Conventional vs virtual autopsy with postmortem MRI in phenotypic characterization of stillbirths and fetal malformations.

OBJECTIVE: To compare virtual autopsy using postmortem magnetic resonance imaging (MRI) with conventional autopsy with respect to phenotypic characterization of stillbirths and malformed fetuses, and acceptability to parents. METHODS: This was a prospective diagnostic evaluation study, conducted from June 2013 to June 2015, including stillbirths and pregnancies terminated owing to fetal malformation at ≥ 20 weeks' gestation, for which parental consent to both conventional autopsy and postmortem MRI was obtained. Cases of maternal and obstetric cause of fetal demise were excluded. Whole-body postmortem MRI (at 1.5 T) was performed prior to conventional autopsy. Taking conventional autopsy as the diagnostic gold standard, postmortem MRI findings alone, or in conjunction with other minimally invasive prenatal and postmortem investigations, were assessed and compared for diagnostic accuracy. RESULTS: Parental consent for both conventional autopsy and postmortem MRI was obtained in 52 cases of which 43 were included in the analysis. In 35 (81.4%) cases, the final diagnosis based on virtual autopsy with postmortem MRI was in agreement with that of conventional autopsy. With conventional autopsy as the reference standard, sensitivity, specificity, positive and negative predictive values of postmortem MRI were, respectively: 77.7%, 99.8%, 97.4% and 98.0% for whole-body assessment; 93.1%, 99.0%, 87.1% and 99.5% for the nervous system; 61.0%, 100.0%, 100.0% and 96.7% for the cardiovascular system; 91.1%, 100.0%, 100.0% and 98.0% for the pulmonary system; 80.6%, 99.8%, 96.7% and 98.7% for the abdomen; 96.2%, 99.7%, 96.2% and 99.7% for the renal system; and 66.7%, 100.0%, 100.0% and 97.2% for the musculoskeletal system. Virtual autopsy was acceptable to 96.8% of families as compared with conventional autopsy to 82.5%. CONCLUSIONS: Virtual autopsy using postmortem MRI and other minimally invasive investigations can be an acceptable alternative to conventional autopsy when the latter is refused by the parents. Postmortem MRI is more acceptable to parents and can provide additional diagnostic information on brain and spinal cord malformations. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Clinicomicrobiological Evaluation of 2% Chitosan Mouthwashes on Dental Plaque.

AIM: This study was conducted to evaluate microbiological and clinical effects of a chitosan chlorhexidine (CH) mouthrinse on plaque control. MATERIALS AND METHODS: Subjects were divided into three groups. Group I included 15 subjects who used 0.2% chlorhexidine digluconate (CHX), group II included 15 subjects who used 2% chitosan (CH) solution, and group III involves 15 subjects who used 0.2% chlorhexidine/2% CH combination. Plaque index (PI), gingival index (GI), and probing depth (PD) were recorded at the baseline, on day 0, and after 4 days. Supragingival plaque samples were subjected for microbiological evaluation. Statistical analysis was done using statistical software IBM Statistical Package for the Social Sciences (SPSS), version 21. RESULTS: Plaque index was lowest in group I at day 0, while it was highest in group III. At day 4, PI was highest in group II, while lowest in group III. Gingival index was lowest in group I and highest in group II at day 0, and lowest in group I and highest in group III at day 4. There was no statistical difference in Streptococcus mutans (S. mutans) count between groups at any time interval. CONCLUSION: Both chitosan and CH were found to be effective in controlling plaque. However, a combination of both provides even better results. CLINICAL SIGNIFICANCE: The present study showed that chitosan can be used as an antiplaque agent.

A comparative study of skeletal fluorosis among adults in two study areas of Bangarpet taluk, Kolar.

BACKGROUND: Skeletal fluorosis is a crippling disease resulting from excessive exposure to high fluoride from different sources. OBJECTIVES: To assess the prevalence of skeletal fluorosis in Bangarpet taluk of Kolar, to compare various epidemiological factors influencing the occurrence of skeletal fluorosis among the two groups with differential water fluoride levels, and to estimate fluoride levels in all the sources of drinking water in study areas. METHODS: A cross-sectional study was conducted among the adults of three randomly selected villages of Bangarpet taluk, Thimmasandra, Batavarahalli, with high (>1.5 mg/L) and Maddinayakanahalli with normal (<1.0 mg/L) fluoride levels. A house-to-house survey was conducted by administering a semi-structured questionnaire. Skeletal fluorosis was assessed by three simple physical tests in the field followed by radiological confirmation among the positives. Fluoride levels of drinking water sources were estimated by the ion-electrode method. Chi-square and Fisher's exact tests were used as tests of association. RESULTS: The prevalence of skeletal fluorosis at field level in both high and normal fluoride groups was 5.0%. Water fluoride levels in Thimmasandra, Batavarahalli, and Maddinayakanahalli were 4.13 mg/L, 2.59 mg/L, and 0.61 mg/L, respectively. Among the subjects with skeletal fluorosis, a significant difference was observed between socioeconomic status and prevalence of skeletal fluorosis in both high and normal fluoride groups (P < 0.05). CONCLUSION: Skeletal fluorosis is a threat among elderly in Bangarpet taluk, Kolar district.

Impact of Chronic Adenoid Hypertrophy on Quality of Life Index in Children and Role of Adenoidectomy.

Objectives: To analyze the effects of chronic adenoid hypertrophy on quality of life (QOL) of children and caregivers and compare quality of life of child before and after adenoidectomy. Materials & Methods: Prospective, observational before and after questionnaire based assessment study at a pediatric otorhinolaryngology specialty center in a metropolitan quaternary care hospital. Children aged between 2 and 12 years undergoing adenoidectomy were included. Parents were asked to fill the Obstructive Sleep Apnea-18 (OSA-18) Quality of Life Index Questionnaire one day before surgery and after one month of surgery during their scheduled follow-up visit. The study was conducted over a period of 1 year and total of 40 children's assessment was done. Results were tabulated and analyzed. Results: The mean age of presentation was 6 years. Based on OSA-18 quality of life assessment scoring the total pre-operative mean score was 73.3 and post-operative was 40.5. There was significant change in OSA-18 total score and individual domain scores post-operatively indicating significant improvement in QOL post adenoidectomy. The domains most affected due to chronic adenoid hypertrophy were physical suffering, caregiver concerns and sleep disturbance (p value < 0.001).Conclusion: Chronic adenoid hypertrophy has major impact on quality of life of a child along with caregiver concern and they show significant improvement after adenoidectomy. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04000-z.

Clinical profile of patients and sensitivity of troponin I in patients with and without acute coronary syndrome: An observational study.

Background Various clinical conditions can cause troponin elevation in the absence of myocardial ischaemia. Elevated troponin represents the likely occurrence of myocardial necrosis and does not itself provide any indication of the aetiology. Identifying the cause for troponin elevation and its sensitivity and specificity in predicting acute coronary syndrome (ACS) and cardiac mortality is an important step in determining the optimal management for these patients. Methods We retrospectively collected data of inpatients who had troponin I (TnI) testing as part of their clinical assessment, either in the emergency department, medical wards, coronary care unit (CCU) or intensive care unit (ICU) with their final diagnosis. TnI was used as the index test of sensitivity to diagnose ACS and either echocardiography or coronary angiogram in those available as the reference gold standard. They were classified into two groups of normal and elevated TnI, and further divided into those with ACS and no ACS. Data on clinical parameters and aetiology of elevated TnI in patients without ACS were analysed. Results Of the 254 patients studied, 114 patients (45%) had normal TnI and 140 (55%) had elevated TnI. Seventy-eight patients had ACS, 66 (84.6%) of whom had elevated TnI and 12 (15.38%) had normal TnI. Seventy-four (52.85%) of 140 patients with elevated TnI had alternate causes of TnI elevation; the most common being sepsis, acute kidney injury (AKI) and heart failure without ACS. All-cause mortality was significantly higher in patients with elevated TnI with or without ACS. There was no cardiac mortality among patients with ACS with normal TnI. Sensitivity and specificity of TnI for predicting ACS was 84.6% (95% CI 74.7%-91.8%) and 58% (95% CI 50.3%-65.3%), respectively. Conclusion A variety of conditions apart from myocardial infarction can lead to elevated TnI. Hence, caution should be exercised while diagnosing a patient with ACS based on TnI value in the absence of other supporting evidence given its low specificity. Elevated TnI portends a worse prognosis regardless of the aetiology and has a role in predicting all-cause and cardiac mortality.

Childhood maltreatment and DNA methylation: A systematic review.

Child maltreatment (CM) encompasses sexual abuse, physical abuse, emotional abuse, neglect, and exposure to domestic and family violence. Epigenetic research investigating CM has focused on differential DNA methylation (DNAm) in genes associated with the stress response, but there has been limited evaluation of the specific effects of subtypes of CM. This systematic review of literature investigating DNAm associated with CM in non-clinical populations aimed to summarise the approaches currently used in research, how the type of maltreatment and age of exposure were encoded via methylation, and which genes have consistently been associated with CM. A total of fifty-four papers were eligible for review, including forty-one candidate gene studies, eight epigenome-wide association studies, and five studies with a mixed design. The ways in which the various forms of CM were conceptualised and measured varied between papers. Future studies would benefit from assessments that employ conceptually robust definitions of CM, and that capture important contextual information such as age of exposure and subtype of CM.

Clinicopathological study of parasitic lesions of the eye and ocular adnexa in a tertiary care ophthalmic center in South India.

Purpose: To study clinical and pathological features of parasitic lesions in the ocular adnexa in a tertiary care ophthalmic center in south India. Methods: 43 cases of ocular parasitosis were analysed clinically and correlated with the pathological findings (gross morphology and histopathology) over a period of five years (2015-2020). Results: Among the 43 cases, the age group ranged from 9 months to 78 years (mean age of 41.6 years). Female patients were more common than male patients, with a percentage of 63% (27) and 37% (16) respectively. Cystic lesion in the lid or orbit was seen in 23 cases (53.4%); solid mass lesions were seen in 17 cases (39.5%); subconjunctival worms in three cases; and subretinal parasite in one. Gross examination and histopathologic study showed Dirofilaria in 23 cases (53.5%), followed by Cysticercus in six cases (14%) and Microfilariae in four cases (9.3%). Exact species identification was not possible in ten cases (23.25%). Correlation between the type of lesion and type of inflammatory cells with the specific parasite was done. Conclusion: Our study showed that important clinicopathological correlations can be made from the parasitic lesions in the eye and adnexa, which can aid in definitive diagnosis and prompt identification of the parasite for patient management.

Diabetic Nephropathy and Proton Pump Inhibitors - Pilot Case-Control Study.

Introduction: Proton pump inhibitors (PPIs) are liberally used over the counter medication and is largely considered safe. Off late, there are many reports that suggest increased incidence of chronic kidney disease with long-term PPI use. PPIs are often prescribed in patients with diabetes mellitus (DM) and one of the well-known complications of DM is diabetic nephropathy (DN). Thus, the aim of our study was to evaluate association between PPI use and DN. Methods: It was a case-control study conducted over a 2-year period (April 2017-March 2019). Cases were outpatients with type II DM and associated DN. Controls were age and sex-matched type II DM without DN. Results: A total of 200 participants, 100 each in the case and control group, were recruited. The proportion of participants using PPI was 62% in the cases and 42% in the controls (P = 0.005). The most common PPI used was pantoprazole. Increased duration of PPI use was significantly associated with DN [adjusted odds ratio: 1.171; 95% confidence interval: 1.022, 1.341; P = 0.023]. Conclusion: There is a significant association between the use of PPIs and DN in patients with type II DM. Since PPIs have other beneficial effects in patients with DM such as glycaemic control and relief from gastro-oesophageal symptoms, need for risk benefit assessment for long-term use of PPIs in DM is warranted.

Statistical analysis of impact of COVID 19 on India commodity markets.

How did a fitness crisis translate to a financial crisis? Why did coronavirus bring the worlds financial system to its knees? The solution is to be found in two approaches. Initially, this contagious virus resulted in a lockdown of the business world and economy. A ratio at which the virus has been proliferating, the increased uncertainty is exactly the reason for this bad situation which resulted as unsecured initialization investment between traders. We rely on the present environment in evaluating the constricting procedures, fiscal policies and public health actions that were implemented in that time. This study examines volatility transmission over the financial crisis. Recently established causality in impulse response functions and variance test to everyday data from January 2020 has been implied. To recognize the effect of the food cost crisis, statistics are separated into two intervals i.e. post-COVID period and the pre-COVID period. The variance causality test indicates that the risk transmission among agricultural commodity is zero, but oil market volatility spills on the markets for agricultural products excluding sugar in the post-crisis period. Thus, this paper signifies that the statistical volatility transmission differs post food price crisis. Following, risk transmission materializes as an additional element of the statistical interrelations among agricultural and energy markets.

Cost of Tuberculosis Care in Programmatic Settings from Karnataka, India: Is It Catastrophic for the Patients?

BACKGROUND: TB diagnostic and treatment services in India are provided free of cost in the programmatic context across the country. There are different costs incurred during health care utilization, and this study was conducted to estimate such costs. Methodology. A longitudinal study was conducted among patients of three urban tuberculosis units (TUs) of Davangere, Belagavi, and Bengaluru, Karnataka. Trained data collectors administered a validated questionnaire and recorded monthly costs incurred by the patients which are expressed in median Indian National Rupees (INR). The analysis was done using SPSS version 23.0. A p value of <0.05 was taken as statistically significant. RESULTS: Among 214 patients, about 37%, 42%, and 21% belonged to Davangere, Belagavi, and Bengaluru, respectively. Median total pre- and postdiagnostic costs incurred across the three TUs were 3800 and 4000 INR, respectively. The direct nonmedical cost was higher for accommodation (median cost of 800 INR) and direct medical cost for non-TB drugs (median cost of 2000 INR). However, maximum direct medical and nonmedical costs were attributed to hospital admissions (1200 INR) and accommodation costs (700 INR) in the postdiagnostic period, respectively. The median indirect cost incurred was 300 INR overall, and the maximum total indirect cost was 40000 INR in the postdiagnostic period. About one-third of patients faced loss of income and 19.6% faced coping costs. Patients spent about 6.7% (0.97%-52.3%) of their income on TB treatment. About 12.3% patients faced catastrophic expenditure. Median cost was significantly higher among those seeking private health care facilities (12100 INR in private vs. 6800 INR in public; p < 0.05) during the prediagnostic period. Prediagnostic and diagnostic out-of-pocket expenditures (OPE) were significantly higher across all the three centres (p < 0.05). CONCLUSION: The TB patients experienced untoward expenditure under programmatic settings. The costs encountered by one in eight patients were catastrophic by nature.

Determinants of helmet use among health-care providers in urban India: Leveraging the theory of planned behavior.

CONTEXT: Wearing helmet during road traffic accidents among motorcycle riders decreases the likelihood of death by 39%. The theory of planned behavior (TPB), a psychological model helps to explain the failure in helmet usage, by assuming a causal chain. The current study was taken up as no studies have elicited the determinants of helmet usage in terms of TPB among health-care providers, the role models for healthful behavior by virtue of their profession in the current urban Indian context. AIMS: The aims of the study were (1) to determine the proportion of proper use of helmets and (2) to identify TPB-related factors and other factors influencing the use of helmets. MATERIALS AND METHODS: A cross-sectional study was conducted among 147 students and staff of a tertiary health-care center, Bengaluru, using a pretested, validated, semi-structured, self-administered questionnaire. Convenience sampling was used. Hierarchical regression model was used to explain variation in the scores of helmet-use behavior on the basis of TPB variables. P < 0.05 was considered as statistically significant. RESULTS: About 65% of respondents practiced "proper use" of helmets. Intention, perceived behavioral control (direct), and attitude (indirect) were significant predictors of helmet use (P < 0.05). Mean scores of knowledge on helmet use and behavior showed positive correlation (P > 0.05). CONCLUSIONS: Application of TPB in urban Indian context was successful in identifying precursors of helmet use. This study throws a light on the strong influencers of helmet use which can assist policy developers in developing effective programs to successfully promote the "proper use" of helmets.

Availability of all-trans retinoic acid and support systems for management of acute promyelocytic leukemia in Michigan and Louisiana, USA.

Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia with high induction mortality in the general population despite evidence of high cure rates in the clinical trials. Aggressive supportive care is essential for ideal management of these patients. We conducted a survey to collect data on these important issues required for successful treatment/outcome of APL patients from two states (Michigan and Louisiana) due to their low one-year survival rate among the Surveillance, Epidemiology, and End Results registries. All eligible hospitals (253) were obtained from the Data Medicare online directory. Availability of ATRA, formulary process to obtain it, blood back availability and established treatment protocols for the management of APL patients were queried. Since most of the hospitals surveyed do not have a treatment protocol, we believe that outcome could be improved if a standardized and simplified set of treatment and supportive care guidelines are developed for all hospitals treating APL.

Pyrolysis of polystyrene waste in the presence of activated carbon in conventional and microwave heating using modified thermocouple.

Pyrolysis process was experimented using two types of heating source, namely conventional and microwave. Polystyrene (PS) plastic waste was used as feedstock in a batch reactor for both the conventional (slow pyrolysis) and microwave pyrolysis. The effect of activated carbon to polystyrene ratio on (i) yield of oil, gas and residues (ii) reaction temperature (iii) reaction time were studied. Quality of oil from pyrolysis of polystyrene were assessed for the possible applicability in fuel production. Microwave power of 450 W and polymer to activated carbon ratio of 10:1, resulted in the highest oil yield of 93.04 wt.% with a higher heating value of 45 MJ kg-1 and a kinematic viscosity of 2.7 cSt. Microwave heating when compared to conventional heating method, exhibits a reaction temperature and time of 330 °C in 5.5 min, whereas in conventional heating system it was 418 °C in 60 min. The gas chromatography-mass spectrometry analysis of liquid oil from microwave pyrolysis predominantly yields alkenes of 8.44 wt.%, α-methyl styrene 0.96 wt.%, condensed ring aromatics 23.21 wt.% and benzene derivatives 26.77 wt.% when the polystyrene to activated carbon ratio was 10:1. Significant factor of using microwave heating is the amount of energy converted (kWh) is lesser than conventional heating.

A comparative study of dental fluorosis and non-skeletal manifestations of fluorosis in areas with different water fluoride concentrations in rural Kolar.

BACKGROUND: Fluorosis is an endemic disease which results due to excess exposure to high fluoride from different sources. The climatic factors and dependency on ground water add to the risk of fluorosis in Kolar. In addition to it, the epidemiological studies conducted on fluorosis in Kolar are very few. AIMS: (1) To estimate age-specific prevalence of dental fluorosis in the study population. (2) To determine the proportion of study subjects with non-skeletal manifestations of fluorosis (3) To assess and compare the influence of various socio-epidemiological factors in the occurrence of dental fluorosis among the study population in areas with high and normal fluoride. METHODOLOGY: A cross-sectional study was conducted among the residents of three randomly selected villages, Thimmasandra and Batwarahalli (high fluoride) and Maddinayakanahalli (normal fluoride) belonging to Bangarpet taluk, Kolar for 1 year. Dental fluorosis was assessed by the Dean's grading. Non-skeletal manifestations were elicited based on clinical features. Fluoride levels of drinking water sources were estimated by ion-electrode method. The Chi-square and Fisher's exact tests were used to see the difference in proportions and a P value of <0.05 was considered for statistical significance. RESULTS: The prevalence of dental and non-skeletal fluorosis in the study groups with high and normal fluoride groups were 13.17%, 5.5%, 3.84%, 1.9%, respectively. The prevalence of dental fluorosis was significantly higher among the children and adolescents compared to adults (P < 0.05). CONCLUSION: Dental fluorosis is a public health problem mainly affecting children and adolescents in Bangarpet.

Combined external beam radiotherapy and vaginal brachytherapy versus vaginal brachytherapy in stage I, intermediate- and high-risk cases of endometrium carcinoma.

PURPOSE: Randomized trials on the effect of external beam radiotherapy (EBRT) with or without vaginal brachytherapy (VBT) for endometrial carcinoma are very few. In view of this, the current study was conducted with the hypothesizes: whether the escalated dose of 26 Gy (VBT alone) in comparison with various major international trials (PORTEC-2) has any difference in rates of disease-free and overall survival with fewer adverse effects in low resource setting like India. MATERIAL AND METHODS: An open-labeled, non-inferiority, randomized control trial was undertaken at a regional cancer center among patients with stage IA or IB high-intermediate risk endometrial carcinoma. A total of 50 patients were divided equally among two arms of combined EBRT with VBT (arm I) and VBT alone (arm II). A dose of 50-50.4 Gy in 25-28 fractions of EBRT with 2 fractions of VBT 6.5 Gy each were delivered to patients in arm I and 4 fractions of VBT 6.5 Gy each to patients in arm II, and were followed up for 60 months. RESULTS: During the median follow-up of 36.5 months, two patients developed loco-regional recurrence in arm II, three (arm II), and one (arm I) developed distant metastasis. The 5-year survival rates for arms I and II were 96.0% vs. 92.0% overall, and 88.0% vs. 84.0% disease-free, respectively, and were not found to be statistically significantly different. Dermatological, gastro-intestinal toxicities, and cystitis were lower in the VBT group compared to combined group. CONCLUSIONS: VBT alone is as effective as EBRT+VBT in ensuring loco-regional control and achieving comparable survival rates, with fewer toxic effects for patients with stage I intermediate- and high-risk endometrial carcinoma. The dose escalation did not make a difference in the survival rates and was like in the other major trials (PORTEC-2).

Violence against Educated Women by Intimate Partners in Urban Karnataka, India.

BACKGROUND: Initially viewed as a human rights issue, partner violence is increasingly seen as an important public health problem of international concern. OBJECTIVES: To assess the extent of physical, sexual, psychological, and controlling behavior of intimate partners against women in an educated society and find the association with age, age of marriage, married years, educational status of the women and that of partner. MATERIALS AND METHODS: A prevalence of 15% was taken and final sample was 200, after considering loss of follow-up. STATISTICAL METHODS: Proportion, Z-test, Chi-square test. RESULTS: The prevalence of violence against intimate partner in educated society was found to be 40.5% in a South Indian city. Physical assault was high in 30-50 years and increased with duration of marriage from 5.5% at 5 years to 33.3% in 10-20 years of married life. Sexual and psychological assault also increased in <5 years of married life to 35% and 47.6% in 10-20 years duration of marriage, which was statistically significant. Sexual and psychological assault showed a bimodal presentation. Less educated women and their partners were found to report more violence, which was statistically significant. CONCLUSION: Violence against women is not uncommon in the educated society.

Characterization of soluble dietary fiber from Moringa oleifera seeds and its immunomodulatory effects.

Moringa oleifera (moringa or drumstick) seeds are a potential source of dietary fiber with 6.5% w/w soluble dietary fiber. Biochemical characterization of moringa seed soluble fiber revealed that it is a glycoprotein with 5% neutral sugars. Arabinose and xylose are the major neutral sugars identified by gas liquid chromatography (GLC). Moringa seed soluble fiber was identified as protease resistant-glycoprotein and termed as moringa seed resistant protein (MSRP). MSRP was found to be a homodimer (18kDa) containing two 9kDa monomeric units as revealed by SDS-PAGE analysis with pI 10.8. Immunostimulating activity of MSRP was assessed by murine splenocyte proliferation and production of NO from macrophages. MSRP at low concentration (0.01µg/well) strongly increased proliferation of splenocytes, while MSRP at high concentration weakly responded. MSRP induced 6-fold increase in NO production when compared to the control which indicates the activation of macrophages. MSRP isolated from defatted moringa seed flour is a potent mitogen, enhancing the proliferation of lymphocytes and inducing NO from macrophages. This study concludes that moringa seed is a potential nutritional source to promote the immune system of the host.

Squamous cell carcinoma arising in a chronic osteomyelitic sinus tract in the peri-anal region involving pelvis: a rare occurrence.

Squamous cell carcinoma is a rare, but well documented complication of chronic osteomyelitis. Squamous cell carcinoma arising in a sinus tract following chronic osteomyelitis of the pelvic bone is a very rare occurrence. The patient presented with multiple draining sinuses and an ulcerative growth at the mouth of one of the sinuses in the peri-anal region. X-ray findings and sinogram showed de- struction of part of pubic bone. Biopsy from the growth confirmed a well differentiated squamous cell carcinoma. Therefore it is imperative that these lesions be biopsied for accurate diagnosis, adequate therapy and follow-up.