Incidence of new onset dementia and health care utilization following spine fusions: A propensity score matching analysis.

BACKGROUND: Dementia following spine fusions is not described in the literature. Also, the impact of new onset dementia on long-term health care utilization is not described. The aim of our study was to define the incidence of new onset dementia and its long-term health care utilization in elderly patients. MATERIALS AND METHODS: MarketScan database were queried using the ICD-9/10 and CPT 4th edition, from 2001 to 2019. We included patients≥55 of age who underwent spine fusions with at least 5years follow-up. Outcomes were new onset dementia (>6months after the procedure) length of stay (LOS), discharge disposition, hospital readmissions, outpatient services, and medication refills. RESULTS: Of 45,129 patients who underwent spine fusions, 1283 patients (2.84%) were diagnosed to have new onset dementia. There was no difference in the reoperation rates among the dementia and non-dementia cohort at 1-, 2- and 5-years following the index procedure. Patients in the dementia cohort incurred higher number of hospital readmissions up to 5-years after the index procedure. In terms of combined index procedure and post-discharge utilization payments, significant differences were noted among the dementia vs. non-dementia cohorts at 5-years ($126,628 vs. $77,098), following the index procedure. CONCLUSION: Elderly age, higher comorbidities, Medicare insurance, multilevel lumbosacral fusions were identified as risk markers for developing dementia following spine fusions. Dementia resulted in significantly higher health care utilization with no increased rate of reoperations for up to 5-years following the index procedure.

A proposed "Radiological Evaluation Score for Bone Tumors" (REST): An objective system for assessment of a radiograph in patients with suspected bone tumor.

BACKGROUND: Although radiographs have been widely used in the evaluation of patients with suspected bone tumors, the lack of an objective radiological assessment method leads to a challenge in reaching correct diagnosis. The study aimed to propose a Radiological Evaluation Score for Bone Tumors (REST) which includes eight radiological factors [characteristics, content, cortical breach, distinctiveness, distribution, periosteal reaction, fracture, and soft tissue swelling] to form a single score along with its validation by multidisciplinary observers. METHODS: We reviewed the radiographs of 100 patients with a primary bone tumor which were selected at random from the database between January 2017 and January 2019 of a tertiary cancer center. Four reviewers (two orthopedic oncologists and two surgical oncologists) independently assessed the radiographs, based on the reporting system of REST. We constituted two groups according to the probable diagnosis of bone tumor (suspected benign tumor and suspected malignant tumor). RESULTS: The mean score in the suspected benign tumor group was 1.1 (range 0-3, 95% CI 0.8-1.3) and in malignant tumor group was 6.1 (range 2-8, 95% CI 5.8-6.4). A receiver operator characteristic (ROC) curve for REST was with a cutoff of 3.5, with the most diagnostic value area under curve (AUC) of 0.99. The sensitivity was 98% and specificity was 100% with a positive predictive value of 100% and a negative predictive value of 98%. The inter-observer correlation coefficient was 0.985 (p value < 0.05), and Fleiss kappa value for the prediction of the benign or malignant lesion was 0.97 (p value < 0.05). The characteristics and content of tumor, cortical erosion, distinctiveness, distribution, periosteal reaction, and soft tissue mass had a significant correlation with the aggressiveness of bone lesion p value < 0.05. CONCLUSIONS: The Radiological Evaluation Score for Bone Tumors (REST) is a structured reporting and objective method for the assessment of radiographs in patients with suspected bone tumors. This method is a reliable and helpful tool for clinicians in their outdoor patient department to differentiate a radiograph of a suspected benign tumor from a malignant bone tumor.

Assessment of non-point source of pollution using chemical mass balance approach: a case study of River Alaknanda, a tributary of River Ganga, India.

The low ionic concentration meltwaters of the rivers originating from the Himalayan glaciers play a significant role in diluting the high solute load emanating from Ganga plain catchments. Hence, any change in the qualitative and quantitative characteristics of the Himalayan tributaries of River Ganga under the changing climatic scenario will impact the hydrochemical parameters of River Ganga as well. Hydrochemical investigations have been carried out in the River Alaknanda, a tributary of River Ganga during the period September 2016-May 2018 and revealed that TSS and COD values were observed above the prescribed criteria limit of 10 mg/L for drinking purpose for river as prescribed by CPCB. The anions for all sampling sites and seasons were observed to be in decreasing order of HCO3- > SO42- > Cl- > NO3- and cations Ca2+ > Mg2+ > Na+ > K+. The weathering of rock forming minerals of drainage basin is responsible for the chemical composition of river water. HCO3- being the dominant anion in the study area accounts for its presence due to carbonate and silicate weathering. Ion exchange process controls the major ion chemistry of the river water. The assessment and management of non-point sources (NPS) pollution are difficult by any deterministic method and require a vast amount of data to compensate for their extent of contamination, in the account of their prevailing nature in response to hydrological processes and land use patterns. In the present investigation, the application of a simple chemical mass balance approach based on law of conservation of mass/matter has been applied on River Alaknanda, a tributary of River Ganga for measuring the chemical mass loadings of some selected water quality constituents, viz., major cations (sodium, potassium, calcium, magnesium, and ammonium) and major anions (chloride, sulfate, nitrate, and phosphate) at upstream and downstream of different point source locations for examining the contribution made by non-point sources of pollution to the river. Time series analysis of various ion concentrations at point source sites and upstream/downstream sites inferred that the fluvial variations pertaining to ion concentration and flux are strongly dependent on the seasonal changes. More contribution (> 30-50%) for almost all constituents from uncharacterized sources was observed in the months of November to February, which may be attributed to intensified agricultural activities during the winter months particularly cereals and vegetables.

Role of 18F-FDG PET/CT in the Assessment of Response to Antitubercular Chemotherapy and Identification of Treatment Endpoint in Patients With Tuberculosis of the Joints: A Pilot Study.

AIMS: The aim of this study was to explore the utility of 18F-FDG PET/CT in the assessment of response to antitubercular treatment (ATT) and identification of treatment endpoint. PATIENTS AND METHODS: Forty patients (mean age, 35.3 years; 27 men) with clinically, radiologically, and histopathologically proven joint tuberculosis prospectively underwent clinical, biochemical, and PET/CT evaluation at baseline and after ~6, 12, and 18 months of ATT. Two patients were lost to follow-up, and 1 defaulted treatment. The remaining 37 were followed up until complete response (CR) was achieved. Images were visually and quantitatively (SUVmax ratio and metabolically active disease volume [MV]) evaluated by 2 experienced nuclear medicine physicians. RESULTS: Knee (n = 18) and ankle (n = 7) were the most frequently involved sites. The median MV and SUVmax ratio at baseline were 85.10 mL and 7.21, respectively. Five patients had noncontiguous vertebral involvement, 12 had pulmonary lesions, 2 had abscesses, 6 had mediastinal, and 30 had local lymph nodal involvement. Complete response was seen in 1/39, 11/37, and 30/37 patients after 6, 12, and 18 months of ATT. Significant reductions in visual analog scale score, tenderness, joint swelling, SUVmax ratios, and MVs (Friedman test, P < 0.001) were seen after each follow-up. The median time-to-CR in skeletal lesions was significantly longer than extraskeletal lesions (591 vs 409 days; Wilcoxon signed-rank test, P < 0.001). Time-to-CR in joint lesions positively correlated with MV at first follow-up (Pearson = 0.452, P = 0.005) and negatively correlated with percentage change in MV (first follow-up from baseline) (Pearson = -0.620, P < 0.001). ROC analysis yielded a cutoff of ≤71% reduction in MV at first follow-up (80.8% sensitivity, 81.8% specificity) to predict extension of ATT beyond 12 months. Using ROC analysis at second follow-up, a cutoff of ≤12.67 mL (for CR) was derived and was validated in patients at the third follow-up, with an accuracy of 84.4%. Patients with CR in PET/CT maintained disease-free state during a mean follow-up of 271 days. CONCLUSIONS: 18F-FDG PET/CT is an excellent tool in estimating total disease burden, assessing response to ATT and identification of treatment endpoint in joint tuberculosis.

A proposed ''A to Z RAM (Radiograph Assessment Method)'' for triage of patients with a suspected bone tumour.

INTRODUCTION: We propose a ''A to Z RAM (Radiograph Assessment Method)'' for evaluation of Radiograph of patients with a suspected bone tumour. METHODS: In the current study, ten radiological features with letters 'A, B, C, D, E, F and Z' were used and which included the age of the patient, involved part of the bone, characteristics, content, distinctiveness, the exterior of the bone, fracture, and zone of transition. Four independent observers (orthopaedic oncologists and surgical oncologists) evaluated a set of 30 radiographs of bone tumour selected at random from our hospital database based on A to Z RAM. We classified the lesions into two groups according to the traffic signal system; Green (suspected benign lesion) and Red (suspected malignant lesion). RESULTS: There were 18 (60%) benign bone lesions and 12 (40%) malignant lesions in the current study. 91.6% of malignant tumours and 88.8% of the benign tumours were identified correctly by the four observers. The inter-observer variability with Fleiss kappa was 0.884 (95% CI 0.7-1.03 p-value < 0.05), suggestive of agreement not by chance. These radiographs were again reassessed by the four observers after 3 months. The interobserver variability by Fleiss kappa was 1.0 (95% CI 0.8-1.1) suggesting complete agreement amongst the observers. Both orthopaedic oncologists had intra-observer kappa as 1.0 each and both surgical oncologists had 0.795 and 0.930 respectively. CONCLUSION: The proposed A to Z RAM is an easy to use and reproducible method for reviewing radiographs in the out-patient department along with clinical findings for better management of patients with suspected bone lesions. The A to Z RAM can be a medical triage tool and subdivide bone lesions into two subgroups i.e. suspected benign lesion with a suggestion of further investigations with MRI and biopsy and suspected malignant lesion with a suggestion of MRI or early referral to a tertiary cancer center with expertise in orthopaedic oncology. IMPLICATIONS FOR PRACTICE: The A to Z RAM (Radiologic Assessment Method) is a reproducible method for reviewing radiographs in the out-patient department and can be an aid for better management of patients. A to Z RAM is useful as a medical triage system, subdividing patients according to the probable diagnosis into a suspected benign lesion and suspected malignant lesion.

Development of indices for surface and ground water quality assessment and characterization for Indian conditions.

Water quality indices are mathematical equations that transform water quality data into a particular number which describe the status of water. A number of water quality indices have been developed by various researchers for categorizing the water quality for different uses. These indices are developed based on classification criteria, sub-indices, and aggregation function. In the present study, a generalized Composite Water Quality Index (CWQI) is developed to classify the water into five categories, viz excellent, good, fair, poor, and polluted. For this purpose, the concentration ranges have been categorized on the basis of the Indian Standards (IS) and Central Pollution Control Board (CPCB) standards and considering International standards of World Health Organization (WHO) and European Commission (EC). Twenty-five water quality parameters are selected based on the social and environmental impacts, and weights are computed using the Saaty's Analytic Hierarchy Process (AHP) Multiple Criteria Decision Analysis (MCDA) tool. These parameters are selected such that the same indices can be used to assess the quality of both surface and ground water. The computed weights minimize the subjectivity in assigning the parameter weights. The proposed index improves understanding of water quality issues by integrating complex data and generates a score which describes the status of water quality. The index will be very useful for the water management authorities to maintain good health of surface water resources.

Assessment of system characteristics of Gangotri glacier headwater stream.

The study examine the major ion chemistry and p(CO2) variations of Ganga headwater stream for a stretch of 18 km from Gangotri glacier snout at Gomukh to Gangotri for characterising the open and closed system conditions and its temporal variations. The study has been carried out at three locations along the stream continuum, at the glacier snout (0 km), Bhojwasa (4 km) and Gangotri (18 km) covering three consecutive melt seasons from the year 2014 to 2016 and reveals the persistence of closed system conditions along the stream stretch. The year 2014 and 2016 melt seasons experience high p(CO2) closed system conditions associated with high suspended sediment flux, whereas the year 2015 experienced low p(CO2) closed system condition associated with low sediment flux suggesting in-stream sulphide oxidation during high sediment flux years and results into low values of the C-ratio. On the other hand, the melt season with low sediment flux such as the year 2015 showed dominance of HCO3- over SO42- and higher C-ratio. The study shows that the headwater reach of River Bhagirathi from Gomukh to Gangotri has prevalence of high p(CO2) closed system characteristics associated with high sediment flux and dominance of SO42- during the seasonal peak flow. This is suggested as a unique characteristic of the meltwaters of the upper Bhagirathi basin.

The value of male human papillomavirus vaccination in preventing cervical cancer and genital warts in a low-resource setting.

OBJECTIVE: To estimate health benefits and incremental cost-effectiveness of human papillomavirus (HPV) vaccination of pre-adolescent boys and girls compared with girls alone for preventing cervical cancer and genital warts. DESIGN: Model-based economic evaluation. SETTING: Southern Vietnam. POPULATION: Males and females aged ≥9 years. METHODS: We simulated dynamic HPV transmission to estimate cervical cancer and genital warts cases. Models were calibrated to epidemiological data from south Vietnam. MAIN OUTCOME MEASURES: Incremental cost-effectiveness ratios (ICERs): cost per quality-adjusted life-year (QALY). RESULTS: Vaccinating girls alone was associated with reductions in lifetime cervical cancer risk ranging from 20 to 56.9% as coverage varied from 25 to 90%. Adding boys to the vaccination programme yielded marginal incremental benefits (≤3.6% higher absolute cervical cancer risk reduction), compared with vaccinating girls alone at all coverages. At ≤25 international dollars (I$) per vaccinated adolescent (I$5 per dose), HPV vaccination of boys was below the threshold of Vietnam's per-capita GDP (I$2800), with ICERs ranging from I$734 per QALY at 25% coverage to I$2064 per QALY for 90% coverage. Including health benefits from averting genital warts yielded more favourable ICERs, and vaccination of boys at I$10/dose became cost-effective at or below 75% coverage. Using a lower cost-effectiveness threshold of 50% of Vietnam's GDP (I$1400), vaccinating boys was no longer attractive at costs above I$5 per dose regardless of coverage. CONCLUSION: Vaccination of boys may be cost-effective at low vaccine costs, but provides little benefit over vaccinating girls only. Focusing on achieving high vaccine coverage of girls may be more efficient for southern Vietnam and similar low-resource settings. TWEETABLE ABSTRACT: Limited cervical cancer reduction from including boys in HPV vaccination of girls in low-resource settings.

Cost-effectiveness of human papillomavirus vaccination and cervical cancer screening in Thailand.

OBJECTIVE: To assess the health and economic outcomes of various screening and vaccination strategies for cervical cancer prevention. DESIGN: Cost-effectiveness analysis from a societal perspective. SETTING: Thailand. POPULATION: Females aged 9 years and older. METHODS: Using a mathematical model of human papillomavirus (HPV) infection and cervical cancer, calibrated to epidemiological data from Thailand, we estimated the cost-effectiveness of pre-adolescent HPV vaccination, screening [visual inspection with acetic acid (VIA), HPV DNA testing, and cytology] between one and five times per lifetime in adulthood, and combined pre-adolescent vaccination and screening. Vaccine efficacy, coverage, cost, and screening frequency were varied in sensitivity analyses. MAIN OUTCOME MEASURES: Incremental cost-effectiveness ratios, expressed as cost per year of life saved (YLS). RESULTS: Assuming lifelong efficacy and 80% coverage, pre-adolescent HPV vaccination alone was projected to reduce the lifetime risk of cervical cancer by 55%, which was greater than any strategy of screening alone. When cost per vaccinated girl was I$10 (approximately $2 per dose) or less, HPV vaccination alone was cost saving. Pre-adolescent vaccination and HPV DNA testing five times per lifetime, starting at age 35 years, reduced the lifetime cervical cancer risk by 70%, and had a cost-effectiveness ratio less than Thailand's GDP per capita (I$8100), provided the cost per vaccinated girl was I$200 or less. CONCLUSIONS: Low cost pre-adolescent HPV vaccination followed by HPV screening five times per lifetime is an efficient strategy for Thailand. Costs may need to be lower, however, for this strategy to be affordable. If vaccination is not feasible, HPV DNA testing five times per lifetime is efficient.

Non-invasive assessment of healing of bacteria infected and uninfected wounds using optical coherence tomography.

BACKGROUND/PURPOSE: Bacterial infection is one of the main predisposing factors for the delay in wound healing. To facilitate a timely decision for correct therapy, it is important to accurately monitor the morphological changes in the infected wounds using noninvasive tools. In the present study, we have explored the use of optical coherence tomography (OCT) for monitoring the healing of superficial wounds infected with Staphylococcus aureus in mice under in vitro and in vivo conditions and studied the changes in collagen birefringence in the infected wounds. METHODS: The tape stripping method was used for generating superficial skin wounds in mice and wounds were infected with S. aureus. For in vitro studies, infected and uninfected wound tissues were resected, back scattered intensity and birefringence changes in collagen during wound healing were studied on the 2, 4 and 10th day of postinfection using polarization-sensitive (PS) OCT and images were compared with histology. Real-time OCT was used for studying the kinetics of healing of infected wounds under in vivo conditions. RESULTS: From the PS-OCT images, different phases of wound healing such as inflammation, reepithelialization and collagen remodeling could be identified. The edematic regions appeared prominent in infected wounds. Compared with uninfected wounds, reepithelization and collagen remodeling phases of wound healing were delayed significantly in the infected wounds. These changes were comparable with the different stages of wound healing observed under in vivo conditions. CONCLUSION: OCT imaging can provide a rapid assessment of the morphological changes associated with bacteria-infected and uninfected wounds and thereby aid in timely treatment planning.

Group dynamics and social interaction in a South Asian online learning forum for faculty development of medical teachers.

BACKGROUND: Group dynamics of online medical faculty development programs have not been analyzed and reported in literature. Knowledge of the types of content of posted messages will help to understand group dynamics and promote participation in an asynchronous learning environment. This paper assesses group dynamics and social interactivity in an online learning environment for medical teachers in the South Asian context. METHODS: Participants of a medical education fellowship program conducted by the Foundation for Advancement of International Medical Education and Research (FAIMER) Regional Institute at Christian Medical College, Ludhiana (CMCL) in India interact on a listserv called the Mentoring-Learning Web (ML-Web). Monthly topics for online discussion are chosen by fellows through a standard tool called "multi-voting". Fellows volunteer to moderate sessions and direct the pace of the discussion. We analyzed the content and process of the discussion of one particular month. The emails were categorized as those that reflected cognitive presence (dealing with construction and exploration of knowledge), teacher presence (dealing with instructional material and learning resources), and social presence, or were administrative in nature. Social emails were further classified as: affective, cohesive and interactive. RESULTS: Social emails constituted one-third of the total emails. Another one-quarter of the emails dealt with sharing of resources and teacher presence, while cognitive emails comprised 36.2% of the total. More than half of the social emails were affective, while a little less than one-third were cohesive. CONCLUSION: Social posts are an inevitable part of online learning. These posts promote bonding between learners and contribute to better interaction and collaboration in online learning. Moderators should be aware of their presence and use them as tools to promote interactivity.

Female mate preferences in Drosophila simulans: evolution and costs.

Female mate preference is central to sexual selection, and all indirect benefit models require that there is genetic variation in female preference. This has rarely been tested however, with relatively few studies documenting heritable variation in female preference and even fewer that have directly selected on mate preference to unequivocally show that it can evolve. Additionally, costs of mate preference are poorly understood even though these have implications for preference evolution. We selected on female preference for ebony-males in replicate Drosophila simulans lines, and generated a rapid evolutionary response in both replicates, with the proportion of females mating with ebony-males increasing from approximately 5% to 30% after five generations of selection. This increase was independent of changes in ebony-males as only females were included in our selection regime. We could detect no cost to mate preference itself other than that associated with the fitness consequences of mating with ebony males.

An assessment of institutional deliveries under JSY at different levels of health care in Jaipur District, Rajasthan.

BACKGROUND & OBJECTIVE: Janani Suraksha Yojana (JSY) has been implemented in the country to enhance institutional deliveries. This study assess the gaps in delivery services and utilization of resources at Basic and Comprehensive Emergency Obstetric Care Centers (BEmOCs, & CEmOCs), accredited sub centers and private hospitals in district Jaipur, Rajasthan. METHODS: The study was undertaken during October-December 2008 in 31 selected health facilities (5 CEmOCs, 4 BEmOCs, 14 accredited subcentres and 8 accredited private hospitals) in district Jaipur. Both primary and secondary data was collected using qualitative and quantitative techniques, by facility survey, interview of service providers (specialists, medical officers, and paramedical staff) and beneficiaries. RESULTS: There is an increase in institutional deliveries following implementation of JSY. Though the normal deliveries were conducted 24 hours by the BEmOCs and CEmOCs however the necessary drugs like parental antibiotics, mesoprostol, magsulf etc were in short supply and use of partograph was absent at the health facilities. The quality of emergency obstetric care services was still poor due to the lack of blood storage units and anesthetists in CEmOCs. Private accredited hospitals fared better as they had the manpower and managed more complicated cases as compared to government facilities, for caesarean sections. The accredited sub centers were nonfunctional negating the very objective of accreditation. Community is still unaware of the 24 hour stay post delivery and provision of grievance redressal system. CONCLUSION: The quality aspects of institutional deliveries are far from desired level mostly because of lack of resources, both manpower and materials; non achievement of IPHS standards etc. The service quality related to antenatal, intranatal and postnatal care need to be improved. The JSY is perceived as an effective scheme by the beneficiaries but gaps in resources and lack of quality of services needs to be adequately dealt with.

Brain abscess caused by Cladophialophora Bantiana in an immunocompetent host: need for a novel cost-effective antifungal agent.

We report a 53-year-old male who presented with headache, tremor and memory disturbance. Radiological evaluation was suggestive of brain abscess. He underwent gross total excision of the cerebral abscess. The histopathological examination and pus culture was suggestive of brain abscess caused by Cladophialophora bantiana. Authors report a rare case of biopsy and culture proven Cladophialophora bantiana brain abscess in an immunocompetent host. The authors review the relevant literature and current treatment options while emphasizing the need for a cost-effective novel antifungal drug to salvage a subset of patients suffering from this rare but increasingly frequent condition.

Metal pollution assessment of sediment and water in the River Hindon, India.

The metal pollution in water and sediment of the River Hindon in western Uttar Pradesh (India) was assessed for Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn. The metal concentrations in water showed wide temporal variation compared with bed sediment because of variability in water discharge and variations in suspended solid loadings. Metal concentrations in bed sediments provided a better evaluation of the degree and the extent of contamination in the aquatic environment, Santagarh and Atali being the most polluted sites of the river. The ratio of heavy metals to conservative elements (Fe, Al, etc.) may reveal the geochemical imbalances due to the elevated metal concentrations normally attributed to anthropogenic sources. Metal/A1 ratios for the bed sediments of the river Hindon were used to determine the relative mobility and general trend of relative mobility occurred Fe > Mn > Zn > Cr > Ni > Pb > Cu > Cd.

Effects of sarcoptic mange and its control with oil of Cedrus deodara, Pongamia glabra, Jatropha curcas and benzyl benzoate, both with and without ascorbic acid on growing sheep: epidemiology; assessment of clinical, haematological, cell-mediated humoral immune responses and pathology.

The aim of this study was to evaluate the therapeutic efficacy of commonly used acaricidal drugs in India and also to assess the effect of ascorbic acid (AA) as adjunct therapy in 72 growing sheep with sarcoptic mange, aged 5-6 months and weighing 20.4-31.7 kg. Eight replicates of nine animals were formed based on sex, and day 0 body weight. Another set of 12 healthy sheep (5-6 months old) constituted the healthy control group. Drugs were applied locally on the affected parts daily and recovery changes in skin lesions were observed at the time of every application. L-Ascorbic acid was administered intramuscularly. Skin scrapings were collected daily from each group and examined for the presence of mites. Blood samples from each group were collected and analysed for total erythrocytes, leucocytes, haematocrit, haemoglobin and lymphocytes on 0, 14th and 28th day post-treatment (PT). Cell-mediated (CMI) and humoral immune (HI) responses were assessed on 0 and 28 days PT. Within groups treated with the drug alone, recovery in oil of Jatropha curcas group was faster and lesions were free from mites after the eighth application. For each drug, the recovery was faster with AA as an adjunct therapy when compared with the group treated with the drug alone. Within all groups, recovery in oil of J. curcas plus ascorbic acid (OJC-AA) group was fastest and the lesions were mite-free after three applications. The overall mean values were higher for all haematological parameters in OJC-AA group. Recovery with respect to suppressed CMI and HI responses during infection was also faster in this group. Gross and microscopic pathological studies revealed a marked adverse effect of infection on skin, kidney, spleen and liver. The OJC-AA group indicated faster recovery. It is concluded from this study that oil of J. curcas was found more efficacious in controlling sarcoptic mange in sheep and AA might be beneficial as adjunct in case of sarcoptic mange to get quick recovery with lesser applications of main therapy. However, the pharmacology of AA with reference to health of skin needs to be investigated.