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Background: Transverse abdominus plane (TAP) block is a regional anesthetic technique which provides an excellent analgesia without major adverse effects. The primary aim of this study was to evaluate the efficacy of dexmedetomidine in comparison to tramadol when added as adjuvant to levobupivacaine in TAP block on duration of post operative analgesia following laproscopic orchidopexy. Methods: Sixty American Society of Anaesthesiologists (ASA) grade 1 pediatric patients undergoing laproscopic orchidopexy under general anaesthesia were randomized into two groups (GroupLD and Group LT). Group LD recieved ultrasound guided bilateral TAP block with 0.3 ml/kg 0.25% levobupivacaine with 1µg/ kg of dexmedetomidine on both sides and Group LT recieved TAP block with 0.3 ml/kg 0.25% levobupivacaine with 1mg/ kg of tramadol. During the first 24 h postoperatively, we assessed hemodynamic stability, respiratory depression, and postoperative pain using face, legs, activity, cry, consolability (FLACC) pain scale. Results: Total duration of analgesia (986.67 ± 47.29 min vs. 690 ± 53.49 min, P value- 0.000), and the total consumption of paracetamol in the first 24 hours postoperatively (324.28 ± 35.5 mg vs. 580.14 ± 38.23, P value – 0.000) were statistically highly significant in group LD in comparison to group LT. The FLACC score were lower in Group LD as compared to group LT and side effects profile were similar in both the groups. Conclusion: Dexmedetomidine in a dose of 1 μg.kg-1 when added to levobupivacaine in ultrasound guided transverse abdominus plane block significantly prolongs the duration of postoperative analgesia as compared to tramadol with levobupivacaine without major side effects.

PURPOSE: To compare the therapeutic effect of sodium hyaluronate (SH)–trehalose (Trehalube, Microlabs, Bangalore, India, SH 0.1% and trehalose 3%) or SH (0.1% Hylotears, Raymed, Chandigarh, India) alone in patients with dry eye disease (DED). MATERIALS AND METHODS: Patients were randomized into two groups: SH-trehalose (SH 0.1% and trehalose 3%) or SH (0.1% Hylotears) alone. The Ocular Surface Disease Index (OSDI) questionnaire was used to assess patient's symptoms. Patients were followed up at 4 and 8 weeks, and OSDI score, tear film break-up time (TBUT), tear film height (TFH), Schirmer's test, and conjunctival staining were evaluated at each visit. RESULTS: A total of 384 patients were included in the study, 192 patients in each arm. The mean age of participants was 37.62 + 14.4 years and 225 were women (56%). The improvement in Schirmer's test was significantly better in the SH-trehalose group at 8 weeks (5.26 + 4.3 mm, 95% confidence interval = 4.6–5.9 mm) compared to the SH group (3.71 + 3.9, 95% confidence interval = 3.15–4.28 mm). The TBUT and TFH showed slight improvement at 4 weeks in both groups, but not at 8 weeks. There were no group differences at all-time points in terms of conjunctival staining and OSDI-based grades of DED. CONCLUSION: It was found that treating dry eye with SH-trehalose leads to greater improvement in the Schirmer's values and TBUT after 8 weeks of sustained use in patients with DED, and this was more pronounced in those with severe DED.

Introduction: The shear bond strength obtained with an acid primer might not be clinically reliable. The present study evaluated the use of a new self-etch primer as compared with the conventional bonding procedure. The findings indicated that the use of a self-etch primer to bond orthodontic brackets to the namel surface provided lower, but clinically accept-able, shear bond forces (mean, 7.1 ± 4.4 MPa). Hence, this study has been designed to evaluate the shear bond strength of orthodontic brackets bonded with a self-etching primer system, and compare it with the conventional acid etching priming system. Materials and Methods: This study was designed to compare the shear bond strength of orthodontic brackets bonded with conventional acid etching- priming and a self-etching primer. For this purpose, one hundred and twenty noncarious, not subjected to any pretreatment chemical agents (e.g. hydrogen peroxide), no cracks caused by the presence of the extraction forceps, no caries and unrestored human maxillary 1st and 2nd premolars, freshly extracted for orthodontic treatment were collected and stored in distilled water before bonding. Separate molds of cold-cure acrylic were prepared and the extracted premolar teeth were embedded in the cold cure acrylic up to the cement enamel junction. Results: For the control group, the mean shear bond strength was 9.38 ± 6.02 MPa and for the experimental group, it is 6.91 ± 3.58 MPa. Group comparison using Chi-square test for the self-etching primer group adhesive remnant index (ARI) scores shows that more than half of the adhesive left over the tooth surface (score 3 and 4). For the conventional group, ARI scores show that there was no or slight amount of adhesive left over the tooth surface (score 5). The proportion of ARI score is significantly (P < 0.001) more in conventional (68.33%) as compared to self-etch primer (SEP) (28.33%). The proportion of ARI scores 4 and less is significantly more in SEP (71.67%) as compared to Conventional (6.67%) with P = 0.004 as per the Chi-square test. Conclusion: The bond strength of SEP is comparatively lesser than the conventional acid etching technique, but is definitely more or less to the required bond strength to resist masticatory forces. Majority of the studies conducted on self-etching primer are in vitro studies. Results of these cannot be extrapolated to the intraoral environment. Hence, further long-term clinical studies need to be carried out before actually recommending the use of self-etching primer in routine orthodontic bonding.

Objective: The venom neutralization potential of silver nanoparticle(AgNP-AS) mediated bark extract of Alstonia scholaris Linn R.Br was investigated in the study. Methods & materials: AgNP-AS was synthesized with respect to optimal temperature, pH of extract. UV–vis, FT-IR, XRD, TEM, SEM studies were used to characterize silver nanoparticles of Alstonia scholaris Linn(AgNP-AS). The potential of AgNP-AS in neutralization of venom lethality, rise in myotoxicity markers(LDH) and proinflammatory cytokines(IL6, TNFα) were evaluated in animal models. Results: AgNP-AS was synthesized optimally with AgNO3 (2 mM); extract concentration, 0.2 gm/l (1% w/v); extract (pH 9) and optimal temperature (40 °C). The colour change and synthesis of AgNP-AS was validated by UV–vis analysis at 432 nm. Transmission electron microscopy of AgNP-AS showed that the particle size for AgNP-AS was 14 nm-20 nm. FT-IR revealed peaks at 3445 cm−1, 1646 cm−1, 1346 cm−1 and 1108 cm−1. From the dynamic light scattering studies the hydrodynamic diameter (115.87 nm) and zeta potential(-29.8 mV) were estimated. The EDAX exhibited a peak for silver validating that the synthesized silver was pure. The biosynthesized (AgNP-AS) could significantly neutralize Viper russelli venom(VRV) induced rise in serum lactate dehydrogenase(LDH) and proinflammatory cytokines(IL6, TNFα) in animal models. Conclusion: The culmination of nanotechnology with herbal medicine might endow with a really constructive tool in coming up with future drugs with fewer toxicity.

Background: The Bethesda (BSRTC) category III has been ascribed a malignancy rate of 5-15%, however, the probability of malignancy remains variable. Aim: To evaluate category III with respect to its rate and risk of malignancy and substratify it. Settings and Design: Atypia of undetermined significance/Follicular lesion of undetermined significance (AUS/FLUS) percentage, cytohistological correlation, and risk of malignancy were analyzed and substratification was done. Material and Methods: Category III cases over a 2-year period were analyzed retrospectively. Statistical Analysis: Two-tailed Fisher exact test, with a level of significance set at 0.05, was performed for data analysis. Results: Of 1169 thyroid fine needle aspirations (FNAs), 76 (6.5%) were category III. A total of 48 patients had follow up; 24 patients underwent surgery, 12 repeat FNA, and 12 were clinically followed. Repeat FNA cytology was unsatisfactory in 8.3%, benign in 66.7%, AUS in 8.3%, and follicular neoplasm in 16.7%. Of the 24 operated, 8 (33.3%) were malignant (follicular variants of papillary thyroid carcinoma), 5 (20.8%) were follicular adenomas, and 11 (45.8%) were non-neoplastic. Among all AUS/FLUS nodules with follow-up, malignancy was confirmed in 16.7% (8/48) whereas with nodules triaged to surgery only, the malignancy rate was 33.3% (8/24). Substratification into categories of "cannot exclude PTC" and "favor benign" helped detect malignancy better, as 85.7% cases in the first subcategory (P < 0.001) and none (P < 0.02) in the last proved malignant. Conclusion: Though the rate of Category III in our study is in accordance to BSRTC, the risk of malignancy in AUS/FLUS nodules is higher. Substratification of AUS/FLUS may help better patient management. [ABSTRACT FROM AUTHOR]

Abstract COVID-19 pandemic has almost made hand sanitization a ritual resulting in a steep increase in the frequency of hand sanitization and an unprecedented surge in demand for hand sanitizers. In fact, several governments had to ration hand sanitizers in the retail outlets and over the counter chemist shops. Additionally, Indian government has put a cap on the prices of hand sanitizers. Currently, large sections of global and Indian population are grappling under financial crises. Therefore, mandatory hand sanitization has made an unwelcoming, yet unavoidable addition to the already-hard-to-maintain-grocery-list. Here, we have compared the anti-microbial efficacy of Patanjali Hand Sanitizer (PHS), developed and marketed by Patanjali Ayurved Ltd. (an India-based food and herbal medicine company) with one of the topmost hand sanitizers currently used under clinical set-ups. PHS has anti-microbial efficacy comparable to that of the standard hand sanitizer. Besides, disc diffusion and time-dependent thumb print assays showed that PHS has longer retentivity on the applied surfaces, suggesting lesser consumption of the sanitizer and concomitant relaxation on the monthly grocery budget. Observed anti-bacterial potency of PHS is attributed to the disruption of bacterial cell membrane, as employed by alcohol-based hand sanitizers. A rough estimation revealed that PHS is ~ 4.3 times cost effective than the standard hand sanitizer used as the positive control in this study. Taken together, PHS is a suitable alternative for existing hand sanitizers available in the market that can relax the demand–supply strain and soften significantly the burden of monthly expenditure on hand sanitizers.

Non-Orthogonal multiple access (NOMA) and Cognitive radio (Cr) are seen as one of the most promising techniques, which improves the utilization of the spectrum in 5G. The expanding number of wireless applications like new gadgets, IOT brought about developing a block in the ISM groups. The FCC requested to permit unlicensed clients to work in the void area without obstruction to an authorized guest. Cr gives an answer for an extra range prerequisite issue for productive spectrum usage. The foremost condition for permitting CRs to utilize spectrum is not causing obstruction to licensed users. Spectrum sensing permit secondary users (Su) to separately recognize the idle portions of the spectrum, and thus evade obstruction to licensed users. In existing spectrum sensing techniques, SU can only utilize the unused spectrum when PU is not present. Therefore, spectrum exploitation of the conventional system is very low. In recent times NOMA has been projected to utilize the spectrum in an efficient manner. The proposed work permits the SU to utilize a spectrum of PU, both at its absence. Spectrum sensing in NOMA is not explored so far. Hence, in this paper, NOMA based matched filter detection is designed for QAM-64 and QAM-256. Matlab simulation is applied to study the operation of the proposed detection technique in NOMA in respect of several parameters like bit error rate (BER) Vs signal to noise ratio (SNR), the probability of detection (Pd), and probability of false alarm (Pfa).

The aim of this review article is to summarize the available literature on physiologic and pathologic ocular changes during pregnancy and the effect of diseases in pregnancy. A literature search was conducted using PUBMED, MEDLINE, and Cochrane library in English. In addition, the cited references in the published articles were manually reviewed for the relevant results. Pregnancy encompasses a multitude of changes in all body systems, including the visual system of the female. The changes can be physiological, i.e., changes occurring in the lids and adnexa, cornea, conjunctiva, changes in tear film composition and intraocular pressure, retina, choroid, and visual field. Pathological changes in a pregnant woman's eye include changes related to preeclampsia and eclampsia, central serous chorioretinopathy, retinal artery or vein occlusions, and disseminated intravascular coagulation. Preexisting diseases like diabetic retinopathy, Graves' disease, idiopathic intracranial hypertension, various inflammatory conditions can undergo changes in their course during pregnancy. Ophthalmic medications can have an effect on both mother and the baby and hence should be used cautiously. In addition, intrauterine infections play a major role in causing inflammation in the eye of the baby. Hence, vaccination of the mother prior to pregnancy plays an important role in preventing intrauterine infections in the neonate. A regular eye examination in the perinatal period plays a vital role in recognizing ophthalmic pathologies which might require a prompt medical intervention. Pathological ocular diseases should be discriminated from physiologic changes to establish an individualized treatment or preventive plan. This approach to ocular benefits of treatment to the mother should always weigh against the potential harm to the fetus.

Bezoars are usually defined as collections of nondigestible matter that most commonly accumulates in the stomach and can sometimes extend to the small bowel. Trichobezoars are a rare entity which is most commonly observed in young psychiatric females with trichotillomania and trichophagia. Here, we report a case of giant gastric trichobezoar and a novel technique of laparoscopic removal in a 16 year old female with trichophagia. The giant gastric trichobezoar weighing about half a kilogram was removed en masse laparoscopically by a novel technique. She had an uneventful postoperative recovery and was discharged after psychiatric counseling.

Occupational radiation safety and health is the most neglected aspect in the health sector in Nepal. There has been gross negligence in occupational safety and health as a whole in Nepal. This paper is a review of previously published articles on topics of occupational radiation safety and health in Nepal. Keywords such as Nepal, occupational safety, radiation safety, radiation risk, and health were used to search for relevant articles in PUBMED and Google Scholar. A total of 15 research articles were reviewed, which dealt with different forms of occupational radiation risks and exposure, regulatory works and consequently its knowledge and awareness among the professionals. The reviewed articles are basically of 3 types: analytical or progress reports, knowledge or awareness assessment, and measurement-based research articles. The overall status of occupational radiation safety and health does not look satisfactory. Although occupational radiation safety and health is a very important issue at an individual, social and national level in any hospital, agricultural or industrial sector, it has not received much attention so far in Nepal. This is evident by the minimal number of literature available on the status of occupational radiation safety and health in Nepal. Standard work situations and criteria have to be set up and regular radiation monitoring should be done to ensure the maintenance of quality at work. In addition, workshops, seminars, symposiums, training courses, and Continuing Professional Education (CPE) programs should be organized regularly to raise the level of radiation awareness in the profession. The state agencies need to develop and update respective national laws, policy and programs for occupational radiation safety and health. There is an utmost need for extensive researches to be performed covering overall radiation health and other services of the professionals in Nepal where radiation is being used for their advantageous purposes.

Impetuous urbanization and population growth are driving increased demand for plastics to formulate impeccable industrial and biomedical commodities. The everlasting nature and excruciating waste management of petroleum-based plastics have catered to numerous challenges for the environment. However, just implementing various end-of-life management techniques for assimilation and recycling plastics is not a comprehensive remedy; instead, the extensive reliance on finite resources needs to be reduced for sustainable production and plastic product utilization. Microorganisms, such as bacteria and algae, are explored substantially for their bioplastic production repertoire, thus replacing fossil-based plastics sooner or later. Nevertheless, the utilization of pure microbial cultures has led to various operational and economical complications, opening the ventures for the usage of mixed microbial cultures (MMCs) consisting of bacteria and algae for sustainable production of bioplastic. The current review is primarily focuses on elaborating the bioplastic production capabilities of different bacterial and algal strains, followed by discussing the quintessence of MMCs. The present state-of-the-art of bioplastic, different types of bacterial bioplastic, microalgal biocomposites, operational factors influencing the quality and quantity of bioplastic precursors, embracing the potential of bacteria-algae consortia, and the current global status quo of bioplastic production has been summarized extensively.

The rapidly increasing global burden of healthcare associated infections (HAI) is resulting in proportionate increase in chemical disinfection in healthcare settings, adding an extra burden of environmental toxicity. Therefore, alternative disinfection techniques with less or no adverse side-effects need to be explored. In this regard, ayurvedic ‘ dhoopan ’ technique involving slow combustion of medicinal herbs, minerals and animal products hold great promise. In this study, dhoopan of a traditionally defined ayurvedic medicinal mix, ‘Vishaghn Dhoop’ (VD) has been assessed for its anti-microbial potentials against both Gram-positive and negative pathogenic bacteria, Mycobacterium and pathogenic fungus, Candida albicans . Fume generated from slow combustion of VD was subjected to physico-chemical characterization and was assessed for anti-microbial effects. VD fume contained particles of 354 ± 84 nm size, laden with anti-microbial metabolites. On agar plates, VD fumigation reduced bacterial growth by 13 - 38%. Liquid culture aeration with VD fume inhibited bacterial growth by 50 - 85%, and fungal growth by 80%. In real life settings (in vivo) , un-sanitized rooms fumigated with VD fumes for 30 min reduced the environmental microbial loads by 10 folds. In addition, the safety of VD fumigation was evaluated through in vitro cytotoxicity assay on human lung epithelial (A549) cells. Cells exposed to media-collected VD fumes for 24 h exhibited normal cyto-safety profile. Collectively, these observations provide scientific evidence in support of a traditional technique of disinfection, which can be fine-tuned to have implications in clinical, healthcare and food industry where, disinfection is a prime requirement.

Introduction: Locally advanced cervical cancer is still a major cause of mortality in developing countries. Recently, personalized medicine has changed the treatment paradigm for many solid cancers but no robust biomarkers has yet been validated for predicting response to chemo radiation in cervical cancer patients. Aim: To assess the role of hematological parameters as a cost-effective predictive marker of response to concurrent chemo radiation in cervical cancer patients. Materials and Method: This is a retrospective analysis of 90 cervical cancer patients treated with concurrent chemo radiation in a tertiary cancer center. Clinical details of the patients were extracted from the case records. For end point evaluation, the pre-treatment levels of hemoglobin, neutrophil, lymphocyte, platelet, platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) were compared and statistically analyzed between responders and non-responders. The optimal cutoff values of hematological parameters were estimated by the receiver operating characteristics (ROC) curve. Result: Out of 90 patients, 60 (66.66%) were complete responders and remaining 30 (33.33%) were non-responders. The mean value of platelet, NLR, and PLR was significantly higher in the non-responder group. ROC curve analysis showed the optimal cut-off value of pre-treatment Hb, PLT, NLR and PLR to be 11 gm/dl, 3, 177 × 109/L, and 70 respectively. Conclusion: Our study suggests that simple hematological markers like NLR, PLT count and PLR could be used as a cost effective pretreatment predictive marker for response to chemo radiation in cervical cancer patients.

ABSTRACT Equitable and timely access to COVID-19-related care has emerged as a major challenge, especially in developing and low-income countries. In India, ∼65% of the population lives in villages where infrastructural constraints limit the access to molecular diagnostics of COVID-19 infection. Especially, the requirement of a cold chain transport for sustained sample integrity and associated biosafety challenges pose major bottlenecks to the equitable access. Here, we developed an innovative clinical specimen collection medium, named SupraSens microbial transport medium (SSTM). SSTM allowed a cold chain-independent transport at a wide temperature range (15°C to 40°C) and directly inactivated SARS-CoV-2 ( −3.50), thereby improving diagnostic sensitivity of SSTM (18.79% [34/181]) versus that of VTM (11.05% [20/181]). Overall, SSTM had detection of COVID-19 patients 70% higher than that of VTM. Since the logistical and infrastructural constraints are not unique to India, our study highlights the invaluable global utility of SSTM as a key to accurately identify those infected and control COVID-19 transmission. Taken together, our data provide a strong justification to the adoption of SSTM for sample collection and transport during the pandemic. IMPORTANCE Approximately forty-four percent of the global population lives in villages, including 59% in Africa (https://unhabitat.org/World%20Cities%20Report%202020). The fast-evolving nature of SARS-CoV-2 and its extremely contagious nature warrant early and accurate COVID-19 diagnostics across rural and urban population as a key to prevent viral transmission. Unfortunately, lack of adequate infrastructure, including the availability of biosafety-compliant facilities and an end-to-end cold chain availability for COVID-19 molecular diagnosis, limits the accessibility of testing in these countries. Here, we fulfill this urgent unmet need by developing a sample collection and transport medium, SSTM, that does not require cold chain, neutralizes the virus quickly, and maintains the sample integrity at broad temperature range without compromising sensitivity. Further, we observed that use of SSTM in field studies during pandemic improved the diagnostic sensitivity, thereby establishing the feasibility of molecular testing even in the infrastructural constraints of remote, hilly, or rural communities in India and elsewhere.

Background: Biofilms are responsible for the growing resistance of bacteria to antibiotics, preventing the antibiotic accessibility to bacterial cells. As an alternative to antibiotics, fatty acids (FAs) have been explored for their antibiofilm activities due to their diffusible nature and ability to modulate the membrane fluidity of the bacteria. Fatty acids have been shown as anti-biofilm agents mostly for Gram-positive pathogens. Therefore, we chose to explore the anti-biofilm activity of FAs from Withania somnifera (L.) Dunal (Solanaceae) seeds fixed oil (WSSO) on the Gram-negative pathogen, Salmonella enterica. Biofilm formation in Salmonella spp enhances its resistance to antibiotics and host immune response, with consequent increase in its virulence and chronicity of infection. FAs from WSSO was reported for their effectivity against Psoriasis-like skin inflammation. Biofilms are implicated in Psoriasis pathology and anti-biofilm therapy can provide new treatment options. In view of its biological importance, we have explored the activity of WSSO against planktonic and biofilm forms of S. enterica. Purpose: The purpose of the current study is to evaluate the potentials of fixed fatty acids from an important medicinal plant (W. somnifera) as antibiofilm agents against a Gram-negative bacterium (S. enterica). Methods: Antibacterial activity of WSSO against planktonic form of S. enterica was evaluated through broth microdilution method. Antibiofilm activity in terms of prevention of biofilm initiation, inhibition of biofilm formation and disruption of mature biofilm were quantified through crystal-violet staining. WSSO induced loss of membrane integrity, and concomitant effect on S. enterica motility were assessed through quantification of intracellular potassium and nucleotide effluxes, and motility assays, respectively. Results: The minimal inhibitory concentration of WSSO required for 50% reduction in the planktonic bacterial load (IC50) was 5.78 mg/ml. Cells lost their motility when treated with WSSO at IC50. At a similar concentration of 6.28 mg/ml, WSSO disrupted mature biofilm of S. enterica. Bacterial cell membrane was compromised after treatment with 5.40 mg/ml WSSO as evident from potassium (K+) ion and nucleotide effluxes. Conclusion: WSSO not only prevented initiation of biofilm formation and but also efficiently disrupted mature biofilm of S. enterica. Taken together, these results indicated that WSSO has the potentials to be used as an alternative antibacterial agent against Gram-negative pathogenic S. enterica. The mode of action of WSSO seems to be linked to its ability to modulate membrane integrity and to restrain bacterial motility, most likely by its abundant and trace fatty acid contents.

Individuals with calcium oxalate (CaOx) kidney stones can have secondarily infected calculi which may play a role in the development of recurrent urinary tract infection (UTI). Uropathogenic Escherichia coli (UPEC) is the most common causative pathogen of UTIs. Macrophages play a critical role in host immune defense against bacterial infections. Our previous study demonstrated that oxalate, an important component of the most common type of kidney stone, impairs monocyte cellular bioenergetics and redox homeostasis. The objective of this study was to investigate whether oxalate compromises macrophage metabolism, redox status, anti-bacterial response, and immune response. Monocytes (THP-1, a human monocytic cell line) were exposed to sodium oxalate (soluble oxalate; 50 µM) for 48 hours prior to being differentiated into macrophages. Macrophages were subsequently exposed to calcium oxalate crystals (50 µM) for 48 hours followed by UPEC (MOI 1:2 or 1:5) for 2 hours. Peritoneal macrophages and bone marrow-derived macrophages (BMDM) from C57BL/6 mice were also exposed to oxalate. THP-1 macrophages treated with oxalate had decreased cellular bioenergetics, mitochondrial complex I and IV activity, and ATP levels compared to control cells. In addition, these cells had a significant increase in mitochondrial and total reactive oxygen species levels, mitochondrial gene expression, and pro-inflammatory cytokine (i.e. Interleukin-1β, IL-1β and Interleukin-6, IL-6) mRNA levels and secretion. In contrast, oxalate significantly decreased the mRNA levels and secretion of the anti-inflammatory cytokine, Interleukin-10 (IL-10). Further, oxalate increased the bacterial burden of primary macrophages. Our findings demonstrate that oxalate compromises macrophage metabolism, redox homeostasis, and cytokine signaling leading to a reduction in anti-bacterial response and increased infection. These data highlight a novel role of oxalate on macrophage function.

Background: The present study determined white spots with the help of quantitative light-induced fluorescence (QLF) in patients undergoing fixed orthodontics. Materials and Methods: Sixty-four patients undergoing fixed orthodontics above 12 years underwent debonding, and the presence of carious lesion was assessed at baseline and after 6 weeks, 6 months, and 2 years. QLF images were taken with intraoral fluorescence camera. QLF images were examined visually for signs of demineralization, and scoring system was used. Results: It is found that there was fluorescence loss over a period of time. The median sum of fluorescence loss per patient was 55.6% and 29.2% and 101.4% at quartiles at baseline which changed to 51.2% and 26.5% at the first quartile and 101.4% at the second quartile. At 2 years, it was 43.7% and at the first quartile was 22.1% and at the second quartile was 99.1%. There was significant improvement at T2 (P < 0.05), however, between baseline and F1 and between F1 and F2, there was nonsignificant improvement (P > 0.05). The median value for total lesion area per patient was 3.6 mm2 with quartiles 1.2 mm2 and 8.2 mm2 at baseline, 2.6 mm2 with quartiles 0.7 mm2 and 6.3 mm2 at 6 weeks, 2.3 mm2 with quartiles 0.7 mm2 and 6.3 mm2 at 6 months, and 1.8 mm2 with quartiles 0.5 mm2 and 5.8 mm2 at 2 years which was statistically significant (P < 0.05). Conclusion: The authors found that white spots during fixed orthodontic treatment and after debonding is a common phenomenon. Although there was improvement in disappearance of these lesions, complete removal cannot be ensured.

Many countries are taking steps to establish national strategies to improve the financial well-being (FWB) of their people. However, FWB as a term is still in the infancy stage with a handful of models developed in the context of developed countries. Thus, there is a need to understand FWB from a multi-disciplinary and multi-dimensional approach to draft and implement efficient strategies, especially in the context of developing countries like India. In this study, we have performed path analysis to identify the specific constituents of financial literacy, financial behavior (FinB), and personality traits that affect the FWB (perceived and objective) of an individual in Indian context. Survey responses of 349 respondents are analyzed to empirically validate the proposed relationships using the partial least squares structural equation modeling (PLS-SEM) approach. The analysis mostly provides support to existing literature and challenges some. The findings provide support to 12 out of 17 tested effects with eight hypotheses. The understanding of pathways that lead to increased FWB of individuals has the potential to facilitate effective policy-making and designing of curriculum to support efforts of individuals toward higher FWB and responsible FinBs.

As a stewardship for watershed services, an incentivizing mechanism of payment for ecosystem services (PES) has been increasingly discussed in global policy arena. In this context, various models of incentivizing mechanisms have been implemented as a pilot program. This study assesses the existing financing mechanisms for watershed services at the national level and examines the pilot PES programs that have been implemented in four different sites of Nepal. Using various participatory and qualitative research methods; this study analyses institutional arrangement, operational procedures and implementation practices from the study sites. Our findings reveal that the pilot PES programs have shown fairly satisfactory outcomes in watershed management. Based on our findings, we argue that the PES mechanism can be a promising approach in financing sustainable watershed management in Nepal. Nevertheless, PES mechanism should be flexible and contextual in terms of institutional arrangement and needs to be strengthened with a strong linkage between service providers and service users, through a regulatory mechanism. An intermediary role of the local government is found to be utmost important to institutionalize the PES mechanism as a sustainable financing mechanism for ensuring watershed services in Nepal.

Objective: Snake envenomation is a major cause of death and disability in the developing countries. In India and neighboring countries, the four venomous snakes of concern include – Indian cobra(Naja naja), Common Krait (Bungarus caeruleus); Russell's Viper (Daboia russelli); Saw Scaled Viper (Echis carinatus). We describe the management protocol for snakebite treatment in a tertiary care hospital of Paschim Medinipur district, West Bengal based on case reports of subjects admitted and treated in Ghatal Subdivisional Hospital(GSH) during 2013–2016. Methods &materials: We developed a structured data collection form to record demographic and clinical details of patients hospitalized at GSH between 1 January 2013 through 31 December 2016. Results: Snake bite cases in Ghatal Subdivisional hospital(GSH) were assessed during the period 2013–2016. A total 18 deaths due to snakebite has been reported from this tertiary care hospital during the period. Total patients admitted in this hospital with snakebite is 1160 during the period 2013–2016. In 80% of the cases the lower extremities were affected. Preliminary first aid was provided in 45% cases. About 65% of the affected victims suffered snakebite in the morning hours. Some of the recommended drugs that were prescribed by the physicians of GSH were neostigmine, atropine, adrenaline, hydrocortisone, Amoxicillin. WBCT20 and Urea, Creatinine level were routinely performed. Conclusion: Hospital studies are a key source of information about snake bites. The ready availability and appropriate use of AVS, close monitoring of patients, the institution of ventilator support and if required, early referral to a larger hospital all help to reduce the mortality. Thus knowledge of the varied clinical manifestations of snake bite is important for effective management in hospitals by a complete health care team. Keywords: Snake envenomation, Russell's viper

Platelet-rich plasma (PRP) has been gaining popularity for degenerative joints because of its success and ease of performing procedure; however, there is a lack of standardized protocols for PRP preparation and clinical applications. Various studies have reported inconsistency and variations in their results. Evidence are inconclusive for its usage in knee osteoarthritis. We conducted a search in the English language literature using keywords such as “Platelet-rich plasma,” “knee joint,” “osteoarthritis,” “techniques,” “growth factors,” or “complications” in PubMed, Embase, and Google Scholar databases. Obtained articles were scrutinized and relevant content was included. This article has reviewed various studies regarding the definition, preparation, concentrates, and clinical application of PRP with respect to degenerative knee joint.

Respiratory tract diseases are public health problems, and these diseases affect the air passages, including the nasal passages, the bronchi, and the lungs. They range from acute infections, such as pneumonia and bronchitis, to chronic conditions such as asthma and chronic obstructive pulmonary disease. The prevalence of chronic respiratory morbidity among females is significantly higher compared to the general population of the country. It is a conditions affecting the organs and tissues that make gas exchange possible and includes conditions of the upper respiratory tract, trachea, bronchi, bronchioles, alveoli, pleura and pleural cavity, the nerves, and muscles of breathing. Females had respiratory illness were also higher among the users of tobacco and alcohol. Respiratory diseases range from mild and self-limiting, such as the common cold, to life-threatening entities such as bacterial pneumonia, acute asthma, and lung cancer. When women must cope with respiratory disease in the face of significant psychological, social, or cultural challenges, such as depression, economic burdens, competing family responsibilities, or disease stigma, the risk of nonadherence may increase. Women response with drugs is a big issue, because women of child-bearing age were excluded from participating in clinical studies, and information regarding gender-dependent responses to drugs in general and to respiratory drugs specifically has been lacking.

Introduction: Cigarette smoking is the most predominant risk factor for development of chronic obstructive pulmonary disease (COPD). However, a considerable amount of patients do develop COPD without exposure to cigarette smoking. We aimed to analyze the incidence, demographic and clinical profile of nonsmoker COPD subjects at a tertiary care center. Methods: In this prospective observational study, 410 patients were screened for dyspnea. On the basis of spirometry findings, 360 patients were diagnosed as COPD and enrolled into the study. Patients were categorized into 2 groups on the basis of smoking habits (smoker and nonsmoker COPD). Clinical and demographic attributes were compared in between these two groups. This study was conducted over a period of one year, from August 2014 to July 2015. All statistical analyses were performed using Statistical Package for the Social Sciences version 19.0 (SPSS Inc, Chicago, IL, USA). Values were considered to be statistically significant at P < 0.05. Results: Out of 360 COPD cases, about 2/3rd (60%) were smokers and the rest nonsmokers. Majority of the patients were in the age group of 51-70 years. The mean age of smokers with COPD was significantly higher than nonsmokers with COPD (59.29 ± 10.28 years vs. 53.90 ± 8.77 years; P = 0.0001). Overall, males were predominant (57.2%) but there were higher number of female patients in nonsmoker group (25% vs. 70%; P = 0.001). At presentation, majority of nonsmoker with COPD were in GOLD severity grade II while in the smoking cohort majority were in GOLD severity Grade III. Among the 144 nonsmoker COPD patients, the most important and statistically significant risk factor was exposure to biomass smoke (68.06%). Other risk factors were long-standing asthma (37.50%), lower respiratory tract infection in childhood (32.60%), exposure to outdoor air pollution (17.92%). Conclusion: Nonsmoker COPD is emerging as a distinctive phenotype. They have less impairment in airflow limitation, and a lower prevalence of emphysema, chronic cough, and sputum compared with their smoking counterparts.

There has been an increase in the frequency and intensity of floods in the region straddling Nepal and northern Bihar. Stricken by acute poverty despite being rich in water resources, frequent floods, and shared vulnerabilities across borders, is a grave concern for the communities in the region. This hazard adversely impacts the lives and livelihoods of millions of people especially the poor and marginalised who draw their livelihood from the immediate environment. Hence, there is potential for bringing about positive impacts on the wellbeing of the dependent communities through sustainable actions at a transboundary scale. This paper focusses on the flood-related, transboundary challenges in the Koshi and Gandak river basins. It stresses that the floods have strong upstream-downstream linkages therefore, their management demands joint action at various levels of governance. Transboundary cooperation is essential for developing a relationship of trust and a common understanding to work towards managing floods, especially in downstream areas of Nepal and India. Potential actions for transboundary flood management between Nepal and India are recommended in this paper to enhance the resilience of communities and river basins.

Anaplastic large cell lymphoma (ALCL) is a T-cell lymphoma, accounting for <5% of non-Hodgkin's lymphoma. Cutaneous involvement can be primary or secondary arising in systemic ALCL. The diagnostic feature in both is the presence of pleomorphic, CD30 positive hallmark cells. We present a case of ALCL in a 19-year-old male presenting as an ulcerated scalp swelling. Clinical impression was actinomycosis or scrofuloderma. Cytology smears showed large dispersed pleomorphic cells with hyperlobated nuclei and multinucleated giant cells. The differentials considered were ALCL, rhabdomyosarcoma, and poorly differentiated carcinoma. Immunocytochemistry (ICC) showed positivity for leukocyte common antigen (LCA) and CD30 while negativity for desmin, favoring ALCL. Computed tomography (CT) showed a lytic paravertebral lesion. Subsequently, both paraspinal and scalp lesions were biopsied and immunochemistry confirmed the diagnosis of ALCL. Thus, cutaneous involvement in ALCL can resemble inflammatory and other neoplastic lesions clinically and cytologically. Hence, a high index of suspicion and ICC can aid in the correct diagnosis on fine needle aspiration cytology (FNAC). [ABSTRACT FROM AUTHOR]

Introduction In a series of day care office procedures, techniques like fat plug myringoplasty and Trichloroacetic acid (TCA) cauterization are becoming increasingly popular for managing small central perforations now-a-days[Office1] . These are minor, cost effective procedures and have success rates that match success rates of conventional tympanoplasty[Office2] . The aim of this prospective randomized controlled trial, was to compare the effectiveness of fat plug myringoplasty and chemical cauterization in the management of small centrally located perforations of the pars tensa. Materials and Methods The study was carried out over a period of 2 years on 62 patients selected from ENT OPD in our tertiary health care setup of central India. All the selected patients were grouped into two using a random allocation software EPi Info7.1.1.14. Group A included those who underwent fat plug myringoplasty while group B were those who underwent TCA cauterization. Results At 6 months follow up there was closure of perforation in 29 out of 30(96.6%) patients of group A and 29 out of 32(91%) patients of group B. In both groups success was defined by closure of perforation. Comparison of results was done using Fisher Exact Test. The difference between the success rates of the two procedures was statistically insignificant with p value of 0.6624, indicating that both the office procedures are equally effective and can be used according to the needs of the patients. Conclusion These office procedures can revolutionize the protocol of tympanoplasty which has an obvious higher morbidity and more days of absenteeism as compared to these minor procedures.

The history of Naini Lake Basin reveals that this beautiful scenic natural surrounding has been a victim of landslides, mass erosion, rock-fall and slumping. Its location in highest rainfall zone, weak lithology and topography are the obvious reasons for these activities. Moreover the rising anthropogenic interferences like construction activities and deforestation on this geo-dynamically unstable zone has added more to the problem. The manuscript accounts of incidences of landslide and erosion activities, their causes and effects afterwards. An effort to stratify and to mark the comparatively lesser stable zones and patches in and around the lake basin has been made to demarcate the risk prone belt. Adequate measures for environmental planning and proper implementation of such plans are the utmost need of the hour to safeguard not only the beautiful basin but also the olives and property of population living under the continuous threat of disaster.

Introduction In a series of day care office procedures, techniques like fat plug myringoplasty and Trichloroacetic acid (TCA) cauterization are becoming increasingly popular for managing small central perforations now-a-days[Office1] . These are minor, cost effective procedures and have success rates that match success rates of conventional tympanoplasty[Office2] . The aim of this prospective randomized controlled trial, was to compare the effectiveness of fat plug myringoplasty and chemical cauterization in the management of small centrally located perforations of the pars tensa. Materials and Methods The study was carried out over a period of 2 years on 62 patients selected from ENT OPD in our tertiary health care setup of central India. All the selected patients were grouped into two using a random allocation software EPi Info7.1.1.14. Group A included those who underwent fat plug myringoplasty while group B were those who underwent TCA cauterization. Results At 6 months follow up there was closure of perforation in 29 out of 30(96.6%) patients of group A and 29 out of 32(91%) patients of group B. In both groups success was defined by closure of perforation. Comparison of results was done using Fisher Exact Test. The difference between the success rates of the two procedures was statistically insignificant with p value of 0.6624, indicating that both the office procedures are equally effective and can be used according to the needs of the patients. Conclusion These office procedures can revolutionize the protocol of tympanoplasty which has an obvious higher morbidity and more days of absenteeism as compared to these minor procedures.