Individualized Homeopathic Medicines in the Management of Symptomatic Adenotonsillar Hypertrophy in Children: A Prospective Observational Study.

BACKGROUND: Globally, adenotonsillar hypertrophy (ATH) is one of the most prevalent upper respiratory tract disorders of children, with associated troublesome symptoms such as sleep apnea and cognitive disturbances. In this study, we evaluated the potential role of individualized homeopathic medicines in the management of symptomatic ATH in children. METHODS: A multicenter prospective observational study was conducted at five institutes under the Central Council for Research in Homoeopathy, India. Primary and secondary outcomes (symptom score for adenoids, other symptoms of ATH, Mallampati score, tonsillar size, Sleep-Related Breathing Disorder of the Paediatric Sleep Questionnaire [SRBD-PSQ]) were assessed through standardized questionnaires at baseline and at 3, 6, 9 and 12 months. Radiological investigations for assessing the adenoid/nasopharyngeal (A/N) ratio were carried out at baseline, 6 and 12 months. All analyses were carried out using an intention-to-treat approach. RESULTS: A total of 340 children were screened and 202 children suffering from ATH were enrolled and followed up monthly for 12 months. Each patient received individualized homeopathic treatment based on the totality of symptoms. Statistically significant reductions in adenoid symptom score, Mallampati score (including tonsillar size), SRBD-PSQ sleep quality assessment and A/N ratio were found over time up to 12 months (p < 0.001). Homeopathic medicines frequently indicated were Calcarea carbonicum, Phosphorus, Silicea, Sulphur, Calcarea phosphoricum, Pulsatilla, Lycopodium and Tuberculinum. No serious adverse events were recorded during the study period. CONCLUSION: This study suggests that homeopathic medicines may play a beneficial role in the management of symptomatic ATH in children. Well-designed comparative trials are warranted.

Views on virtual education during the COVID-19 pandemic among medical and paramedical students in India.

The COVID-19 pandemic has made the educational institutions to implement the mandatory virtual learning in medical education. It is undeniable that electronic gadget aided learning have a significant role to play during a pandemic. Both faculty and students are getting accustomed to this 'New Normalcy'. Therefore, it is of interest to determine the effectiveness and perception of virtual teaching and learning during the COVID 19 pandemic. A cross-sectional study was conducted in which 336 medical and 336 paramedical students of both the genders with age group of 17 - 21 years participated. The data obtained were analyzed using the SPSS software. The shift from class room teaching to virtual learning has led to many health issues among students such as eye strain, anxiety, depression, musculoskeletal problems and obesity. The students also had inadequate time to interact with faculties. Data shows that virtual learning an alternative mode to traditional method during a pandemic.

Visualizing Field Data Collection Procedures of Exposure and Biomarker Assessments for the Household Air Pollution Intervention Network Trial in India.

Here, we present a visual representation of standard procedures to collect population-level data on personal exposures to household air pollution (HAP) from two different study sites in a resource-constrained setting of Tamil Nadu, India. Particulate matter PM2.5 (particles smaller than 2.5 microns in aerodynamic diameter), carbon monoxide (CO), and black carbon (BC) were measured in pregnant mothers (M), other adult women (OAW), and children (C) at various times over a 4 year period. In addition, stove usage monitoring (SUMs) with data-logging thermometers and ambient measurements of air pollution were carried out. Furthermore, the feasibility of collecting biological samples (urine and dried blood spots [DBSs]) from study participants at the field sites was successfully demonstrated. Based on findings from this and earlier studies, the methods used here have enhanced the data quality and avoided issues with household air pollution and biological sample collection in resource-constrained situations. The procedures established may be a valuable educational tool and resource for researchers conducting similar air pollution and health studies in India and other low- and middle-income countries (LMICs).

Food grade zinc oxide bulk particle composite can replace the toxic zinc oxide nano composite towards the control of pathogenic and spoilage bacteria.

ZnO-Nanoparticle-Chitosan (ZnO-NP-CH) composite has potential biomedical and food applications due to its better antimicrobial activity. However, the presence of nano-metal-oxide in the composite makes the material unsuitable for any food applications. Moreover, the cost involved in the preparation of Zinc Oxide-Nano-Particle (ZnO-NP) is a major limitation for commercial food applications. Hence a suitable alternative for ZnO-NP is highly needed for food application. Since ZnO-Bulk Particles (ZnO-BP) are food grade and there is no study on the composite prepared from ZnO-Bulk Particle-Chitosan (ZnO-BP-CH), in the present study, antimicrobial activity was assessed for ZnO-BP-CH and compared with ZnO-NP-CH. Based on the study, it was observed that in the individual form of ZnO-NP possessed significantly higher antimicrobial activity than ZnO-BP. The composite form of ZnO-NP-CH and ZnO-BP-CH possessed higher antimicrobial activity than chitosan. However, no significant difference was observed between the composite forms. Hence, ZnO-BP-CH could be recommended as a suitable alternative to ZnO-NP-CH for future studies related to chitosan with ZnO composite to avoid costly nanomaterials preparation.

Comparison of Extended Nasolabial Flap Versus Buccal Fat Pad Graft in the Surgical Management of Oral Submucous Fibrosis: A Prospective Pilot Study.

AIM: To evaluate the application of extended nasolabial flap versus buccal fat pad graft in the surgical management of oral submucous fibrosis. SETTINGS AND DESIGN: This prospective study was carried out in the Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai. MATERIAL AND METHODS: A total of 8 patients (6 men and 2 women) with age range from 21 to 65 years were selected for study. These 8 patients were randomly divided into two groups of four namely group 1 and group 2. In group 1 patients, reconstruction was planned with extended nasolabial flaps and in group 2 patients, reconstruction was planned with buccal fat pad graft respectively. STATISTICAL ANALYSIS USED: Paired t test, Independent sample t test, ANOVA test. RESULTS: The mean preoperative mouth opening in group 1 was 8.5 mm and in group 2 was 11.75 mm. The mean increase in group 1 after one year of postoperative period was 21.50 mm and in group 2 was 24.75 mm. CONCLUSIONS: In the present study, buccal fat pad graft proved to give better results as the interposition material as it has good patient acceptance, rapid epithelization, minimal donor site morbidity and minimal intra and postoperative complications.

Imaging of the small intestine in Crohn's disease: Joint position statement of the Indian Society of Gastroenterology and Indian Radiological and Imaging Association.

The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Indian Radiological and Imaging Association (IRIA) developed combined ISG-IRIA evidence-based best-practice guidelines for imaging of the small intestine in patients with suspected or known Crohn's disease. These 29 position statements, developed through a modified Delphi process, are intended to serve as reference for teaching, clinical practice, and research.

Fate of Costochondral Graft in Temporomandibular Joint Reconstruction: A Histological Study.

OBJECTIVE: To asses the fate of the costochondral graft (CCG) used to stimulate mandibular growth in the management of Temporomandibular joint (TMJ) reconsrtuction in ankylosis-histologically. MATERIALS AND METHODS: Ten patients who had undergone CCG grafting for TMJ ankylosis between 1994-2009 in the department of Oral & Maxillofacial Surgery, Tamil Nadu Govt Dental College and Hospital, Chennai and had come back with reankylosis, were surgically explored and the graft along with the ankylotic mass was excised and evaluated histologically. There is no documented human study and clinically it is not possible. RESULTS: Histological evaluation revealed the presence of osseous tissue, fibrous tissue and osteocytes but no evidence of any chondroid tissue. CONCLUSION: Our study showing the absence of chondroid tissue raises the question on the rationale of CCG in TMJ reconstruction when other interpositional gap arthroplasty can achieve a disease free joint.

Process development for biological production of butanol from Eastern redcedar.

Eastern redcedar is an invasive softwood species in Oklahoma and across grasslands in the Central Plains of the United States and potential feedstock for butanol production. Butanol has higher energy content than ethanol and can be upgraded to jet and diesel fuels. The objective of this study was to develop a process for production of butanol from redcedar. Results showed that Clostridium acetobutylicum ATCC 824 and Clostridium beijerinckii NCIMB 8052 did not grow in fermentation medium with citrate buffer. However, both strains grew in the medium with acetate buffer, resulting in 3-4g/L greater butanol than without acetate. Detoxification of redcedar hydrolyzate was required to increase butanol concentration from 1 to 13g/L. Hydrolyzate was detoxified by activated carbon to remove inhibitors. Fermentations in detoxified redcedar hydrolyzate reached 13g/L butanol and 19g/L total ABE, comparable to glucose control. This shows the potential for redcedar use in butanol production.

Life cycle assessment of the production of ethanol from eastern redcedar.

This life cycle assessment (LCA) evaluates the environmental impacts of an ethanol production system using eastern redcedar (Juniperus virginiana L.) as the feedstock. Aspen Plus® was used to model the acid bisulfite pretreatment, enzymatic hydrolysis, fermentation, and distillation steps. A cradle-to-gate LCA was conducted to evaluate the environmental impacts from cutting the trees to the production of anhydrous ethanol. The environmental impacts of the redcedar ethanol process were compared to those from the production of corn ethanol. Inventory data for the system were collected and used to calculate a life cycle impact assessment (LCIA) using the IMPACT 2002+ and BEES+ framework in SimaPro 8.0.0. Four impact categories were evaluated: land occupation, water use, greenhouse gas (GHG) emissions, and non-renewable energy use. Results indicate that acid bisulfite pretreatment contributed to 65% of GHG emissions, 81% of non-renewable energy use, and 77% of water use of the overall process.

Simultaneous saccharification and fermentation of Eastern redcedar heartwood and sapwood using a novel size reduction technique.

This study investigated the effect of two wood zones (sapwood versus heartwood) and size reduction techniques [Crumbles® (Crumbles® is a registered trademark of Forest Concepts, LLC, Auburn, WA, USA) particles versus ground particles] on wood glucan-to-ethanol yield after acid bisulfite pretreatment and simultaneous saccharification and fermentation (SSF) of Eastern redcedar. SSFs were conducted at 8% solids loading (w/w dry basis) using Accellerase® 1500 at a loading of 46FPU/g glucan and Saccharomyces cerevisiae D5A for ethanol fermentation. The size reduction technique had no effect on ethanol yield. However, sapwood glucan-to-ethanol yields were significantly greater than heartwood yields. The highest wood glucan-to-ethanol yield of 187L/dryMg (95% of theoretical) was achieved with sapwood crumbled particles in 240h. Ground sapwood, crumbled heartwood and ground heartwood achieved ethanol yields of 89%, 81% and 80% of theoretical in 240h, respectively. Preliminary mass balances showed 100% glucan recovery with crumbled sapwood and extensive (72%) delignification.

Effect of high dry solids loading on enzymatic hydrolysis of acid bisulfite pretreated Eastern redcedar.

This study investigates hydrolysis of cellulose from Eastern redcedar to glucose at high solids loading. Enzymatic hydrolysis of pretreated redcedar was performed with 0.5 ml Accelerase® 1500/g glucan (46 FPU/g glucan) using dry solids loading from 2% to 20% (w/w). Rheological challenges observed at high solids loading were overcome by adding stainless steel balls to shake flask reactors. The highest glucose concentration, 126 g/L (84% glucan-to-glucose yield), was obtained using 20% solids loading with stainless steel balls as a mixing aid. This enzymatic hydrolyzate was fermented into ethanol using Saccharomyces cerevisiae D5A to produce 52 g/L of ethanol (corresponding to 166 L/dry Mg of redcedar). Reducing enzyme dosage at 16% solids loading from 46 to 11.5 FPU/g glucan reduced glucan-to-glucose yields. This study has demonstrated the possibility of extracting sugars from the invasive species of Eastern redcedar with high solid loadings and their conversion into ethanol.

Development of an efficient pretreatment process for enzymatic saccharification of Eastern redcedar.

This study investigates the potential for extracting sugars from the polysaccharides of Eastern redcedar. Pretreatment temperature, time, sulfuric acid loading, sodium bisulfite loading and impregnation time were varied using factorial treatment design experiments for identifying near optimal overall wood glucan-to-glucose yields during acid bisulfite pretreatments. The highest overall wood glucan-to-glucose yield of 87% was achieved when redcedar was impregnated with pretreatment liquor containing 3.75 g of sulfuric acid/100g of dry wood and 20 g of sodium bisulfite/100g of dry wood at 90 °C for 3h followed by increasing the temperature to 200 °C with a hold time of 10 min. Hemicellulose and lignin removal during pretreatments made the substrate amenable to enzymatic hydrolysis using 0.5 ml of Accelerase® 1500/g of glucan at 2% (w/w) solid loading. Preliminary mass balances showed 97% glucan recovery at pretreatment condition with 87% overall wood glucan-to-glucose yield and 59% delignification.

Effects of cellulose, hemicellulose and lignin on thermochemical conversion characteristics of the selected biomass.

The objective of this study was to investigate effects of biomass constituents (cellulose, hemicellulose and lignin) on biomass thermal decomposition and gas evolution profiles of four biomass materials. Switchgrass, wheat straw, eastern redcedar and dry distilled grains with solubles (DDGS) were selected as the biomass materials. No significant difference was observed in the weight loss profiles of switchgrass, wheat straw and eastern redcedar even though their cellulose, hemicellulose and lignin contents were considerably different. The weight loss kinetic parameters were also not significantly different except for activation energy of the eastern redcedar. However, biomass composition did significantly affect gas evolution profiles. The higher contents of cellulose and hemicellulose in switchgrass and wheat straw may have resulted in their higher CO and CO(2) concentrations as compared to eastern redcedar. On the other hand, higher lignin content in eastern redcedar may have resulted in significantly its high CH(4) concentration.

Reduction of acetone to isopropanol using producer gas fermenting microbes.

Gasification-fermentation is an emerging technology for the conversion of lignocellulosic materials into biofuels and specialty chemicals. For effective utilization of producer gas by fermenting bacteria, tar compounds produced in the gasification process are often removed by wet scrubbing techniques using acetone. In a preliminary study using biomass generated producer gas scrubbed with acetone, an accumulation of acetone and subsequent isopropanol production was observed. The effect of 2 g/L acetone concentrations in the fermentation media on growth and product distributions was studied with "Clostridium ragsdalei," also known as Clostridium strain P11 or P11, and Clostridium carboxidivorans P7 or P7. The reduction of acetone to isopropanol was possible with "C. ragsdalei," but not with P7. In P11 this reaction occurred rapidly when acetone was added in the acidogenic phase, but was 2.5 times slower when added in the solventogenic phase. Acetone at concentrations of 2 g/L did not affect the growth of P7, but ethanol increased by 41% and acetic acid concentrations decreased by 79%. In the fermentations using P11, growth was unaffected and ethanol concentrations increased by 55% when acetone was added in the acidogenic phase. Acetic acid concentrations increased by 19% in both the treatments where acetone was added. Our observations indicate that P11 has a secondary alcohol dehydrogenase that enables it to reduce acetone to isopropanol, while P7 lacks this enzyme. P11 offers an opportunity for biological production of isopropanol from acetone reduction in the presence of gaseous substrates (CO, CO2, and H2).

HIV coinfection among multidrug resistant and extensively drug resistant tuberculosis patients--a trend.

Infection with human immunodeficiency virus (HIV) is found to increase the occurrence of drug resistant tuberculosis. The data for HIV and multidrug resistant tuberculosis (MDR-TB) coinfection is scarce in India. The study aims to find out the prevalence of MDR-TB and extensively drug resistant tuberculosis (XDR-TB) among chronic TB patients and to identify their trend with HIV coinfection over time. Non-responding chronic pulmonary tuberculosis patients were selected for the study from 2004 to 2007. They were all subjected to HIV screening and drug susceptibility testing (DST) for anti-TB drugs. In all 2927 chronic tuberculosis patients were assessed for DST and HIV coinfection; 2156 patients (73.7%) had culturable Mycobacterium tuberculosis in their sputum specimens; 1651 patients (56.4%) were found to have drug resistant mutants to one or more anti-TB drugs; 993 patients (33.9%) had MDR-TB and 48 (1.6%) had XDR-TB. Significantly, 17.9% of 1651 patients with drug resistance were found to have fluoroquinolone (ofloxacin) resistant strain. HIV was found to coexist with 141 (14.2%) of 993 MDR-TB patients. Three XDR-TB patients had HIV coinfection. The HIV coinfection was observed among MDR-TB patients to the tune of 12.3%, 14.7%, 17% and 12.6% during 2004, 2005, 2006 and 2007 respectively (p = 0.81). Prevalence of HIV coinfection with MDR-TB was found to be high among chronic TB patients. It would be appropriate to screen all the chronic TB patients for HIV coinfection apart from their sputa examined for drug resistant tuberculosis, especially in HIV high prevalent states. Indiscriminate use of fluoroquinolone should be stopped.