Aspergillus sensitization in bronchial asthma: A separate phenotype.

Background: Bronchial asthma is one of the common chronic respiratory illnesses worldwide, with a global disease burden that affects approximately 300 million individuals. It affects 5-10% of the population in developed countries. India constitutes approximately one-tenth of the global disease burden, where an estimated 7 million children are affected by this illness. Airway hyperresponsiveness or bronchial hyperreactivity in asthma is an exaggerated response to numerous exogenous and endogenous stimuli. In India, the most important endogenous stimuli is considered to be fungal antigens from the genus, Aspergillus. Positive skin reactions to Aspergillus fumigatus among individuals with atopic asthma is 10 to 20%; however, a causal relationship is yet to be established. A separate entity, termed "severe asthma with fungal sensitivity," is often used to describe milder allergic reactions to fungal aeroallergens that has fungal sensitization as the starting point of pathogenesis than allergic bronchopulmonary aspergillosis. Methods: A total of 57 patients with bronchial asthma were prospectively enrolled and evaluated for Aspergillus sensitization and its impact on asthma control. Results: Symptoms were well controlled in a majority of patients (57.89%) and partly controlled in 14.04%. Uncontrolled symptoms were observed in only 28.07% of patients. The proportion of patients with uncontrolled symptoms was higher among patients who were sensitized (45.00%) compared with patients who were not sensitized (18.92%). The proportion of patients with well-controlled symptoms was higher in individuals who were not sensitized compared with individuals who were sensitized (62.16% versus 50.00%). Conclusion: The severity of asthma was associated with fungal sensitization, with sensitization to Aspergillus as a part of the pathogenesis. Aspergillus sensitization is significantly associated with bronchiectasis, even in the absence of clinical features.

I have heard about it for the first time from you! Implementation of tobacco control law by police personnel in India.

Setting and Objetives: Police personnel, alongside other key stakeholders, are responsible for implementing the Cigarettes and Other Tobacco Products Act (COTPA) in India. This study aimed to assess knowledge and attitudes about COTPA among police personnel and explore enablers and barriers in implementing it. Design: This convergent parallel mixed-methods study used a self-administered questionnaire (quantitative) and key informant interviews (qualitative). Of 300 police personnel across all eight police stations in Daman, 155 participated. Quantitative data were analysed using descriptive statistics and the χ2 test. Qualitative data from in-depth interviews of six key informants from all coordinating departments were analysed thematically. Results: Overall, 63.2% of responders were aware of any tobacco control law in India, and only 12.9% were trained in its implementation. One person had conducted inspections for COTPA compliance in the last 12 months. The majority (78.1%) of the police personnel, and significantly more tobacco non-users than users (81.2% vs. 52.9%, P = 0.016), felt that enforcing anti-tobacco regulations is one of their most important functions. Perceived benefits of the act and formal authority to act were the two main enablers of COTPA implementation. Lack of awareness and coordination, competing priorities, concentration of authority with higher-ranking officials and evasion of the law by retailers and the public hampered effective implementation of the law. Conclusion: Knowledge about the COTPA was average and implementation poor. Sensitisation and training of implementers, systematic transparent reporting and creating awareness among public are recommended for effective implementation.

Contexte et objectifs : Le personnel de la police, en collaboration avec d'autres partenaires clés, est responsable de la mise en œuvre de la Loi cigarettes et autres produits dérivés du tabac (COTPA) en Inde. Cette étude a eu pour but d'évaluer les connaissances et l'attitude au sein du personnel de la police en ce qui concerne la COTPA et a exploré les facilitateurs et les entraves à sa mise en œuvre.Schéma : Cette étude convergente parallèle à méthodes mixtes s'est basée sur un questionnaire auto-administré (méthode quantitative) et sur des entretiens avec des informateurs clés (méthode qualitative). Sur 300 personnels de police dans les huit stations de police de Daman, 155 ont participé. Les données quantitatives ont été analysées grâce à des statistiques descriptives et au test du χ2. Les données qualitatives émanant des entretiens approfondis avec six informateurs clés de tous les services de coordination ont été analysées de manière thématique.Résultats : Au total, 63,2% des participants étaient au courant de l'existence d'une loi de lutte contre le tabac en Inde, et seulement 12,9% ont été formés à sa mise en œuvre. Un seul avait réalisé des inspections relatives au respect de la COTPA au cours des 12 derniers mois. La majorité (78,1%) du personnel de police, et significativement plus de non-utilisateurs que d' utilisateurs de tabac (81,2% contre 52,9%, P = 0,016), estimaient que mettre en œuvre la loi anti-tabac était l'une de leurs fonctions importantes. Les bénéfices perçus de cette loi et le pouvoir officiel ont été les deux principaux facilitateurs de la mise en œuvre de la COTPA. Le manque de sensibilisation et de coordination, les priorités concurrentes, la concentration de l'autorité au sein des supérieurs et l'évasion de la loi par les revendeurs et le public a entravé une véritable mise en œuvre de la loi.Conclusion : La connaissance de la loi a été moyenne et sa mise en œuvre médiocre. La sensibilisation et la formation des responsables de la mise en œuvre, des rapports systématiques transparents et la sensibilisation du public sont recommandés pour une mise en œuvre efficace.

Marco de Referencia y Objetivos: El personal policial, junto con otros interesados directos, tienen a su cargo la ejecución de la COPTA (del inglés, Cigarettes and Other Tobacco Products Act, por ley sobre el consumo de cigarrillos y otros productos del tabaco) en la India. En el presente estudio se evaluaron los conocimientos y las actitudes de los miembros de la policía con respecto a la COPTA y se exploraron los factores facilitadores y los obstáculos a su aplicación.Método: Fue este un estudio de métodos mixtos convergentes y paralelos que utilizó cuestionarios rellenados por el encuestado (cuantitativos) y entrevistas a informantes clave (cualitativos). De los 300 oficiales de policía de las ocho estaciones de Daman, 155 participaron en la encuesta. Los datos cuantitativos se analizaron mediante métodos estadísticos descriptivos y la prueba del χ2. Los datos cualitativos de las entrevistas exhaustivas de seis informantes clave de todos los departamentos coordinadores se analizaron temáticamente.Resultados: En general, el 63,2% estaba al corriente de una ley de control del tabaco en la India, y solo el 12,9% había recibido capacitación relacionada con su aplicación. Solo un funcionario había realizado inspecciones sobre la conformidad con la COTPA en los últimos 12 meses. La mayor parte del personal de policía (78,1%), y una mayor proporción de no consumidores de tabaco (81,2% contra 52,9%; P = 0,016), consideraba que la aplicación de la reglamentación antitabaco constituía una de sus funciones importantes. Los dos principales factores facilitadores de la aplicación de la COPTA fueron la percepción de los beneficios de la ley y la autoridad oficial para actuar. El desconocimiento y la falta de coordinación, las prioridades concurrentes, la concentración de la autoridad en los funcionarios superiores y la evasión de la ley por parte de los comerciantes al por menor y de la población obstaculizan la aplicación eficaz de la ley.Conclusión: Se observó un conocimiento insuficiente y una escasa aplicación de la COTPA. Con miras a lograr una aplicación eficaz, se recomienda sensibilizar y capacitar al personal encargado de aplicar la ley, practicar una notificación sistemática transparente y trabajar por la concienciación de la población.

Two cases of eyelid tuberculosis - An uncommon presentation of ocular tuberculosis.

Mycobacterium tuberculosis apart from being the causative agent of pulmonary tuberculosis is also notorious to cause tuberculosis at various sites in the human body and ocular tuberculosis is one of the extra pulmonary manifestations of this organism. The most common presentation of ocular tuberculosis is anterior uveitis or choroiditis caused by hematogenous infection or hypersensitivity after another organ infection. Eyelid involvement by tuberculosis is most of the times secondary to orbital involvement and often seen in the form of drainage sinus. Isolated eyelid tuberculosis is however uncommon. Here we report two such cases of eyelid tuberculosis in different age groups; first case in a young female and second case of an old aged female with different presentation. Fortunately both of them responded well to the antitubercular treatment.

FATIGUE OF BIOMATERIALS: HARD TISSUES.

The fatigue and fracture behavior of hard tissues are topics of considerable interest today. This special group of organic materials comprises the highly mineralized and load-bearing tissues of the human body, and includes bone, cementum, dentin and enamel. An understanding of their fatigue behavior and the influence of loading conditions and physiological factors (e.g. aging and disease) on the mechanisms of degradation are essential for achieving lifelong health. But there is much more to this topic than the immediate medical issues. There are many challenges to characterizing the fatigue behavior of hard tissues, much of which is attributed to size constraints and the complexity of their microstructure. The relative importance of the constituents on the type and distribution of defects, rate of coalescence, and their contributions to the initiation and growth of cracks, are formidable topics that have not reached maturity. Hard tissues also provide a medium for learning and a source of inspiration in the design of new microstructures for engineering materials. This article briefly reviews fatigue of hard tissues with shared emphasis on current understanding, the challenges and the unanswered questions.

Aging and the reduction in fracture toughness of human dentin.

An evaluation of the crack growth resistance of human coronal dentin was performed on tissue obtained from patients between ages 18 and 83. Stable crack extension was achieved over clinically relevant lengths (0< or = a < or =1mm) under Mode I quasi-static loading and perpendicular to the nominal tubule direction. Results distinguished that human dentin exhibits an increase in crack growth resistance with extension (i.e. rising R-curve) and that there is a significant reduction in both the initiation (K(o)) and plateau (K(p)) components of toughness with patient age. In the young dentin (18< or =age< or =35) there was a 25% increase in the crack growth resistance from the onset of extension (K(o)=1.34 MPa m(0.5)) to the maximum or "plateau" toughness (K(p)=1.65 MPa m(0.5)). In comparison, the crack growth resistance of the old dentin (55< or =age) increased with extension by less than 10% from K(o)=1.08 MPa m(0.5) to K(p)=1.17 MPa m(0.5). In young dentin toughening was achieved by a combination of inelastic deformation of the mineralized collagen matrix and microcracking of the peritubular cuffs. These mechanisms facilitated further toughening via the development of unbroken ligaments of tissue and posterior crack-bridging. Microstructural changes with aging decreased the capacity for near-tip inelastic deformation and microcracking of the tubules, which in turn suppressed the formation of unbroken ligaments and the degree of extrinsic toughening.

An examination of fatigue striations in human dentin: in vitro and in vivo.

Although striations are often used in evaluating fatigue crack growth in engineering materials, they have not been used in studying the mechanics of fracture in hard tissues. The primary objective of this study was to evaluate the striations resulting from fatigue crack growth in the dentin of human teeth. Compact tension (CT) specimens obtained from the coronal dentin of molars from young (17 < or = age < or = 37 years) and senior (age > or = 50 years) patients were subjected to cyclic Mode I loads. Striations evident on the fracture surfaces were examined using a scanning electron microscope (SEM) and contact profilometer. Fatigue crack growth striations that developed in vivo were also examined on fracture surfaces of restored molars. A power spectrum analysis of surface profiles from the CT specimens showed that the striation spacing ranged from 50 to 170 microm. The average spacing in the dentin of seniors (130 +/- 23 microm) was significantly larger (p < 0.001) than that in young dentin (88 +/- 13 microm). Fatigue striations in the restored teeth exhibited features that were consistent with those that developed in vitro and a spacing ranging from 59 to 95 microm. Unlike metals, the striations in dentin developed after a period of cyclic loading that ranged from 1 x 10(3) to 1 x 10(5) cycles. A quantitative evaluation of the striation spacing using the Bates-Clark equation suggested that cyclic crack growth within the restored teeth occurred at a stress intensity range near 0.7 MPa x m(0.5), and a stress range of approximately 12 MPa.

Transition behavior in fatigue of human dentin: structure and anisotropy.

The influence of tubule orientation on the transition from fatigue to fatigue crack growth in human dentin was examined. Compact tension (CT) and rectangular beam specimens were prepared from the coronal dentin of molars with three unique tubule orientations (i.e., 0 degrees , 45 degrees and 90 degrees). The CT specimens (N=25) were used to characterize fatigue crack initiation and steady-state cyclic extension, whereas the rectangular beams (N=132) were subjected to 4-pt flexure and used in quantifying the stress-life fatigue response. The transition behavior was analyzed using both the Kitagawa-Takahashi and El Haddad approaches. Results showed that both the fatigue crack growth and stress-life responses were dependent on the tubule orientation. The average Paris Law exponent for crack growth perpendicular (90 degrees) to the tubules (m=13.3+/-1.1) was significantly greater (p<0.05) than that for crack growth oblique (45 degrees) to the tubules (m=11.5+/-1.87). Similarly, the fatigue strength of dentin with 90 degrees tubule orientation was significantly lower (p<0.05) than that for the other two orientations, regardless of the range of cyclic stress. The apparent endurance strengths of specimens with 0 degrees (44MPa) and 45 degrees (53MPa) orientations were nearly twice that of the 90 degrees (24MPa) orientation. Based on these results, human dentin exhibits the largest degree of anisotropy within the stress-life regime and the transition from fatigue to fatigue crack growth occurs under the lowest cyclic stress range when the tubules are aligned with the cyclic normal stress (90 degrees orientation).