidism and chronic liver disease, which to our knowledge is being described for the first time in literature.

Dental caries prevalence among HIV adult population in India: A systematic review

Dental caries is a universal disease. Untreated dental caries adds to the existing burden of diseases. It is necessary to have national data on the same, especially in HIV cases, to understand the epidemiological aspects and formulate a treatment plan for the population. Hence, a systematic review was carried out to collectively report the dental caries prevalence among this population. A systematic search for articles was done in PubMed and Google Scholar using the keywords: Dental Caries, India, HIV, AIDS and adults from January 1990 to December 2019. All freely available full-text articles were evaluated based on the inclusion criteria. Only four articles fulfilled the criteria based on qualitative analysis. Decayed, Missing and Filled Teeth index was used to record dental caries. Risk factors related to the same were not specified by any of the authors. Studies were not from different regions of India. More epidemiological studies are needed to understand the prevalence rate and correlated to dental caries among HIV-positive population in India.

FRI0010 GM-CSFR PATHWAY IS IMPLICATED IN PATHOGENIC INFLAMMATORY MECHANISMS IN GIANT CELL ARTERITIS

Background:

Giant Cell Arteritis (GCA) is characterized by inflammation of large and medium arteries. Classic symptoms include headaches, malaise and, in severe cases, blindness and aortic aneurysms. Corticosteroids (CS) are the first line of treatment. Relapsing disease patients undergo multiple courses of CS therapy increasing their CS exposure and toxicity. A significant unmet need for disease-modifying CS-sparing therapy remains in GCA as the efficacy of current treatment options, including tocilizumab have limitations.

We have previously reported elevated expression of granulocyte-macrophage colony stimulating factor (GM-CSF) pathway transcriptomic signature in GCA vessels. GM-CSF may contribute to underlying disease mechanisms by regulating inflammatory macrophages, dendritic cells (DCs) and T helper (TH1/TH17) cells which are involved in GCA pathogenesis. GM-CSF produced by T cells1can promote polarization of inflammatory macrophages2and recruitment and differentiation of monocytes into inflammatory DCs2that can in turn recruit T cells and stimulate TH1/TH17 differentiation creating a feedback loop. GM-CSF may also exert direct effects on angiogenesis3and vessel wall remodeling4.

Objectives:

To demonstrate the contributing role of GM-CSF pathway to inflammation in GCA arteries.

Methods:

Immunostaining was used to examine expression of GM-CSF and GM-CSF-Rα proteins in temporal artery biopsies (TABs) from GCA and controls (patients with suspected but not confirmed GCA and a negative TAB). Costaining with cell markers such as CD31, CD3, and CD68 allowed visualization of cells expressing GM-CSF and GM-CSF-Rα. Expression of GM-CSF pathway molecules such as phospho-JAK2 and PU.1 proteins was detected by immunohistochemical staining of GCA and control TABs.Ex vivocultured GCA arteries treated (10 each) with mavrilimumab (anti-GM-CSF-Rα) or placebo for 5 days were assayed for gene expression by qPCR, and culture supernatants were analyzed by ELISA.

Results:

Endothelial cells and macrophages were the main cell types expressing GM-CSF and GM-CSF-Rα. Increased expression of phospho-JAK2 (activated signaling molecule) and nuclear-localized PU.1 (transcription factor) in GCA TABs compared to controls indicated the presence of active GM-CSF signaling pathway in GCA.

Inhibition of PU.1 mRNA expression inex vivocultures of GCA arteries treated with mavrilimumab indicated blockade of GM-CSFR signaling pathway. Mavrilimumab induced decrease in mRNA expression of key cell type markers including DC and macrophage activation markers CD83 and HLA-DRA, monocyte markers CD14 and CD16, T cell marker CD3ε, and B cell marker CD20 in these GCA artery cultures. Expression of inflammatory TH1/TH17 factors IFNγ (mRNA), TNFα, CXCL10 (IFNγ-stimulated chemokine) and IL-6 (mRNA and protein) was also inhibited by mavrilimumab in GCA artery cultures.

Conclusion:

Increased GM-CSF, GM-CSF-Rα, and downstream pathway-associated protein levels in GCA biopsies were consistent with previously-observed increased transcriptome signature. Expression of genes associated with inflammatory cells was suppressed by mavrilimumab in cultured GCA arteries. These data implicate the GM-CSF pathway in GCA pathophysiology and increase confidence in rationale for targeting the GM-CSF pathway in GCA.

References:

[1]GM-CSF and T-cell responses: what we do and don’t know. Shiet al., Cell Res 2006

[2]GM-CSF-Dependent Inflammatory Pathways. Hamilton, Front Immunol 2019

[3]GM-CSF increases tumor growth and angiogenesis. Zhenget al., Tumour Biol 2017

[4]GM-CSF deficiency affects vascular elastin production and integrity of elastic lamellae. Weissen-Plenzet al., J Vasc Res 2008

Disclosure of Interests:

Maria C. Cid Grant/research support from: Kiniksa Pharmaceuticals, Consultant of: Janssen, Abbvie, Roche, GSK, Speakers bureau: Vifor, Sujatha Muralidharan Shareholder of: Kiniksa, Employee of: Kiniksa, Marc Corbera-Bellalta: None declared, Georgina Espigol-Frigole Consultant of: Roche and Janssen, Javier Marco Hernandez: None declared, Amanda Denuc: None declared, Roberto Rios-Garces: None declared, Nekane Terrades-Garcia: None declared, John F. Paolini Shareholder of: Kiniksa, Employee of: Kiniksa, Annalisa D’Andrea Shareholder of: Kiniksa, Employee of: Kiniksa

Six-year study on peripheral venous catheter-associated BSI rates in 262 ICUs in eight countries of South-East Asia: International Nosocomial Infection Control Consortium findings

BACKGROUND

Short-term peripheral venous catheter-associated bloodstream infection rates have not been systematically studied in Asian countries, and data on peripheral venous catheter-associated bloodstream infections incidence by number of short-term peripheral venous catheter days are not available.

METHODS

Prospective, surveillance study on peripheral venous catheter-associated bloodstream infections conducted from 1 September 2013 to 31 May 2019 in 262 intensive care units, members of the International Nosocomial Infection Control Consortium, from 78 hospitals in 32 cities of 8 countries in the South-East Asia Region: China, India, Malaysia, Mongolia, Nepal, Philippines, Thailand, and Vietnam. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System.

RESULTS

We followed 83,295 intensive care unit patients for 369,371 bed-days and 376,492 peripheral venous catheter-days. We identified 999 peripheral venous catheter-associated bloodstream infections, amounting to a rate of 2.65/1000 peripheral venous catheter-days. Mortality in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.53% and 12.21% in patients with peripheral venous catheter-associated bloodstream infections. The mean length of stay in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.40 days and 7.11 days in patients with peripheral venous catheter and peripheral venous catheter-associated bloodstream infections. The microorganism profile showed 67.1% were Gram-negative bacteria: Escherichia coli (22.9%), Klebsiella spp (10.7%), Pseudomonas aeruginosa (5.3%), Enterobacter spp. (4.5%), and others (23.7%). The predominant Gram-positive bacteria were Staphylococcus aureus (11.4%).

CONCLUSIONS

Infection prevention programs must be implemented to reduce the incidence of peripheral venous catheter-associated bloodstream infections.

Oral Health-related Quality of Life in HIV: A Systematic Review

AIM

To systematically evaluate the literature evidence related to oral health and quality of life (QoL) among HIV-positive adults.

BACKGROUND

The oral health-related quality of life (OHRQoL) is an essential entity to be measured for understanding the domains affected due to oral health problems. HIV comes with an array of complexities in the oral cavity and is also reflection of the systemic illness of the oral cavity. Hence, it is essential to know the area affected and also the lesions that contribute the most to decrease the QoL in this aspect. A systematic review was carried out in relation to studies across PubMed and Google Scholar regarding HIV and OHRQoL from January 1970 to May 2019. Of the 1,374 articles screened, 11 studies were filtered for the final review.

REVIEW RESULTS

The physical domain followed by the psychological domain is the most affected in the HIV-positive patients. The maximum effect is due to dental caries and periodontitis. No studies report about oral substance abuse and its effect.

CONCLUSION

Studies are further needed on a larger sample size and on similar scales and parameters to ensure greater evidence for intervention related to areas that should be focused upon for improving the QoL of HIV-positive patients.

CLINICAL SIGNIFICANCE

There is a greater need to include quality-based assessment while treating HIV-positive people. Also not just physical indicators like pain or dental caries, even social indicators like mental and social dimensions of a patient's life should be included while deciding the treatment approach.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher.

CONCLUSIONS

Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.

Assessment of the existing dental education environment at a dental teaching institution

Introduction

An important aspect of creating a competent medical practitioner is the teaching-learning environment that shapes the mentality and instigates an urge among the students to learn. To facilitate a motivating learning setup, the faculty members need to inadvertently establish a successful and safe learning environment which is extensively feasible, given that the faculty gets to control their own style of teaching. A lot of research focuses on student's perception of the learning environment, seldom studies have reported the teacher's perspective. This present study focuses on the teacher's side of the story regarding the current scenario of the workplace that is one of the essential factors to alter the approach toward andragogy.

Materials and Methods

A cross-sectional questionnaire study was carried out using the Assessment of Medical Education Environment by Teachers (AMEET) questionnaire. The AMEET questionnaire was administered to 50 staff members at MA Rangoonwala College of Dental Sciences and Research Centre, Pune. All the participants were assured of confidentiality of their personal details and they all signed a written informed consent before participating in the study.

Results

Majority of the participants had a positive attitude which was seen more in the seniors compared to the juniors. The teacher's perception of teaching is that there needs to be a greater emphasis on what the student learns rather than what the teacher does. Junior staff members felt that students do not prepare and come for classes nor are the expected outcomes clear to them. Assignments are also a task for the students that are never on time.

Conclusion

It was observed that more senior faculties were positive toward the existing education environment. In addition, even though opportunities are available for the staff as well as students for upgrading and imbibing newer information, they were not being benefitted by the same due to underutilization.

Dentition status and treatment needs of human immunodeficiency virus-positive patients on anti retro viral therapy in Raichur taluk, Karnataka, India: A cross sectional study

Objective:

The aim of the study was to assess the dentition status and the treatment needs of the HIV-positive patients on ART for more than a year in Raichur, Karnataka.

Materials and Methods:

Convenience sampling was followed. The sample size was 170. The dentition status and treatment needs of the patients were recorded as per the WHO guidelines.

Results:

The overall prevalence of dental caries was 79.4%. Males had higher percentage of dental caries than the females, and this was found to be statistically significant. The prevalence of dental caries was higher among the participants who used finger to clean their teeth compared to the toothbrush, neem stick, and charcoal users, and this was found to be statistically significant.

Conclusion:

Higher prevalence of dental caries was observed among the study population. Most of them required some type of treatment. Patients with a low CD4 count required higher treatments than the others.

Oral Health Literacy and Oral Health Knowledge among 2,263 First-time Pregnant Urban Women: A Cross-sectional Questionnaire Study

AIM

The present study aimed to see the oral health literacy rate among first-time pregnant women across 12 corporate hospital setups in the city of Pune, India.

MATERIALS AND METHODS

For the survey, the REALD 30 questionnaires were used to assess the adult literacy rate (with 0 being least score and 30 being the highest score) and the knowledge of the participants related to oral health was assessed using a set of 6 questions. The study was carried out for a period of 1 year from January 2018 to December 2018. The total participants at the end of the study were 2,263. All the women were pregnant for the first time, in their 1st trimester of pregnancy. Written consent was taken from all the participants. Epi Info was used to carry out the statistical analysis. All the p values less than 0.05 was considered to be statistically significant.

RESULTS

The mean REALD 30 score was 23.8 ± 8.34. The REALD score was higher for those with a postgraduate degree; this could be due to more number of participants in the group. There were higher percentages of women with correct answers to all the knowledge-based questions. We observed that there was a positive correlation with the REALD total scores and the correct answers provided to the questions on oral health (r = 0.76). There was a positive correlationship between the REALD scores and the oral health knowledge of the participants.

CONCLUSION

The educated pregnant women had a high oral health literacy rate. There was a positive correlation of literacy with the REALD 30 score.

CLINICAL SIGNIFICANCE

Healthcare providers should focus on clearing the myths and misconceptions that are still prevalent in a small portion of the urban population.

Cross-country transport and isolation and identification of Streptococcus pneumoniae by use of alternate sources of blood supplemented media among laboratories in India

Background

The isolation of S. pneumoniae (Sp) depends on specimen integrity / transport, media and expertise. The non-availability of sheep blood agar poses a challenge in identification of colonial morphology and identification in India.

Methods

Laboratories processed swabs containing either pure Sp or Sp in mixed cultures with a second (confounding) bacterium shipped across the country in cold conditions. Duplicate set of swabs was shipped back to the central laboratory to assess the impact of shipping on culture viability. The identical swab was cultured on sheep, human blood and one additional agar plate used in the laboratory.

Results

46/60(77%) of cultures containing only Sp were correctly identified. In specimens where Sp was present in mixed culture, the proportion of isolates in which Sp was correctly identified varied, with most variability attributed to the particular confounding organism rather than the media. There was no discernible impact of temperature-controlled (4-6°C) transport on the isolation of Sp from culture swabs.

Conclusions

The study clearly elucidates the ability of laboratories for isolation of S. pneumoniae on human blood agar in resource limited settings. The results highlight the difficulties inherent in correctly identifying pathogens in mixed cultures in needs improvement using standardized tests across the study centers. The study also reaffirms the ability to transport biological specimens over long geographical distances without loss.

Follow-up and management of valvular heart disease patients with prosthetic valve: a clinical practice guideline for Indian scenario

PURPOSE

Valvular heart disease (VHD) patients after prosthetic valve implantation are at risk of thromboembolic events. Follow-up care of patients with prosthetic valve has a paramount role in reducing the morbidity and mortality. Currently, in India, there is quintessential need to stream line the follow-up care of prosthetic valve patients. This mandates the development of a consensus guideline for the antithrombotic therapy in VHD patients post prosthetic valve implantation.

METHODS

A national level panel was constituted comprising 13 leading cardio care experts in India who thoroughly reviewed the up to date literature, formulated the recommendations, and developed the consensus document. Later on, extensive discussions were held on this draft and the recommendations in 8 regional meetings involving 79 additional experts from the cardio care in India, to arrive at a consensus. The final consensus document is developed relying on the available evidence and/or majority consensus from all the meetings.

RESULTS

The panel recommended vitamin K antagonist (VKA) therapy with individualized target international normalized ratio (INR) in VHD patients after prosthetic valve implantation. The panel opined that management of prosthetic valve complications should be personalized on the basis of type of complications. In addition, the panel recommends to distinguish individuals with various co-morbidities and attend them appropriately.

CONCLUSIONS

Anticoagulant therapy with VKA seems to be an effective option post prosthetic valve implantation in VHD patients. However, the role for non-VKA oral therapy in prosthetic valve patients and the safety and efficacy of novel oral anticoagulants in patients with bioprosthetic valve need to be studied extensively.

Cutaneous Bacteriological Profile in Patients with Pemphigus

BACKGROUND

Pemphigus is an autoimmune blistering disease. The common cause of death in pemphigus is septicemia which is usually secondary to cutaneous bacterial infection.

AIM

The aim was to study the cutaneous bacteriological profile in patients with pemphigus.

MATERIALS AND METHODS

Pus for culture and sensitivity was collected from clinically infected lesions of pemphigus patients in the Department of Dermatology, St. John's Medical College Hospital, Bengaluru, from June 2013 to June 2014.

RESULTS

Of the 49 patients included in the study, 44 were suffering from pemphigus vulgaris, 4 from pemphigus foliaceus and one had pemphigus vegetans. There were 31 male and 18 female patients. The mean age of the group was 35.51 year. Mean Autoimmune Bullous Disorder Intensity Score was 17.36. About 32.7% were diabetic. About 40.81% showed the growth of Staphylococcus aureus, 12.24% of Pseudomonas aeruginosa, 6.12% of Proteus mirabilis, 4.08% of β-hemolytic streptococci and nonfermenting Gram-negative bacilli, and 2.04% of Proteus vulgaris, Staphylococcus saprophyticus, Enterococcus species, and Klebsiella species. S. aureus showed 100% sensitivity to antibiotics - tetracycline, amikacin, chloramphenicol, and netilmicin; 90% resistance was found for penicillin and 55% resistance was found for ciprofloxacin and erythromycin. Methicillin-resistant S. aureus was 30%. P. aeruginosa showed 100% sensitivity to ciprofloxacin, amikacin, gentamicin, piperacillin, piperacillin + tazobactam, and netilmicin.

CONCLUSION

S. aureus was the most common organism showing sensitivity to tetracycline, amikacin, chloramphenicol, and netilmicin and resistance to penicillin, ciprofloxacin, and erythromycin.

Prevalence of Soft-Tissue Lesions among Women in Sex Work in the Red Light Area of Pune, India: A Cross-Sectional Survey

Aim and Objective

The women in sex work have no felt need for oral health and much of the stress has always been on sexually transmitted infections (STIs). There is a need for a baseline data for the oral lesions of these women to further assist in the policy formulations and training of personnel for the identification of the oral conditions which need treatment. The aim of the study was to evaluate the presence of oral lesions among female sex workers in the red light area of Pune, India.

Materials and Methods

The Community Periodontal Index and loss of attachment (LA) index was recorded along with the other soft-tissue lesions as per the WHO Oral Health Assessment from 1997. The calculated sample was 350. Systematic sampling technique was followed. The data collected were subjected to statistical analysis and analysis was done using SPSS package 16.0.

Results

A total of 110 (31.4%) women had leukoplakia, 6 women (1.7%) had ulceration, 41 (11.7%) women had candidiasis, and 1 woman (0.3%) had swollen gingiva. As the age increased, there was an increase in the number of pockets. The percentage of women above 60 years had higher LA.

Conclusion

The women in sex work are mainly spoken to about HIV and STIs. With almost all of these women requiring some or the other form of treatment, utilization of the available dental workforce with both government and public partnership could be the route.

Dentition Status and Treatment Needs among Women involved in Sex Work as a Profession in the Red Light District of Pune, Maharashtra, India: A Cross-sectional Study

INTRODUCTION

The overall rehabilitation of women in sex work is unfortunately limited most of the time only to moving them to another profession, but it should be focused on including health as an important factor. Factors that restrict regular dental care include misconceptions, dental fear and expense of dental care, unpleasant dental experiences, and socioeconomic factors, but such a direct correlation cannot be made in the case of such women. Until now, no study has been conducted related to the complete dentition status and treatment needs of women in sex work.

AIM

The aim of our survey was to evaluate the dentition status and treatment needs among the brothel-based women engaged in sex work.

MATERIALS AND METHODS

A pilot study was conducted on 30 women and the final sample size was estimated to be 350. All the women were above 18 years old. Systematic random sampling method was followed after line listing of the brothels. The dentition status and treatment needs were recorded using the World Health Organization assessment form, 1997. The data collected were tabulated and analyzed using Statistical Package for the Social Sciences (SPSS), version 16.0. The Chi-squared test was carried out to check the association, and all p-values below 0.05 were considered to be statistically significant.

RESULTS

The mean number of decayed teeth per person was 5.05 (±4.81), missing teeth per person was 0.96 ± 2.71, filled teeth per person was 0.04 (±0.34), and the mean of decayed missing filled permanent teeth per person was 6.05 (±5.84). There was a significant association between dental caries and age, using finger to clean the teeth, and not visiting the dentist.

CLINICAL SIGNIFICANCE

Due to different risk factors, such as diet, improper oral hygiene maintenance, and substance abuse, the overall dental health was found to be compromised in this population. Economic burden is an important factor that influences their attitude toward oral health and is likely to be inherited by their next generation also.

Assessment of orthodontic treatment need among tribal children of Indore division, Central India

Introduction

India is home to many tribes which have an interesting and varied history of origins, customs and social practices. Oral health care in tribal areas is limited due to shortage of dental manpower, financial constraints and the lack of perceived need for dental care among tribal masses.

Objective

To assess orthodontic treatment need among tribal children of Indore division, Central India.

Methods

A cross-sectional house to house survey was carried out among 800 tribal children aged 5 to 15 years old in two major tribal districts of Indore division. Permissions and consent were obtained from local administrative authorities, ethical committee and parents respectively. A structured proforma was used to record demographic data. Examination for dentofacial anomalies was conducted according to WHO 1997 survey methods. Descriptive tables and analytical tests like ANOVA, post-hoc and chi-square test were employed.

Results

The mean age was 9.75(±2.43) years. The mean DAI score among 12 to 15 years old children was 23.19±5.22. Female exhibited higher (24.51±5.34) mean DAI score compared to males (22.12±4.87) (p<0.05). The Patelia tribes (24.38±5.13) reported higher mean DAI score than Bhilala (23.02±5.69) and Bhil tribe (22.73±4.79) (p<0.005).

Conclusion

The tribal children had minor malocclusion with no or slight treatment need. Categorization of orthodontic treatment need according to malocclusion severity is particularly important for the planning of corresponding public policies. The isolation of the villages, lack of transportation options imposes limitations on the availability of health professionals to provide dental services.

Anticoagulation Management in Patients with Valve Replacement

BACKGROUND

Prosthetic valve implantation requires postoperative prophylactic anticoagulation to preclude thrombotic events. The aim of this review is to assess the role of anticoagulation therapy in the management of valve replacement patients.

METHODOLOGY

Literature from PubMed, Embase, Medline and Google Scholar were searched using the terms "valvular heart disease", "anticoagulant", "mechanical heart valve", "bioprosthesis", "bridging", "Vitamin K antagonist (VKA)", and "acenocoumarol". A committee comprising leading cardiothoracic surgeons from India was convened to review the literature and suggest key practice points.

RESULTS

Prosthetic valve implantation requires postoperative prophylactic anticoagulation to preclude thrombotic events. A paramount risk of thromboembolic events is observed during the first three months after surgery for both mechanical and bioprosthetic devices. The VKA therapy with individualized target international normalized ratio (INR) is recommended in patients after prosthetic valve replacement. Therapies for the management of prosthetic valve complications should be based on the type of complications. Special care is mandated in distinguished individuals and those with various co-morbidities.

CONCLUSION

In patients with prosthetic valve replacement, anticoagulant therapy with VKA seems to be an effective option. The role for non-VKA oral anticoagulants in the setting of prosthetic valve replacement has yet to be established. Furthermore, whether the novel oral anticoagulants are safe and efficacious in patients after placement of a bioprosthetic valve remains unanswered.

Dentition status and treatment needs and its correlation with oral health-related quality of life among men having sex with men and transgenders in Pune city: A cross-sectional study

Introduction:

Dental diseases are universal in nature. Their presence and severity may vary from one individual to another and is also affected by multiple factors such as gender, knowledge, attitude and the affordability of dental/oral care. Gay, bisexual and transgender community is one among the socially disadvantaged community in our country. The present study was carried out in the city of Pune, India, to evaluate the prevalence of dentition status and the treatment needs among the men who have sex with men (MSMs) and transgenders (TGs) and its correlation with the oral health-related quality of life.

Materials and Methods:

The sample size was 270. Convenience sampling was followed. The WHO oral health assessment for 1997 was used to record dentition status and treatment needs. Oral Health Impact Profile-14 was used to record the oral health-related quality of life. SPSS 22.0 (Chicago, IL, USA) was used for statistical analysis. All P < 0.05 were considered to be statistically significant.

Results:

There was no statistically significant difference seen across the various domains in the overall impact of the oral quality of life. There was a significant correlation between the decayed teeth, missing teeth and overall decayed, missing and filled teeth scores with respect to the seven domains. Problems arising due to past dental experience (dental caries), lost natural tooth structures replaced with restorative material and a cumulative impact significantly affected the outcome of the oral health-related quality of life of the participants.

Conclusion:

There was an alteration in quality of life of the MSMs and TGS with respect to dental caries. This calls for an intervention that is tailor-made to meet the needs of this group.

Prevalence of Periodontitis and Soft Tissue Lesions among Human Immunodeficiency Virus-positive Patients on Antiretroviral Therapy in Raichur Taluk, Karnataka, India

INTRODUCTION

In countries where human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is widespread and highly active antiretroviral therapy (HAART) medications are too expensive, or patients are failing HAART, oral disease management and risk remain an important issue.

AIM

The aim of the study was to evaluate the prevalence of oral mucosal lesions and periodontitis among the HIV-positive adult patients and assess the association of these lesions with age, sex, duration of HIV, time on ART, dietary habits, and oral hygiene habits.

MATERIALS AND METHODS

Sample size was 170. Demographic data of the patients along with community periodontal index (CPI) and loss of attachment (LA) were recorded. Oral soft tissue lesions, such as ulcerations, sores, erosions, and fissures were also recorded. The study was carried out in Raichur Taluk, Karnataka, India. Convenience sampling design was followed. Statistical Package for the Social Sciences (SPSS) version 20.0 (Chicago, USA) was used for data analysis. Chi-square test was carried out; p < 0.05 was considered to be statistically significant.

RESULTS

There was no association between the oral mucosal conditions and the age and the adverse habits, such as tobacco and alcohol, CD4 count, and the time duration of HIV and ART among these patients. A higher percentage of people with 4 to 5 mm of pockets was seen with those who cleaned their teeth with a finger, which was statistically significant.

CLINICAL SIGNIFICANCE

The present study highlights the poor condition of the oral health of these patients and their unmet dental needs.

Stigma and Discrimination faced by HIV-infected Adults on Antiretroviral Therapy for more than 1 Year in Raichur Taluk, Karnataka, India

AIM

The aim of this study was to evaluate the stress and discrimination faced by human immunodeficiency virus (HIV)-affected adult patients on antiretroviral therapy (ART) for more than 1 year.

MATERIALS AND METHODS

A cross-sectional study was carried out among 170 adults on ART, reporting to the ART center of the District Civil Hospital, for more than 1 year in Raichur Taluk, Karnataka, India. Convenience sampling technique was followed. Descriptive statistics was performed (Chi-square test) using Statistical Package for the Social Sciences version 16.0.

RESULTS

A total of 156 (91.8%) patients' families had knowledge about their seropositive status. Seventeen (10.9%) HIV-positive patients reported of change in the attitude of their family members. The main reasons for not revealing the HIV status were the internalized stigma and fear of rejection. Women faced greater discrimination from family, friends, and neighbors than men.

CONCLUSION

It is necessary to not undermine the effect of rejection due to HIV. It is the only infection that has so many associated social and psychological norms which we need to tend at the earnest. Till date, there is an existence of condescendence toward treatment approach.

CLINICAL SIGNIFICANCE

The presence of stigma and the fear of being discriminated could be a major hurdle in the rehabilitation of these patients into the mainstream society. Furthermore, it serves as an existing challenge to ascertain these individuals to achieve overall health.

Correction: The biology of environmental stress: molecular biomarkers in Sydney rock oysters (Saccostrea glomerata)

Correction for 'The biology of environmental stress: molecular biomarkers in Sydney rock oysters (Saccostrea glomerata)' by D. A. Raftos et al., Environ. Sci.: Processes Impacts, 2016, 18, 1129-1139.

The biology of environmental stress: molecular biomarkers in Sydney rock oysters (Saccostrea glomerata)

This review describes our recent work on environmental stress in Sydney rock oysters, focusing on the identification of molecular biomarkers for ecotoxicological analysis. We begin by describing the environmental pressures facing coastal estuaries in Australia, with particular reference to Sydney Harbour. After providing that context, we summarise our transcriptional and proteomic analyses of Sydney rock oysters responding to chemical contamination and other forms of environmental stress. This work has shown that the intracellular processes of oysters are highly responsive to environmental threats. Our data agree with the broader literature, which suggests that there is a highly conserved intracellular stress response in oysters involving a limited number of biological processes. We conclude that many effective molecular markers for environmental biomonitoring are likely to lie within these biological pathways.

Oxygen evolution catalytic behaviour of Ni doped Mn3O4 in alkaline medium

In this study, the electrocatalytic behavior of Mn₃O₄ was enhanced by non-precious metal doping.

Different mechanisms for Arabidopsis thaliana hybrid necrosis cases inferred from temperature responses

Temperature is a major determinant of plant growth, development and success. Understanding how plants respond to temperature is particularly relevant in a warming climate. Plant immune responses are often suppressed above species-specific critical temperatures. This is also true for intraspecific hybrids of Arabidopsis thaliana that express hybrid necrosis due to inappropriate activation of the immune system caused by epistatic interactions between alleles from different genomes. The relationship between temperature and defence is unclear, largely due to a lack of studies that assess immune activation over a wide range of temperatures. To test whether the temperature-based suppression of ectopic immune activation in hybrids exhibits a linear or non-linear relationship, we characterised the molecular and morphological phenotypes of two different necrotic A. thaliana hybrids over a range of ecologically relevant temperatures. We found both linear and non-linear responses for expression of immunity markers and for morphological defects depending on the underlying genetic cause. This suggests that the influence of temperature on the trade-off between immunity and growth depends on the specific defence components involved.

Crystal structure of bis[4-(dimethylamino)pyridinium] bis(2-nitrobenzoate) trihydrate

The title salt, 2C7H11N2+·2C7H4NO4−·3H2O, crystallized with two anions and two cations in the asymmetric unit, together with three water molecules. Both 4-dimethylaminopyridinium cations are protonated at their pyridine N atoms with the plane of the N(CH3)2hetero atoms inclined to the pyridine ring by 4.5 (2) and 1.4 (2)°. In the 2-nitrobenzoate anions, the carboxyl and nitro groups are inclined to their respective benzene rings by 77.1 (3) and 20.0 (3)°, and 75.8 (2) and 20.9 (3)°. In the crystal, the anions are linkedviaO—H...O hydrogen bonds involving the water molecules, forming chains along [100]. The cations are linked to these chains by N—H...O hydrogen bonds. The chains are linkedviaC—H...O hydrogen bonds and C—H...π and π–π interactions [inter-centroid distances range from 3.617 (1) to 3.851 (1) Å], forming a three-dimensional structure.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN.

Technology: an aid to clinical judgement

Complete removal of renal cell tumor with thrombus which extends above the diaphragm often necessitates use of cardiopulmonary bypass. Transesophageal echocardiography (TEE) can play an important role in delineating the extent of tumor growth. We describe a patient with renal cell carcinoma with thrombosis invading into the right ventricle and its complete removal with the aid of TEE.

Organochlorine pesticide residues in eggs and tissues of house sparrow, Passer domesticus, from Tamil Nadu, India

This study provides information on the current status of contamination by organochlorine pesticides (OCPs) in eggs and tissues of House Sparrow, Passer domesticus, in Tamil Nadu, India. The mean concentration of total hexachlorocyclohexane (∑HCH) and total dichloro-diphenyl-trichloroethane (∑DDT) in eggs ranged from 0.01 to 1.81 μg/g and 0.02 to 1.29 μg/g, respectively. Concentration of 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (p,p'-DDE) ranged from below detectable limit (BDL) to 0.64 μg/g, representing more than 60% of the ∑DDTs. About 28% of samples had p,p'-DDE levels above the critical concentration associated with reproductive impairment. However, the mean concentrations of cyclodiene insecticides were less than 0.5 μg/g. Although OCPs levels detected in tissues are not indicative of toxicity, continuous monitoring is recommended.

Metal contamination in select species of birds in Nilgiris district, Tamil Nadu, India

Variation in metal contamination in six species of birds, namely the Cormorant (Phalacrocorax carbo), Cattle Egret (Bubulcus ibis), Little Egret (Egretta garzetta), Pond Heron (Ardeola grayii), Common Myna (Acridotheres tristis) and Jungle Babbler (Turdoides striatus) in Nilgiris district, Tamil Nadu, India. The accumulation of heavy metals differed among the species studied. On an average, Little Egret accumulated high concentrations of copper (53.31 ± 23.19 ppm) followed by Cattle Egret (16.27 ± 9.83 ppm) in liver. Of all the species, Jungle Babbler recorded the maximum concentrations (20.59 ± 9.07 ppm) in muscle. The Pond Heron recorded the maximum concentration (35.38 ± 11.14 ppm) in brain. On an average the maximum level was in the kidney of Common Myna (7.76 ± 1.80 ppm).

A Validated RP-HPLC Method for Simultaneous Estimation of Nebivolol and Hydrochlorothiazide in Tablets

A simple, selective, rapid, precise and economical reverse phase high pressure liquid chromatographic method has been developed for the simultaneous estimation of nebivolol and hydrochlorthiazide from pharmaceutical formulation. Phenomenex Gemini C₁₈ (25 cm×4.6 mm i.d., 5 μ) column with a mobile phase consisting of acetonitrile: 50mM ammonium acetate (adjusted to pH 3.5 using orthophosphoric acid) (70:30 v/v) at a flow rate of 1.0 ml/min was used. Detection was carried out at 254 nm. Probenecid was used as an internal standard. The retention times of probenecid, nebivolol and hydrochlorthiazide were 13.05, 3.32 and 4.25 min, respectively. The developed method was validated in terms of accuracy, precision, linearity, limit of detection, limit of quantitation and solution stability. The proposed method can be used for the estimation of these drugs in combined dosage forms.

Diclofenac residues in blood plasma and tissues of vultures collected from Ahmedabad, India

The study reports residues of diclofenac, a non-steroidal anti inflammatory drug, in tissues of 11 White-backed Vulture, Gyps bengalensis collected between 2005 and 2007 and blood plasma of 12 White-backed Vulture, four Egyptian Vulture, Neophron percnopterus and two Griffon Vulture, Gyps fulvus collected during 2005. Samples were analysed using High Performance Liquid Chromatograhy (HPLC) equipped with UV detector. One of the White-backed Vultures collected during 2005 had substantial urate deposits on its viscera and diclofenac was detected in its liver (1.42 ppm wet weight) and kidney (1.18 ppm wet weight), which is suggestive of diclofenac exposure and intoxication. Although uric acid crystals were not observed in the remaining birds received during 2005, the residues of diclofenac detected were at levels higher than the toxic limits (0.25-1 ppm). No residues were detected in any of the tissues of birds collected during 2006 and 2007 (6 birds). About 89% (16 of 18) of plasma samples collected during 2005 had diclofenac residues (White-backed vulture: BDL to 0.17 ppm; Egyptian vulture: BDL to 0.09 ppm; Griffon vulture: 0.07-0.14 ppm). However, plasma diclofenac concentrations were less than the concentrations reported to be toxic. Although use of diclofenac for treating cattle has been banned in India, regular monitoring is recommended to assess the effectiveness of the ban on the drug in support of the conservation of these species.

Comparative evaluation of two cold staining methods with the Ziehl-Neelsen method for the diagnosis of tuberculosis

In developing countries pulmonary tuberculosis is usually diagnosed by detecting acid-fast bacilli (AFB) in sputum using a Ziehl-Neelsen (Z-N) staining method. However, in the field the traditional method of staining is difficult to carry out. This study evaluates the efficiency of two cold staining methods, namely Gabbet's and a modified two reagent cold staining method compared with the Z-N taken as the gold standard. Triplicate smears were prepared from 267 sputum samples and stained by the Z-N, Gabbet's, and a modified cold staining method, the smears were positive for AFB in 21 (7.87%), 18 (6.74%) and 19 (7.12%), respectively. The sensitivities for the Gabbet's and modified cold stain were 85.7% and 90.5%, respectively. The positive agreement between the Z-N and Gabbet's (92.3%) and Z-N and modified cold stain (95%) were good. The modified cold staining method was less time consuming and easier to perform in the field.