Advance Teaching of Fundamentals of Homoeopathy (ATFH): redefining competency based approach

The curriculumin academic medicine is defined by writing effective Learning objectives (LO). LO iselaborated based on perceptions of unbiased written aspects,of course, the rationale in statements is explained and tested through the completion of educational activity. These are the foundations for defining the outcomes in building up strong educational policieswhich are instructionalaligned through predefined effective curriculum courseswith added mapped outcomes. This letter provides the ongoing aspect of the development of Homoeopathic education in India regulated by the National Commission for Homoeopathy for the subject course of Advance Teaching of Fundamentals of Homoeopathy (ATFH). The essential components for the ATFHsubject course with LO and outcome assessment is been discussed and would provide a new arena of academic research in building up rationale in the programed [Doctor of Homoeopathy(MD,(Hom).

Moderately Hypofractionated Radiotherapy and Androgen Deprivation Therapy for High-risk Localised Prostate Cancer: Predictors of Long-term Biochemical Control and Toxicity.

AIMS: There is a paucity of long-term data on outcomes of high-risk prostatic adenocarcinoma after moderately hypofractionated radiotherapy with elective nodal treatment and long-term androgen deprivation therapy (ADT). We report long-term control and toxicity outcomes and analyse the predictors of failure and toxicity. MATERIALS AND METHODS: The records of 120 consecutive high-risk prostate cancer patients treated in a single institution between February 2012 and December 2016 were retrospectively analysed. A moderately hypofractionted radiotherapy (HypoRT) regimen of 60 Gy in 20 fractions over 4 weeks with simultaneous elective pelvic irradiation to 44 Gy in 20 fractions with intensity-modulated radiotherapy was used, together with long-term ADT with either orchiectomy or medical castration for a total duration of 2-3 years. We analysed biochemical control, metastasis-free survival and late toxicities and their predictive factors using survival analysis. RESULTS: Patients had locally advanced cancers (cT3 77.5%, median pretreatment prostate-specific antigen 30 ng/ml, Gleason score 8-10 in 45.8%). The median follow-up time was 70 months. The 3- and 5-year probability of freedom from biochemical progression was 93% and 80%, respectively. The 5-year probability of freedom from local relapse/intra-pelvic nodal relapse/distant metastases as the site of first failure was 96%/97%/86%, respectively. Gleason score 8-10 and medical ADT for 2-3 years (as opposed to orchidectomy) were independent risk factors for distant metastases. A total of 18 grade 2 and above late gastrointestinal toxicity events and a total of 23 grade 2 and above late genitourinary toxicity events were documented. Patients who underwent a transurethral resection of prostate prior to radiotherapy had worse urological toxicity. CONCLUSIONS: HypoRT with elective nodal treatment results in excellent pelvic control. Distant metastases are the primary mode of failure. Risk of metastases is associated with Gleason score and the duration of ADT. Late urinary toxicities are more common in those with prior transurethral resection of prostate.

Immunomodulatory effects of Andrographis paniculata extract in healthy adults - An open-label study.

BACKGROUND: Andrographis paniculata (Burm.f.) Nees has been well-researched for its immunomodulatory effects. OBJECTIVE(S): To investigate the immunomodulatory effects of standardized A. paniculata extract (SAPE) in healthy adults. MATERIALS AND METHODS: The study was an open-label, single-centre study conducted for 30 days. Thirty participants with absolute lymphocyte counts of 1000-4000 cells/mm3 were enrolled and were instructed to ingest 200 mg of SAPE daily for 30 days. The participants visited the clinic at baseline, and days 3, 7, and 30. Immune cells such as NK cell (CD3-CD16+CD56+), T cells (CD3+), T helper cells (CD3+CD4+), T cytotoxic cells (CD3+CD8+) were measured using flow cytometry. Serum cytokines that include interferon gamma (IFN-γ), interleukin-4 (IL-4), interleukin-2 (IL-2), interleukin-12 (IL-12), and tumor necrosis factor alpha (TNF-α) were measured using ELISA. The SAPE used in this study was a standardized proprietary extract (AP-Bio®/KalmCold®) developed from the leaf extracts of A. paniculata. RESULTS: SAPE increased T cells, T helper cells and significantly increased IFN-γ, IL-4, and decreased IL-2 at day 30. A subgroup analysis of participants with absolute lymphocyte counts of 1000-3000 cells/mm3 indicated that there is a significant increase in the T cells, T helper cells at day 7 and 30 and significant increase in IFN-γ, IL-4 and decrease in IL-2 at day 30. There was no treatment related adverse effects following SAPE intake for 30 days. CONCLUSION: Supplementation of SAPE resulted in immunomodulatory effects evidenced by its effects on immune cells and cytokines and it was found to be safe and tolerable.

Cost-Effectiveness of Rifaximin Treatment in Patients with Hepatic Encephalopathy.

BACKGROUND: Hepatic encephalopathy (HE) is a complication of cirrhosis of the liver causing neuropsychiatric abnormalities. Clinical manifestations of overt HE result in increased health care resource utilization and effects on patient quality of life. While lactulose has historically been the mainstay of treatment for acute HE and maintenance of remission, there is an unmet need for additional therapeutic options with a favorable adverse event profile. Compared with lactulose alone, rifaximin has demonstrated proven efficacy in complete reversal of HE and reduction in the incidence of HE recurrence, mortality, and hospitalizations. Evidence suggests the benefit of long-term prophylactic therapy with rifaximin; however, there is a need to assess the economic impact of rifaximin treatment in patients with HE. OBJECTIVE: To assess the incremental cost-effectiveness of rifaximin ± lactulose versus lactulose monotherapy in patients with overt HE. METHODS: A Markov model was developed in Excel with 4 health states (remission, overt HE, liver transplantation, and death) to predict costs and outcomes of patients with HE after initiation of maintenance therapy with rifaximin ± lactulose to avoid recurrent HE episodes. Cost-effectiveness of rifaximin was evaluated through estimation of incremental cost per quality-adjusted life-year (QALY) or life-year (LY) gained. Analyses were conducted over a lifetime horizon. One-way deterministic and probabilistic sensitivity analyses were conducted to assess uncertainty in results. RESULTS: The rifaximin ± lactulose regimen provided added health benefits despite an additional cost versus lactulose monotherapy. Model results showed an incremental benefit of $29,161 per QALY gained and $27,762 per LY gained with rifaximin ± lactulose versus lactulose monotherapy. Probabilistic sensitivity analyses demonstrated that the rifaximin ± lactulose regimen was cost-effective ~99% of the time at a threshold of $50,000 per QALY/LY gained, which falls within the commonly accepted threshold for incremental cost-effectiveness. CONCLUSIONS: The clinical benefit of rifaximin, combined with an acceptable economic profile, demonstrates the advantages of rifaximin maintenance therapy as an important option to consider for patients at risk of recurrent HE. DISCLOSURES: This analysis was funded by Salix Pharmaceuticals, a division of Bausch Health US. Salix and Xcenda collaborated on the methods, and Salix, Xcenda, Jesudian, and Ahmad collaborated on the writing of the manuscript and interpretation of results. Bozkaya and Migliaccio-Walle are employees of Xcenda. Ahmad reports speaker fees from Salix Pharmaceuticals, unrelated to this study. Jesudian reports consulting and speaker fees from Salix Pharmaceuticals, unrelated to this study. The results from this model were presented at AASLD: The Liver Meeting 2014; November 7-11; Boston, MA.

Trophic state modeling for shallow freshwater reservoir: a new approach.

Lakes and reservoirs around the world are facing a substantial water quality degradation problem that poses significant environmental, social, and economic impacts. Reservoir productivity is influenced primarily by the climatic, morphometric, and hydro-edaphic features. High nutrient loadings in the reservoir from agriculture runoff often provide ideal conditions for algal blooms, leading to eutrophication. Reservoir and lake management to prevent or reduce eutrophication, therefore, has become the need of the hour. The traditional approach of trophic state monitoring by rigorous field surveys and eutrophication modeling has been revised in the present study by developing a new trophic state index (TSI)-based model for tropical shallow freshwater reservoirs. The new model has been constructed based on Carlson's Limnology and Oceanography, 22, 361-369, (1977) guidelines by establishing an empirical relationship between trophic parameters including total phosphorus (TP), Secchi disk depth (SDD), and chlorophyll (Chl-a). After comparing the new model with various earlier models for its applicability and validation with actual field conditions, it was found to be most precise over previous TSI models. Temporal and spatial fluctuations in the water quality of the Tiru reservoir were primarily attributed to the changing climatic conditions during the study period. Seasonal monsoon with less frequency, heavy nutrient loading from agriculture runoff, and increased turbidity due to a high level of sediment inflow during monsoon raised the TSI (SDD) values of the Tiru reservoir to place it in the hyper-eutrophic class. Average TSI values during winter for SDD, Chl-a, and TP were indicative of the meso-eutrophic to eutrophic state. Saturation of nutrients due to low water level during summer season caused the poly-eutrophic condition for TSI (SDD)- and TSI (TP)-based estimates and eutrophic condition as per TSI (Chl-a) estimates. However, seasonal deviations of the TSI values based on the relationship between TSI (Chl-a) and TSI (SD) indicated a predominance of smaller particles (non-algal turbidity) during all seasons. Even though TP present in the Tiru reservoir is controlling the algal production, it is also affected by low-light conditions due to non-algal turbidity. The recommendation from this study is that the TSI method for estimating the health of the water bodies is the efficient, cost-effective, and time-saving approach. The model developed during the study would help managers and policy makers to take necessary steps to reduce eutrophication levels in the reservoir and would be helpful for researchers in developing new concepts and protocols, mainly focusing on shallow freshwater reservoirs.

Autoantibodies in acquired myasthenia gravis: Clinical phenotype and immunological correlation.

BACKGROUND: Data on antibody profile in myasthenia gravis (MG) from India are limited. OBJECTIVES: To investigate antibody profile in patients with MG and their clinical correlates. PATIENTS AND METHODS: Patients of MG (n = 85, M:F::1.1:1, mean age: 39.29 ± 17.3 years, mean symptom duration: 72.94 ± 91.8 months) were evaluated for clinical features, MG foundation of America (MGFA) score, response to treatment, and outcome at last follow-up. Antibodies to acetylcholine receptor (AChR), muscle-specific kinase (MUSK), titin and ryanodine receptor (RYR) were analysed using ELISA. RESULTS: Based on the regional distribution of weakness, the cohort could be categorized as: generalized: 60, ocular: 16 and oculo-bulbar: 9. Sixty patients were followed up for a mean duration of 26.74 ± 13.8 months. Outcome at last follow-up was as follows: remission-22, no remission-33 and dead-5. AChR and MUSK antibodies were detected in 58 and 8 patients, respectively. Frequency of generalized MG, worse MGFA score during the disease course and thymomatous histology significantly correlated with presence of AChR-antibodies, though outcome at last follow-up was comparable between AChR-antibody positive and negative groups. Patients with MUSK antibodies had oculo-bulbar or generalized MG and frequent respiratory crisis, but majority improved or remitted with treatment. Titin antibodies were detected in 31.8% and RYR antibodies in 32.9%. Their presence did not correlate with age at onset of MG, severity or presence of thymoma. CONCLUSION: This report highlights the spectrum of antibodies in MG in an Indian cohort. AChR-antibody positivity correlated with clinical severity. Outcome was good in majority of MUSK antibody-positive MG. The role of other antibodies, complementary vs epiphenomenon, remains open.

Saponins isolated from roots of Chlorophytum borivilianum reduce acute and chronic inflammation and histone deacetylase.

OBJECTIVE: The roots of Chlorophytum borivilanum are used in traditional medicine for the treatment of arthritis and inflammation. The aim of the work was to evaluate the anti-inflammatory activity of isolated saponins from Chlorophytum borivilianum (ISCB). METHODS: The ISCB was screened using the carrageenan-induced paw edema, histamine-induced paw edema, cotton pellet-induced granuloma, and Freund's adjuvant-induced arthritis in rats at orally administered doses of 3, 10, and 30 mg/kg. Effect of ISCB on histone deacetylase (HDAC) level was measured by the HDAC assay at the highest dose (30 mg/kg). RESULTS: The results showed that the ISCB significantly reduced carrageenan-induced inflammation, histamine-induced inflammation, cotton pellet-induced granuloma and Freund's adjuvant-induced arthritis in rats. The ISCB at a dose of 30 mg/kg significantly inhibited HDAC level in rat paw tissue. CONCLUSION: It is concluded that saponins isolated from roots of C. borivilianum possess anti-inflammatory and anti-arthritic properties. ISCB may act by inhibiting histamine, prostaglandin and HDAC. This suggests that ISCBs have potential for therapeutic use in the treatment of inflammation and arthritis.

Effects of a green tea extract, Polyphenon E, on systemic biomarkers of growth factor signalling in women with hormone receptor-negative breast cancer.

BACKGROUND: Observational and experimental data support a potential breast cancer chemopreventive effect of green tea. METHODS: We conducted an ancillary study using archived blood/urine from a phase IB randomised, placebo-controlled dose escalation trial of an oral green tea extract, Polyphenon E (Poly E), in breast cancer patients. Using an adaptive trial design, women with stage I-III breast cancer who completed adjuvant treatment were randomised to Poly E 400 mg (n = 16), 600 mg (n = 11) and 800 mg (n = 3) twice daily or matching placebo (n = 10) for 6 months. Blood and urine collection occurred at baseline, and at 2, 4 and 6 months. Biological endpoints included growth factor [serum hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF)], lipid (serum cholesterol, triglycerides), oxidative damage and inflammatory biomarkers. RESULTS: From July 2007-August 2009, 40 women were enrolled and 34 (26 Poly E, eight placebo) were evaluable for biomarker endpoints. At 2 months, the Poly E group (all dose levels combined) compared to placebo had a significant decrease in mean serum HGF levels (-12.7% versus +6.3%, P = 0.04). This trend persisted at 4 and 6 months but was no longer statistically significant. For the Poly E group, serum VEGF decreased by 11.5% at 2 months (P = 0.02) and 13.9% at 4 months (P = 0.05) but did not differ compared to placebo. At 2 months, there was a trend toward a decrease in serum cholesterol with Poly E (P = 0.08). No significant differences were observed for other biomarkers. CONCLUSIONS: Our findings suggest potential mechanistic actions of tea polyphenols in growth factor signalling, angiogenesis and lipid metabolism.

Saponins isolated from roots of Chlorophytum borivilianum reduce acute and chronic inflammation and histone deacetylase / 中西医结合学报

<p><b>OBJECTIVE</b>The roots of Chlorophytum borivilanum are used in traditional medicine for the treatment of arthritis and inflammation. The aim of the work was to evaluate the anti-inflammatory activity of isolated saponins from Chlorophytum borivilianum (ISCB).</p><p><b>METHODS</b>The ISCB was screened using the carrageenan-induced paw edema, histamine-induced paw edema, cotton pellet-induced granuloma, and Freund's adjuvant-induced arthritis in rats at orally administered doses of 3, 10, and 30 mg/kg. Effect of ISCB on histone deacetylase (HDAC) level was measured by the HDAC assay at the highest dose (30 mg/kg).</p><p><b>RESULTS</b>The results showed that the ISCB significantly reduced carrageenan-induced inflammation, histamine-induced inflammation, cotton pellet-induced granuloma and Freund's adjuvant-induced arthritis in rats. The ISCB at a dose of 30 mg/kg significantly inhibited HDAC level in rat paw tissue.</p><p><b>CONCLUSION</b>It is concluded that saponins isolated from roots of C. borivilianum possess anti-inflammatory and anti-arthritic properties. ISCB may act by inhibiting histamine, prostaglandin and HDAC. This suggests that ISCBs have potential for therapeutic use in the treatment of inflammation and arthritis.</p>

Therapeutic Effects of Oral Nutritional Supplements during Haemodialysis: Physician's Experience.

OBJECTIVES: To evaluate the effects of predialytic oral nutritional supplementation in chronic kidney disease (CKD) patients on maintenance haemodialysis (MHD). METHODS: NEPRO HP was provided to 77 CKD patients on maintenance haemodialysis (MHD) over 3 months. Efficacy parameters were improvement in albumin levels, weight and haemoglobin levels; safety parameters were serum potassium and phosphorus values; other parameters were SGA and MIS scores. RESULTS: Mean serum albumin values showed a statistically significant increase. There was a statistically significant improvement in the mean body weight and haemoglobin of the patients in the second and third months of treatment. Serum phosphorus and potassium levels did not change in a statistically significant manner. There was improvement in nourishment status as detected by MIS and SGA scores. Two patients expired during the course of the study. CONCLUSION: Predialytic oral supplementation with NEPRO HP improves nutritional status of CKD patients on MHD.

Tibetan sound meditation for cognitive dysfunction: results of a randomized controlled pilot trial.

OBJECTIVE: Although chemotherapy-induced cognitive impairment is common among breast cancer patients, evidence for effective interventions addressing cognitive deficits is limited. This randomized controlled trial examined the feasibility and preliminary efficacy of a Tibetan Sound Meditation (TSM) program to improve cognitive function and quality of life in breast cancer patients. METHODS: Forty-seven breast cancer patients (mean age 56.3 years), who were staged I-III at diagnosis, 6-60 months post-chemotherapy, and reported cognitive impairment at study entry were recruited. Participants were randomized to either two weekly TSM sessions for 6 weeks or a wait list control group. Neuropsychological assessments were completed at baseline and 1 month post-treatment. Self-report measures of cognitive function (Functional Assessment of Cancer Therapy (FACT)-Cog), quality of life (SF-36), depressive symptoms (Center for Epidemiologic Studies Depression Scale), sleep disturbance (Pittsburgh Sleep Quality Index), fatigue (Brief Fatigue Inventory), and spirituality (FACT-Sp) were completed at baseline, the end of treatment, and 1 month later. RESULTS: Relative to the control group, women in the TSM group performed better on the verbal memory test (Rey Auditory Verbal Learning Test trial 1) (p = 0.06) and the short-term memory and processing speed task (Digit Symbol) (p = 0.09) and reported improved cognitive function (p = 0.06), cognitive abilities (p = 0.08), mental health (p = 0.04), and spirituality (p = 0.05) at the end of treatment but not 1 month later. CONCLUSIONS: This randomized controlled trial revealed that TSM program appears to be a feasible and acceptable intervention and may be associated with short-term improvements in objective and subjective cognitive function as well as mental health and spirituality in breast cancer patients.

A novel aphrodisiac compound from an orchid that activates nitric oxide synthases.

Nitric oxide (NO) is known to have roles in several crucial biological functions including vasodilation and penile erection. There are neuronal, endothelial and inducible NO synthases that influence the levels of NO in tissues and blood. NO activates guanylate cyclase and thereby increases the levels of cyclic GMP (cGMP). Viagra (sildenafil), a top selling drug in the world for erectile dysfunction, inhibits phosphodiesterase-5, which hydrolyses cGMP to GMP. Thus, it fosters an NO-mediated increase in the levels of cGMP, which mediates erectile function. Here, we show the aphrodisiac activity of a novel chemical isolate from the flowers of an epiphytic orchid, Vanda tessellata (Roxb.) ex Don, which activates neuronal and endothelial, but not inducible, NO synthases. The aphrodisiac activity is caused by an increase in the level of NO in corpus cavernosum. The drug increases blood levels of NO as early as 30 min after oral administration. The active compound was isolated by column chromatography. Based on the spectral data, the active compound is found to be a new compound, 2,7,7-tri methyl bicyclo [2.2.1] heptane. We anticipate that our findings could lead to the development of a commercially viable and valuable drug for erectile dysfunction.

"Effect of pranayama and meditation as an add-on therapy in rehabilitation of patients with Guillain-Barré syndrome--a randomized control pilot study".

OBJECTIVE: To study the add-on effects of pranayama and meditation in rehabilitation of patients with Guillain-Barré syndrome (GBS). PATIENTS AND METHOD: This randomized control pilot study was conducted in neurological rehabilitation unit of university tertiary research hospital. Twenty-two GBS patients, who consented for the study and satisfied selection criteria, were randomly assigned to yoga and control groups. Ten patients in each group completed the study. The yoga group received 15 sessions in total over a period of 3 weeks (1 h/session), one session per day on 5 days per week that consisted of relaxation, Pranayama (breathing practices) and Guided meditation in addition to conventional rehabilitation therapeutics. The control group received usual rehabilitation care. All the patients were assessed using Pittsburgh Sleep Quality Index, Numeric pain rating scale, Hospital anxiety and Depression scale and Barthel index score. Mann-Whitney U test and Wilcoxon's signed rank test were used for statistical analysis. RESULTS: Quality of sleep improved significantly with reduction of PSQI score in the yoga group (p = 0.04). There was reduction of pain scores, anxiety and depression in both the groups without statistical significance between groups (pain p > 0.05, anxiety p > 0.05 and depression p > 0.05). Overall functional status improved in both groups without significant difference (p > 0.05). CONCLUSIONS: Significant improvement was observed in quality of sleep with yogic relaxation, pranayama, and meditation in GBS patients.

Development of a chewable tablet from Dugdhamalakyadi Yoga: An Ayurvedic preparation.

BACKGROUND: Amalaki (Embelica officinalis Gaertn.) is one of the most celebrated herbs in the Indian system of traditional medicine. It is one of the best Rasayana-s (health promoting) drug. In Dugdhamalakyadi yoga, Amalaki (Embelica officinalis Gaertn.) powder is administered along with milk in case of svarabhanga (hoarseness of voice). Here an attempt is made to convert this formulation into chewable tablet without altering its property to improve its palatability, shelf life and fixation of proper therapeutic dose. METHODOLOGY: Chewable tablets were prepared by wet granulation method. Here, Amalaki powder was prepared initially and it was mixed with additives and preservatives. Granules were prepared from this mixture by adding binding agent, finally compressed in to tablets. RESULTS AND CONCLUSION: The physico-chemical analysis of Amalaki standard are: Foreign Matter-Nil, Acid insoluble Ash-0.51%w/w, Water soluble Ash-2.01% w/w, Alcoholic Extractives-44.48%, Aqueous Extractives 67.52%, pH-3.1, Moisture content-8.19%. Quality control test for chewable tablet was carried out and found satisfactory with general characteristics of tablet viz. hardness 1.8, disintegration time 15-20 min, friability 0.5%, weight variation +/- 3%. The TLC of Amalaki powder showed 3 spots with Rf value 0.14, 0.4, and 0.73 and the chewable tablets showed 2 spots with Rf value 0.31 and 0.89 under 254 nm. The adaptation of modern techniques or methods to convert the Ayurvedic formulations without altering its therapeutic property is necessary to made them suitable for the present trends of newer drug delivery dosage forms.

The effects of an airborne-particle abrasion and silica-coating on the bond strength between grooved titanium alloy temporary cylinders and provisional veneering materials.

STATEMENT OF PROBLEM: Even though mechanical retentive features, such as grooves, are incorporated into the surface of titanium alloy temporary cylinders, a reliable bond to veneering provisional materials is not always achievable for screw-retained provisional implant restorations. There is insufficient information about the effect of tribochemical silica coating on the bond strength between provisional materials and grooved titanium alloy temporary cylinders. PURPOSE: The purpose of this study was to evaluate, in vitro, the effect of an airborne-particle abrasion and silica-coating technique on the bond strength between grooved titanium alloy temporary cylinders and provisional veneering bisphenol-A glycidyl methacrylate and polymethyl methacrylate materials. MATERIAL AND METHODS: Forty grooved titanium alloy (Ti-6Al-4V) internal connection implant temporary cylinders were used. A disc of veneering material (7.1 × 3.4 mm) was created around the midsection of each cylinder. Forty specimens were divided into 4 groups (n=10): group NoTxPMMA, no surface treatment and polymethyl methacrylate veneering material; group NoTxBisGMA, no surface treatment and BisGMA veneering material; group AbPMMA, airborne-particle abrasion, silica-coating surface treatment (Rocatec), and polymethyl methacrylate; and group AbBisGMA, airborne-particle abrasion, silica-coating surface treatment (Rocatec), and BisGMA. Each specimen was subjected to ultimate shear load testing at the interface of the veneering material and the temporary cylinder in a universal testing machine at a constant crosshead speed of 5 mm/min. Data were analyzed with a 1-way ANOVA (α=.05) followed by post hoc Student-Newman-Keuls test. Each specimen underwent surface observation with a light microscope at ×40 magnification to compare fracture patterns. RESULTS: Airborne-particle abrasion and silica-coating surface treatment significantly lowered the shear bond strength (P<.05). The type of provisional material did not significantly affect the shear bond strength, with or without surface treatment. Group AbBisGMA demonstrated the lowest mean value (3.49 MPa) compared to the other groups. CONCLUSIONS: Airborne-particle abrasion and silica-coating treatment did not improve the bond between grooved titanium alloy temporary cylinders and provisional veneering materials. It weakened the provided mechanical retention, especially when it was used with BisGMA veneering material. Material choice, whether it was polymethyl methacrylate or BisGMA, did not make a statistically significant difference.

Efficacy of pulsed electromagnetic field therapy in healing of pressure ulcers: A randomized control trial.

BACKGROUND: Pressure ulcers are one of the most common complications in health care settings. Still there are no optimal protocols to manage the pressure ulcers. AIM: To assess the effectiveness of pulsed electromagnetic field therapy (PEMF) in healing of pressure ulcers in patients with neurological disorders. DESIGN: Randomized double blind control trial. SETTING: Neurological rehabilitation department in a university research hospital. PARTICIPANTS: Twelve patients (M:F, 9:3) having neurological disorders, with age between 12-50 years (mean 30.166 +/- 11.32 yrs) and 24 pressure ulcers. INTERVENTION: Six patients with 13 ulcers received PEMF therapy and the remaining 6 patients with 11 ulcers received sham treatment, for 30 sessions (45 minutes each) using the equipment 'Pulsatron'. The frequency of PEMF was set at 1 Hz with sine waves and current intensity of 30 mili ampere. Whole body exposure was given in both the groups. OUTCOME MEASURES: Bates-Jensen wound assessment tool (BJWAT) score was used as main outcome measure and scores at the end of session were compared with initial scores and analyzed. Similarly National Pressure Ulcer Advisory Panel (NPUAP) scores were compared and analyzed as secondary outcome measure. RESULTS: Thirteen ulcers were in stage IV and 11 were in stage III at the start of the study. Significant healing of ulcers was noted, BJWAT scores, in both the treatment and sham groups (P < 0.001 and 0.003 respectively) at the completion of the study. However, when comparing between the groups, healing was not significant (P = 0.361). Similarly trend was noted with NPUAP scores with no significant difference between the treatment and sham groups (P = 0.649) at the completion of study. CONCLUSIONS: No significant difference in pressure ulcer healing was observed between PEMF treatment and sham group in this study.

Hepatoprotective effect of Carissa carandas Linn root extract against CCl4 and paracetamol induced hepatic oxidative stress.

Oral pre-treatment with ethanolic extract of the roots of C. carandas (ERCC; 100, 200 and 400 mg/kg, po) showed significant hepatoprotective activity against CCl4 and paracetamol induced hepatotoxicity by decreasing the activities of serum marker enzymes, bilirubin and lipid peroxidation, and significant increase in the levels of uric acid, glutathione, super oxide dismutase, catalase and protein in a dose dependent manner, which was confirmed by the decrease in the total weight of the liver and histopathological examination. Data also showed that ERCC possessed strong antioxidant activity, which may probably lead to the promising hepatoprotective activities of C. carandas root extract. These findings therefore supported the traditional belief on hepatoprotective effect of the roots of C. carandas.

Radial neuropathy due to occupational lead exposure: Phenotypic and electrophysiological characteristics of five patients.

Lead is a ubiquitous and versatile metal that has been used by mankind for many years. It is a toxic heavy metal that ranks as one of the most important environmental poisons in the world. Research conducted in recent years has increased public health concern about the toxicity of lead at low doses and has supported a reappraisal of the levels of lead exposure that may be safely tolerated in the workplace. Neuropathy is one complication of lead poisoning. The aim of this study is to describe the phenotypic and electrophysiological profile in five male patients working in a battery factory who developed radial nerve neuropathy due to lead exposure. All patients had elevated blood lead levels that were in the toxic range. The concerned regulatory bodies should make it mandatory for workers to undergo regular health checkups to detect signs of lead poisoning and must ensure that workers are aware about the ill effects of exposure to this metal. Chelation therapy removes lead from the blood and soft tissues and chronic lead exposure often requires repeated courses of treatment.

Successful treatment of tremor in Wilson's disease by thalamotomy: A case report.

Little information is available on the surgical treatment of movement disorders in Wilson's disease. We report a successful outcome of left-sided stereotactic thalamotomy in a 30-year-old man with Wilson's disease, who had severe postural-kinetic tremor of both hands. The improvement was bilateral. Our case illustrates that stereotactic thalamotomy may be considered as an option in treating severe tremor in selected patients of Wilson's disease and merit further trials.

Efficacy of multiwavelength light therapy in the treatment of pressure ulcers in subjects with disorders of the spinal cord: A randomized double-blind controlled trial.

OBJECTIVE: To study the efficacy of multiwavelength light therapy in the treatment of pressure ulcers in subjects with spinal cord disorders. DESIGN: Randomized controlled trial. SETTING: Neurologic rehabilitation ward of a referral center in India. PARTICIPANTS: Thirty-five subjects with spinal cord injury, with 64 pressure ulcers (stage 2, n=55; stage 3, n=8; stage 4, n=1), were randomized into treatment and control groups. One subject refused consent. Mean duration of ulcers in the treatment group was 34.2+/-45.5 days and in the control group, 57.1+/-43.5 days. INTERVENTIONS: Treatment group received 14 sessions of multiwavelength light therapy, with 46 probes of different wavelengths from a gallium-aluminum-arsenide laser source, 3 times a week. Energy used was 4.5 J/cm(2). Ulcers in the control group received sham treatment. MAIN OUTCOME MEASURES: Healing of the ulcer, defined as the complete closure of the wound with healthy scar tissue, time taken for the ulcer to heal, and stage of the ulcer and Pressure Sore Status Tool score 14 days after last treatment. RESULTS: There was no significant difference in healing between the treatment and control groups. Eighteen ulcers in treatment group and 14 in control group healed completely ( P =.802). Mean time taken by the ulcers to heal was 2.45+/-2.06 weeks in the treatment group and 1.78+/-2.13 weeks in the control group ( P =.330). Time taken for stage 3 and 4 ulcers to reach stage 2 was 2.25+/-0.5 weeks in treatment group and 4.33+/-1.53 weeks in control group ( P =.047). CONCLUSIONS: Multiwavelength light therapy from a gallium-aluminum-arsenide laser source did not influence overall healing pressure ulcers. Limited evidence suggested that it improved healing of stage 3 and 4 pressure ulcers.