Cell-based therapy in the management of Class III Miller's recession - A case report with 45-month follow-up.

Miller's Class III gingival recessions (GRs) have always posed a challenge to the clinicians in terms of achieving complete root coverage (CRC). In the present case, a cell-based therapy with autologous fibroblasts seeded onto a Type 1 collagen membrane, through an in-vitro culturing method was utilized. The fibroblasts-seeded membrane was surgically placed under a laterally repositioned flap. The patient presented with a CRC, which was stable even at the postoperative period of 45 months. In addition, a 3-mm substantial gain in the width of keratinized tissue was achieved and maintained throughout the postoperative period. Hence, the results of the cell-seeded therapy emphasize that it can serve as an effective alternative method for the management of Miller's Class III GRs.

Refractive profile of children treated with intravitreal bevacizumab for retinopathy of prematurity.

Purpose: To study the refractive profile of children after they received intravitreal injection of bevacizumab for retinopathy of prematurity (ROP). Methods: The study was conducted at a tertiary eye care hospital in South India. ROP patients of more than 1 year of age, presenting to the Pediatric Ophthalmology Clinic and Retina Clinic and having history of treatment for type I ROP with intravitreal bevacizumab (IVB) or intravitreal bevacizumab and laser photocoagulation were included in the study. Cycloplegic refraction was done, and the refractive status was evaluated. The refractive status of age-matched, full-term children with uneventful perinatal and neonatal history was also recorded and compared to the study group. Results: Among 134 eyes of 67 study subjects, the major refractive error was myopia in 93 eyes (69.4%; spherical equivalent [SE] = -2.89 ± 3.1, range = -11.5 to -0.5 D). There were 75 eyes (56%) with low-to-moderate myopia; high myopia was seen in 13.4%, emmetropia in 18.7%, and hypermetropia in 11.9% of eyes. The majority of them (87%) had with-the-rule (WTR) astigmatism. In 134 eyes, the SE was -1.78 ± 3.2 (range = -11.5 to 4 D); the SE of the 75 eyes with low-to-moderate myopia was -1.53 ± 1.2 (range = -0.50 to -5 D). In the control group, the majority had emmetropia (91.8%). There was no significant association between the age at which IVB had been injected and the development of refractive errors (P = 0.078). The prevalence of low-to-moderate myopia was more than high myopia in patients with zone I and zone II ROP before treatment (60.0% and 54.5%, respectively). Conclusion: Myopia was the major refractive error seen in post-IVB pediatric patients. WTR astigmatism was more commonly seen. The age at which IVB injection had been given had no effect on the development of refractive errors.

A cross-sectional study of pre- and posttraining evaluation of inhaler use technique among outpatients with bronchial asthma or chronic obstructive pulmonary disease at a tertiary care hospital in India.

Context: Management of asthma and chronic obstructive pulmonary disease (COPD) includes use of inhalers as an integral component of drug delivery. Awareness about inhaler devices along with demonstration of the usage of inhaler technique aids in the optimization of therapeutic outcome. Aim: This study aimed to assess the correct use of inhaler technique following pre- and posttraining sessions for the management of COPD and asthma among pulmonary outpatients at a tertiary care hospital. Settings: This prospective cross-sectional study was carried out among patients diagnosed with asthma or COPD and prescribed with inhaler medication in the form of pressurized metered-dose inhaler (pMDI), MDI with spacer, or dry powder inhaler (DPI). Subjects and Methods: The inhaler device use by the patients was assessed initially, followed by a demonstration on inhaler device technique, and reassessed post training using a checklist. Statistical Analysis: Comparison of the median total score of pretraining and posttraining inhaler technique was analyzed by Wilcoxon signed rank test. P < 0.05 was considered statistically significant. Results: Out of 144 patients, 55.6%, 27.7%, and 16.7% of them were prescribed pMDI, MDI with spacer, and DPI, respectively. Post inhaler technique training, about 79.2% of the patients were able to demonstrate the inhaler technique correctly compared to 52.1% prior to training. A statistically significant difference in the median score of inhaler technique has been observed before and after training. Conclusions: This study reports a significant improvement in the correct use of inhaler technique post training. In addition, the most frequent error among inhaler users was revealed to be in the breath actuation.

An Observational Study on the Effect of Yoga and Sudarshan Kriya in Type 2 Diabetes Mellitus Patients.

Introduction One of the major health problems in many countries including India is type 2 diabetes. Yoga is being explored as an alternative therapy for the management of diabetes. Methods Among the total of 137 participants who successfully completed the 'Living Well' workshop by the Art of Living, 84 with type 2 diabetes were assessed for change in random blood sugar levels, systolic and diastolic blood pressure levels (SBP/DBP), and pulse rate over seven days. In the Living Well workshop, the participants performed a comprehensive Yogic Breathing Program that included yogic movements and postures (Asana), relaxation practice, three-stage Pranayama, Sudarshan Kriya Yoga (SKY), breathing techniques, and discussion of stress relieving principles over those seven days. The parameters were recorded at the time of enrollment and after the completion of seven days of the workshop. Results There was a greater (p<0.05) percent reduction in the mean blood sugar level in diabetics as compared to non-diabetic individuals. However, the reduction in SBP and DBP were similar (p>0.05) in diabetics and non-diabetics. The percent reduction in the pulse rate however was greater (p<0.05) in diabetics than non-diabetics. Conclusion Comprehensive yogic breathing practices comprising SKY may be beneficial in patients with type 2 diabetes mellitus.

Prescription audit of a teaching hospital in South India using World Health Organization core prescribing indicators - A cross-sectional study.

Aim: World Health Organization (WHO) core prescribing indicators are highly standardized tools in reliably assessing the essential aspects of drug utilization pattern. It is critical that the rational use of drug prescribing is scrutinized for the utmost benefit of patient welfare. In this study, we aim to assess the prescription pattern and prescribing behavior of physicians using the WHO-recommended core prescribing indicators at a teaching hospital in South India. Materials and Methods: A prospective, descriptive cross-sectional study was conducted in the general medicine outpatient department of a tertiary care hospital for a period of 1 month in June 2019. A total of 600 prescriptions were sampled based on the WHO "How to investigate drug use in health facilities" document recommendation. The WHO guidelines and methods were observed to ensure data reliability. Descriptive statistical analyses such as frequencies, percentages, mean, and standard deviation were used to present the data. Results: The WHO core prescribing indicators analysis revealed that the average number of drugs per encounter was 2.38 ± 1.1 and only 796 (55.4%) of the drugs were prescribed by generic name. Whereas, the percentage of encounters prescribed with an antibiotic 44 (7.3%) and an injection 63 (10.5%) was less than the ideal recommendations as per WHO and 1265 (88%) of the drugs were prescribed from the National List of Essential Medicines. Conclusion: This study on prescription pattern audit done using the WHO core prescribing indicators highlights that prescriptions encountered with antibiotic and injection use were in accordance with the WHO recommendations.

Potpourri of retinopathies in rare eye disease - A case series.

This case series describes the ocular and retinal manifestations of rare eye diseases in systemic syndromes. This observational case series consists of five patients with varied ophthalmic manifestations and documentation of imaging in rare pediatric and adult retinopathies. Two patients had Kearns Sayre syndrome (KSS) based on the classical triad of external ophthalmoplegia, pigmentary retinopathy, and onset before 20 years of age. In one patient of KSS, the mitochondrial retinopathy was seen in an asymmetric pattern, and the second patient presented with KSS after being mis-diagnosed as myasthenia gravis elsewhere. A case of Senior Loken syndrome in pediatric age is described in this series with varied ophthalmic manifestations ranging from retinitis pigmentosa to orbital abscess. This series also enlightens features of Hallervorden Spatz syndrome presenting with bull's eye maculopathy and a case of spino-cerebellar ataxia type 7 presenting with pigmentary retinopathy.

Chlordiazepoxide-induced delirium in a patient undergoing alcohol withdrawal: a case report.

BACKGROUND: Ethanol dependence is associated with a discontinuation withdrawal delirium. Chlordiazepoxide is frequently successfully used in its treatment. CASE PRESENTATION: A 27-year-old, Caucasian female with ethanol dependence who had objective symptoms of withdrawal experienced worsening of her delirium after administration of chlordiazepoxide, but improved with lorazepam and cleared with discontinuation of benzodiazepine administration. CONCLUSIONS: Worsening of delirium appears to be related to the specific use of chlordiazepoxide, but the mechanism of this effect is not clear. While this case does not alter the standard care of ethanol dependence, it does alert clinicians that our treatment approach may not be fully benign.

Comparison of Accuracy of Dentaport ZX, Rootor and E-Pex Pro Electronic Apex Locators in Two Simulated Clinical Conditions: An In Vitro Study.

Background: The aim of this in vitro study was to determine the accuracy in measuring the working length (WL) using Dentaport ZX, Rootor, and a newly introduced budget friendly electronic apex locator (EAL), E-Pex Pro in two commonly simulated clinical conditions (in the presence of irrigant and blood). Materials and Methodology: Eighty-eight single-rooted premolars were randomly assigned to two groups according to simulated clinical conditions: Group 1: Presence of irrigant (5% NaOCl) and Group 2: Presence of blood. WL was determined with all three EAL and was then compared with actual length (AL) of the tooth, which was measured using Vision Inspection System. The difference between the length measured by EAL and AL was tabulated and statistically analyzed using one-way analysis of variance (ANOVA) with post hoc Dunnett's test. All testing was done using two-sided tests at alpha 0.05 (95% confidence level). Thus, the criteria for rejecting the null hypothesis were "P < 0.05." Results: Measurement using Dentaport ZX, Rootor, and E-Pex Pro had an accuracy of 99.79%, 99.69%, and 99.64%, respectively, in Group 1 and 99.95%, 99.7%, and 99.74%, respectively, in Group 2. ANOVA revealed that the mean error value is least for Dentaport ZX followed by Rootor and then E-Pex pro EAL. Conclusion: Dentaport ZX gave better results both in the presence of NaOCl and blood followed by Rootor and E-Pex Pro EALs.

Comparative evaluation of postoperative pain following chemomechanical preparation of single-rooted nonvital teeth with symptomatic apical periodontitis with and without laser irradiation: A double-blind randomized placebo controlled clinical trial.

Background: Postoperative pain can occur because of residual infection even after effective chemomechanical preparation. This study aimed to compare postoperative pain after chemomechanical preparation with placebo and laser irradiation in nonvital teeth having symptomatic apical periodontitis. Materials and Methods: Sixty (n = 30) participants after obtaining written consent were enrolled in the study. In Group 1, chemomechanical preparation followed by mock laser therapy was carried out in which laser tip was applied but not activated. In Group 2, chemomechanical preparation followed by a laser irradiation was applied and activated. Postoperative pain scores were evaluated at baseline, 24 h, 48 h, and 72 h using the Visual Analog Scale. Preoperative and postoperative percussion pain scores were also recorded. Subjects needing rescue medication were recorded as well. Mann-Whitney U test and Wilcoxon test were used for intergroup comparison and intragroup comparison. The Chi-square test was used for comparing rescue medication. Results: There was significant reduction in pain scores in the laser group as compared to placebo group at all time points. There was also significant difference in the preoperative and postoperative percussion pain scores. 9 and 3 subjects required rescue medication in Groups 1 and 2, respectively. Conclusion: Laser irradiation following chemomechanical preparation led to significant reduction in postoperative pain and can be considered as a valuable adjunct.

Assessment of yogic relaxation techniques for its anxiolytic effects in patients requiring endodontic treatment: A prospective, randomized controlled study.

BACKGROUND: The aim of the study is to assess the anxiolytic effects of yogic relaxation technique (YRT) in patients requiring root canal treatment (RCT). MATERIALS AND METHODS: In this prospective, randomized, placebo-controlled study, 30 patients undergoing RCT with baseline visual analog scale for anxiety (VAS-A) of score >4 were divided into Group 1: YRTs; Group 2: alprazolam (0.25 mg/0.5 mg), and Group 3: placebo. After 30 min of completion of YRT, endodontic treatment was performed. Reduction in anxiety was analyzed using state anxiety score (domain) of the state-trait anxiety inventory scale. RESULTS: There was no significant difference in anxiety score 1 h before RCT between groups (P = 0.401). Ten minutes before (P < 0.0001) and after RCT (P < 0.0001), there was significant difference between groups (yogic relaxation vs. alprazolam [P < 0.0001]; yogic relaxation vs. placebo [P < 0.0001]). Ten minutes before RCT, yoga relaxation showed significant difference in anxiety score for pain versus alprazolam and placebo (P < 0.0001 for both). Ten minutes after RCT, the change from baseline in mean anxiety score for pain was significantly different with yogic relaxation (versus alprazolam [P = 0.043]; versus placebo [P = 0.002]). As per the global assessment of efficacy, the response was excellent in 9 (90%), 2 (20%), and 1 (10%) patients in yoga relaxation group, alprazolam group, and placebo group, respectively. Difference in response between three groups was significant (P < 0.0001). There was no significant difference in the global assessment of tolerability between three groups (P = 0.535). No adverse events were reported. CONCLUSION: Before RCT, YRT is an effective alternative to anxiolytic agents, alprazolam.

Drug utilization pattern and factors associated with polypharmacy and excessive polypharmacy in geriatric medical out-patients at a rural health training centre in India.

CONTEXT: Multiple chronic illnesses associated with ageing population demands the role of polypharmacy. Drug utilization study in terms of description of drug use pattern in the geriatric patients aids in monitoring polypharmacy as well as to determine the factors contributing to it. OBJECTIVES: To analyse the drug utilization pattern in geriatric patients at a rural health training centre. SUBJECTS AND METHODS: A cross-sectional study was conducted in a rural health centre to assess the drug utilization pattern using the WHO core drug prescribing indicators. Polypharmacy was defined as usage of 5-8 drugs and excessive polypharmacy as intake of 10 or more drugs. The drugs were coded using Anatomical Therapeutical Chemical classification. Univariate and bivariate analysis were done using SPSS to present the data. RESULTS: Among 207 patients, 29.5% were on polypharmacy and 1.5% patients on excessive polypharmacy. About 75% of patients had one or more comorbid medical condition. A total number of 829 drugs were prescribed and the average number of drugs per prescription was 4.02. CONCLUSION: The drug utilization pattern analysis in the geriatric patients reveals deviation of the average number of drugs per prescription from the WHO standard recommendation. The most common comorbid condition among the geriatric patients was diabetes mellitus. This drug utilization study imparts knowledge about the use of polypharmacy, comorbidities and the pattern of commonly used drugs among the geriatric patients in rural area. Periodic assessment of the pattern of drug utilization in the elderly aids to improve the prescribing pattern and minimize patient harm.

A review on network pharmacology based phytotherapy in treating diabetes- An environmental perspective.

Diabetes has become common lifestyle disorder associated with obesity and cardiovascular diseases. Environmental factors like physical inactivity, polluted surroundings and unhealthy dieting also plays a vital role in diabetes pathogenesis. As the current anti-diabetic drugs possess unprecedented side effects, traditional herbal medicine can be used an alternative therapy. The paramount challenge with the herbal formulation usage is the lack of standardized procedure, entangled with little knowledge on drug safety and mechanism of drug action. Heavy metal contamination is a major environmental hazard where plants tend to accumulate toxic metals like nickel, chromium and lead through industrial and agricultural activities. It becomes inappropriate to use these plants for phytotherapy as it may affect the human health on long term consumption. This review discuss about the environmental risk factors related to diabetes and better implication of medicinal plants in anti-diabetic therapy using network pharmacology. It is an in silico analytical tool that helps to unravel the multi-targeted action of herbal formulations rich in secondary metabolites. Also, a special focus is attempted to pool the databases regarding the medicinal plants for diabetes and associated diseases, their bioactive compounds, possible diabetic targets, drug-target interaction and toxicology reports that may open an aisle in safer, effective and toxicity-free drug discovery.

Evaluation of the anti-rheumatic properties of thymol using carbon dots as nanocarriers on FCA induced arthritic rats.

Rheumatoid Arthritis (RA) is an autoimmune disease that commences as inflammation and progressively destroys the articular joint. In this study, we assess the anti-rheumatic potential of the monoterpenoid class of thymol conjugated with Carbon Dots (CDs). Waste biomass in the form of dried rose petals was chosen as a precursor for the synthesis of CDs via a one-step hydrothermal bottom-up methodology. The prepared CDs exhibited absorption in the near-visible region, and unique excitation-dependent emission behaviour was confirmed from UV-Visible and fluorescence measurements. The surface morphology of CDs was confirmed by SEM and HR-TEM analysis to be quasi-spherical particles with an average size of ∼5-6 nm. The presence of various functional moieties (hydroxyl, carbonyl, and amino) was confirmed via FT-IR measurement. The graphitization of CDs was confirmed by the D and G bands for sp2 and sp3 hybridization, respectively, through Raman analysis. Esterification methodology was adopted to prepare the CDs-thymol conjugate and confirmed via FT-IR analysis. CDs play the role of a nanocarrier for thymol, an anti-arthritic agent. The bioactive compound of thymol showed potent anti-arthritic activity against RA targets through in silico docking studies. Further, the in vivo studies revealed that CDs-thymol conjugates (10 mg per kg body weight) showed a significant reduction in rat paw volume along with reduced levels of RF and CRP (2.23 ± 0.42 IU ml-1 and 16.96 ± 0.22 mg ml-1) when compared to the disease control rats. X-ray radiography and ultrasonic imaging revealed less bone destruction, joint derangement, and swelling in arthritis-induced Wistar rats. They could also potentially improve the Hb (14.14 ± 0.19), RBC (6.01 ± 0.11), PCV (6.01 ± 0.11) levels and elevate the status of antioxidant enzymes (GPx, SOD, MDA), and the activity was comparable to the standard drug, ibuprofen (10 mg kg-1), suggesting that the CDs-thymol conjugate at 10 mg kg-1 could act as a strong anti-arthritic agent. This work is evidence for the utilization of waste biomass as a value-added product such as a nanocarrier for biomedical applications.

Identification of polyphenolic contents, in vitro evaluation of antioxidant and antidiabetic potentials of a polyherbal formulation-Mehani.

Diabetes has become a global disease that needs an alternative drug treatment with lesser side effects. The present study was aimed to evaluate the antioxidant and antidiabetic activities of soxhlet and microwave assisted extraction of a polyherbal formulation-Mehani using aqueous, hydroalcoholic and hexane solvents. Preliminary investigation shows that the heavy metal contents were within the permissible limits. Comparative antioxidant studies showed that hydroalocoholic soxhlet (HAS) and microwave (HAM) extracts possessed highest activity as assessed through DPPH assay (93.8 ± 0.04%, 94.85 ± 0.04%), H2O2 assay (88.7 ± 0.9%, 87.2 ± 1.4%), reducing power assay (absorbance-1.61 ± 0.12, 2.08 ± 0.03) and nitric oxide scavenging activity (51.1 ± 0.9%, 56.5 ± 0.18%) at 500 µg/mL concentration. HAS and HAM also exhibited 80.3 ± 1.12% and 85.3 ± 1.86% of α-amylase inhibitory activity and 78.7 ± 0.15% and 80.0 ± 0.63% of glucosidase inhibitory activity. HPLC analysis in both the extracts reveals the presence of eight polyphenols with gallic acid being the predominant compound; these might be responsible for the highest activities.

Assessment on knowledge and practice of postexposure prophylaxis of human immuno-deficiency virus among staff nurses and paramedical workers at a tertiary care hospital in South India.

INTRODUCTION: Adequate knowledge about the presence of postexposure prophylaxis (PEP) against human immuno-deficiency virus (HIV) is imperative for health-care workers. This study focuses on the evaluation of the present knowledge and practice of nurses and paramedical workers on the post exposure prophylaxis against HIV. AIM: The aim of this study is to assess and compare the knowledge and practice of PEP against HIV among Staff Nurses and Paramedical workers. SUBJECTS AND METHODS: A descriptive cross-sectional questionnaire study about the knowledge and practice of PEP against HIV among Staff nurses and Paramedical workers done at a tertiary care hospital in South India. The analysis of the data was performed using SPSS software version 24. The statistical tests used to compare the knowledge between nurses and paramedical workers was Chi-square test. P < 0.05 was considered statistically significant. RESULTS: About 339 nurses and 66 paramedical workers participated in the study. An overall of 65.4% of the study participants had a good level of knowledge, higher (P = 0.000) among nurses (71.1%) compared to paramedical workers (36.3%). However, only 23% of nurses and 14.3% of paramedical workers received PEP after a needle prick injury. CONCLUSION: This study revealed a low-level practice of HIV PEP among staff nurses and paramedical workers despite their good knowledge. This can be improved by providing formal training sessions to the health care workers.

Lynch Syndrome-Associated Variants and Cancer Rates in an Ancestrally Diverse Biobank.

PURPOSE: Limited data are available on the prevalence and clinical impact of Lynch syndrome (LS)-associated genomic variants in non-European ancestry populations. We identified and characterized individuals harboring LS-associated variants in the ancestrally diverse BioMe Biobank in New York City. PATIENTS AND METHODS: Exome sequence data from 30,223 adult BioMe participants were evaluated for pathogenic, likely pathogenic, and predicted loss-of-function variants in MLH1, MSH2, MSH6, and PMS2. Survey and electronic health record data from variant-positive individuals were reviewed for personal and family cancer histories. RESULTS: We identified 70 individuals (0.2%) harboring LS-associated variants in MLH1 (n = 12; 17%), MSH2 (n = 13; 19%), MSH6 (n = 16; 23%), and PMS2 (n = 29; 41%). The overall prevalence was 1 in 432, with higher prevalence among individuals of self-reported African ancestry (1 in 299) than among Hispanic/Latinx (1 in 654) or European (1 in 518) ancestries. Thirteen variant-positive individuals (19%) had a personal history, and 19 (27%) had a family history of an LS-related cancer. LS-related cancer rates were highest in individuals with MSH6 variants (31%) and lowest in those with PMS2 variants (7%). LS-associated variants were associated with increased risk of colorectal (odds ratio [OR], 5.0; P = .02) and endometrial (OR, 30.1; P = 8.5 × 10-9) cancers in BioMe. Only 2 variant-positive individuals (3%) had a documented diagnosis of LS. CONCLUSION: We found a higher prevalence of LS-associated variants among individuals of African ancestry in New York City. Although cancer risk is significantly increased among variant-positive individuals, the majority do not harbor a clinical diagnosis of LS, suggesting underrecognition of this disease.

Asian-Pacific perspective on the psychological well-being of healthcare workers during the evolution of the COVID-19 pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers. AIMS: In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes. METHOD: From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country. RESULTS: A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries. CONCLUSIONS: This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.