Assessment of Nursing Staff's Knowledge, Attitude and Practice Regarding Oral Hygiene Care in Intensive Care Unit Patients: A Multicenter Cross-sectional Study.

Background: Oral care is one of the fundamental nursing care procedures used to decrease oral colonization, dental plaque, respiratory infections, patient stay, and cost. The importance of good oral hygiene for patients in intensive care units (ICUs) is well recognized, however, the most effective way to achieve good oral care in the ICU is unclear. Therefore, the aim of this study was to assess the knowledge, attitude, and practice of nursing professionals regarding oral healthcare in ICUs among various medical institutes across India. Materials and methods: A questionnaire-based multicentric cross-sectional survey was conducted among registered nursing professionals employed at ICUs of three government tertiary healthcare centers (THC) of India: THC-I, THC-II, and THC-III located in the eastern and northern parts of India between February 2022 and July 2022. Results: A total of 150 nurses completed the questionnaire form (response rate: 62.5%) comprised of 49 (32.7%) males and 101 (67.3%) females with a mean age of 35.69 ± 7.7 years. Nursing officers' knowledge surpassed that of staff nurses regarding the duration of toothbrushing (p = 0.033). Among interinstitutional comparisons, THC-I nurses showed the greatest knowledge regarding the duration of toothbrushing and the mechanism of preventing saliva accumulation to reduce microbial growth (p = 0.013 and p = 0.003, respectively). Based on total work experience, participants were segregated into three groups: Group I (<7 years), group II (7.1-13.9 years), and group III (>14 years). Group II surpassed the knowledge of denture removal during sleep, cleaning after every meal, and storing in personalized air-tight containers (p = 0.001 and p = 0.036, respectively). The majority from group II recommended plain saline as the material for oral hygiene maintenance in ICU patients (p = 0.008). Group III predominantly practiced the ideal handwashing technique pre- and post-patient contact which was statistically significant (p = 0.001). Conclusion: This study observed that a knowledge gap exists among the nurses of the three institutes across India pertaining to the oral hygiene care of ICU patients. Nurse's education and implementation of the proper oral hygiene measures for intubated patients in ICU setup is an essential need. How to cite this article: Kumar S, Singh B, Mahuli AV, Kumar S, Singh A, Jha AK. Assessment of Nursing Staff's Knowledge, Attitude and Practice Regarding Oral Hygiene Care in Intensive Care Unit Patients: A Multicenter Cross-sectional Study. Indian J Crit Care Med 2024;28(1):48-57.

Unusual Case of Secondary Pneumothorax in a Patient of Allergic Bronchopulmonary Aspergillosis (ABPA).

Pulmonary aspergillosis is a well-recognized fungal lung disease caused by the Aspergillus species (especially Aspergillus fumigatus). Allergic bronchopulmonary aspergillosis (ABPA) is milder form of pulmonary aspergillosis compared to other more invasive forms. However, if left untreated, ABPA can cause significant lung damage. We present the case of a 33-year-old man who came with complaints of shortness of breath, chest discomfort, and productive cough. The patient underwent High Resolution Computed Tomography (HRCT) scan of the chest which, suggested the diagnosis of ABPA with secondary tension pneumothorax.

Management of Hypertension in Patients with Diabetes: A Comprehensive Review of the Perceptions and Practices of Health Care Providers in India.

OBJECTIVES: This study evaluated the perception and practices of health care providers (physicians, diabetologists, and endocrinologists) regarding the treatment of hypertension in patients with diabetes in India. METHODS: Health care providers throughout India who treated patients with diabetes and hypertension were invited to participate in an online survey and periodic 21 virtual meetings. They were questioned about their perception and practices in managing these patients, and strategies to improve blood pressure (BP). RESULTS: The online survey was completed by 2,513 health care providers, and 344 participated in virtual meetings. More than 50% reported that 31-50% of their patients with diabetes also had hypertension. Home BP monitoring was recommended by 88%, and lifestyle modifications were consistently recommended. Choice of antihypertensive treatment varied based on comorbidities, and a renin-angiotensin system blocker plus a calcium channel blocker (CCB) was the most common combination for dual antihypertensive therapy. Suggested strategies to improve BP control included patient awareness/education, lifestyle modifications, better follow-up/monitoring, and optimization of therapy. CONCLUSION: Indian health care providers were aware of clinical recommendations and practices regarding treatment of patients with diabetes and hypertension, and generally make clinical decisions consistent with current guidelines. Optimization of care for these patients is essential to reduce cardiovascular disease risk and improve patient outcomes.

Quantitative Analysis of Publication Trends in the Journal of Indian Prosthodontic Society between 2011 and 2020.

AIM: To analyze quantitatively the trends in publication and compare the scientific content published during 2011-2015 and 2016-2020. MATERIALS AND METHODS: An online search for all the different manuscripts published from 2011 to 2020 was performed electronically on the website of the Journal of Indian Prosthodontic Society (JIPS). The manuscripts were grouped into the following broader categories: Author, article grouping, original article subtype, prosthetic division, and statistical analysis. RESULTS: The authors from private institutions showed higher publication trends than the authors from government institutions. The period 2016-2020 showed a higher number of publications with four or more authors. There was more original research published, followed by case reports. There was an increasing trend in a systematic review during 2016-2020 as compared to the period 2011-2015. There were a greater number of in vitro experimental studies published with a comparison of the means in the statistical analysis. There was more publication on materials and technology, followed by implants in the prosthetic division of articles. CONCLUSION: The analysis shows the overall progress of the journal explains the characteristics of the authors involved in the research, highlights the types of research done, statistical methods used, and important areas of research and trends in research in prosthodontics at a national level. CLINICAL SIGNIFICANCE: The publication trends will focus on the research thrust areas and the type of research done in the specialty, pointing out the gaps in the research and identifying the future course of action for authors and journals. It also helps for comparison with international publication trends in prosthodontics and provides information to prospective authors to focus research on the priority areas of the concerned journal for better acceptance.

SARS-CoV-2 prevalence and maternal-perinatal outcomes among pregnant women admitted for delivery: Experience from COVID-19-dedicated maternity hospital in Jammu, Jammu and Kashmir (India).

The impact of SARS-CoV-2 infection in pregnant women and their neonates is an area of research interest nowadays. To date, there is limited knowledge about SARS-CoV-2 prevalence, maternal and perinatal outcomes of pregnant women at term in middle- and low-income countries. In the present retro-prospective study, medical records of pregnant women admitted for delivery were reviewed from the largest Covid-19 dedicated Shri Maharaja Gulab Singh (SMGS) maternity hospital. The SARS-CoV-2 screening was carried out for all pregnant women admitted for delivery using RT-PCR. All neonates born from SARS-CoV-2-positive mothers were isolated and tested for SARS-CoV-2 infection. Most of the pregnant women (90.6%) were asymptomatic at the time of admission with a low prevalence (3.4%) of SARS-CoV-2. A higher rate of asymptomatic prevalence (86.1%) was found among SARS-CoV-2-positive pregnant women. On the basis of the RT-PCR result (negative vs. positive), statistically significant differences were found for maternal characteristics, such as mean gestational age (37.5 ± 2.2 vs. 36.6 ± 3.3), medical comorbidity (2.9% vs. 7.4%), and maternal outcomes like the C-section rate (29.8% vs. 58.3%), preterm delivery (14.6% vs. 28.3), and neonatal outcomes like mean birth weight (2840 ± 450 vs. 2600 ± 600), low Apgar score (2.7% vs. 6.48%), and fetal distress (10.9% vs. 22.2%) among SARS-CoV-2 negative and positive cases, respectively. No neonate from SARS-CoV-2-positive pregnant women was found to be positive for SARS-CoV-2 infection.

Correlation between Radiomorphometric Indices and Edentulous Mandibular Arches to Diagnose Osteoporosis Using Orthopantomogram in West Bengal State in India.

AIM: To assess the influence of gender and age on different parameters of alveolar bone loss using orthopantomogram. MATERIALS AND METHODS: Eighty subjects were enrolled in the study (20 dentulous and 60 completely edentulous), fulfilling the inclusion and exclusion criteria. Completely edentulous subjects were divided into four groups (15 males and 15 females above 60 years) and (15 males and 15 females below 60 years). Dentulous group comprised 20 subjects (10 males and 10 females) between 41 and 75 years. After taking panoramic radiographs, vertical as well as horizontal reference lines were drawn. The parameters used for evaluation included mandibular cortical index (MCI), inferior mandibular cortical width (MCW), panoramic mandibular index (PMI), alveolar bone loss (ABL), and height of bone at first premolar (Hp) and first molar (Hm) of the mandible. RESULTS: There was significant association between MCI and age for females with C2 and C3 categories being more common with advancing age. MCW was stable in all groups, except in females above 60 years of age. PMI and ABL were nonsignificant for age and gender. Although the average values of bone height (Hm and Hp) for males were higher than those of females, the results were statistically insignificant. CONCLUSION: Panoramic radiographic measurements could provide much valuable information and could help in evaluating patients with a low bone mineral density (BMD) with a few limitations. CLINICAL SIGNIFICANCE: Dental professionals could screen the patients through panoramic radiographs taken during routine clinical examination, which could help in identifying patients with a low BMD so that further treatment could be initiated early and thus to prevent a pathologic fracture.

Transhepatic intraperitoneally migrated biliary stent: A rare finding during laparoscopic cholecystectomy.

Biliary endoprostheses are increasingly being utilised across both the developing and developed world, due to growing access to endoscopic biliary stenting. Stent migration, a well-documented complication of this minimally invasive procedure, occurs in up to 10% of cases post-insertion, sometimes leading to catastrophic complications. While distal migration frequently leads to spontaneous passage of the stent, proximal migration can result in a variety of problems. We here describe a rare case of transhepatic intraperitoneal migration of a double-pigtail, plastic stent and present a comprehensive review of literature.

Routine versus Selective Fortification of Human Milk with Powdered Human Milk Fortifiers in Very Low Birth Weight (VLBW) Preterm Infants: A Retrospective Pre-Post Cohort Study.

OBJECTIVES: The objective of this study was to show the effects of routine vs. selective fortification of human milk (HM) on short-term growth and metabolic parameters. METHODS: Single-centre retrospective pre-post cohort study in India. Preterm infants ≤32 weeks' gestation and weighing ≤1500 g were included. Routine fortification: pre-fixed feed volume (100 ml/kg/day in our unit) at which fortification was done. Selective fortification: feed volume was gradually optimized till 180-200 ml/kg/day. If weight gain was below the expected threshold (<10 g/kg/day), then fortification was considered. Primary outcome measure was rate of growth till discharge. RESULTS: The median rate of weight gain (g/kg/day) in the routine fortification group [10.8 (3.3, 17.1)] was comparable with that in the selective fortification group [8.4 (0, 14.2), p = 0.6]. Serum phosphorus showed a significantly higher value (5.9 vs. 4.8, p = 0.03), while rest of the metabolic parameters showed a trend towards a favourable outcome in the selective fortification group. Adverse outcomes showed a trend towards decreased feed intolerance, necrotizing enterocolitis, and sepsis in the selective fortification group. CONCLUSIONS: Selective fortification had a comparable growth rate and showed a trend towards better metabolic parameters and lesser adverse outcomes compared with routine fortification of HM.

Experience of Perinatal and Neonatal Chikungunya Virus (CHIKV) Infection in a Tertiary Care Neonatal Centre during Outbreak in North India in 2016: A Case Series.

BACKGROUND: In 2016, there was a massive outbreak of chikungunya in North India. During the epidemic, we observed many neonatal and early infantile cases of chikungunya, with a probable perinatal transmission. METHODS: This retrospective study was carried out in a tertiary care neonatal centre between August 2016 and November 2016. Chikungunya virus (CHIKV) infection was detected and confirmed by reverse transcription-polymerase chain reaction (RT-PCR) and/or serology (anti-CHIKV IgM) in mothers and infants. Clinical features and laboratory parameters were recorded. RESULTS: There were 16 cases of confirmed CHIKV infections during the study period. For babies presenting during the neonatal period (n = 13), the median age of presentation was 9.5 (range: 3-15) days, whereas for babies (three) presenting after the neonatal period, the median age was between 1 and 3 months. The most common presentation was fever (69%), followed by lethargy (56%) and seizures (50%). Skin manifestations were observed in 25% of the cases, which included maculopapular rashes, bullous lesions and hyperpigmentation over the axilla, perioral and genital areas. None of the cases had any feature of arthritis. Of all the cases included in the study (n = 16), RT-PCR for CHIKV was positive in 14 (87.5%), whereas the serum anti-CHIKV IgM antibody test was positive in two (12.5%) cases. Six (37.5%) cases were documented as perinatal CHIKV, as RT-PCR for CHIKV was positive in both mothers and babies. Fifteen babies survived and were discharged in a stable condition with no oxygen requirement and on full feeds. One baby died because of multi-organ failure and catecholamine refractory hypotension. CONCLUSION: In endemic areas, paediatricians should have a low threshold of suspicion for perinatal or neonatal chikungunya in any infant presenting with signs and symptoms mimicking sepsis, especially with skin manifestations, seizure and/or encephalopathy.

Cerebral Venous Sinus Thrombosis and Posterior Reversible Encephalopathy Syndrome Coexisting in a Woman: A Rare Coincidence.

Cerebral venous sinus thrombosis (CVST) and posterior reversible encephalopathy syndrome (PRES) are two rare diseases which may present with similar symptoms and signs. We report a case with coexisting PRES and CVST in a 34 years old postpartum female presented with multiple episodes of generalized seizures and bilateral vision loss after delivery. MRI brain and venography revealed left transverse sinus, sigmoid sinus and internal cerebral vein thrombosis with vasogenic edema in bilateral parieto-occipital, right temporal and left frontal area, which was suggestive of posterior reversible encephalopathy syndrome (PRES). She was treated with antihypertensive, low molecular weight heparin (LMWH), oral anticoagulant and responded well to the treatment.

Antimicrobial resistance and typing of Salmonella isolated from street vended foods and associated environment.

The present study was carried out to find out the occurrence and types of Salmonella present in street vended foods and associated environment, and their resistance pattern against various antibiotics. About 1075 street vended food and associated environment samples were processed for isolation and confirmation of different Salmonella spp. by targeting gene specific invA gene and serotype specific Sdf I, Via B and Spy genes by PCR. Selected Salmonella isolates were screened for antibiotic resistance by using Baeur-Kirby disk diffusion test. Out of 1075 samples, only 31 (2.88%) isolates could be amplified the invA gene of which 19 could be recovered from meat vendors; 8 from egg vendors while remaining 4 from milk vendors. Though, majority of Salmonella recovered from raw foods the ready-to-eat food like chicken gravy and rasmalai also showed its presence which pose a serious public health threat. Overall, 19, 6 and 1 isolates of S. Typhimurium, S. Enteritidis and S. Typhi could be detected by PCR while remaining 5 isolates could not be amplified suggesting other type of Salmonella. Selected Salmonella isolates were completely resistance to Oxacillin (100%) followed by Cefoxitin (30.43%) and Ampicillin (26.10%). Thus, it is observed that the street vended foods of animal origin and associated environment play an important role in transmission of food borne pathogens including Salmonella.

Molecular cloning, sequence characterization and recombinant expression of Nanog gene in goat fibroblast cells using lentiviral based expression system.

Nanog is a homeodomain containing protein which plays important roles in regulation of signaling pathways for maintenance and induction of pluripotency in stem cells. Because of its unique expression in stem cells it is also regarded as pluripotency marker. In this study goat Nanog (gNanog) gene has been amplified, cloned and characterized at sequence level with successful over-expression in CHO-K1 cell line using a lentiviral based system. gNanog ORF is 903 bp long which codes for Nanog protein of size 300 amino acids (aas). Complete nucleotide sequence shows some evolutionary mutation in goat in comparision to other species. Protein sequence of goat is highly similar to other species. Overall, gNanog nucleotide sequence and predicted protein sequence showed high similarity and minimum divergence with cattle (96 % identity/4 % divergence) and buffalo (94/5 %) while low similarity and high divergence with pig (84/15 %), human (81/23 %) and mouse (69/40 %) indicating evolutionary closeness of gNanog to cattle and buffalo. gNanog lentiviral expression construct was prepared for over-expression of Nanog gene in adult goat fibroblast cells. Lentiviral expression construct of Nanog enabled continuous protein expression for induction and maintenance of pluripotency. Western blotting revealed the expression of Nanog gene at protein level which supported that the lentiviral expression system is highly promising for Nanog protein expression in differentiated goat cell.

Ag nanoparticles-anchored reduced graphene oxide catalyst for oxygen electrode reaction in aqueous electrolytes and also a non-aqueous electrolyte for Li-O2 cells.

Silver nanoparticles-anchored reduced graphene oxide (Ag-RGO) is prepared by simultaneous reduction of graphene oxide and Ag(+) ions in an aqueous medium by ethylene glycol as the reducing agent. Ag particles of average size of 4.7 nm were uniformly distributed on the RGO sheets. Oxygen reduction reaction (ORR) is studied on Ag-RGO catalyst in both aqueous and non-aqueous electrolytes by using cyclic voltammetry and rotating disk electrode techniques. As the interest in non-aqueous electrolyte is to study the catalytic performance of Ag-RGO for rechargeable Li-O2 cells, these cells are assembled and characterized. Li-O2 cells with Ag-RGO as the oxygen electrode catalyst are subjected to charge-discharge cycling at several current densities. A discharge capacity of 11 950 mA h g(-1) (11.29 mA h cm(-2)) is obtained initially at low current density. Although there is a decrease in the capacity on repeated discharge-charge cycling initially, a stable capacity is observed for about 30 cycles. The results indicate that Ag-RGO is a suitable catalyst for rechargeable Li-O2 cells.

Production of tannase under solid-state fermentation and its application in detannification of guava juice.

Guava juice is known to be rich in antioxidant activity due a high level of vitamins A and C. However, tannins present in the guava juice form tannin-protein complexes that affect the utilization of vitamins and minerals and inhibit digestive enzymes. Beside this, bitterness and cloudiness are the other major problems of juice industries. The present study aimed to utilize a low-cost substrate (tea residue) for the production of tannase and its application in detannification of guava juice. Solid-state fermentation (SSF) was evaluated to produce tannase from Aspergillus niger. Maximum tannase (1.86 U/g dry substrate) production was observed at 30°C after 96 hr of the incubation period. The optimum pH of the moistening agent was found to be 5.0. Partially purified enzyme using ammonium sulfate precipitation was subjected to guava juice treatment at a level of 0.5, 1.0, and 2.0% for 30 and 60 min. Decrease in tannic acid content of guava juice was found to be 17.60, 29.04, and 44.38% after 30 min and 40.59, 53.69, and 59.23% after 60 min, respectively.

Simultaneous detection of major pome fruit viruses and a viroid.

A rapid and sensitive two-step RT-PCR protocol for simultaneous detection of major apple viruses, namely Apple mosaic virus (ApMV), Apple stem pitting virus (ASPV), Apple stem grooving virus (ASGV), Apple chlorotic leaf spot virus (ACLSV) and Apple scar skin viroid (ASSVd), was developed. Five specific primer pairs were tested and confirmed for these viruses and viroid together in a single tube, giving amplicons of ~198, ~330, ~370, ~547 and ~645 bp corresponding to ASGV, ASSVd, ASPV, ApMV and ACLSV, respectively. Using a guanidinium-based extraction buffer along with a commercial kit resulted in better quality RNA as compared to kit, suited for multiplex RT-PCR. A rapid CTAB method for RNA isolation from apple tissue was developed, which produce good yield and saves time. To the best of our knowledge, this is the first report on the simultaneous detection of five pathogens (four viruses and a viroid) from apple with NADH dehydrogenase subunit 5 (nad5) as an internal control.

An in vitro study of the bond strength of five adhesives used for vinyl polysiloxane impression materials and tray materials.

Although stock trays often provide mechanical retention for elastomeric impression materials, manufacturers typically recommend the use of an adhesive, whether a stock or custom tray is used. The mention of the bond strength on the adhesive packaging is not available, therefore the clinician has no idea whatsoever of the ideal adhesive. The aim of this study was to evaluate the bond strength of three vinyl polysiloxane (VPS) materials, one with a poly(methyl methacrylate) autopolymerizing (PMMA) specimen and another with a light-polymerizing tray material (VLC), using the adhesive recommended by the manufacturer of the impression material, and two universal adhesives. A total of ninety specimens (15 × 15 × 20 mm) were used, 45 specimens were made in PMMA and rest 45 was made in VLC. Five paint-on adhesives (Coltene, Caulk, 3M, universal Zhermack and universal GC) were applied. Three impression materials, Affinis, Reprosil, and 3M, were mixed and injected into a perforated poly vinyl chloride cylinder. Tray specimens were positioned against the open cylinder end in contact with the VPS material. Tensile strength tests were conducted until adhesive separation failure. Mean values and standard errors of the adhesive strength were recorded in MPa for each material combination. GC paint-on universal adhesive provided significantly higher adhesive strength values.

In situ growth of a redox-active metal-organic framework on electrospun carbon nanofibers as a free-standing electrode for flexible energy storage devices.

The rational construction of free-standing and flexible electrodes for application in electrochemical energy storage devices and next-generation supercapacitors is an emerging research focus. Herein, we prepared a redox-active ferrocene dicarboxylic acid (Fc)-based nickel metal-organic framework (MOF) on electrospun carbon nanofibers (NiFc-MOF@CNFs) via an in situ approach. This in situ approach avoided the aggregation of the MOF. The NiFc-MOF@CNF flexible electrode showed a high redox-active behavior owing to the presence of ferrocene and flexible carbon nanofibers, which led to unique properties, including high flexibility and lightweight. Furthermore, the prepared electrode was utilized in a supercapacitors (SC) without the use of any binder, which achieved a specific capacity of 460 C g-1 at 1 A g-1 with an excellent cyclic retention of 82.2% after 25 000 cycles and a good rate capability. A flexible asymmetric supercapacitor device was assembled, which delivered a high energy density of 56.25 W h kg-1 and a long-lasting cycling performance. Also, the prepared electrode could be used as a freestanding electrode in flexible devices at different bending angles. The obtained cyclic voltammetry curves showed negligible changes, indicating the high stability and good flexibility of the electrode. Thus, the use of the in situ strategy can lead to the uniform growth of redox-active MOFs or other porous materials on CNFs.

Analysis of the Microstructural and Mechanical Properties of 3D-Printed Removable Partial Denture Base Materials.

Background: Recent advancements in three-dimensional (3D) printing have introduced novel materials for removable partial dentures (RPD) base fabrication, promising improved mechanical properties, and biocompatibility. Materials and Methods: In this study, three different RPD base materials were evaluated: conventional heat-cured acrylic resin (Control), biocompatible 3D-printed resin (Test Group A), and a novel nanocomposite 3D-printed resin (Test Group B). A total of 30 standardized RPD base specimens (n = 10 per group) were fabricated according to established protocols. Microstructural analysis was performed using scanning electron microscopy (SEM), and the mechanical properties, including flexural strength and modulus, were determined using a universal testing machine. Results: Microstructural analysis revealed distinct differences among the materials. SEM images showed a well-defined and homogeneous microstructure in Test Group B, while Test Group A exhibited fewer voids compared to the Control group. Mechanical testing results indicated that Test Group B had the highest flexural strength (120 ± 5 MPa), followed by Test Group A (90 ± 4 MPa), and the Control group (75 ± 3 MPa). Similarly, Test Group B demonstrated the highest flexural modulus (3.5 ± 0.2 GPa), followed by Test Group A (2.8 ± 0.1 GPa), and the Control group (2.1 ± 0.1 GPa). Conclusion: These findings suggest that 3D-printed RPD base materials, particularly nanocomposite resins, hold promise for improving the overall quality and durability of removable partial dentures.

A Preliminary Report of Maximum Voluntary Bite Force of Young Indian Population.

Introduction: The measurement of bite force is increasingly gaining importance in dentistry. This preliminary report evaluates the maximum voluntary bite force (MVBF) of young healthy individuals with normal occlusion and correlates the effect of age and gender with the maximum bite force (MBF). Materials and Methods: 405 participants in the age group of 18 to 40 years were selected from the outpatient department meeting inclusion and exclusion criteria. MVBF was measured with the help of a digital device called "Byte" at incisors, right first molar, and left first molar region. Results: There was a strong correlation between age with bite force. Bite force increased with age. Males had more bite force than females. The posterior region had higher bite force than the anterior region. Conclusion: Measurement of bite force is very important for every patient undergoing restorative treatment. The "Byte" device was found to be very efficient.