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Background: Recently researches in the field of dental implantology have increased, in spite of that very limited knowledge is available to the patients about dental implants as an option for replacement of missing teeth. Goal of replacement of missing teeth is not only functional rehabilitation but overall improvement in quality of life of the patient. Aim: To assess the awareness of dental implants and to compare oral health related quality of life (OHRQoL) in patients treated with implant supported fixed prosthesis (ISPs) and teeth supported fixed prosthesis (FPDs). Methods: & Material: General implant awareness questionnaire was used to assess the awareness of dental implants in 500 participants. Oral health impact profile (OHIP) questionnaire was used to compare OHRQoL between 300 patients treated with ISPs and 300 patients treated with FPDs. Statistical analysis: Sample size was taken to estimate difference between groups at 30 % & 80% power and 5% risk. IBM SPSS 20 (SPSS Inc., Chicago, IL) was used for statistical analysis. Chi square test and independent t- test was used to find statistical difference between variables. Results: 27.2% participants were aware about dental implants. 74.4% participants agreed that missing teeth should be replaced with prosthetic options. Dentists were primary source of knowledge (66%) of dental implants for patients. Parameters like functional limitations, psychological discomfort and pain during mastication were significantly (p

Thorium is considered as a promising resource for the production of nuclear power, with its abundance in the Earth's crust offering potential for sustainable energy generation to fulfill upcoming energy needs. As a fertile material, thorium has the capability to be converted into fissile uranium-233, which is essential for sustaining nuclear chain reactions. Therefore, the extraction of thorium from the Earth's crust is imperative for its utilization as fuel in nuclear reactors. This study presents the synthesis of titanium dioxide with a mesoporous structure using the solvothermal method for extracting Th(IV) from aqueous solutions. Batch adsorption experiments were carried out to evaluate the impact of solution pH, adsorption kinetics, adsorbent dosage, initial Th(IV) concentration, and temperature. The adsorption process is influenced by the pH, showing a maximum adsorption capacity of 101.4 mg per gram of mesoporous TiO2 adsorbent (MTA) at an initial Th(IV) concentration of 400 mg L − 1 at pH 4.0. Results indicate a significant correlation with the pseudo-second-order and Freundlich adsorption isotherm models. Temperature-dependent investigations revealed that the adsorption of Th(IV) is spontaneous at room temperature and increases with higher temperatures (endothermic process). Moreover, the study highlights the rapid kinetics of Th(IV) adsorption by MTA, making it a favorable choice for upscaling the extraction process of Th(IV). In conclusion, the results suggest MTA as a promising adsorbent for the removal of Th(IV) from aqueous solutions.

Background: Evidence suggests that hypothyroidism may be associated with an increased risk of acute coronary syndrome (ACS).The data regarding the influence of hypothyroidism on cardiovascular disease in the Asian population is conflicting. Therefore, we undertook this study to assess the overall prevalence of hypothyroidism in Acute Coronary Syndrome (ACS) patients and determine if there is a relationship between hypothyroidism, both sub-clinical and overt and other significant risk factors of ACS in an Indian population. Methods: We studied 487 hospitalized patients between March 2018 and February 2021 with a diagnosis of ACS to determine the prevalence of hypothyroidism, both clinical and sub-clinical and their relationship with other known coronary risk factors. Thyroid function Tests - free T3, free T4 and TSH were collected from all the patients within 24 h of their admission to the coronary care unit (CCU) of 2 major hospitals in New Delhi and Imphal (Manipur). Results: Subclinical hypothyroidism was prevalent in 44 (9 %), followed by overt hypothyroidism in 25 (5.2 %).Subclinical hypothyroidism was more common in females, whereas overt hypothyroidism was more common in males. ST Elevation Myocardial Infarction (STEMI) (52 %), followed by Non-ST-Elevation Myocardial Infarction (NSTEMI) (25 %), was the commonest diagnosis at presentation. Patients with overt hypothyroidism showed a higher proportion of increased triglyceride levels.Patients with hypothyroidism had no differences in the prevalence of concomitant diabetes hypertension and other coronary risk factors. Conclusions: Patients with ACS without known thyroid disorders should be screened for hypothyroidism since it is found frequently. There might be a case to treat their thyroid dysfunction appropriately.

Summary: Background: Lung function trajectories (LFTs) have been shown to be an important measure of long-term health in asthma. While there is a growing body of metabolomic studies on asthma status and other phenotypes, there are no prospective studies of the relationship between metabolomics and LFTs or their genomic determinants. Methods: We utilized ordinal logistic regression to identify plasma metabolite principal components associated with four previously-published LFTs in children from the Childhood Asthma Management Program (CAMP) (n = 660). The top significant metabolite principal component (PCLF) was evaluated in an independent cross-sectional child cohort, the Genetic Epidemiology of Asthma in Costa Rica Study (GACRS) (n = 1151) and evaluated for association with spirometric measures. Using meta-analysis of CAMP and GACRS, we identified associations between PCLF and microRNA, and SNPs in their target genes. Statistical significance was determined using an false discovery rate-adjusted Q-value. Findings: The top metabolite principal component, PCLF, was significantly associated with better LFTs after multiple-testing correction (Q-value = 0.03). PCLF is composed of the urea cycle, caffeine, corticosteroid, carnitine, and potential microbial (secondary bile acid, tryptophan, linoleate, histidine metabolism) metabolites. Higher levels of PCLF were also associated with increases in lung function measures and decreased circulating neutrophil percentage in both CAMP and GACRS. PCLF was also significantly associated with microRNA miR-143-3p, and SNPs in three miR-143-3p target genes; CCZ1 (P-value = 2.6 × 10−5), SLC8A1 (P-value = 3.9 × 10−5); and TENM4 (P-value = 4.9 × 10−5). Interpretation: This study reveals associations between metabolites, miR-143-3p and LFTs in children with asthma, offering insights into asthma physiology and possible interventions to enhance lung function and long-term health. Funding: Molecular data for CAMP and GACRS via the Trans-Omics in Precision Medicine (TOPMed) program was supported by the National Heart, Lung, and Blood Institute (NHLBI).

Drug-resistant epilepsy (DRE) poses a significant global challenge, impacting the well-being of patients. Anti-epileptic drugs often fail to effectively control seizures in individuals with DRE. This condition not only leads to persistent seizures but also induces neurochemical imbalances, elevating the risk of sudden unexpected death in epilepsy and comorbidities. Moreover, patients experience mood and personality alterations, educational and vocational setbacks, social isolation, and cognitive impairments. Ketogenic diet has emerged as a valuable therapeutic approach for DRE, having been utilized since 1920. Various types of ketogenic diets have demonstrated efficacy in controlling seizures. By having a multimodal mechanism of action, the ketogenic diet reduces neuronal excitability and the frequency of seizure episodes. In our narrative review, we have initially provided a concise overview of the factors contributing to drug resistance in epilepsy. Subsequently, we have discussed the different available ketogenic diets. We have reviewed the underlying mechanisms through which the ketogenic diet operates. These mechanisms encompass decreased neuronal excitability, enhanced mitochondrial function, alterations in sleep patterns, and modulation of the gut microbiome. Understanding the complex mechanisms by which this diet acts is essential as it is a rigorous diet and requires good compliance. Hence knowledge of the mechanisms may help to advance research on achieving similar therapeutic effects through other less stringent approaches.

A five-year girl was referred to our centre with swelling over the right lower back. The child was evaluated to rule out chronic cutaneous tuberculosis, lymphoma and soft tissue tumor. Biopsy of the lesion on culture yielded Basidiobolus species. Whole genome sequencing of the isolate identified it as Basidiobolus meristosporus. Sequencing of fungi pathogenic to humans which cannot be differentiated by conventional methods of speciation becomes essential to assign pathogenicity, understand epidemiology and resolve the nuances in the ever-evolving taxonomical classification.

Summary: Background: Preeclampsia has been associated with maternal epigenetic changes, in particular DNA methylation changes in the placenta. It has been suggested that preeclampsia could also cause DNA methylation changes in the neonate. We examined DNA methylation in relation to gene expression in the cord blood of offspring born to mothers with preeclampsia. Methods: This study included 128 mother-child pairs who participated in the Vitamin D Antenatal Asthma Reduction Trial (VDAART), where assessment of preeclampsia served as secondary outcome. We performed an epigenome-wide association study of preeclampsia and cord blood DNA methylation (Illumina 450 K chip). We then examined gene expression of the same subjects for validation and replicated the gene signatures in independent DNA methylation datasets. Lastly, we applied functional enrichment and network analyses to identify biological pathways that could potentially be involved in preeclampsia. Findings: In the cord blood samples (n = 128), 263 CpGs were differentially methylated (FDR

Aim: Evaluation of the status of uncontrolled hypertension in diagnosed hypertensives who had been advised drug treatment in the rural areas of 6 districts in Jammu & Kashmir (J&K) and also the risk factors associated with it. Methods: The study was a cross-sectional observational study conducted between August 2020 to July 2021 in the form of health camps in six government health centres in 6 different rural districts. The camps were focussed on patients with hypertension, diabetes with or without heart disease. The areas included Machil in Kupwara, Khan Sahib in Budgam, Rajpora and Hawal in Pulwama, Rainawari in the Srinagar, Banihal in Ramban, and Jagti in Jammu.Enrolled patients were examined for body weight, blood pressure (BP), random blood sugar and serum lipid profile. The definition of hypertension was as per the eighth Joint National Committee (JNC-8) guidelines. Results: A total of 600 patients (50.1% males) were evaluated. Of these 335 (55%) had history of being diagnosed hypertension and had been recommended drugs for BP control Male: Female ratio 1:0.8.211(63.5%) of these had un controlled blood pressures on measurement.Two or more drugs had been prescribed in 65 (30.8%) patients, 34 (16%) were taking only single drug and 112(53%) were not on any drug. Uncontrolled hypertension was seen more often in age group of 40–60 years (49%), subjects more than 60 years had it in 40%.The comparison of risk factors between patients with diagnosed hypertension with those without it revealed use of tobacco, consumption of salted tea, presence of diabetes, dyslipidaemia as significant factors for the presence of uncontrolled hypertension. Conclusion: Uncontrolled hypertension in known patients prescribed drugs is highly prevalent in the rural population of J&K. Steps to mitigate this problem are needed on top priority.

Summary: Background: Identifying novel epigenetic signatures associated with serum immunoglobulin E (IgE) may improve our understanding of molecular mechanisms underlying asthma and IgE-mediated diseases. Methods: We performed an epigenome-wide association study using whole blood from Framingham Heart Study (FHS; n = 3,471, 46% females) participants and validated results using the Childhood Asthma Management Program (CAMP; n = 674, 39% females) and the Genetic Epidemiology of Asthma in Costa Rica Study (CRA; n = 787, 41% females). Using the closest gene to each IgE-associated CpG, we highlighted biologically plausible pathways underlying IgE regulation and analyzed the transcription patterns linked to IgE-associated CpGs (expression quantitative trait methylation loci; eQTMs). Using prior UK Biobank summary data from genome-wide association studies of asthma and allergy, we performed Mendelian randomization (MR) for causal inference testing using the IgE-associated CpGs from FHS with methylation quantitative trait loci (mQTLs) as instrumental variables. Findings: We identified 490 statistically significant differentially methylated CpGs associated with IgE in FHS, of which 193 (39.3%) replicated in CAMP and CRA (FDR < 0.05). Gene ontology analysis revealed enrichment in pathways related to transcription factor binding, asthma, and other immunological processes. eQTM analysis identified 124 cis-eQTMs for 106 expressed genes (FDR < 0.05). MR in combination with drug-target analysis revealed CTSB and USP20 as putatively causal regulators of IgE levels (Bonferroni adjusted P

In the current scenario, a decline in the natural deposits of copper and its alloys has called for the efficient usage of bronze in mechanical components. The development of additive manufacturing processes such as Directed Energy Deposition (DED) provides an opportunity to address this issue by replacing complete bronze components such as worm wheels with parts made of less critical raw materials and provided with bronze coatings on the wear-active interfaces. Therefore, this current work focuses on evaluating the deposition of CuSn10 on a steel substrate using DED. Four types of specimens are manufactured, three having deposition of CuSn10 on the steel substrate and one specimen having an initial deposition of CuSn10 + 316L mixture followed by CuSn10. The laser power for the deposition process was varied through the thickness of the deposition with values varying between a minimum of 600 W to a maximum of 1100 W. The specimens were subjected to wear testing under dry conditions to evaluate their friction behavior and to check for debonding between the substrate and deposition. The effect of different laser power on porosity, microstructure, and microhardness was evaluated. The results, when compared with wrought CuSn10, indicated that the DED CuSn10 can be a probable replacement for wrought CuSn10 in worm wheels.

BACKGROUND: Immune changes that occur during pregnancy may place pregnant women at an increased risk for severe disease following viral infections like SARS-CoV-2. Whether these immunologic changes modify the immune response to SARS-CoV-2 infection during pregnancy is not well understood. OBJECTIVE: This study aimed to compare the humoral immune response to SARS-CoV-2 infection in pregnant and nonpregnant women. The immune response following vaccination for SARS-CoV-2 was also explored. STUDY DESIGN: In this cohort study, 24 serum samples from 20 patients infected with SARS-CoV-2 during pregnancy were matched by number of days after a positive test with 46 samples from 40 nonpregnant women of reproductive age. Samples from 9 patients who were vaccinated during pregnancy were also examined. Immunoglobulin G and immunoglobulin M levels were measured. Trends in the log antibody levels over time and mean antibody levels were assessed using generalized estimating equations. RESULTS: The median number of days from first positive test to sampling was 6.5 in the pregnant group (range, 3–97) and 6.0 among nonpregnant participants (range, 2–97). No significant differences in demographic or sampling characteristics were noted between the groups. No differences in immunoglobulin G or immunoglobulin M levels over time or mean antibody levels were noted among pregnant and nonpregnant participants following SARS-CoV-2 infection for any of the SARS-CoV-2 antigen targets examined (spike, spike receptor-binding domain, spike N-terminal domain, and nucleocapsid). Participants who were vaccinated during pregnancy had higher immunoglobulin G levels than pregnant patients who tested positive for all SARS-CoV-2 targets except nucleocapsid antibodies (all P

Introduction: Peer-assisted learning (PAL) has been extensively used in professional courses. However, its effectiveness as an adjunct to teacher-assisted learning (TAL) has not been evaluated. The objective of this study was to evaluate the effectiveness of Online PAL as an independent teaching methodology and as an adjunct to TAL, for dental students. Methods: Forty BDS year 3 students were divided into 2 groups of 20 each. Four year 5 students were chosen as tutors to teach 4 different topics using the Microsoft teams platform. The study was conducted in two parts. At first, two topics were taught to one group by the tutor (peer-led group) and the other group, by a teacher (teacher-led group). Next, the remaining two topics were taught to both groups by the teacher initially. This was followed by repeated teaching of the topics to peer-led group by tutors, while other group did self-study. Students’ perception and performance scores were compared using an independent sample t-test for all the topics. Results: The mean performance scores in the teacher-led group for topics 1 and 2 were 86.15 and 90.22, whereas scores in the peer-led group were 75.38 and 79.21 which was statistically significant (p

The growing understanding of nanoemulsion biomedical applications necessitates a basic understanding of protein–drug-loaded nanoemulsion interaction. In our present study, we investigated the binding interactions of Mefloquine (MEF)-loaded black cumin seed oil (Thymoquinone) nanoemulsion of different concentrations towards human and bovine serum albumin (HSA&BSA).Fluorescenceemission,three-dimensionalspectra,UV–visible spectroscopy, and FTIR-spectroscopy, techniques were used together with molecular docking studies to identify the binding effects. The ground state complex formation between Mefloquine-loaded black cumin seed oil nanoemulsion and protein fluorophores was confirmed by a decrease in fluorescence intensity and disputed hyper-chronicity found in the UV–visible spectra of albumins. According to three-dimensional fluorescence spectral analysis, the addition of MEF in thymoquinone impacted the microenvironment around aromatic amino acid (tryptophan and tyrosine) residues in HSA. The quenching mechanism is determined to be static contact by stern–volmer analysis, resulting in the formation of a stable bioconjugate. Significant modifications in the amide FTIR frequencies at around 1600 cm−1 correlate to variations in the secondary alpha-helical structures of biomolecules at the MEF-loaded nanoemulsion interface. Molecular dynamic studies have shown the binding affinity scores of the proteins BSA and HSA with the drug, MEF-loaded black cumin seed oil nanoemulsion. The determined thermodynamic parameters were found to agree with molecular docking data, indicating that vander-waals and hydrogen bonding forces were important in the interaction process. MEF prefers a highly polar binding site at the exterior area of domains in HSA than BSA, as shown in the molecular model, and the hydrogen bonds are highlighted. From our results, we have observed that drug delivery has a detrimental effect on protein frame confirmation by altering its physiological function.

A complication rate of 6.1% exists with Le Fort I osteotomies and 4% of it accounts for vascular events. A Le Fort I osteotomy typically involves the posterior maxilla which houses the pterygoid plexus and is a major source of bleeding. Effective hemostasis is essential to curb persistent bleeding, minimize operative time, delayed wound healing and infection. In this literature, we have devised a simple technique of gelfoam wrapped in surgicel being placed into the pterygoid region to control persistent capillary leak in Le Fort I advancement cases.

Objectives: To examine the psychometric characteristics of the Nepean Belief Scale (NBS) in psychiatric inpatients with delusions. The NBS is a five-item, clinician-administered scale that assesses the characteristics of beliefs, i.e. conviction, fixity, fluctuation, resistance and awareness that the belief is unreasonable. Methods: Fifty-five patients were interviewed by two clinicians, within three days of admission to an acute psychiatric unit and were assessed using the NBS, the Brown Assessment of Belief Scale (BABS), the MINI International Neuropsychiatric Interview (MINI) and the Depression Anxiety Stress Scale 21-Item Version (DASS-21). The NBS was administered after two weeks to available participants, to assess test-retest reliability. Results: Results demonstrated excellent inter-rater reliability of 0.93, Cronbach's alpha coefficient for internal consistency was 0.77. The NBS was found to have good convergent validity with the BABS and good discriminant validity with the DASS. Two-week test-retest reliability suggests that the NBS is sensitive to therapeutic change. Conclusions: Advantages of the NBS include its brevity, its ability to assess belief-related insight, its clear instructions and its definitions of belief characteristics. Thus, the NBS has the potential to greatly improve our ability to more objectively assess delusional beliefs.

There is considerable association of thyroid function and the cardiovascular system during various acute systemic illnesses. It is well established that the normal thyroid homeostasis is known to alter in disease states including the acute coronary syndromes (ACS). Abnormal thyroid hormonal status has been shown to be related to worse outcomes and prognosis. This review focuses on the relationship of alterations in thyroid function and its influence on the pathophysiological mechanisms and cardiovascular hemodynamics in ACS and based upon the literature, summarises all the existing evidence to this date on this subject. The data largely points out that low levels of triiodothyronine (T3) levels seen in ACS might be useful in prognosticating the outcomes of ACS.

The COVID-19 pandemic caused and still causes unprecedented disruptions in daily lives of billions of people globally. It affects practices and routines across all household consumption domains, including clothing consumption. Drawing on Social Practice Theory, this article explores and compares changes in clothing acquisition practices during COVID-19 across nine countries: the USA, the UK, Finland, Germany, Switzerland, Iran, Czech Republic, India, and Hong Kong SAR. Data was obtained through a standardized survey containing rated and open-ended questions, which were analyzed through descriptive quantitative analysis and inductive qualitative content analysis of open-ended questions. The results of this cross-country research indicate that all forms of fashion consumption, including more sustainable practices, have decreased during the pandemic. The most visible impacts have occurred in the material arrangements associated with fashion acquisition practices (e.g., closed physical shops, shipping disruptions, cancelled events, remote work, etc.). However, changes that result from these disruptions may be shorter-lived that changes that happened as a result of changing meanings associated with fashion consumption and its more sustainable forms and new competencies and skills acquired during the pandemic that could ensure more lasting practicing of more sustainable forms of fashion consumption.

Oral health influences general well-being and quality of life. Oral diseases can be debilitating and are a major heath concern worldwide. Medicinal plants have been used for thousands of years for treating human diseases. Considering the emergence of multi-drug resistant pathogens and financial difficulties in developing countries, there is an urgent need for developing new antimicrobial compounds which are safe, efficient and cost effective. Liquorice also known as yashtimadhu, sweetwood or mulhatti is one such herbal remedy which has shown to have immense potential in treatment of orofacial diseases. Liquorice is rich in secondary metabolites which are used in cosmetics, foods, traditional and modern medicine. It has well known properties such as antiviral, glucocorticoid, anti-inflammatory, antioxidant, anti-ulcerative, anti-carcinogenic and many more. Liquorice extracts and liquorice bioactive ingredients such as glabridin, licoricidin, licorisoflavan A, licochalcone A, and glycyrrhizin have shown beneficial effects in preventing and treating oral diseases. This paper reviews the effects of liquorice and its constituents on oral diseases such as dental caries, periodontitis, gingivitis, candidiasis, recurrent aphthous ulcer and oral cancer and its use as a root canal medicament and summarizes the results of clinical trials that investigated the potential beneficial effects of liquorice and its constituents as a prevention and treatment modality in oral diseases. Clinical trials, case reports and review of literature evaluating the effect of liquorice on oral microorganisms and oral diseases are included. Literature pertaining to the effects of liquorice on systemic diseases have been excluded from this review of literature. Keywords: Liquorice, Dental caries, Candidiasis, Gingivitis, Periodontitis, Oral cancer, Aphthous, Dentistry

Subcutaneous zygomycosis is a rare fungal infection caused by Basidiobolus ranarum. This entity is usually endemic in South India and only limited numbers of cases have been reported from central India. We report a case of 4-year-old male child from Chhattisgarh, who presented with a painless, non-tender, large, subcutaneous swelling of 4 months duration on the right upper arm, which was initially misdiagnosed as benign spindle cell tumor and advised surgical resection. But the fungal culture of the affected tissue grown Basidiobolus ranarum and the child responded very well to itraconazole therapy only. Keywords: Basidiobolus ranarum, Subcutaneous zygomycosis, Fungal infection, Spindle cell tumor, Itraconazole therapy

We modified the methods by Ballard et al. [1]. They sought to study eye-hand coordination strategies and created both a real world and a virtual model copying task consisting of three different areas: model, source, and workspace. Participants followed a pickup and place exercise and used a mouse to control stimuli presented on a computer monitor in the virtual task. We also considered the method presented by Hayhoe et al. [2] and Aivar et al. [3] who designed a similar model copying task in a 3D virtual environment. Stimuli were displayed in a head mounted display and participants held a motion sensor to select and move virtual objects in 3D space. Moreover, Aivar et al. [3] also included extra assembly pieces and a variation in the position of the assembly pieces located in the resource area.• It proposes an assembly task designed at a 1:1 scale for two environments, real and virtual environments.• It introduces a reading sequence for the model that is being replicated and it also introduces distractor assembly blocks with similar colors and shapes as the required assembly blocks, and a change in the location for all assembly blocks in the resource area.• It modifies the interaction for the VR environment by using hand gestures to select, move and position virtual assembly blocks. This was possible by incorporating a LEAP® motion controller which although it does not provide haptic feedback, it provides a virtual representation of the participant's hand. Our VE also includes visual and auditory feedback to guide depth perception and virtual control.The software used for this research study is available at: http://virtualete.com/research/fsam.php

The data presented in this article is related to the research article “RNAi of selected candidate genes interrupts growth and development of Helicoverpa armigera” (Chikate et al., 2016) [1]. RNA interference (RNAi) is emerging as a potent insect pest control strategy over current methods and their resistance by pest. In this study we tested 15 different in vitro synthesized dsRNAs for gene silencing in Helicoverpa armigera. These dsRNAs were specific against H. armigera enzymes/proteins such as proteases like trypsins (HaTry2, 3, 4 and 6), chymotrypsin (HaChy4) and cysteine proteases such as cathepsin (HaCATHL); glutathione S-transferases (HaGST1a, 6 and 8); esterases (HaAce4, HaJHE); catalase (HaCAT); super-oxide-dismutase (HaCu/ZnSOD); fatty acid binding protein (HaFabp) and chitin deacetylase (HaCda5b). These dsRNAs were fed to second instar larvae at an optimized dose (60 µg/day) for 3 days separately. Effects of dsRNA feeding were observed in terms of larval mass gain, percentage mortality and phenotypic abnormalities in later developmental stages of H. armigera. These findings might provide potential new candidates for designing sequence-specific dsRNA as pesticide in crop protection. Keywords: RNAi, dsRNA, H. armigera, Gene silencing, Pest control

In India, herbal medicines are mainly based on the Ayurvedic system. The main drawback of traditional medicines is a lack of standardized products. Standardization of any herbal formulation is essential in order to assess the quality, purity, safety, and efficacy of drugs based on the analysis of their active properties. Testing of Ayurvedic preparations using scientific methodologies will add to quality and authenticity of the product. This article reports standardization parameters for Hutabhugādi cūrṇa (HC) used traditionally in the treatment of Agnimāndya (digestive impairment), Pāndu (anemia), Sopha (edema), and Ārsa (piles). The formulation was prepared as per Ayurvedic Formulary of India, and it was standardized by organoleptic characterization, macro–microscopic evaluation, physicochemical testing, and thin-layer chromatography/high-performance thin-layer chromatography profiling employing a standard methodology. Results of the experiments conducted provided diagnostic characteristics to identify and standardize the formulation prepared using official ingredients of HC. Based on the data obtained, a monograph on quality standards for HC is proposed. The monograph based on the present investigation results would serve as a document to control the quality of HC.

Aims: The study was planned to compare Anti-thrombotic strategies for patients undergoing PCI in a real world population with an emphasis on occurrence of major bleeding, composite ischemic end points and economic outcomes. Methods: The present study is a single center, prospective, observational study in consecutive patients undergoing PCI at Fortis Escorts Heart Institute (FEHI) and describes Authors' experience with three different Anti-Thrombotic Strategies in a real world population. Patients were consecutively enrolled in the study and the choice of Anti-thrombotic strategy was left to individual operator(s) based on their own clinical judgment and patient's affordability. No specific inclusion/exclusion criteria were specified on the choice of Anti-Thrombotic Strategy. Results: A total 1453 patients were consecutively enrolled into the study and were followed telephonically after 30 days. 252 patients were treated with Bivalirudin (Angiomax) during PCI (17.3%), 430 (29.6%) patients were treated with Heparin plus GPI & remaining 771 (53.1%) were treated with Heparin monotherapy. Incidence of major bleeding was lowest in patients treated with Bivalirudin (1.59%) when compared to Heparin plus GPI (3.49%) and Heparin monotherapy (5.97%), p = 0.005 Bivalirudin vs. Heparin Monotherapy, and p = 0.145, Bivalirudin vs. Heparin + GPI. No bleeding was observed in STEMI patients treated with Bivalirudin compared to 7.4% in patients treated with GPI and 14.3% in patients treated with UFH. Similarly non-access site bleeding was lowest in patients treated with Bivalirudin. Only 4 patients (1.6%) treated with Bivalirudin required Blood transfusion compared to 25 in Heparin plus GPI (5.8%) and 38 (5%) in Heparin Monotherapy arm. In Composite Ischemic end-points, no “All-cause Mortality” was observed in Bivalirudin group compared to 2.8% in Heparin plus GPI. Early stent thrombosis was seen in 1 patient with Heparin plus GPI and none with Heparin monotherapy and Bivalirudin group. None of the patients underwent TLR (target lesion revascularization) and TVR (target vessel revascularization) within 30 days post procedure other than one early stent thrombosis reported with Heparin plus GPI. Cost of blood product transfusion was lower with Bivalirudin as compared to Heparin plus GP IIb/IIIa arm (p = 0.01) and with Heparin alone (p = 0.001). Due to lower complications including blood transfusions and reduced hospital stay in Bivalirudin group, these benefits outweigh the incremental cost due to higher acquisition cost of the drug. Conclusion: Bivalirudin use during PCI is associated with a distinct advantage of having lower access site and non-access site bleeding without compromising on the efficacy. We observed a reduction in blood transfusions, hospital stay and mortality for patients treated with Bivalirudin compared with Heparin plus GPI or Heparin Monotherapy. Bivalirudin can be safely adopted into our Institutional protocol for the treatment of high risk PCI such as STEMI, ACS, and Complex elective PCI.