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Context: Complex left atrial appendage (LAA) morphology is increasingly associated with cryptogenic ischemic stroke as compared to cardioembolic stroke due to atrial fibrillation (AF). However, data on such an association in patients with other etiological stroke subtypes in the absence of AF is limited. Aim: The study aimed to assess the LAA morphology, dimension and other echocardiographic parameters by transesophageal echocardiography (TEE) in patients with embolic stroke of undetermined source (ESUS) and compare it with other etiological stroke subtypes without known AF. Methods: This was a single-Centre, observational study involving comparison of echocardiographic parameters including LAA morphology and dimension in ESUS patients (group A; n ¼ 30) with other etiological stroke subtypes i.e., TOAST (Trial of Org 10172 in Acute Stroke Treatment) class I-IV without AF (group B; n ¼ 30). Results: Complex LAA morphology was predominant in group A (18 patients in group A versus 5 patients in group B, p-Value ¼ 0.001). Mean LAA orifice diameter (15.3 þ 3.5 mm in group A versus 17 þ 2.0 mm in group B, p-Value ¼ 0.027) and LAA depth were significantly lower in group A (28.4 þ 6.6 mm in group A versus 31.7 þ 4.3 mm in group B, p-Value ¼ 0.026). Out of these three parameters only complex LAA morphology was found to be independently associated with ESUS [OR ¼ 6.003, 95% CI {1.225e29.417}, p ¼ 0.027]. Conclusion: Complex LAA morphology is a predominant feature in ischemic stroke patients with ESUS and may contribute to an increased risk of stroke in these patients.
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Background & objectives: COVID-19 pandemic has triggered social stigma towards individuals affected and their families. This study describes the process undertaken for the development and validation of scales to assess stigmatizing attitudes and experiences among COVID-19 and non-COVID-19 participants from the community. Methods: COVID-19 Stigma Scale and Community COVID-19 Stigma Scale constituting 13 and six items, respectively, were developed based on review of literature and news reports, expert committee evaluation and participants’ interviews through telephone for a multicentric study in India. For content validity, 61 (30 COVID-19-recovered and 31 non-COVID-19 participants from the community) were recruited. Test–retest reliability of the scales was assessed among 99 participants (41 COVID-19 recovered and 58 non-COVID-19). Participants were administered the scale at two-time points after a gap of 7-12 days. Cronbach’s alpha, overall percentage agreement and kappa statistics were used to assess internal consistency and test–retest reliability. Results: Items in the scales were relevant and comprehensible. Both the scales had Cronbach’s ? above 0.6 indicating moderate-to-good internal consistency. Test–retest reliability assessed using kappa statistics indicated that for the COVID-19 Stigma Scale, seven items had a moderate agreement (0.4-0.6). For the Community COVID-19 Stigma Scale, four items had a moderate agreement. Interpretation & conclusions: Validity and reliability of the two stigma scales indicated that the scales were comprehensible and had moderate internal consistency. These scales could be used to assess COVID-19 stigma and help in the development of appropriate stigma reduction interventions for COVID-19 infected, and mitigation of stigmatizing attitudes in the community.
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Introduction: Hemorrhoids are one of the most frequent anorectal disorders encountered by clinicians in day-to-day practiceand constitute about 50% of colorectal investigations. Stapled hemorrhoidopexy (SH) represents the first dramatic change inthe treatment of hemorrhoids. Since its introduction, some researchers have raised concerns about the recurrence rate as wellas patient satisfaction. Hence, the present study was carried out to evaluate recurrence rate and patient overall satisfactionwith SH procedure at a tertiary care center in North India.Materials and Methods: Ethical clearance was obtained at the start of the study from the Institutional Review Board. A totalof 100 patients with Grade III/IV hemorrhoids were included. SH was performed as per the standard procedures. Data werecollected on complications developed post operatively at different follow-ups and an overall patient satisfaction. The data werecoded and entered into Microsoft Excel 2010.Results: Post-operative complications we observed at the 1st week were bleeding and discharge in 5%, pain in 9%, and urinaryretention in 11% of enrolled cohorts. At 1 month, hematoma formation was observed in 7.3% of total remaining patients (n = 96)and 5.2% still had post-operative pain. At 6 months, pruritus and stenosis were witnessed in 4.3% and 1.1%, respectively, oftotal remaining patients (n = 93). Recurrence rate was found 4.3% at the end of 6 months. The overall complication rates at 1week, 1 month, and 6 months follow-up were 25%, 12.5%, and 9.7%, respectively.Conclusion: The findings of our study confirm that SH is associated with a high patient satisfaction and with a lesser postoperative complications. We conclude that SH is safe with many short-term benefits.
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Introduction: Hemorrhoid disease therapy is effectively been treated with conventional excisional hemorrhoidectomy. Stapledhemorrhoidopexy (SH) revolutionized the traditional surgical approach by the introduction of the theory of dealing with the rectalmucosal prolapse by resecting a mucosal cylinder above the dentate line by means of mechanical stapling. It is a non-excisionalapproach for the surgical treatment of hemorrhoid disease.Materials and Methods: Ethical clearance was obtained from the institution. A total of 100 adult patients with Grade III/IVhemorrhoids indicated for surgery were recruited for the study purpose. Data collected were post-operative pain in the form ofVAS scale, immediate complications, duration, or length of stay in the hospital along with the time to resume work again. SPSS17.0 was used to carry out the analysis. All P < 0.05 were considered to be statistically significant.Results: The mean age of the study group was 45 ± 14.93 years. The mean length of hospital stays, postoperatively for 21%subjects, was mere 1 day; however, it was 2 days for the rest of population studied. The only complication was with 2% of thestudy population having excessive intraoperative bleeding. The mean time to return to work was 8 days. About 77% of thepatients resumed their work within 8 days of surgery.Conclusion: Within the given limitations of the study, we can conclude that SH is a successful procedure for Grade-III/IVhemorrhoids in terms of immediate post-operative complications, pain as well as the duration of hospital stay
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Introduction: Parkinson’s disease (PD) is the widespreadneurodegenerative disorder ranked second in this categoriesand PD is also the most common movement disorder. PDdisorder affects more than 0.1% of the total population olderthan 40 years of age. Contemporary, therapies of PD arerestricted to only symptomatic relief without dealing withthe basic disease etiology such as aggregation of αSyn, thusthe progression of the disease continues with the currenttherapies. The major objective of this study was to find outputative inhibitors of human alfa-synuclein to search possibletherapeutics of Parkinson’s disease.Material and Methods: Our study included Moleculardocking study of 3D-Structure of alfa- synuclein of humanretrieved from PDB with their chemical ligands. The proteinligands docking were performed using AutoDock4.2.5.1.Further, Molecular Dynamic Simulation for protein-ligandcomplex of best dock complex was carried out usingGromacs16.10.Result: Total nineteen molecules was selected for dockingstudy out of which Amento flavones molecule shows bestbinding. The molecular docking simulation results indicatethat the protein complexes were stable throughout MDsimulations and thus proteins possess the ability to stability.Conclusion: This study provides an insight of in-silico drugdesigning approach towards alfa- synuclein modulators as apromising therapeutics of Parkinson’s’s disease.
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Introduction: Post-operative sore throat (POST) andhoarseness of voice are common complaints from patientsreceiving tracheal intubation. Budesonide is used to reduceall these complications and metered dose delivery of drugis considered as simple and less time consuming with highpatient acceptability. The present study was study was plannedto assess the effect of use of preoperative inhaled budesonideto reduce postoperative sorethroat incidence after endotrachealintubation.Material and methods: All the patients scheduled to undergoshort elective laproscopic surgeries, lasting <2hrs undergeneral anaesthesia with endotracheal intubation will beincluded in this study. The patients were selected randomlyinto two equal groups as follows: Group A- 20 patientsreceived 200μg budesonide inhalation suspension, using ametered dose inhaler 10 min before intubation, which wasrepeated 6hrs after extubation. Group B- 20 patients with nosuch interventions was performed before intubation or afterextubation. Post-operative sore throat was assessed at 2,6,12and 24hrs. All the results were categorized and summarized.Results: Incidence of POST was significantly higher amongsubjects of Group B in comparison to subjects of group A atdifferent time intervals.Conclusion: Administration of budesonide significantlyreduced the incidence of postoperative cough hoarseness ofvoice and POST among subjects undergoing laparoscopiccholecystectomy
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Background: For middle ear surgery, familiarity with theinterrelationships of the anatomical structures is as essential asknowledge of their individual morphology, as surgery isstrongly influenced by the close spatial relations between thedifferent components. In the present study, we assessed andcompared the efficacy of nalbuphine and dexmedetomidineversus nalbuphine and propofol in middle ear surgeries undermonitored anaesthesia care.Materials & Methods: A total of 40 patients scheduled toundergo MESs were included in the present study and werebroadly divided into two categories as follows: Group 1:Included patients who received injection dexmedetomidinealong with nalbuphine (intravenously), Group 2: Includedpatients who received injection propofol along with nalbuphine(intravenously). Visual analogue score (VAS) was used forassessing the intraoperative and postoperative pain. Recoveryto be assessed using Modified Aldrete scoring system (scoreranging from 0 to 10) in the recovery room every 5 min, tillscore of 10 was achieved. Adverse events were recorded. Bothpatient satisfaction score (PSS) and surgeon satisfaction score(SSS) were recorded on a scale on 1 to 7; with 1 indicatingextremely dissatisfied and 7 indicating extremely satisfied.Results: Significant results were obtained while comparing themean VAS, number of patients with PSS of 5 to 7 and numberof patients with SSS of 5 to 7 in between the two study groups.Non-significant results were obtained while comparing theincidence of complications between the two study groups.Conclusion: In patients undergoing middle ear surgeries,Nalbuphine/ dexmedetomidine appeared to be significantlymore effective combination in comparison to the nalbuphine/propofol combination.
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Background: Monitoring and reporting of adverse drug reactions (ADRs) is very important to minimize or prevent drug caused harm. Thus, pharmacovigilance deals with it and ensures the patient safety. However, most of pharmacovigilance centers are concentrated in the urban tertiary care hospitals and contributes the maximum reports of ADRs. Participation of the rural health workers is equally important towards the success of pharmacovigilance.Methods: The study was conducted using a pre-validated questionnaire among forty doctors in rural Sub district hospital Akhnoor, Jammu after approval of the institutional ethical committee of Government Medical Jammu. The questionnaire consisted of 16 questions (7 related to knowledge, 4 related to attitude, and 4 related to practice and one question pertained to under reporting). The responses were recorded, and data obtained was analysed and presented as number and percentage.Results: Total 66.6% doctors gave correct response regarding the definition of pharmacovigilance and purpose of pharmacovigilance was given by 76.6% of doctors. 70% agreed that ADR reporting is a professional obligation for them. 80% responded that health care professionals are responsible for reporting ADRs. 63.3% of them were aware of a pharmacovigilance programme of India. A total of 96.6% doctors agreed that reporting of ADR is necessary and 93.3% were of the view that pharmacovigilance should be taught in detail. Majority of doctors have experienced ADRs in patients and 36.6% have seen the ADR reporting form. However, only 10% have ever reported ADR to a pharmacovigilance center. No remuneration (50%), lack of time to report ADR (30%), belief that a single unreported case may not affect ADR database (10%), and difficulty to decide whether ADR has occurred or not (10%) were important causes for under reporting of ADRs.Conclusions: Current study has shown that majority of the doctors have good knowledge and attitude about pharmacovigilance. However, under reporting is still a major concern among rural doctors and efforts are needed to address this problem of under reporting by conducting CMEs on regular basis.
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Background: Capsules are the most commonly used solid drug dosage form and are made up of gelatin or non gelatin. Currently the gelatin based capsules drug formulations are more used. However, current issue of vegetarian and non vegetarian capsules has come up due to recent Indian government initiative to promote vegetarian capsules.Methods: There were 100 capsule dosage forms were examined for the gelatin or HPMC wall contents and nature of medicine contained in capsules, whether ayurvedic or allopathic.Results: Out of 100 capsules studied 55 had gelatin wall base while 25 had HPMC and 20 capsule labels did not mention the nature of capsule wall constituent. Out of 55 gelatin capsules 30 were of allopathic while 25 capsules were of ayurvedic medicines. Among HPMC, 15 were ayurvedic while 10 allopathic. 20 capsules had no mention of its constituent and among these non labelled capsule formulations had 11 from ayurvedic and 9 from allopathic medicines.Conclusions: The current study revealed that gelatin capsules forms bulk in Indian market. Even the gelatin capsules contained ayurvedic medicines while 10% of HPMC capsules contained allopathic medicines. Non labelled capsules formed 20% of total capsules. These findings suggest wider scope for promotion of HPMC based capsules.
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Background: Indian pharmaceutical market is fast going and there is a stiff competition amongst them as single product is marketed by different brand names. The pharmaceutical houses adopt different strategies to influence the physician to promote their products. These strategies are known to influence the prescription behaviour of physician, which may have variable impact among rural and urban doctors. Aim of the study was to compare the impact of marketing strategies of pharmaceutical houses on prescription practices of rural and urban doctors.Methods: The current crossover study was conducted among urban and rural doctors. A questionnaire consisting of 17 questions was presented to the doctors and their responses regarding different aspects of marketing strategies was recorded. Comparison between two groups was done using unpaired t-test.Results: Different strategies had impact on prescription pattern of doctors working in rural and urban institutions. All 17 parameters were affected similarly except e-mailing where urban doctors were more influenced (p=0.005).Conclusions: Present study indicates marketing strategies by different pharmaceutical houses do influence prescription pattern of physicians. Both urban and rural doctors were similarly affected except e- mailing which had more impact on urban doctors.
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Objective: To prospectively assess safety outcome of TRUS guided prostate biopsy in patients taking low dose aspirin. Materials and methods: Consecutive patients, who were planned for 12 core TRUS guided prostate biopsy and satisfied eligibility criteria, were included in the study and divided into two Groups: Group A: patients on aspirin during biopsy, Group B: patients not on aspirin during biopsy, including patients in whom aspirin was stopped prior to the biopsy. Parameters included for statistical analysis were: age, serum prostate specific antigen (PSA), prostate volume, hemoglobin (Hb %), number of hematuria episodes, number of patient reporting hematuria, hematuria requiring intervention, number of patient reporting hematospermia and number of patient reporting rectal bleeding. Results: Of 681 eligible patients, Group A and B had 191 and 490 patients respectively. The mean age, prostate volume, serum PSA and pre-biopsy hemoglobin were similar in both Groups with no significant differences noted between them. None of the post-biopsy complications, including number of hematuria episodes (p=0.83), number of patients reporting hematuria (p=0.55), number of patients reporting hematospermia (p=0.36) and number of patients reporting rectal bleeding (p=0.65), were significantly different between Groups A and B respectively. None of the hemorrhagic complication in either group required intervention and were self limiting. Conclusion: Continuing low dose aspirin during TRUS guided prostate biopsy neither alters the minor bleeding episodes nor causes major bleeding complication. So, discontinuation of low dose aspirin prior to TRUS guided prostate biopsy is not required.
Subject(s)
Aged , Humans , Male , Middle Aged , Aspirin/administration & dosage , Biopsy, Large-Core Needle/methods , Hemorrhage/prevention & control , Platelet Aggregation Inhibitors/administration & dosage , Prostate/pathology , Ultrasonography, Interventional/methods , Biopsy, Large-Core Needle/adverse effects , Hemorrhage/etiology , Platelet Count , Prospective Studies , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Prostate-Specific Antigen/blood , Prostatic Neoplasms/pathology , Reproducibility of Results , Risk Factors , Rectum , Ultrasonography, Interventional/adverse effectsABSTRACT
Plasmodium vivax is one of the most widely distributed human malaria parasites and due to drug-resistant strains, its incidence and prevalence has increased, thus an effective vaccine against the parasites is urgently needed. One of the major constraints in developing P. vivax vaccine is the lack of suitable in vivo models for testing the protective efficacy of the vaccine. P. vivax and P. cynomolgi bastianelli are the two closely related malaria parasites and share a similar clinical course of infection in their respective hosts. The merozoite surface protein-1 (MSP-1) of these parasites has found to be protective in a wide range of host-parasite systems. P. vivax MSP-1 is synthesized as 200 kDa polypeptide and processed just prior to merozoite release from the erythrocytes into smaller fragments. The C- terminal 42 kDa cleavage product of MSP-1 (MSP-1(42)) is present on the surface of merozoites and a major candidate for blood stage malaria vaccine. In the present study, we have biochemically and immunologically characterized the soluble and refolded 42 kDa fragment of MSP-1 of P. vivax (PvMSP-1(42)) and P. cynomolgi B (PcMSP-1(42)). SDS-PAGE analysis showed that both soluble and refolded E. coli expressed P. vivax and P. cynomolgi B MSP-1(42) proteins were homogenous in nature. The soluble and refolded MSP-1(42) antigens of both parasites showed high reactivity with protective monkey sera and conformation-specific monoclonal antibodies against P. cynomolgi B and P. vivax MSP-1(42) antigens. Immunization of BALB/c mice with these antigens resulted in the production of high titres of cross-reactive antibodies primarily against the conformational epitopes of MSP-1(42) protein. The immune sera from rhesus monkeys. immunized with soluble and refolded MSP-1(42) antigens of both parasites also showed high titered cross-reactive antibodies against MSP-1(42) conformational epitopes. These results suggested that the soluble and refolded forms of E. coli expressed P. vivax MSP-1(42) antigens were highly immunogenic and thus a viable candidate for vaccine studies.