A study of clinical profile of snake bite at a tertiary care centre.

BACKGROUND: Snake bite is an important occupational and rural hazard because India has always been a land of Exotic snakes. In Maharashtra, common poisonous snakes are Cobra, Russell's Viper, Saw Scaled Viper, and Krait. It is a fact that inspite of heavy morbidity and mortality, very little attention is paid by the clinicians to this occupational hazard. AIMS: To study the prevalence of poisonous and non-poisonous snake bites in part of Western Maharashtra with reference to age, sex, occupation, part of body bitten, time of bite and seasonal variation, and the types of poisonous snakes common in this locality and their clinical manifestations along with the systemic envenomation from various types of poisonous snakes and their effective management in reducing the mortality rate. MATERIALS AND METHODS: This was a retrospective study conducted between May 2010 to May 2012 at a tertiary health care center in Maharashtra. RESULT: A total of 150 patients were studied in our hospital. Out of 150, 76 patients were of poisonous snake bite and 74 patients were of non-poisonous snake bite. Out of these 76 poisonous snake bites, 42 were viperine snake bites, 21 were neuroparalytic snake bites and 13 were locally toxic (LT) snake bites. CONCLUSION: Snake bite is a common life-threatening emergency in the study area. Delay in hospitalization is associated with poor prognosis and increased mortality rate due to consumptive coagulopathy, renal failure, and respiratory failure. Unusual complications like pulmonary edema, intracerebral hemorrhage, Disseminated intravascular coagulation (DIC) were observed in present study.

Effect of complete dentures on craniofacial growth of an ectodermal dysplasia patient: a clinical report.

The aim of this clinical report was to observe the effect of complete dentures on craniofacial growth and development of an ectodermal dysplasia (ED) patient. A complete anodontia patient diagnosed with ED was successfully rehabilitated with conventional complete dentures at the ages of 5, 8, and 10 years. Three sets of complete dentures were made with age-appropriate denture teeth and a bilaterally balanced lingualized occlusal scheme. Periodic follow-up and adjustment when needed was done to maintain proper oral function and esthetics. Serial cephalometric analysis exhibited a marked restriction of forward growth at the anterior nasal spine (ANS) point between 5 and 10 years of age, although there was little change from average in the anteroposterior length of the mandibular body and the height of the mandibular ramus. So, while maxillary growth was reduced, mandibular growth did not significantly change. Cast analysis showed that the increase in arch length was greater than in arch width for both the maxilla and mandible. There was little increase in alveolar ridge height in the anterior region but a considerable increase in the height of the alveolar ridge in the middle and the posterior region. Our findings concluded that the absence of teeth did not affect the growth of the jaws, and it is probable that the denture flange did not arrest the jaw growth, but rather improved the masticatory function by providing good denture stability and retention.

A Preliminary Study to Analyze the Cranio-facial Growth of an Ectodermal Dysplasia Patient After Prosthetic Rehabilitation.

An experimental study on craniofacial development and jaw growth pattern of an ectodermal dysplasia patient was performed and was compared with normal individual. An ectodermal dysplasia patient with complete anodontia was prosthetically rehabilitated with complete dentures at age of 6 and 8 years. Two sets of complete dentures were made with age-appropriate denture teeth and a lingualized occlusal scheme. Periodic follow up and adjustment whether needed was done to maintain proper oral function and aesthetics. Serial cephalometric analysis exhibited a marked restriction of forward growth at the ANS point during 6-8 years of age although there was a little change from average in the anteroposterior length of mandibular body and the height of mandibular ramus. So, the maxillary growth was reduced but there was no significant change in the mandibular growth. Cast analysis showed that increase in arch length was greater than in arch width for both maxilla and mandible. There was a little increase in alveolar ridge height in the anterior region but there was a considerable increase in the height of the alveolar ridge in the middle and the posterior region. Our findings concluded that the absence of teeth did not affect the growth of the jaws and probably the denture flange did not arrest the jaw growth, rather it improved the masticatory function by providing good denture stability and retention.

A framework for student-led education conferences.

Attendance at conferences as part of undergraduate studies is key in health professional education for exploring speciality interests, sharing research, exchanging expertise and passing on knowledge. In addition, conferences offer valuable opportunities to present work and the potential to win prizes and network with others in the field. This article provides insight and guidance into how student-led and designed health science and education conferences can be implemented more effectively. It is aimed at students hoping to organise conferences and also to clinical educators and staff who help facilitate these. We present recommendations, a framework of steps to be followed and a case study, as well as an exploration of the challenges that COVID-19 has presented and how these have been overcome.

Remote risk-stratification of dyspnoea in acute respiratory disorders: a systematic review of the literature.

BACKGROUND: Telephone and video-based triage of dyspnoea has become commonplace and clinicians are faced with a new challenge in risk stratification of patients with dyspnoea due to suspected COVID-19. This review aimed to identify existing remote assessment modalities for acute dyspnoea which can be applied during pandemics. METHODS: We conducted a systematic search of Medline, Embase, the Cochrane Library and medRxiv for studies of remote assessment of dyspnoea [PROSPERO ID: CRD42020202292]. A total of 3014 abstracts were screened independently by two reviewers and 32 studies were progressed to full text screening. RESULTS: Five studies met the inclusion criteria. Commonly assessed clinical features included respiratory rate, work of breathing, counting time and mental status. All studies found remote triage modalities to be appropriate for detecting severe respiratory distress or the need for emergency level care. CONCLUSION: Evidence-based tools to remotely assess dyspnoea will reduce resource strain during current and future pandemics.

Effects of charge on osmotic reflection coefficients of macromolecules in fibrous membranes.

A model based on continuum hydrodynamics and electrostatics was developed to predict the combined effects of molecular charge and size on the osmotic reflection coefficient (sigma(o)) of a macromolecule in a fibrous membrane, such as a biological hydrogel. The macromolecule was represented as a sphere with a constant surface charge density, and the membrane was assumed to consist of an array of parallel fibers of like charge, also with a constant surface charge density. The flow was assumed to be parallel to the fiber axes. The effects of charge were included by computing the electrostatic free energy for a sphere interacting with an array of fibers. It was shown that this energy could be approximated using a pairwise additivity assumption. Results for sigma(o) were obtained for two types of negatively charged fibers, one with properties like those of glycosaminoglycan chains, and the other for thicker fibers having a range of charge densities. Using physiologically reasonable fiber spacings and charge densities, sigma(o) for bovine serum albumin in either type of fiber array was shown to be much larger than that for an uncharged system. Given the close correspondence between sigma(o) and the reflection coefficient for filtration, the results suggest that the negative charge of structures such as the endothelial surface glycocalyx is important in minimizing albumin loss from the circulation.

Efficacy and Safety of Canagliflozin 300 mg in Overweight and Obese Type 2 Diabetes Mellitus Patients in a Real-world Setting: COLOR Study.

BACKGROUND AND AIMS: To assess the efficacy and safety of canagliflozin (CANA, 300 mg/d) in overweight and obese patients with type 2 diabetes mellitus (T2DM). METHODS: In a single centre, retrospective, observational study, we included overweight or obese patients with T2DM who had HbA1c >7% and received CANA as addition to existing therapy for at least 24 weeks. Primary endpoint assessed was changes in HbA1c, fasting and post-prandial plasma glucose (FPG and PPG), and secondary endpoints included changes in weight, waist circumference (WC), systolic blood pressure (SBP) and diastolic BP (DBP) over 12 and 24 weeks. RESULTS: Among 90 patients, mean age was 53.5 ± 10.8 years and 42.2% were females. Majority of the patients (46.7%) were receiving two antidiabetic drugs. Significant reduction in HbA1c from baseline to week 24 (9.1 ± 1.8% vs. 7.5 ± 1.1% respectively, mean difference: - 1.6 ± 0.9%, P < 0.0001) was seen. Reduction in FPG (mean difference: - 63.0 ± 45.2 mg/dL, P < 0.0001) and PPG (mean difference: - 97.7 ± 54.3 mg/dL, P < 0.0001) was also significant. Mean reduction in weight was - 4.3 ± 2.2 kg (P < 0.0001) at 24 weeks. Reductions in WC, SBP and DBP were also significant at week 24 (P < 0.0001 for all). Changes in all these parameters were also significant at week 12. Proportion of patients achieving the target HbA1c of <7% was 28.9% and 52.2% at week 12 and week 24, respectively. Genital mycotic infections were seen in 20% patients and was present in higher proportion of females than males (28.9% vs. 13.5%, P = 0.070). No episodes of hypoglycaemia were found. CONCLUSION: Canagliflozin should be considered from among the various antidiabetic drugs in overweight and obese patients with T2D in India.

Analysis of Long Term Study Indicates Both Agronomic Optimal Plant Density and Increase Maize Yield per Plant Contributed to Yield Gain.

Concurrent to yield, maize (Zea Mays L.) plant density has significantly increased over the years. Unlike yield, however, the rate of change in plant density and its contribution to maize yield gain are rarely reported. The main objectives of this study were to examine the trend in the agronomic optimum plant density (AOPD) and quantify the contribution of plant density to yield gain. Maize hybrid by seeding rate trials were conducted from 1987-2016 across North America (187,662 data points). Mixed model, response surface, and simple linear regression analyses were applied on the meta-data. New outcomes from this analysis are: (i) an increase in the AOPD at rate of 700 plant ha-1 yr-1, (ii) increase in the AOPD of 1386, 580 and 404 plants ha-1 yr-1 for very high yielding (VHY, > 13 Mg ha-1), high yielding (HY, 10-13 Mg ha-1) and medium yielding (MY, 7-10 Mg ha-1), respectively, with a lack of change for the low yielding (LY, < 7 Mg ha-1) environment; (iii) plant density contribution to maize yield gain ranged from 8.5% to 17%, and (iv) yield improvement was partially explained by changes in the AOPD but we also identified positive impacts on yield components as other sources for yield gain.

Effectiveness of iron-fortified infant cereals on hemoglobin levels of children aged 12-24 months: A cross-sectional study from New Delhi, India.

INTRODUCTION: Iron deficiency anemia represents 3rd largest disease burden, with an estimated 6.9 billion disability-adjusted life years. Iron-fortified cereals (IFIC) can contribute substantially in preventing iron deficiency anemia and maintaining an adequate body iron status. The aim of this study is to assess the effectiveness of IFIC intake along with other complementary food/s on the hemoglobin (hb) level of children from 12 to 24 months of age. MATERIALS AND METHODS: A cross-sectional study was conducted from November 2015 to February 2016 in three pediatric outpatient clinics of New Delhi, India. A predesigned questionnaire was used to elicit information on socio-demography, complementary feeding, and intake of IFIC from 66 mother and child pairs. Child's anthropometric measurement and hb levels were recorded by the pediatrician. Chi-square and Student's t-tests were used to compare the key study variables between IFIC (minimum 1-2 serving/day) and non-IFIC groups. Multiple logistic regression analysis was applied to explore the independent correlates of anemia in the study groups. RESULTS: Out of 66 children, 60.6% (n = 40) of children were boys. The prevalence of anemia (hb% <11 g/dl) was 42.4% (95% confidence interval (CI): 30.5%-55.2%, n = 28). Multiple logistic regression analysis revealed that the children in IFIC group were unlikely to be anemic (adjusted odds ratio (OR): 0.007, 95% CI: 0.001-0.079, P < 0.001). On the contrary, boys (adjusted OR: 11.6, 95% CI: 1.23-108.9, P = 0.032) and children with low birth weight (adjusted OR: 11.7, 95% CI: 1.23-111.76, P = 0.032) were associated with anemic status. CONCLUSION: Intake of IFIC (minimum 1-2 serving/day) was associated with the lesser chance of anemia in children of 12-24 months. However, gender and low birth weight were also associated with anemia. IFIC may have a role in mass fortification programs. However, further larger and controlled studies are recommended to test this hypothesis.

Fasting-Evoked En Route Hypoglycemia in Diabetes (FEEHD): An Overlooked Form of Hypoglycemia in Clinical Practice.

OBJECTIVE: Many patients with diabetes opt to fast for lab tests, especially for lipid profiles, thus missing breakfast. In parallel, recent studies and international guidelines have indicated that routine fasting for lipid panels may not be necessary. Missing breakfast while fasting for lab tests may invoke hypoglycemia, if patients are not properly instructed about adjusting diabetes medications on the night before or on the day of the lab test. Our group described this form of hypoglycemia and introduced the term FEEHD to refer to it (fasting-evoked en route hypoglycemia in diabetes). In a recently published small study, we reported a rate of occurrence of FEEHD of 27.1%. The objective of this study was to evaluate the rate of occurrence of FEEHD in another clinic. METHODS: Patients with diabetes were asked to complete a simple, 2-page survey inquiring about hypoglycemic events while fasting for labs in the preceding 12 months. RESULTS: A total of 525 patients completed the surveys out of 572 patients invited (91.8% response rate). A total of 363 patients with complete data were analyzed, with a mean age of 60.6 (SD 12.5) years. A total of 62 (17.1%) patients reported having experienced one or more FEEHD events in the prior 12 months. Of the 269 patients who were at higher risk of FEEHD (on insulin secretagogues or on insulin), 59 (21.9%) reported having experienced FEEHD. Only 33 of FEEHD patients (53%) recalled having contacted their provider regarding the events and only 22 (35%) indicated having received some sort of FEEHD prevention instructions. CONCLUSION: Our study shows a significant rate of occurrence of FEEHD in the real world (a clinical practice). FEEHD is especially dangerous, as patients often commute (drive) to and from the laboratory facility (potential risk of traffic accidents). Given study limitations, further studies are needed to assess prevalence of FEEHD in other settings and in the general populations.

Antileishmanial and immunomodulatory potential of Ocimumsanctum Linn. and Cocosnucifera Linn. in murine visceral leishmaniasis.

The role of immunomodulation in the therapeutic treatment of visceral leishmaniasis has gained eminence in view of moderate to severe drawbacks of the currently available drugs like toxicity, drug resistance and prohibitive costs. The potential for modulation of the immune system of many herbal plants can be tapped to address these problems. We conducted the present research study to investigate the antileishmanial and immunomodulatory effects of Ocimum sanctum Linn. and Cocos nucifera Linn. during the progression of visceral leishmaniasis in BALB/c mouse model. The IC50 values of the ethanolic leaf extract of O. sanctum and that of the aqueous husk-fibre extract of C. nucifera against the sodium stibogluconate (SSG) susceptible strain (MHOM/IN/80/Dd8) were found to be 73.3 and 62 µg/ml respectively. On treatment of infected BALB/c mice with the extracts, we observed a reduction in hepatic parasite load by 43.63 % (O. sanctum), 65.42 % (C. nucifera) and 75.61 % (O. sanctum + C. nucifera) at 1st post treatment day (p.t.d.), while at 15th p.t.d., the reduction was 73.61 % (O. sanctum), 76.59 % (C. nucifera) and 94.12 % (O. sanctum + C. nucifera). This was accompanied by an up-scaling of the DTH response, skewing of the humoral response towards Th1 type and hepatoprotection in the form of normalization of liver function tests. Overall, administration of the extracts of these two plants in combination as compared to their administration alone rescued the affected mice from the disease greatly, which can be attributed to their antileishmanial and immunomodulatory activities.

Novel bis-acac-O,O-Ir(III) catalyst for anti-Markovnikov, hydroarylation of olefins operates by arene CH activation.

A novel, thermally stable, homogeneous Ir catalyst for the anti-Markovnikov, hydroarylation of olefins is shown to operate by arene CH activation via the formation of a bisacac-O,O phenyl-Ir(III) species.

Prosthetic rehabilitation of partial ear loss with custom-made acrylic attachment and long-term soft liner.

BACKGROUND: The craniofacial implants are used for retaining the prostheses although these are costly and often require complex laboratory procedures. The aim of this case report is to describe a case of successful rehabilitation of partial ear loss with long-term soft liner and mechanically retained by custom-made heat-cured acrylic attachment. CASE DESCRIPTION AND METHODS: A female patient underwent a scalp avulsion injury and lost major portion of her hair and upper part of the left ear till the antitragus. A partial auricular prosthesis was fabricated, and mechanical retention was achieved through custom-made heat-cured acrylic attachment engaged in anatomic undercuts of remained ear. FINDINGS AND OUTCOMES: Permanent soft liner provided a life-like appearance and consistency to the prosthetic ear and bonded to custom-made heat-cured acrylic attachment through chemical cross-linking. CONCLUSION: Patient accepted the prosthesis satisfactorily without any social and psychological embracement. This technique simplified the clinical and laboratory procedures and reduced the cost of the prosthesis.

Modified functionally generated path technique for single complete denture against non-modified natural dentition.

BACKGROUND: A clinical report of a patient complaining of frequent fractures of her maxillary complete denture opposing dentulous mandibular arch is presented. MATERIALS AND METHODS: The patient was rehabilitated with a maxillary complete denture using modified functionally generated path technique to achieve harmonious occlusion between the complete denture and the natural dentition. DISCUSSION: Using the patient's own denture to record the functionally generated path made the technique much easier and also saved valuable chair-side time. Occlusal balancing in the trial denture bases gave us the flexibility to move the teeth slightly, or grind them in order to balance the occlusion. SUMMARY AND CONCLUSION: Our modification of the functionally generated path technique resulted in successful rehabilitation of the patient without any fracture of the prosthesis in the 2-year follow-up, and has saved valuable chair-side time and laboratory effort.

Effects of charge on osmotic reflection coefficients of macromolecules in porous membranes.

A computational model was developed to predict the effects of solute and pore charge on the osmotic reflection coefficients (sigma(o)) of spherical macromolecules in cylindrical pores. Results were obtained for particles and pores of like charge and fixed surface charge densities, using a theory that combined low Reynolds number hydrodynamics with a continuum, point-charge description of the electrical double layers. In this formulation steric and/or electrostatic exclusion of macromolecules from the vicinity of the pore wall creates radial variations in osmotic pressure. These, in turn, lead to the axial pressure gradient that drives the osmotic flow. Due to the stronger exclusion that results from repulsive electrostatic interactions, sigma(o) with charge effects always exceeded that for an uncharged system with the same solute and pore size. The effects of charge stemmed almost entirely from particle positions within a pore being energetically unfavorable. It was found that the required potential energy could be computed with sufficient accuracy using the linearized Poisson-Boltzmann equation, high charge densities notwithstanding. In principle, another factor that might influence sigma(o) in charged pores is the electrical body force due to the streaming potential. However, the streaming potential was shown to have little effect on sigma(o), even when it markedly reduced the apparent hydraulic permeability.