AIMS65, Glasgow-Blatchford bleeding score and modified Glasgow-Blatchford bleeding score in predicting outcomes of upper gastrointestinal bleeding: An accuracy and calibration study.

BACKGROUND: Albumin, international normalized ratio (INR), mental status, systolic blood pressure, age >65 years (AIMS65), Glasgow-Blatchford bleeding score (GBS) and modified GBS (mGBS) are three pre-endoscopy scoring systems used in the risk stratification of upper gastrointestinal bleeding (UGIB). The utility of such scoring systems in a population is estimated by their accuracy and calibration in the population. We aimed at validating and comparing the accuracy of the three scoring systems in predicting clinical outcomes including in-hospital mortality, need for blood transfusion, endoscopic treatment and rebleeding risk. METHOD: We conducted a single-center, retrospective cohort study on patients with UGIB at a tertiary care center in India over 12 months. Clinical and laboratory data was collected from all patients admitted with UGIB. All patients were risk stratified using AIMS65, GBS and mGBS. The clinical outcome examined were: in-hospital mortality, requirement of blood transfusion, need for endoscopic treatment and rebleeding during hospital stay. The area under receiver-operating curve (AUROC) was calculated to assess the performance and calibration curves (Hosmer-Lemeshow goodness of fit curve) were plotted to examine how accurately the model describes the data of all three scoring systems. RESULTS: Total 260 patients were included in the study, of which 236 (90.8%) were males. As many as 144 (55.4%) patients required blood transfusion and 64 (30.8%) required endoscopic treatment. While the incidence of rebleeding was 7.7%, in hospital mortality was 15.4%. Of 208 who underwent endoscopy, the most common causes identified were varices (49%) and gastritis (18.2%), followed by ulcer (11%), Mallory-Weiss tear (8.1%), portal hypertensive gastropathy (6.7%), malignancy (4.8%) and esophageal candidiasis (1.9%). The median AIMS65 score was 1, GBS 7 and mGBS 6. The area under curve (AUROC) for AIMS65, GBS and mGBS was (0.77, 0.73,0.70), (0.75, 0.82,0.83), (0.56, 0.58,0.83), (0.81, 0.94,0.53) for in-hospital mortality, blood transfusion requirement, endoscopic treatment and rebleeding prediction, respectively. CONCLUSION: GBS and mGBS are superior to AIMS65 in predicting the requirement of blood transfusion and rebleeding risk, whereas in-hospital mortality was better predicted by AIMS 65. Both scores performed poorly in predicting the need of endoscopic treatment. An AIMS65 of 0,1 and a GBS of ≤ 1 are not associated with significant adverse events. A poor calibration of the scores in our population points to the lack of generalizability of these scoring systems.

Pituitary apoplexy induced by gonadotropin-releasing hormone (GnRH) agonist administration for treatment of prostate cancer: a systematic review.

OBJECTIVE: We aimed to review of literature on the clinical presentation, management and outcomes of pituitary apoplexy following gonadotrophic release hormone (GnRH) agonist administration for the treatment of prostate cancer. METHODS: We used PRISMA guidelines for our systematic review and included all English language original articles on pituitary apoplexy following GnRH agonist administration among prostate cancer patients from Jan 1, 1995 to Dec 31, 2020. Data on patient demographics, prostate cancer type, Gleason score at diagnosis, history of pituitary adenoma, clinical presentation, GnRH agonist, interval to pituitary apoplexy, laboratory evaluation at admission, radiologic findings, treatment of pituitary apoplexy, time to surgery if performed, pathology findings, and clinical/hormonal outcomes were collected and analyzed. RESULTS: Twenty-one patients with pituitary apoplexy met our inclusion criteria. The mean age of patients was 70 (60-83) years. Leuprolide was the most common used GnRH agonist, used in 61.9% of patients. Median duration to symptom onset was 5 h (few minutes to 6 months). Headache was reported by all patients followed by ophthalmoplegia (85.7%) and nausea/vomiting (71.4%). Three patients had blindness at presentation. Only 8 cases reported complete anterior pituitary hormone evaluation on presentation and the most common endocrine abnormality was FSH elevation. Tumor size was described only in 15 cases and the mean tumor size was 26.26 mm (18-48 mm). Suprasellar extension was the most common imaging finding seen in 7 patients. 71.4% of patients underwent pituitary surgery, while 23.8% were managed conservatively. Interval between symptoms onset to pituitary surgery was 7 days (1-90 days). Gonadotroph adenoma was most common histopathologic finding. Clinical resolution was comparable, while endocrine outcomes were variable among patients with conservative vs surgical management. CONCLUSION: Although the use of GnRH agonists is relatively safe, it can rarely lead to pituitary apoplexy especially in patients with pre-existing pituitary adenoma. Physicians should be aware of this complication as it can be life threatening. A multidisciplinary team approach is recommended in treating individuals with pituitary apoplexy.

Antibiotic Prescription Practices for Surgical Prophylaxis in India: An Observational Study.

Perioperative prophylactic antibiotics following surgeries have been shown to reduce surgical site infections, and their administration is common practice. Despite clear guidelines regarding this being set forth by the Infectious Disease Society of America (IDSA), adherence to them is yet to translate to common practice in many parts of the world. A retrospective chart review of 409 patients who underwent elective surgeries over a period of 7 months at three different hospitals in India was performed. In-hospital antibiotic prescriptions of these patients were examined for any apparent inappropriateness (use of antibiotics with coverage broader than the target microbes and use of antibiotics with overlapping spectrum of target microbes). Four hundred ninety-five (48.9%) of the 1,012 patient intensive care unit (ICU) days had apparent inappropriateness in the choice of their prophylactic antibiotics and only 3.2% of the antibiotic units used were in accordance with the present IDSA guidelines. Injudicious use of broad-spectrum antibiotics for surgical prophylaxis is prevalent in low- and middle-income countries such as India. This poses the risk of emergence of resistant microorganisms in these areas and their potential spread across the borders. There is an acute need for diligent antibiotic stewardship programs in these areas to curb such practices.

The Birhor tribes of Ramgarh District, Jharkhand - a ferret into their oral health status and treatment needs.

AIM AND OBJECTIVES: Jharkhand is a land of 32 listed Tribes, out of which eight tribes have been categorized as 'Primitive Tribes' and the Birhors are one among these. The study was aimed at assessing the oral health status and treatment needs of the native Birhors. MATERIAL AND METHODS: A cross-sectional household survey of 400 Birhors in the panchayats of Basantpur, Kuju Purvi and Mandu Chatti was conducted. A modified World Health Organization (WHO) Oral Health Assessment Form (1997) was utilized and examined according to the WHO methodology (1997). The recorded data were statistically analyzed using the SPSS version 15. RESULTS: Based on the occupation, it was found that 141 (35.25%) subjects were hunters and 90 (22.50%) subjects practiced agriculture. A majority of 337 (84.25%) subjects were using the Sakhua twigs (Shorea robusta) to clean their teeth. It was observed that 381 (95.25%) subjects were quite healthy and had no oral mucosal lesions. Almost half of the study subjects (45%) were habituated to tobacco and among them 101 (56.11%) subjects were using khaini, followed by 46 (25.56%) subjects who used bidis. The mean decayed, missing, and filled teeth (DMFT) Index scores among males and females was 1.05±2.59 and 1.02±2.17, respectively. Subjects with bleeding gums were predominantly seen in the age group of 2-5 years (26.75%) and those with shallow pockets were more commonly seen in the age group of 16-34 years (47.12%). A total of 53 (13.25%) subjects and 33 (8.25%) subjects had a LOA of 4-5 mm and 6-8 mm, respectively. Among males, 0.44±2.60 subjects each needed one/two surface fillings. A total of 14 (3.5%) and 15 (3.75%) subjects needed one-unit prosthesis in the upper and lower jaws, respectively. CONCLUSION: The study showed that a majority of Birhor tribals (84.25%) used Sakhua twigs to clean their teeth. Almost half of the study subjects (45%) were habituated to tobacco in myriad forms.

A Rare Case of Gastric Lipoma Presenting with Gastric Outlet Obstruction Treated Endoscopically.

An 85-year-old male referred to the Gastroenterology (GI) clinic with three-month history of failure to thrive and three-week history of nausea, vomiting, and melanotic stools. Ulcerative mass obstructing gastric outlet was found on endoscopy and on follow-up CT abdomen a homogeneous submucosal mass in the gastric antrum was identified. Radiological diagnosis of giant gastric lipoma was established and patient was evaluated for surgery and, however, was rendered unfit for surgery due to his comorbid conditions. Patient was taken for endoscopic resection of the mass. On endoscopy, only partial resection was achieved due to the size of the mass, but endoloops were deployed at the stalk at the end of the procedure in hope of limiting blood supply to the lesion. On six-week follow-up endoscopy, patient's mass had completely disappeared with limited scar tissue at the site.

Association between different blood groups, depression and oral health status of dental students.

INTRODUCTION: Knowledge of blood groups and their association with oral diseases and depression is very important, as it may help in early diagnosis and treatment strategies. METHOD: A cross sectional descriptive study was conducted among dental students of a private dental college. The study was conducted in two phases, in the first phase the blood samples of each student were collected and sent for blood group examination in laboratory. Data for oral health status was collected by recording oral hygiene, dental caries and questions regarding oral hygiene habits and adverse oral habits. Depression level was recorded using a pre-validated, 21 item close ended questionnaire. Data thus collected was subjected to statistical analysis using chi-square and frequency distribution test using SPSS software. RESULTS: The total study subjects were 315, 95 males and 220 females. On applying chi-square test between blood group and Decayed, Missing and Filled Teeth (DMFT) score, a highly significant association (p=0.00) was observed. A non-significant association p=0.217 and p=0.668 was observed between gender and DMFT and Oral hygiene index-simplified and Blood group respectively. When comparing blood group and Depression score, a non-significant association (p=0.74) was observed. CONCLUSION: DMFT score varies in different blood groups and this might suggest a positive association between blood groups and DMFT score, while depression, oral hygiene and gender might not be affected by the different blood groups.

Impact of sociodemographic attributes and dental caries on quality of life of intellectual disabled children using ECOHIS.

OBJECTIVES: To assess the impact of oral health outcomes on Oral Health-Related Quality of Life (OHRQoL) among intellectual disabled children and their families. METHODOLOGY: OHRQoL based study was conducted among 150 intellectual disabled children students in the North West part of the country, Rajasthan, India. Guardians were asked to complete questionnaire on socioeconomic status and the Early Childhood Oral Health Impact Scale (ECOHIS) on their perception of the children's OHRQoL. Clinical assessment included dental caries and OHI-S INDEX. Univariate regression analysis was fitted to assess covariates for the prevalence of impacts on OHRQoL. RESULTS: 54% of the caregivers reported that their child had an impact on at least one ECOHIS item. Negative impacts were more prevalent on items related to difficulty in eating some foods, difficulty in pronouncing any words and missed preschool, day-care or school. The univariate Poisson regression analysis showed that dental caries was significantly associated with the outcome. The prevalence of any impact on OHRQoL was approximately 1.32 and 2.84 times higher for children with low and higher severity of dental caries respectively when compared with those who were free of caries. CONCLUSION: Patient-oriented outcomes like OHRQoL will enhance our understanding of the relationship between oral health and general health and demonstrate to clinical researchers and practitioners that improving the quality of patient's well-being go beyond simply treating dental disease and disorders.

Assessment of oral health status and treatment needs of Santhal tribes of Dhanbad District, Jharkhand.

AIMS AND OBJECTIVES: India has an assortment of tribal population living in isolated pockets, and the Santhals are numerically predominant in Jharkhand. This study was aimed at assessing the oral health status and treatment needs of Santhals residing in Dhanbad, Jharkhand. MATERIALS AND METHODS: A cross-sectional survey of 921 Santhals of Topchanchi Block was conducted. A modified World Health Organization (WHO) Oral Health Assessment Form (1997) was utilized and examined according to the WHO methodology (1997). The recorded data was statistically analyzed using the Statistical Package for the Social Sciences version 15. RESULTS: Based on the occupation, it was seen that 620 (67.3%) participants practiced agriculture and 206 (22.4%) worked as laborers. The mean decayed missing filled tooth (score was 3.56 ± 1.93 in 2-5-year-old participants. In the higher age groups of 35-44 and 65-74 years, the scores were 5.21 ± 2.34 and 7.42 ± 4.29, respectively. Participants with bleeding gums were predominantly seen in the age group of 35-44 years (0.91 ± 0.08). Approximately 138 (54.1%) participants had a loss of attachment of 4-5 mm in the 35-44 year age group. In the 13-15-year-old age group, 0.14 ± 0.05 teeth needed two surfaces fillings. A total of 118 (12.8%) participants needed one-unit prosthesis in the upper jaw. CONCLUSION: This study showed that a majority of Santhal tribals used twigs to routinely clean their teeth. Poor oral hygiene and periodontal status was seen among the tribes.

Oral health of preschool children in Dhanbad District, Jharkhand: A gander into the maternal behavior and practices.

INTRODUCTION: Mothers have an important role in taking decisions about their children's oral health. The study assessed the echelon of oral health behavior and practices of the mothers in relation to their preschool-aged children, which could possibly influence their oral health. METHODS: A cross-sectional study was carried out among 312 mothers, selected randomly from eight blocks of Dhanbad District, Jharkhand State, by administering a structured questionnaire on oral health behavior and practices regarding oral health. RESULTS: The overall data indicated that the practices of mothers about oral health of their preschool children increased as their age increased, which was however, not statistically significant (P > 0.47). The mothers who had less than higher secondary school education and belonging to lower socioeconomic groups had poorer oral health practices and was found to be statistically significant (P < 0.002). CONCLUSION: The mothers ought to inculcate positive practices and perceptions about preventive oral health for themselves first, to be good role models for their children.

Crystal structure of (E)-N-phenyl-N'-[1-(thio-phen-2-yl)ethyl-idene]formo-hydrazide.

In the title compound, C13H12N2OS, the planes of the thio-phene and phenyl rings are nearly perpendicular to each other, making a dihedral angle of 86.42 (12)°. In the crystal, mol-ecules are linked by C-H⋯O hydrogen bonds, forming a helical chain along the b-axis direction.

(4-Fluoro-phen-yl)(2-hy-droxy-5-methyl-phen-yl)methanone.

In the title compound, C14H11FO2, the dihedral angles beteen the central C3O ketone residue and the fluoro- and hy-droxy-substituted benzene rings are 50.44 (9) and 12.63 (10)°, respectively. The planes of the benzene rings subtend a dihedral angle of 58.88 (9)° and an intra-molecular O-H⋯O hydrogen bond closes an S(6) ring. No directional inter-actions beyond van der Waals packing contacts were identified in the crystal structure.

Purification and characterization of antifungal phenazines from a fluorescent Pseudomonas strain FPO4 against medically important fungi.

The strain FPO4 was isolated from the rhizoplane of rice plant root and identified as a fluorescent Pseudomonas aeruginosa on the basis of 16S rDNA sequences and BLAST analysis. The extracellular metabolites produced by this strain were purified by silica gel column chromatography and isolated four pure compounds. Based on the spectral data the four compounds were identified as phenazin-1-ol, phenazine-1-carboxylic acid (PCA), 2-heptyl-3-hydroxyl-4(1H)-quinolone (PQS), and phenazine-1-carboxamide (PCN), respectively. Phenazin-1-ol and PCA were active against all the eight fungi tested. The highest activity of 4 µg/mL by PCA was recorded against Trichophyton rubrum, a human pathogen responsible for causing athlete's foot, jock itch, ringworm and fingernail fungus infections, followed by Candida albicans and Candida tropicalis. The activity of phenazin-1-ol, PCA against Candida spp. was found to be better than the standard antifungal agent amphotericin B. Furthermore, the present study reports the antimicrobial activity of the purified phenazines on major human pathogen, T. rubrum for the first time.

(4-Fluoro-phen-yl)(4-hy-droxy-3-methyl-phen-yl)methanone.

In the title compound, C14H11FO2, the two benzene rings are not coplanar, with a dihedral angle of 57.45 (12)° between their planes. In the crystal, mol-ecules are linked by an O-H⋯O hydrogen bond, forming a 21 helical chain along the b axis.

Cyclo(D-Tyr-D-Phe): a new antibacterial, anticancer, and antioxidant cyclic dipeptide from Bacillus sp. N strain associated with a rhabditid entomopathogenic nematode.

A new microbial cyclic dipeptide (diketopiperazine), cyclo(D-Tyr-D-Phe) was isolated for the first time from the ethyl acetate extract of fermented modified nutrient broth of Bacillus sp. N strain associated with rhabditid Entomopathogenic nematode. Antibacterial activity of the compound was determined by minimum inhibitory concentration and agar disc diffusion method against medically important bacteria and the compound recorded significant antibacterial against test bacteria. Highest activity was recorded against Staphylococcus epidermis (1 µg/ml) followed by Proteus mirabilis (2 µg/ml). The activity of cyclo(D-Tyr-D-Phe) against S. epidermis is better than chloramphenicol, the standard antibiotics. Cyclo(D-Tyr-D-Phe) recorded significant antitumor activity against A549 cells (IC50 value: 10 µM) and this compound recorded no cytotoxicity against factor signaling normal fibroblast cells up to 100 µM. Cyclo(D-Tyr-D-Phe) induced significant morphological changes and DNA fragmentation associated with apoptosis in A549 cells. Acridine orange/ethidium bromide stained cells indicated apoptosis induction by cyclo(D-Tyr-D-Phe). Flow cytometry analysis showed that the cyclo(D-Tyr-D-Phe) did not induce cell cycle arrest. Effector molecule of apoptosis such as caspase-3 was found activated in treated cells, suggesting apoptosis as the main mode of cell death. Antioxidant activity was evaluated by free radical scavenging and reducing power activity, and the compound recorded significant antioxidant activity. The free radical scavenging activity of cyclo(D-Tyr-D-Phe) is almost equal to that of butylated hydroxyanisole, the standard antioxidant agent. We also compared the biological activity of natural cyclo(D-Tyr-D-Phe) with synthetic cyclo(D-Tyr-D-Phe) and cyclo(L-Tyr-L-Phe). Natural and synthetic cyclo(D-Tyr-D-Phe) recorded similar pattern of activity. Although synthetic cyclo(L-Tyr-L-Phe) recorded lower activity. But in the case of reducing power activity, synthetic cyclo(L-Tyr-L-Phe) recorded significant activity than natural and synthetic cyclo(D-Tyr-D-Phe). The results of the present study reveals that cyclo(D-Tyr-D-Phe) is more bioactive than cyclo(L-Tyr-L-Phe). To the best of our knowledge, this is the first time that cyclo(D-Tyr-D-Phe) has been isolated from microbial natural source and also the antibacterial, anticancer, and antioxidant activity of cyclo(D-Tyr-D-Phe) is also reported for the first time.

Three bioactive cyclic dipeptides from the Bacillus sp. N strain associated with entomopathogenic nematode.

In continuation of our search for new bioactive secondary metabolites from Bacillus cereus associated with entomopathogenic nematode (EPN), three cyclic dipeptides (CDPs), cyclo(L-Leu-D-Arg) (1), cyclo(2-hydroxy-Pro-L-Leu) (2), and cyclo(L-Val-L-Pro) (3) were purified from the ethyl acetate extract of B. cereus. The chemical structure of the compounds was identified by 1D, 2D NMR and HR-ESI-MS. Cyclo(L-Leu-D-Arg) recorded best antifungal activity and the highest activity was recorded against Cryptococcus neoformans (1 µg/mL), which is better than the standard antifungal agent amphotericin B. MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay was used for finding cell proliferation inhibition and cyclo(L-Leu-D-Arg) recorded significant activity against breast cancer cell line (MDAM-B231) (IC50 value: 25 µM) and the three cyclic dipeptides recorded no toxicity against normal human cell (fore skin (FS) normal fibroblast) up to 50 µM except cyclo(L-Val-L-Pro). Cyclo(L-Leu-D-Arg) induced significant morphological changes and DNA fragmentation associated with apoptosis in MDAM-B231 cells by acridine orange/ethidium bromide staining and flow cytometry analysis. Out of three cyclic dipeptides tested only cyclo(2-hydroxy-Pro-L-Leu) recorded significant antioxidant activity. The hydroxyl radical scavenging activity of cyclo(2-hydroxy-Pro-L-Leu) is greater than BHA, the standard antioxidant agent. Cyclo(L-Leu-D-Arg) was isolated for the first time from a natural source with a d-arginine residue. To the best of our knowledge, this is the first time that the bioactivity of the isolated cyclic dipeptides is reported against medically important fungi and cancer cells. This study is a significant contribution to the knowledge of cyclo(L-Leu-D-Arg) from B. cereus as potential sources of new drugs in the pharmacological industry, especially as potent antifungal and anticancer agent.

Oral Health of Pre-School Aged Children in Dhanbad District, Jharkhand, India- A Peek into their Mother's Attitude.

INTRODUCTION: Mothers are directly responsible for the dental health of their children and play a major role in shaping the dental health behaviors of their children. They also play an important role in preventing oral diseases in them. OBJECTIVE: To assess the level of attitude of mothers in relation to their pre-school aged children, which in turn can influence the level of oral health. METHOD: A cross-sectional study was carried out among 312 mothers, selected randomly from eight blocks of Dhanbad district, Jharkhand, India. They were administered with a structured questionnaire on attitude, by an interviewer. RESULTS: The overall data indicated that the attitude of mothers about oral health in their pre-school children increased as their age increased which was not statistically significant (p>.066). Mothers who had less than higher secondary school education and belonged to socio-economically lower groups had poor knowledge of oral health which was statistically significant (p<.001). CONCLUSION: Mothers should be motivated so that their attitude about their child's oral health is enhanced which in turn would improve their oral health related quality of life.

Emerging trends of herbal care in dentistry.

Herbs are staging a comeback and herbal 'renaissance' is happening all over the globe. The herbal products, today, symbolize safety, in contrast to the synthetics that are regarded as unsafe to humans and the environment. A herb, botanically speaking, is any plant that lacks the woody tissue which is characteristic of shrubs or trees. More specifically, herbs are plants which are used medicinally or for their flavour or scent. Herbs with medicinal properties are a useful and an effective source of treatment for various disease processes. Herbal extracts have been successfully used in dentistry as tooth cleaning and antimicrobial plaque agents. The use of herbal medicines continues to expand rapidly across the world. Many people take herbal medicines or herbal products now for their health care in different national healthcare settings. Herbal extracts have been used in dentistry for reducing inflammation, as antimicrobial plaque agents, for preventing release of histamine and as antiseptics, antioxidants, antimicrobials, antifungals, antibacterials, antivirals and analgesics. They also aid in healing and are effective in controlling microbial plaque in gingivitis and periodontitis, thereby improving immunity.

(4-Hy-droxy-3-methyl-phen-yl)(phen-yl)methanone.

In the title compound, C14H12O2, the benzene rings make a dihedral angle of 58.84 (12)°. In the crystal, mol-ecules are linked into chains along the b-axis direction by O-H⋯O hydrogen bonds. These chains are further linked by C-H⋯O hydrogen bonds, forming layers parallel to the bc plane.