Effect of Hydroxychloroquine and Azithromycin Combination Use in COVID-19 Patients - An Umbrella Review.

Background: Hydroxychloroquine and Azithromycin combination was used rampantly in management of COVID-19 patients in different countries. Present review was conducted to evaluate the efficacy of Hydroxychloroquine and Azithromycin combination compared to the control (standard care) and any adverse effect following this combination use in COVID-19 patients if any. Material and Methods: We included all the systematic review with or without meta-analysis reporting the effect of Hydroxychloroquine (HCQ) and Azithromycin (AZM) combination use in COVID-19 patient using three databases namely PubMed, medline, CINHAL, Web of Science from July 2020 till Jan 2022. Results: The systematic search strategy has identified 104 studies in total, after removal of duplicates only 4 systematic reviews were included in the qualitative synthesis. The various tools for assessing and reporting the data in the reviews were PRISMA, ROBINS-I, Robs2, AMSTAR, MASTER checklists. Mortality among the hydroxychloroquine with azithromycin combination group was significantly higher than among the Standard Care group. The duration of hospital stay in days was shorter in the Standard Care group in comparison with the hydroxychloroquine group or the hydroxychloroquine and azithromycin combination group. Of the 4 systematic reviews included, 3 had low risk of bias and one had unclear risk of bias using the ROBIS tool. Chloroquine or Hydroxychloroquine combination did not shorten the duration of hospital stay. Conclusion: Rampant use of Chloroquine or Hydroxychloroquine alone or with Azithromycin combination caused adverse effects like QT prolongation. Finally, there is no evidence to support use of either Hydroxychloroquine with or without Azithromycin, for the treatment of COVID-19.

Isolated choroid plexus cysts and health and developmental outcomes in childhood and adolescence - A systematic review.

OBJECTIVES: Choroid plexus cysts (CPCs) are incidental findings on ultrasound examination of the fetal brain. It is not known if isolated CPCs are associated with any adverse health or neurodevelopmental outcomes during the life course. This systematic review aimed to collate and synthesize the evidence on whether or not isolated choroid plexus cysts are associated with an increased risk of adverse health or developmental outcomes during childhood and adolescence. METHODS: A search strategy was developed specifically for this study and applied to four electronic databases Medline (Ovid), Embase (Ovid), Web of Science, and Google Scholar. Studies were assessed and selected for inclusion if there was a measurement of CPC (including single or multiple; unilateral or bilateral; isolated or presenting alongside other markers) during the antenatal or early neonatal period (<7 days) with follow-up of children and adolescents for health and developmental outcomes measured at any time from age 1 month onwards. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Due to heterogeneity in the types of outcome measures included and the timing of measurement of outcomes across the studies, it was not possible to pool data across studies and a narrative description of findings was presented. RESULTS: Eight studies (three cohorts and five case series) met the inclusion criteria. Different methods were used for outcome assessment, such as in-person assessment, parent questionnaires, medical records, and telephone interviews with parents. Six studies measured outcomes only once during the specified duration of follow-up; two studies carried out paediatric reviews of the children several times during follow-up. There were no differences in developmental outcomes or physical health between babies with CPCs reported in the three cohort studies, and no abnormalities were detected in the children that were followed up in four of the five case series studies. Most of the included studies were graded as low quality due to the small sample size, high risk of selection bias, unclear definitions of CPC or lack of a comparison group. CONCLUSIONS: The studies conducted to date do not provide evidence of adverse physical health outcomes or neurodevelopmental delays in babies with CPCs. However, most of these studies were small and included a narrow range of outcomes. Further research is needed to explore the relative incidence of outcomes such as ASD, ADHD, epilepsy and educational attainment in children with CPCs.

Effectiveness-of Calcium Phosphate derivative agents on the prevention and remineralization of caries among children- A systematic review & meta-analysis of randomized controlled trials.

OBJECTIVES: Dental caries among children is a highly prevalent yet easily preventable oral health issue among children. Various calcium phosphate (CaP) derivatives are implicated to exhibit caries preventive potential; however, no study has summarized the anti-caries effectiveness of these agents. This systematic review and meta-analysis sought to assess the caries-preventive and tooth-remineralizing effect of various (CaP) derivative agents compared to no-intervention/placebo or Fluoride (F) use alone among children. MATERIALS AND METHODS: EMBASE, Ovid, PubMed, Scopus, Web of Science, Cochrane central register of controlled trials (CENTRAL), and grey literature were searched for relevant articles up to April 2021. Only English-language articles were included. Total 2636 articles were searched through different databases; out of the 2161 articles were screened after duplicate removal. 26 studies fulfilling the eligibility criteria were included in this systematic review. Methodological quality assessment and quantitative analysis were done using RevMan. GRADE was used to evaluate the certainty of evidence. RESULTS: A total of 26 trials fulfilling the eligibility criteria were included. The meta-analysis of 10 studies revealed that complete white spot lesions (WSLs) regression (RR=1.56; 95% CI, 1.27 to 1.91; P < .0001, I2=0%), post intervention active WSLs (RR=0.80; 95% CI, 0.70 to 0.90; P = .0004, I2=0%) and post intervention Salivary S. mutans count (RR= 0.69; 95% CI, 0.48 to 0.99; P = .47, I2=0%) significantly favored the CaP+F combined therapy as compared to F alone. No significant differences in the lesion area, Delta F, and DIAGNOdent values were observed between the 2 groups. Low certainty of the evidence was found in the present systematic review due to the high/unclear risk of bias, imprecision, and indirectness of included trials. CONCLUSIONS: Topical treatment using CaP+F group showed superior remineralization potential as well as the antibacterial effect on dental caries among children as compared to no intervention and/or placebo or F alone. Apart from CPP-ACP, other CaP derivatives like TCP and fTCP seem to have promising effects in remineralizing early lesions, however, very few trials exist on these potential agents. To provide definitive recommendations in this area, more clinical trials on caries preventive effectiveness of various CaP agents are warranted.

The perceived need for evidence-based COVID-19 management and Tele-education in the North-East region of India: a cross-sectional survey.

Due to the sudden rise in the cases of COVID-19 in the North-Eastern region of India, this study was conducted to survey the felt needs of the medical professionals with regards to education on the evidence-based management of COVID-19. A total of 25 North-East leaders were recruited and a baseline survey was conducted through the digital medium. Out of 25 North-East leaders, 52% were undergoing training in evidence-based medicine in the capacity-building program for evidence-based child health. Participants (48%) strongly agreed and 40% agreed on the possibility of enhanced care by capacity building in the areas of COVID-19 management through discussing cases. Out of 25 North East leaders, 48% agreed to join both as a speaker as well as a participant. Various priority topics on COVID-19 management e.g. childhood, adult, ocular manifestation, ICU management, telemedicine, vaccines, lab protocols, psychological distress, and treatment strategy have emerged. We have presented the findings of the survey which will help guide the mentoring program focusing on evidence-based management of COVID-19 in remote areas through Tele-education.

Role of environmental lead in the occurrence of anemia in Indian children: a systematic review and meta-analysis.

Exposure to lead among children, as well as adults, is a major global health issue. With diverse routes of exposure (e.g., food, air, and water) either environmentally or occupationally, lead among children can cause mild, moderate, to severe health complications in the later stages of life. The average blood lead level reported by CDC in 2021 is 3.5 µg/dL, and the level of blood lead toxicity is ≥ 10 µg/dL. In this study, we planned to systematically analyze the association between blood lead levels (BLLs) (≥ 10 µg/dL and < 10 µg/dL) and the risk of anemia (hemoglobin level < 11 g/dL) among Indian children aged between ≥ 1 and ≤ 18 years. An online literature search of 5 databases, PubMed, Ovid, EMBASE, Web of Science, and Google Scholar was accomplished with a search updated until 8th March 2021. Study designs included cohort, cross-sectional, and case-control studies that have evaluated the association of lead toxicity or exposure with anemia (Hb < 11 g/dL) reported in urban and/or rural Indian children. Meta-analysis was performed among a total of 864 children from 4 cross-sectional studies. The association between lead toxicity (BLLs ≥ 10 µg/dL) and the risk of being anemic was not statistically significant (RR = 1.15 (95% CI: 0.86-1.55, I2 = 77%). The risks of bias in all included studies were low according to the Newcastle Ottawa Scale. Increased blood lead levels did not appear to be the major contributor to anemia in Indian Children. We need to focus primarily on improving the nutritional quality, fortified food supplements, and a balanced diet for children to reduce the anemia burden in India. Lead toxicity should be sought as an etiological factor only in areas of high environmental risk factors which were leaded paints, leaded batteries, a house near major road/traffic areas, and pesticide exposure.

Prevalence of Polycystic Ovarian Syndrome in India: A Systematic Review and Meta-Analysis.

Stein-Leventhal syndrome, often known as polycystic ovarian syndrome (PCOS), is a syndrome that affects women's reproductive health. PCOS is one of the most common endocrine and metabolic disorders in women of reproductive age. The etiology of PCOS remains unknown mainly, and the estimation of PCOS burden in a specific geographical location will impact disease control strategies. Hence, this study estimated the pooled prevalence of PCOS in Indian women. Databases such as PubMed, CINHAL, Scopus, and Google Scholar were thoroughly searched. Only those published Indian studies that reported the prevalence of PCOS from 2010 to 2021 and had at least one of the following diagnostic PCOS criteria were included in the systematic review: the National Institutes of Health (NIH), Rotterdam's criteria, or/and Androgen Excess Society (AES). MetaXL version 5.3 software was used for data analysis. The risk of bias was assessed using modified Joanna Briggs Institute criteria for cross-sectional studies. Out of 17132 articles, 11 articles were selected for systematic review and meta-analysis. The pooled prevalence of PCOS was 11.33(7.69-15.59) using the random effect. The proportion of Hirsute using the Ferriman-Gallwey score was highly variable, ranging from 1.6% to 37.9% (n=6). The prevalence rate of PCOS is high among Indian women. The pooled prevalence of PCOS was close to 10% using Rotterdam's criteria and AES criteria, while it was 5.8% using NIH criteria. The study's overall finding emphasizes the need for more acceptable and uniform diagnostic criteria for screening PCOS. At the same time, policy-makers should consider giving more importance to PCOS in their effort to control non-communicable diseases.

Soil as a tool of revelation in forensic science: a review.

Soil contains diverse and complex natural elements having physical, chemical, mineralogical and biological components. Soil being a transferable physical component (it can be transferred from one location to another with the help of shoes, tires, clothes, tools etc.), acts as a tool of forensic investigation to correlate a specific crime scene with criminal suspects. A variety of techniques and combinations of methods can be used to discriminate soil from different geographical locations. The present review highlights various analytical techniques (ATR-FTIR, pyGC-MS, SEM-EDX, ICP-MS/OES and XRD) for soil analysis (colour comparison, texture and particle size determination, density gradient methods and organic matter estimation) and discusses some of the famous cases solved with soil trace evidence. The objective of the present study is to provide an overview of the importance of soil as physical evidence in forensic science based on literature analysis that will help forensic scientists and researchers to select appropriate methods to discriminate different soil samples. This article reviews various analytical techniques used to differentiate soils and provides compiled information regarding soil as trace evidence in order to help academicians, researchers and forensic soil scientists.

A data-based study in support of Blackbuck related cases from Haryana.

Haryana State (located in the northern part of India), is lacking in natural forest, but it has rich biodiversity of some wild animals, especially the Blackbuck antelopes. The maximum population of Blackbucks in the state is living in open cultivated fields. Blackbucks were once found abundantly throughout Haryana, but now they are limited to the south-west part of the state, driven almost to extinction in the rest of Haryana, mainly because of habitat destruction and wildlife crime. This data report is an outcome of six years (January 2012-September 2017), based on assessment of records in terms of location, year and month wise frequency of death and rescued cases related to Blackbuck reported, as registered by the State Wildlife Department. It is envisioned that this data report will provide appropriate information for the conservationist to plan future conservation strategy for Blackbucks in Haryana.

Dental radiology: an adjunctive aid in age estimation

The concept of using radiographic methods for age estimation has kindled so much interest in the field of forensic dentistry in past few decades. Aim and Objectives: To evaluate the different dental radiographic methods for age estimation and their significance in the field of forensic dentistry. Methodology:- 64articles were collected after an extensive literature review. Literature survey of these articles was done.Conclusion:-Radiographic methods play an indispensible role in age estimation specifically in living persons because of their non-invasive and non-destructive nature. This review paper focus on different radiographic methods and new developments available for radiological dental age estimation and their effective aid in identification and crime investigation.