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Objective: Originating in China in December 2019, coronavirus disease 2019 (COVID-19) rapidly spread to more than 216 countries in the world by May 2020. Because dentists are at a higher risk of contracting the disease, the present study assessed the fear and anxiety among dental practitioners of becoming infected with COVID-19., Methods: An online cross-sectional questionnaire survey comprising of 9 questions was conducted among dental practitioners of Telangana. Age, gender, qualification, type of practice, years of practice, and place of residence were the demographic variables recorded. The response to each question was recorded in a YES or NO format, and mean fear score was calculated to categorize answers into low and high levels of fear. Comparison of mean fear score was done using t-test for 2 variables and analysis of variance for 3 or more than 3 variables. Multiple logistic regression analysis of the levels of fear with demographic variables was done. P < 0.05 was considered statistically significant., Results: The mean fear and anxiety score of this study population reported was high 6.57 ± 2.07, with 58.31% of the population presenting with a low level of fear and anxiety. Only qualification ( P = 0.045) and gender ( P = 0.035) revealed a significant difference in fear to Q7and Q8, respectively. Irrespective of the age, gender, qualification, type of practice, and years in practice, the levels of fear reported in the present study were very similar. Respondents between 41 and 60 y of age (6.70 ± 2.01 y) and those with individual practices (6.70 ± 2.06 y) exhibited high fear scores., Conclusions: The present study demonstrates cross-sectional data of fear and anxiety among dental practitioners during the COVID-19 outbreak. Heightened levels of fear observed in this study call for a nationwide analysis of fear among dentists and deliberate management strategies for the same.

Background: Patient understanding of plan of care is associated with positive outcomes in ambulatory settings. In hospital medicine settings, patient-physician agreement on plan of care (concordance) has been limited and difficult to improve. This study examined the impact of adding a hospitalist to interdisciplinary rounds (IDR) on physician-patient-nurse concordance and the relationship between concordance and outcomes., Methods: IDR were conducted by core teams made up of unit-based nurses, a case manager, and a pharmacist. Over time, with cohorting, hospitalists were included in IDR (hospitalist IDR) for some patients assigned to unit-based hospitalists. In developing hospitalist IDR, the researchers emphasized using an IDR checklist, including a patient communication plan. Patient-nurse-physician interviews were used to assess concordance in the domains of diagnosis, tests and procedures, and expected discharge date. Using two-hospitalist review, agreement was rated as none, partial, or complete, and a total concordance score was calculated for each patient in both IDR groups. Multivariate analysis was used to examine the relationship between concordance, IDR type, patient factors, and utilization outcomes., Results: For 658 patients, the mean concordance score was 11.71 out of a possible 18. There was no difference in concordance between hospitalist and core IDR groups (11.68 vs. 11.84, p = 0.7). Higher total concordance score was associated with lower lengths of stay (p < 0.001) and readmission rates (p = 0.001). Total concordance had a negative association with patient age (p = 0.04)., Conclusion: Concordance did not change with IDR type. Higher concordance appears to be related to positive utilization outcomes. Future studies are needed to evaluate potential interventions to improve concordance., (Copyright © 2020 The Joint Commission. Published by Elsevier Inc. All rights reserved.)

Background: Inflammation involving the postcapillary venular wall is defined as small vessel vasculitis. Small vessel vasculitis has various clinical manifestations. Etiologically, it can be primary or secondary. Literature regarding secondary vasculitis in elderly is scanty., Aim and Objectives: In this case series, we aimed to assess the clinical features and etiologies of biopsy-proven secondary small vessel vasculitis in the elderly., Methodology: Twelve elderly patients with biopsy-proven small vessel vasculitis were included in this study. All patients were thoroughly evaluated to assess the etiology and presence of major organ involvement., Results: Secondary small vessel vasculitis involved both the sexes equally. Constitutional symptoms including fever and weight loss were noticed by most of the (70%) patients. Neurological deficits were present in 83% of the study population. The most common finding in an electromyographic examination was an asymmetric sensory motor distal predominant polyradiculopathy. Fifty percent of the patients did fulfill the criteria for a definite autoimmune disease. More than 30% of the vasculitis was secondary to malignancies., Conclusions: Neurological manifestations are the most common systemic involvement in elderly patients with secondary vasculitis. Meticulous search for underlying malignancies is mandatory in elderly patients with secondary small vessel vasculitis., Competing Interests: There are no conflicts of interest.

Background: Interdisciplinary rounds (IDR) have been described to improve outcomes. However, there is limited understanding of optimal IDR design., Purpose: To systematically review published reports of IDR to catalog types of IDR and outcomes, and assess the influence of IDR design on outcomes., Data Sources: Ovid MEDLINE, Ovid MEDLINE In-Process & Other Non-Indexed Citations, Journals Ovid, Cumulative Index to Nursing and Allied Health Literature (EBSCOhost), and PubMed from 1990 through December 2014, and hand searching of article bibliographies., Study Selection: Experimental, quasiexperimental, and observation studies in English-language literature where physicians rounded with another healthcare professional in inpatient medicine units., Data Extraction: Studies were abstracted for study setting and characteristics, and design and outcomes of IDR., Data Synthesis: Twenty-two studies were included in the qualitative analysis. Many were of low to medium quality with few high-quality studies. There is no clear definition of IDR in the literature. There was wide variation in IDR design and team composition across studies. We found three different models of IDR: pharmacist focused, bedside rounding, and interdisciplinary team rounding. There are reasonable data to support an association with length of stay and staff satisfaction but little data on patient safety or satisfaction. Positive outcomes may be related to particular components of IDR design, but the relationship between design and outcomes remains unclear., Conclusions: Future studies should be more deliberately designed and fully reported with careful attention to team composition and features of IDR and their impact on selected outcomes. We present a proposed IDR definition and taxonomy for future studies. Journal of Hospital Medicine 2016;11:513-523. © 2016 Society of Hospital Medicine., (© 2016 Society of Hospital Medicine.)

Objective: The present study aimed to investigate the probable differences in cell proliferation index of odontogenic cysts and tumors by means of a comparative silver stained nucleolar organizing region (AgNOR) quantification., Study Design: This descriptive cross-sectional study was done on archival paraffin blocks (n = 62), consisting of 10 odontogenic keratocysts, 10 dentigerous cysts, 10 radicular cysts, 10 conventional ameloblastomas, 10 adenomatoid odontogenic tumors, 10 calcifying epithelial odontogenic tumors and 2 ameloblasic carcinomas., Results: The mean AgNOR count of odontogenic cysts was 1.709 and the benign odontogenic tumors was 1.862. Highest AgNOR count was recorded in odontogenic keratocyst and lowest was seen in radicular cyst. Statistically significant difference in AgNOR counts of ameloblastoma and adenomatoid odontogenic tumor, amelobalastoma and calcifying epithelial odontogenic tumor, benign odontogenic tumors and ameloblastic carcinoma were seen. AgNORs in ameloblastic carcinoma were more in number and more widely spread., Conclusion: AgNOR technique may be considered a good indicator of cell proliferation in odontogenic cysts and tumors.

Efforts are being made to express toxin genes from the bacterium, Bacillus thuringiensis (Bt) in chickpea for minimizing the losses due to the pod borer, Helicoverpa armigera. However, there is an apprehension that acidic exudates in chickpea leaves may influence the protoxin-toxin conversion in the insect midgut, and thus, reduce the efficacy of Bt toxins. Therefore, we studied the influence of organic acids (oxalic acid and malic acid) present in the trichome exudates of chickpea on the biological activity and binding of Bt δ-endotoxin Cry1Ac to brush border membrane vesicles (BBMV) of the pod borer, H. armigera. Oxalic and malic acids in combination at concentrations present in chickpea leaves did not influence the biological activity of Bt toxin Cry1Ac towards H. armigera larvae. Amounts of Cry1Ac protein in the midgut of insects reared on diets with organic acids were similar to those reared on artificial diet without the organic acids. However, very high concentrations of the organic acids reduced the amounts of Cry1Ac in the midgut of H. armigera larvae. Organic acids in the artificial diet also increased the excretion of Cry1Ac in the fecal matter. Organic acids reduced the amount of protein in the BBMV of insects reared on diets with Cry1Ac, possibly because of reduced size of the larvae. Oxalic and malic acids at concentrations present in chickpea leaves did not affect the biological activity of Cry1Ac, but it will be desirable to have high levels of expression of Cry1Ac toxin proteins in chickpea for effective control of the pod borer, H. armigera., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Influenza virus is prone to mutations that may alter the intensity of subsequent waves of infection. In this study, we evaluated whether outcomes were different in the two waves of the influenza A (H1N1) 2009 pandemic in patients admitted to the intensive-care unit. Age, gender, lag-time to presentation and APACHE-II scores were similar in both waves. Although ventilatory requirements were similar (36/37 vs. 36/39), non-significant reductions in the durations (days) of ventilation (10.3 ± 8.0 vs. 7.8 ± 9.4, p 0.11) and hospitalization (14.9 ± 10.5 vs. 12.3 ± 14.1, p 0.20) were observed in the second wave. The clinical profile and outcomes were not significantly different between the two waves among severely ill patients., (© 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.)

The use of neem-based products is widespread in the Indian Subcontinent. Neem-based pesticides obtained from neem kernels are considered natural and safe. The toxic effects of ingestion and overdose of this pesticide in adults have not been described in this literature. We report the case of a 35-year-old lady who had consumed Azadirachtin in an attempt of deliberate self-harm. The patient had features of neurotoxicity because of Azadirachtin requiring intensive medical care with mechanical ventilation. The patient survived the overdose with no long-lasting side effects of the toxin.

Introduction: Delirium is common in hospitalized geriatric patients with hip fractures. A number of peri-operative predisposing and postoperative precipitating factors have been identified in Western literature but data regarding this problem within the Indian context is scarce., Method: The objectives of the study were to ascertain the incidence of delirium in geriatric patients admitted for the treatment of hip fractures in the Department of Orthopaedics of a tertiary care referral centre in South India, to delineate their clinical profile and identify probable contributing factors for development of delirium in this group of patients. The study was a prospective, cohort study design that was conducted on patients above the age of 60 years, admitted to the orthopaedic ward with hip fracture and who underwent hip surgery. A total of 81 patients were recruited from May 1st 2004 to April 30th 2005 (total duration of one year)., Results: Of the 81 patients 17 (21%) of the patients developed post-operative delirium. On multivariate analysis the presence of underlying dementia (OR 16.97), duration of surgery > 2.5 hrs (OR 8.23) and preoperative packed cell volume < 25 (OR 8.07) were found to be independent predisposing risk factors that were associated with the development of postoperative delirium. Postoperative infections, metabolic abnormalities and vascular events were found to be important detected medical causes for precipitating post-operative delirium. Patients who had delirium had longer hospital stays and poor ambulation at discharge., Conclusions: Delirium in geriatric patients undergoing hip fracture surgery results in poor postoperative outcomes and increased cost. The etiology of delirium is multi-factorial. A number of potentially modifiable factors have been identified as risk factors for delirium. Appropriate intervention strategies involving physicians and geriatricians need to be implemented within the Indian context to reduce the incidence of delirium.

We present the case of a 16-year-old female patient who presented with dyspnoea, cough and noisy breathing that progressed further in hospital with the development of stridor and severe respiratory compromise requiring mechanical ventilatory support. Investigations were consistent with a diagnosis of endotracheal tuberculosis with tracheal and bronchial stenosis. Despite adequate anti-tuberculous therapy and ventilation the patient had high airway pressures, low tidal volumes and hypercapnia, which prevented weaning from mechanical ventilation. Balloon dilatation and stenting of the 4.5cm long, 2.3mm diameter stenotic tracheal segment was performed under radiological guidance. The patient was weaned successfully from the ventilator post-procedure. This report illustrates the successful management of an uncommon presentation of a common disease with modern endoscopic therapy.

Cysticercosis is a common public health problem in the Tropics. However, disseminated cysticercosis is rare. We report a patient with chronic liver disease and seizures, in whom a simple plain radiographic examination helped in narrowing down the differential diagnosis to disseminated cysticercosis. The diagnosis was confirmed by serum cysticercal antibody enzyme-linked immunosorbent assay (ELISA) and computerized tomography of the brain.

Background: Rifampicin is a potent inducer of the hepatic microsomal enzyme system. However, the drug has been shown to cause clinically important interactions with many drugs. This study was designed to test the interaction of rifampicin with the oral hypoglycaemic agent glibenclamide., Methods: Twenty-nine well-controlled diabetic patients on a combination therapy of diet and glibenclamide, and willing to participate in the trial, received a daily dose of 450 mg (body weight < 50 kg) or 600 mg (body-weight > 50kg) of rifampicin for 10 days., Results: There was a significant (p < 0.001) worsening of fasting and post-prandial blood sugar after administration of rifampicin. Dose modification of glibenclamide was required in 15 of the 17 patients in whom the diabetes became uncontrolled. Blood sugar normalized by day 6 after stopping rifampicin in all patients., Conclusion: Rifampicin and glibenclamide interact. Therefore, necessary dose modifications should be made in order to achieve euglycaemia if these two drugs are given together.