Adverse events and breakthrough infections associated with COVID-19 vaccination in the Indian population.

Vaccines against COVID-19 provide immunity to deter severe morbidities associated with the infection. However, it does not prevent infection altogether in all exposed individuals. Furthermore, emerging variants of SARS-CoV-2 impose a threat concerning the competency of the vaccines in combating the infection. This study aims to determine the variability in adverse events and the extent of breakthrough infections in the Indian population. A retrospective study was conducted using a pre-validated questionnaire encompassing social, demographic, general health, the status of SARS-CoV-2 infection, vaccination, associated adverse events, and breakthrough infections in the Indian population. Informed consent and ethical approval were obtained as per Indian Council of Medical Research (ICMR) guidelines. Participants, who provided the complete information, were Indian citizens, above 18 years, and if vaccinated, administered with either Covishield or Covaxin, were considered for the study. Data have been compiled in Microsoft Excel and analyzed for statistical differences using STATA 11. The responses from 2051 individuals fulfilling the inclusion criteria were analyzed. Among 2051, 1119 respondents were vaccinated and 932 respondents were non-vaccinated. Among 1119 vaccinated respondents, 7 were excluded because of missing data. Therefore, out of 1112 vaccinated, 413 experienced adverse events with a major fraction of younger individuals, age 18-40 years, getting affected (74.82%; 309/413). Furthermore, considerably more females than males encountered adverse consequences to vaccination (p < 0.05). Among vaccinated participants, breakthrough infections were observed in 7.91% (88/1112; 57.96% males and 42.04% females) with the older age group, 61 years and above (odds ratio, 3.25 [1.32-8.03]; p = 0.011), and males were found to be at higher risk. Further research is needed to find the age and sex-related factors in determining vaccine effectiveness and adverse events.

Occurrence of domestic violence among women and its impact on oral health in Jodhpur City.

BACKGROUND: This study had a two objectives to determine the prevalence of domestic violence and to know the impact of the same on the oral health. MATERIALS AND METHODS: An observational cross-sectional study was done in Jodhpur, Rajasthan; among 150 married women of 18 to 60 years of age using a predesigned pretested proforma from 18th January 2014 to 27th February 2014. Pretested semistructured open-ended questionnaire used for collecting the data from the study subjects. Pearson's Chi-square test and p-value were used to calculated the occurrence and impact of domestic violence on oral health among women. RESULTS: The most common form of domestic violence found was physical abuse (54.7%) followed by emotional abuse (20.0%) and financial abuse (14.0%). The most important risk factor was alcoholism followed by literacy status and having a girl child. Study shows that physical abuse is more in graduate than lower level of educational females. Females living in urban area show highest frequency of physical abuse than those living in rural area. Injury to the face were highly reported (38.7%) followed by injury to lip (13.3%) and nose fracture/bleeding nose (9.3%). CONCLUSION: Government has to take stringent action to prevent domestic violence by making women more self-reliant especially by making women more literate and more financially independent.

Percutaneous irreversible electroporation for downstaging and control of unresectable pancreatic adenocarcinoma.

PURPOSE: Treatment of unresectable locally advanced pancreatic cancer (LAPC) usually includes chemotherapy and/or radiation therapy in an attempt to downstage these tumors to the extent of resectability, but outcomes remain poor. Irreversible electroporation (IRE) is an ablative modality that may be useful in this population. The aim of this study was to evaluate the safety of percutaneous IRE in patients with pancreatic adenocarcinoma. MATERIALS AND METHODS: IRE was performed in patients with pancreatic cancer whose tumors remained unresectable after, or who were intolerant of, standard therapy. The procedures were all done percutaneously under general anesthesia. Patients were then followed for adverse events, tumor response, and survival. RESULTS: Fifteen IRE procedures were performed in 14 patients (one was treated twice). Three patients had metastatic disease and 11 had LAPC. All patients had received chemotherapy previously, and 11 had received radiation. The median tumor size was 3.3 cm (range, 2.5-7 cm). Immediate and 24-hour postprocedural scans demonstrated patent vasculature in the treatment zone in all patients. Two patients underwent surgery 4 and 5 months after IRE, respectively. Both had margin-negative resections, and one had a pathologic complete response; both remain disease-free after 11 and 14 months, respectively. Complications included spontaneous pneumothorax during anesthesia (n = 1) and pancreatitis (n = 1), and both patients recovered completely. There were no deaths directly related to the procedure. All three patients with metastatic disease at IRE died from progression of their disease. CONCLUSIONS: Percutaneous IRE for pancreatic adenocarcinoma is feasible and safe. A prospective trial is being planned.

The untold saga of chromotherapy in dentistry.

Being a centuries-old concept and used successfully over years, chromotherapy is the method of treating diseases using coloured food, coloured clothing, colour saturated oils, coloured water and visible spectrum of electromagnetic radiation. The basis of chromotherapy depends on the fact that illness is caused by an imbalance in the basic chakras of the body. Colour therapy rebalances the chakras using specific colours. Being a part of complementary and alternative medicine systems, it proves to be effective for various systems of the body and affects neurohormonal pathways. Based on the available literature, this review documents the scientific evolution of colour therapy in medicine and dentistry and its various applications. Future studies will establish exactly how chromotherapy promotes wellbeing, owing to technical advancements and the scientific approach. Till then, it is a low-cost, non-invasive treatment option that is worth a go.

Pericardial Effusion Secondary to Nilotinib in an Elderly Patient With Chronic Myelogenous Leukemia.

Tyrosine kinase inhibitors (TKIs) are the first-line treatment for patients with chronic myelogenous leukemia (CML). Serositis, including pleural and pericardial effusions, is a frequent adverse event with some TKIs while less frequent with others. We present a case of a 76-year-old woman with CML on nilotinib who presented with progressive fatigue and was eventually found to have cardiac tamponade from a large pericardial effusion attributed to nilotinib. The patient required urgent therapeutic pericardiocentesis and switching of TKIs from nilotinib to bosutinib.

Multiple sexually transmitted co-infections are associated with adverse reproductive outcomes in asymptomatic adolescent pregnant women; A Prospective cohort study.

Background: A prospective cohort was conducted to assess the prevalence of seven RTIs/STIs in adolescent asymptomatic pregnant women to find a significant correlation between infection and pregnancy. Methods: The study was restricted to 18-19 years of asymptomatic adolescent pregnant women attending Ante-Natal Care and the health status of the pregnant women were followed up to parturition. The health status of the infant was followed till 6 months post-delivery. The prevalence of the concerning pathogens and the significance of their association with adverse outcomes of pregnancy were determined. Results: Among 279 subjects, the most significant co-infections were observed for M. hominis with U. parvum (9.31%; p-value-0.0071/OR-2.6421) and U. urealyticum (7.88%; p-value-0.0119/OR-2.6455). Statistically significant associations were found between C. trachomatis [(p-value-0.0439); OR-2.9902] and M. genitalium [(p-value-0.0284); OR-3.442] with PTB, N. gonorrhoeae with LBW <2.5 kg [(p-value-0.0052);OR-4.9017], U. urealyticum with VLBW <2 kg [(p-value-0.0262);OR-3.0207], M. genitalium [(p-value-0.0184); OR-11.7976] and T. vaginalis with PROM [(p-value 0.0063); OR-19.4275] while M. genitalium [(p-value 0.0190); OR-12.9230] and U. urealyticum [(p-value 0.0063); OR-14.5149] with PPROM with 95% CI respectively. Conclusions: Asymptomatic adolescents are at high risk of adverse pregnancy outcomes if infected with the concerned pathogens.

Improved management can be achieved by introducing additional parameters in the syndromic diagnosis of nonviral sexually transmitted infections at low-resource settings.

BACKGROUND: The syndromic approach is a simple and affordable strategy for the management of sexually transmitted infections in countries with low-resource settings. However, because of the lack of specificity and accuracy, the risk of overuse and misuse of antibiotics is very high. Here, we proposed a more specific and accurate algorithm compared with the current algorithm used for syndromic case management of 3 common sexually transmitted pathogens and compared its precision with laboratory-based tests. OBJECTIVE: This study aimed to report a comparative account of the accuracy of existing syndromic case management guidelines followed in mainstream hospitals, for taking care of patients with nonviral sexually transmitted infections, concerning an approach involving an alternative algorithm formulated in our laboratory followed by polymerase chain reaction testing. STUDY DESIGN: This was an observational study that compared the data between 2 categories based on diagnostics accuracy and treatment. In category I, symptoms of infection were scored on the basis of the existing National AIDS Control Organization and National AIDS Control Programme guidelines, and patients were treated before testing by polymerase chain reaction. In category II, patients were recruited on the basis of the National AIDS Control Organization and National AIDS Control Programme guidelines with additional alternative syndromic case management parameters. All samples were tested by polymerase chain reaction for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis and clinically correlated before giving the treatment. RESULTS: In category I, among 646 women with symptomatic infection, only 46 (7.82%) tested positive by polymerase chain reaction assay for at least 1 of the pathogens, and 600 (92.87%) tested negative for infection by any of the 3 pathogens. The total estimated percentages of the overuse and misuse of antibiotics were 92.87% and 8.69%, respectively. Correct and complete treatment based on laboratory outcome compared with National AIDS Control Programme guidelines was 42 of 46 (91.30%). The estimated overuse of azithromycin and cefixime (Gray Kit) was 29.69%, the estimated overuse of a combination of doxycycline, cefixime, and metronidazole (Yellow Kit) was 29.87%, and the estimated overuse of a combination of doxycycline, cefixime, metronidazole, and azithromycin (Gray with Yellow Kit) was 11.45%. In category II, wherein patients were treated using an alternative syndromic approach and polymerase chain reaction diagnostics, 243 of 319 patients (76.15%) were infected with either of the pathogens (Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis), whereas 76 of 319 patients (23.82%) were negative for any of the 3 pathogens. Among 243 patients with infection, 99 of 243 (40.74%) were infected with a single pathogen, whereas 144 of 243 (59.20%) were coinfected. Of 144 coinfected patients, the percentage of Chlamydia trachomatis + Neisseria gonorrhoeae infection was the highest (51.38%), followed by coinfection with all 3 pathogens (30%). Coinfection with Chlamydia trachomatis + Trichomonas vaginalis was 9.72%, and coinfection with Neisseria gonorrhoeae + Trichomonas vaginalis was 9.03%. The estimated overuse of antibiotics was found to be 23.82% only. CONCLUSION: The proposed alternative strategies of syndromic case management can reduce the percentage of misuse and overuse of antibiotics from 92.87% to 23.82%. Moreover, syndromic case management alone was insufficient for disease management.

Arrhythmia prevalence among patients with polymyositis-dermatomyositis in the United States: An observational study.

BACKGROUND: Systemic inflammation has been associated with atherosclerotic cardiovascular diseases (ASCVD) and arrhythmia occurrence in rheumatologic conditions such as rheumatoid arthritis. Polymyositis and dermatomyositis (PD) are rare rheumatologic conditions characterized by symmetrical proximal muscle weakness and, in the case of dermatomyositis, cutaneous eruption. Although there is literature associating PD with ASCVD, no population-level studies have analyzed arrhythmia risk in PD. OBJECTIVE: The purpose of this study was to assess the prevalence of arrhythmia and its subtypes by age and sex in patients with PD and to determine associations between arrhythmia and PD. METHODS: This retrospective cohort study included adults for whom hospitalizations had been recorded in the National Inpatient Sample database in the United States between 2016 and 2018. Patients with PD were matched (1:10) by age to patients without PD. Prevalence of arrhythmia was calculated in the 2 groups and compared by sex and age groups. Associations between PD and arrhythmia were determined after adjustment for common arrhythmia risk factors. RESULTS: From 107,001,355 hospitalizations, 32,085 adults with PD were matched to 320,850 controls. Patients with PD aged <70 years had a higher prevalence of arrhythmia and higher adjusted odds of arrhythmia compared with controls. This increased risk was only seen for supraventricular arrhythmias. Adults with PD had increased odds of in-hospital mortality if they had an arrhythmia diagnosis (odds ratio 3.3; 95% confidence interval 2.5-4.5; P <.001). CONCLUSION: We found a higher prevalence and odds of arrhythmias, particularly supraventricular arrhythmias, in young and middle-aged patients with PD compared with matched controls. Arrhythmias were associated with significant mortality among patients with PD.

Impact of pharmaceutical price controls on the cost of cardiovascular drugs: does essentiality matter?

BACKGROUND: With the goal of improving the affordability of medicines, governments across the globe have instituted various forms of price controls. Since 2013, India has been regulating the prices of drugs included in its national list of essential medicines (NLEM). Here we evaluate the cost variations among available cardiovascular drugs and perform cost-analysis comparing essential and non-essential drugs. METHODS: Data on listed prices of selected cardiovascular drugs - essential (NLEM) and non-essential (NNLEM) - were sourced from multiple drug information compendia. Price of medications was calculated in cost-per-defined-daily-dose (DDD)-units and NLEM vs. NNLEM drugs were compared. Regression analysis was used to explore the determinants of percentage cost variation (PCV) of drugs. RESULTS: The median-cost/DDD of essential medicines was lower as compared to non-essential ones for all therapeutic drug classes, with greatest difference observed for antianginals and least for heart failure medicines. There were substantial cost variations with values in excess of 1000% for six medicines, all being essential. The regression analysis failed to demonstrate a significant effect of essentiality on PCV (ß = 0.19, P = 0.314). CONCLUSIONS: Our analyses demonstrate considerable cost variations for some essential cardiovascular medicines. Given the need for prolonged and often, lifelong-treatment, there is significant potential for cost savings based on chosen brand, highlighting the need for patient as well as prescriber education.

Ponseti Technique for the Management of Congenital Talipes Equinovarus in a Rural Set-Up in India: Experience of 356 Patients.

Congenital talipes equinovarus (CTEV), also known as clubfoot, is a complex congenital deformity of the foot that, left untreated, can limit a person's mobility by making it difficult and painful to walk. Worldwide, 80% of children born with clubfoot are in low- and middle-income countries. The management of clubfoot has a long history. Non-operative management did not become popular, as an increasing number of orthopaedists started leaning towards surgical treatment. The late Dr. Ignacio Ponseti developed a method of clubfoot correction that successfully realigns clubfoot in infants without extensive and major surgery. The aim of the study was to assess the functional outcome of CTEV management by the Ponseti technique, to study the severity of CTEV deformity using the Pirani score, and to evaluate the cost-effectiveness of the technique. A total of 356 cases with 402 feet with CTEV were treated by the Ponseti method. The average age of the children and the number of casts applied before full correction were 4.03 months and 6.91, respectively. There was a good functional outcome in 95.45% of cases (score > 30) at the last follow up. The management of CTEV by the Ponseti technique provides a good functional and cosmetic outcome. In a developing country like India, this technique is a safe, easy, economical method of clubfoot management.

Prevalence of dental caries, periodontitis, and oral hygiene status among 12-year-old schoolchildren having normal occlusion and malocclusion in Mathura city: a comparative epidemiological study.

OBJECTIVE: The aim was to find the prevalence of dental caries, periodontitis, and oral hygiene index-simplified (OHI-S) among 12-year schoolchildren having normal occlusion and malocclusion in Mathura city. MATERIALS AND METHODS: The present study was a cross-sectional study done among the 100 subjects who have been selected from 5 schools in four different geographical locations. The data regarding their socio-demographic characteristics, dental caries status, periodontitis status and oral hygiene status was collected using structured proforma. Means, standard deviations and test of significant were used as statistics to describe the data. RESULTS: The results showed that there was no significant difference between dental caries status, periodontitis status among subjects having normal occlusion and malocclusion (P = 0.06, 0.093) but significant relationship was found OHI-S and children who were having malocclusion (and P = 0.022). Significant difference was also found between periodontitis and oral hygiene status (P = 0.00). CONCLUSION: It was observed from the present study that normal occlusion and malocclusion had no or weak significant effect on overall caries and periodontitis prevalence whereas oral hygiene status had a strong effect on overall periodontitis prevalence but not in relation to prevalence of dental caries in 12-year-old school children in Mathura city.

Evaluation of adult dental patterns on orthopantomograms and its implication for personal identification: A retrospective observational study.

BACKGROUND: Establishing a person's identity is a very complex process and is one of the main objectives of the forensic science also. Dental radiographs are certainly one of the most desirable pieces of antemortem evidence because of their highly objective nature as compared with other records. The aim of the present study is to establish the utility of orthopantomography for human identification. MATERIALS AND METHODS: A total of 300 digital orthomopantographs were randomly selected from those stored at Oral Medicine and Radiology Department of Dr. D.Y. Patil Dental College and Hospital, Pimpri, Pune. Dental patterns were classified into nine types which are commonly observed in dental radiography. The diversity of dental patterns was calculated for full dentition, maxilla and mandible respectively. RESULTS: Diversity of dental patterns observed for full dentition, maxilla and mandible were found to be 99.9%, 98.2% and 98.4% respectively. CONCLUSION: Findings suggests that orthopantomograms prove to be valuable aid in human identification.

Transarterial chemoembolization using DEBIRI for treatment of hepatic metastases from colorectal cancer.

BACKGROUND/AIM: Dismal survival rates of metastatic colorectal cancer (mCRC) to the liver have been recorded. Transarterial chemoembolization (TACE) with irinotecan eluting beads (DEBIRI) may be a safe palliative treatment with fewer serious adverse effects (SAEs). We aimed to establish the safety and efficacy of DEBIRI TACE in the treatment of hepatic metastases from colorectal cancer (CRC). PATIENTS AND METHODS: A retrospective analysis of DEBIRI TACE was performed. Response was assessed using the m-RECIST criteria. The Common Terminology Criteria for Adverse Events (CTCAE v3.0) were used to record toxicity. Survival was estimated using Kaplan Meier analysis. RESULTS: Twenty-eight patients treated with 47 DEBIRI TACE procedures were followed from September 2008 until February 2012. Twenty-two had metastases from colonic cancer and six metastases from rectal cancer; three patients (15%) had complete response, six (30%) partial response, four (20%) stable disease and disease progression was recorded in seven (35%); computer tomography (CT) scans were unavailable for eight patients. AEs included gastrointestinal and acid-base disturbances, hypertension, fever, insomnia, chest pain, pruritus, and neutropenia; five patients did not present AEs. The median time from diagnosis of liver metastases to initial DEBIRI treatment was 19.6 months. The median follow-up was 6.9 months. The median overall survival from first treatment was 13.3 months (95% confidence interval=6.8-19.8 months). CONCLUSION: DEBIRI is a well-tolerated treatment option that can be used safely in the palliative treatment of hepatic metastases from CRC.

Dentofacial characteristics in William's syndrome.

William's syndrome is a chromosomal disorder characterized by multisystem, congenital and panethnic occurrence, characterized by a number of developmental and physical abnormalities. This case report describes the dental management of a 10-year-old male patient with William's syndrome who had multiple dental problems such as caries, periodontal disease and malocclusion.