Frontal fibrosing alopecia: survey of severity assessment methods in routine clinical practice and validation of the International Frontal Fibrosing Alopecia Cooperative Group measurement guidance.

BACKGROUND: The lack of validated and responsive outcome measures in the management of frontal fibrosing alopecia (FFA) significantly limits assessment of disease progression and treatment response over time. AIM: To understand how FFA extent and progression is currently assessed in UK specialist centres, to validate components of the International FFA Cooperative Group (IFFACG) statement on FFA assessment, and to identify pragmatic advice to improve FFA management in clinic. METHODS: Consultant dermatologists with a specialist interest in hair loss (n = 17) were invited to take part. Preferred FFA assessment methods were explored using questionnaires and clinical scenarios. Participants were asked to identify and mark the current hairline in 10 frontal and 10 temporal hairline images (Questionnaire 1), with assessment repeated 3 months later to assess intraindividual variability (Questionnaire 2) and 12 months later to test whether interindividual accuracy could be improved with simple instruction (Questionnaire 3). RESULTS: All 17 clinicians (100%) completed the questionnaire at each time interval. We identified a wide variation in assessment techniques used by our experts. Measurements were perceived as the most accurate method of assessing frontal recession whereas photography was preferred for temporal recession. Inter-rater reliability between clinicians measuring the frontal hairline scenarios indicated a moderate strength of agreement [intraclass coefficient (ICC) = 0.61; 95% CI 0.40-0.85], yet intrarater reliability was found to be poor with wide limits of agreement (-8.71 mm to 9.92 mm) on follow-up. Importantly, when clear guidance was provided on how the hairline should be identified (Questionnaire 3), inter-rater reliability improved significantly, with ICC = 0.70, suggesting moderate agreement (95% CI 0.51-0.89; P < 0.001). A similar pattern was seen with temporal hairline measurements, which again improved in accuracy with instruction. CONCLUSION: We found that accuracy of measurements in FFA can be improved with simple instruction and we have validated components of the IFFACG measurement recommendations.

Assessment of Agaricus Bisporus S-II Extract as a Bio-Controlling Agent against Human Pathogenic Bacterial Species.

Agaricus bisporus mushrooms are well known for their nutritional and medicinal values. A. bisporus is a source of protein (about 40% on a dry basis), ergosterol, several minerals, carbohydrate, and fat. The present study was conducted to investigate the effect of A. bisporus S-II extracts on human pathogenic bacteria in-vitro condition. Totally, three human pathogenic bacterial strains (MTCC culture type) were procured from the Institute of Microbial Technology, India. Out of these three bacterial strains, one was Gram-negative (namely P. aeruginosa MTCC741), and the other two were Gram-positive (B. cereus MTCC9786 and S. aureus MTCC740). Microdilution assay was applied for the evaluation of the minimum inhibitory concentration (MIC). The highest antimicrobial activity was observed in methanol extract (26.5%) against S. aureus MTCC740, compared to ethanol extract (17%). Similar results were obtained for P. aeruginosa MTCC741 (21.8%) and B. cereus MTCC9786 (15%) in methanol extract. Least microbial growth inhibition observed for B. cereus MTCC9786 (13.82%) followed by P. aeruginosa MTCC741 (14%), compared to control in ethanol extract. The highest antimicrobial activity up to 17% with ethanolic extracts recorded against S. aureus MTCC740. The MIC results in microtitre plates showed the growth inhibition of P. aeruginosa MTCC741 and S. aureus MTCC740 at extract concentrations of 15 mg/ml and 20 mg/ml, respectively. However, no MIC detected for B. cereus MTCC9786 below 20 mg/ml extract concentration. Regarding minimum bactericidal concentration, the bactericidal value for P. aeruginosa MTCC741 and S. aureus MTCC740 was obtained at 10 mg/ml concentration. The present study indicated that the extracts of the A. bisporus S-II mushrooms had promising antimicrobial activities against the tested organisms.

Market assessment of tuberculosis diagnostics in India in 2013.

BACKGROUND: India represents a significant potential market for new tests. We assessed India's market for tuberculosis (TB) diagnostics in 2013. METHODS: Test volumes and unit costs were assessed for tuberculin tests, interferon-gamma release assays, sputum smear microscopy, serology, culture, speciation testing, nucleic-acid amplification tests (i.e., in-house polymerase chain reaction, Xpert(®) MTB/RIF, line-probe assays) and drug susceptibility testing. Data from the public sector were collected from the Revised National TB Control Programme reports. Private sector data were collected through a survey of private laboratories and practitioners. Data were also collected from manufacturers. RESULTS: In 2013, India's public sector performed 19.2 million tests, with a market value of US$22.9 million. The private sector performed 13.6 million tests, with a market value of US$60.4 million when prices charged to the patient were applied. The overall market was US$70.8 million when unit costs from the ingredient approach were used for the 32.8 million TB tests performed in the entire country. Smear microscopy was the most common test performed, accounting for 25% of the overall market value. CONCLUSION: India's estimated market value for TB diagnostics in 2013 was US$70.8 million. These data should be of relevance to test developers, donors and implementers.

Comparison of reliability of lateral cephalogram and computed tomography for assessment of airway space.

BACKGROUND AND AIMS: The oropharyngeal (OP) and nasopharyngeal structures seems to play roles in the development of the dentofacial complex. Soft palate as a part of nasopharyngeal and OP apparatus has an important role in phonation, deglutition and respiration. The aim of this study was to find whether any correlation exists between the three types of malocclusion and airway space using lateral cephalogram and computed tomography (CT) and to compare its reliability. To obtain important information on the morphology of the soft palate on lateral cephalogram and to determine its etiopathogenesis in obstructive sleep apnea (OSA). MATERIALS AND METHODS: Lateral cephalogram of 45 subjects were used to measure the pharyngeal airway. The subjects were divided into three groups (each group included 15 subjects) according to ANB angle: Class I (ANB angle 2-4°), Class II (ANB angle > 4°), Class III (ANB angle ≤ 2°). RESULTS: The result showed a significant reduction in pharyngeal airway in ANB Class II. Type I soft palate, leaf-shape was found in maximum subjects. The volume of airway size showed higher statistical significance with the greater coefficient of variation on CT in relation to corresponding cephalometric airway area. CONCLUSION: The sagittal skeletal pattern is a contributory factor in variations in the upper airway dimensions. The measurements acquired from both the modalities are reliable and reproducible, but CT gives the better assessment of cross-sectional dimensions of airway space. Morphology of the soft palate can be used as references for etiological research of OSA.

Imidazo[1,2-a]pyrazine inhibitors of phosphoinositide 3-kinase alpha (PI3Kα): 3D-QSAR analysis utilizing the Hybrid Monte Carlo algorithm to refine receptor-ligand complexes for molecular alignment.

Phosphoinositide 3-kinase alpha (PI3Kα) is a lipid kinase involved in several cellular functions such as cell growth, proliferation, differentiation and survival, and its anomalous regulation leads to cancerous conditions. PI3Kα inhibition completely blocks the cancer signalling pathway, hence it can be explored as an important therapeutic target for cancer treatment. In the present study, docking analysis of 49 selective imidazo[1,2-a]pyrazine inhibitors of PI3Kα was carried out using the QM-Polarized ligand docking (QPLD) program of the Schrödinger software, followed by the refinement of receptor-ligand conformations using the Hybrid Monte Carlo algorithm in the Liaison program, and alignment of refined conformations of inhibitors was utilized for the development of an atom-based 3D-QSAR model in the PHASE program. Among the five generated models, the best model was selected corresponding to PLS factor 2, displaying the highest value of Q(2)test (0.650). The selected model also displayed high values of r(2)train (0.917), F-value (166.5) and Pearson-r (0.877) and a low value of SD (0.265). The contour plots generated for the selected 3D-QSAR model were correlated with the results of docking simulations. Finally, this combined information generated from 3D-QSAR and docking analysis was used to design new congeners.

Evaluation of disease activity in rheumatoid arthritis by Routine Assessment of Patient Index Data 3 (RAPID3) and its correlation to Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI): an Indian experience.

Serial objective assessment of disease activity in rheumatoid arthritis (RA) is imperative to achieve remission. Routine Assessment of Patient Index Data 3 (RAPID3), an index without formal joint counts, appears attractive for evaluation of disease activity in RA patients in a busy clinical setting. This study aims to evaluate correlation and agreement of RAPID3 with Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI) in RA patients. All patients completed a Multidimensional Health Assessment Questionnaire (MDHAQ) at each visit. A physician/assessor 28-joint count and erythrocyte sedimentation rate were completed in 200 literate patients with RA to score DAS28, CDAI, and RAPID3. RAPID3 includes the three MDHAQ patient self-report RA core dataset measures for physical function, pain, and patient global estimate. Proposed RAPID3 (range, 0-30) severity categories of high (>12), moderate (6.1-12.0), low (3.1-6.0), and near remission (≤3) were compared to DAS28 (0-10) activity categories of high (> 5.1), moderate (3.21-5.1), low (2.61-3.2), and remission (≤ 2.6), and CDAI (0-76) categories of >22, 10.1-22.0, 2.9-10.0, and ≤2.8. Statistical significance was analyzed using Spearman correlations, cross-tabulations, and kappa statistics. Comparison of RAPID3 with DAS28 and CDAI indicated Spearman rank-order correlation coefficients for DAS28 with RAPID3 of 0.910, and for CDAI with RAPID3 of 0.907, all highly significant (P < 0.001). There was substantial agreement between RAPID3 and DAS28 (kappa value = 0.634, P < 0.001) and also between RAPID3 and CDAI (kappa value = 0.690, P < 0.001). Overall, 89-94 % of patients who met DAS28 or CDAI moderate/high activity criteria met similar RAPID severity criteria and 84-88 % who met DAS28 or CDAI remission/low activity criteria also met similar RAPID criteria. RAPID3 scores provide similar quantitative information to DAS28 and CDAI, and hence, is an informative index for evaluation of disease activity in RA in busy clinical settings.

Impact of health centre availability on utilisation of maternity care and pregnancy outcome in a rural area of Haryana.

Six hundred married women of 15-45 years age group were interviewed in 4 villages of the district Ambala in Haryana. Impact of health centre (HC) availability on the knowledge, opinion and practices related to maternity care and pregnancy outcome was assessed after adjusting the effect of socio-economic status. Except 17 women (2.8%), everyone knew at least one correct purpose of antenatal care (ANC) and 98.2% women had contacted health staff for ANC. However, knowledge of the respondents about the components of ANC was found to be poor in study villages. Traditional birth attendants (TBAs) conducted delivery in 76.1% cases in sub-centre (SC), 75.6% in villages without a HC compared to 49.8% in primary health centre (PHC) village. However, preference for TBAs in PHC village was 14.9%, in SC village 33.5%, and in villages without HC 36.3% (p < 0.001). Among respondents having better awareness about ANC components, preference and utilisation of modern delivery attendants was found to be higher. For maternity illnesses, consultation rate of government functionaries was 67.9% in PHC village, 52.2% in SC village and 55.8% in villages without a HC. Perinatal mortality rate of 76.0/1000 births in villages without HC was not significantly different from the rate of 87.4/1000 in SC village but rate of 38.9/1000 in the PHC village was significantly lower (p < 0.01). Awareness and availability of modern maternity services were found to have significant influence on the health seeking behaviour and pregnancy outcome.

PIP: A survey conducted in four villages in Ambala district, Haryana state, India, assessed the impact of health care center (HCC) availability on the utilization of maternity care services and pregnancy outcomes. Interviewed were 600 married women with a delivery in the 2 years prior to the survey. One village had a primary HCC, one had a subcenter, and two did not have an HCC, but were within 5 km of such a facility. Overall, 98.2% of respondents had contacted health staff for antenatal care. High awareness of modern maternity care, defined as knowledge of more than 3 components of antenatal care, was present in 9.6% of respondents in the HCC village, 22.1% in the subcenter village, and 15.3% in villages without an HCC. 49.8% of deliveries in the primary HCC village, 76.1% in the subcenter village, and 75.6% in those without an HCC, were performed by a traditional birth attendant (TBA). Preference for a TBA-assisted delivery was expressed by 14.9%, 33.5%, and 36.3% of respondents, respectively (p 0.001). Both preference for and use of TBAs were lower among women with high awareness of the components of antenatal care. The consultation rate of government functionaries for maternal illnesses was 67.9% in the HCC village, 52.2% in the subcenter village, and 55.8% in villages without an HCC. The perinatal mortality rate in villages without an HCC (76/1000 births) was not significantly different from that in the village with a subcenter (87.4/1000), but was significantly higher than that in the village with an HCC (38.9/1000) (p 0.01). These findings indicate that awareness of and access to an HCC equipped with modern maternity facilities has a significant positive impact on the health-seeking behavior and pregnancy outcome of rural women.