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Plaque control, pain control, and modulation of inflammatory mediators to accelerate or stabilize tooth movements are hot issues in orthodontics. The recent advent of phytochemicals as biological mediators has opened new vistas in the aforementioned areas of orthodontics. Adhatoda vasica has caught the attention of investigators due to multiple properties related to orthodontics. This study addresses the potential areas of use of A. vasica in orthodontics, which provide ideas for further investigations. A. vasica possesses antibacterial activity, antifungal activity, anti-oxidant effect, anti-inflammatory activity, analgesic effect, osteogenic, and osteoclastic activities. A. vasica has huge potential in orthodontics, whereas all these vistas need careful and methodical testing before use in clinical orthodontics. In the future, investigators can focus on these aspects of the use of A. vasica to develop products.

Introduction: National strategy for an inclusive and community-based living (NSCIL) for persons with mental health issues 2019 report informs us that the length of stay (LOS) of 36% of inpatients in 43 state-funded tertiary care psychiatric hospitals (TCPHs) is above one year. This is concerning and its public health implications are not studied. Objectives: This study was carried out to estimate the average duration of hospitalization by persons with prolonged hospitalization (PPH) in TCPH and to estimate the number of additional inpatient admissions that could have been offered. Methodology: We analyzed the data in NSICL for calculating cumulative hospitalization years and the mean duration of stay by all PPH under each state. Based on the presumption that each psychiatric bed could cater to at least four admissions, a prediction is made on the number of additional inpatient admissions that could have been offered. Results: The mean duration LOS of 4869 people in these TCPHs is 9.6 years (range 1 – more than 25 years) with significant variation between the states. An additional 190,153 persons could have been offered inpatient care in these TCPHs over 25 years duration, and a minimum of 7606 additional admissions could be accommodated every year. Conclusions: Our predictions suggest a need for research on the possibility of deferred inpatient care to others with acute mental health needs and the scope for inpatient care to as many as in need by unblocking these beds.

In the past decades, more than fifty different yoga styles have been implemented in the therapeutic context to manage various diseases. Yet, not all of these yoga styles have been validated or standardized as a program. The aim of this article is to review the different methodologies used for yoga module development and to assess their quality. Three databases (PubMed, Web of Science, and Scopus) were searched using the following keywords and Boolean operators: (validation OR development OR design) AND (yoga OR mind-body) AND (module OR protocol OR program). Three thousand six hundred and seventy-one articles were enlisted, and based on the inclusion and exclusion criteria, 37 articles were narrowed down for review. Since no checklist exists to assess the quality of yoga modules, the authors designed a 23-item checklist to categorize each having low, medium, or high quality. As per the yoga module quality checklist, only 21.6% of the studies had high quality, while 75.3% of the articles had medium quality and 8.11% had low quality. A commonly used development method was literature review, while for validation, experts' scoring of the Likert scale was the preferred means. The feasibility of the module was carried out only by half of the studies. Few diseases such as cardiovascular disease, diabetes mellitus, obesity, Parkinson's disease, and obesity had more than one yoga module developed. The findings of this systematic review have shed some light on the growing need for standardized methods of yoga module development. The 23-item checklist can guide researchers in the homogeneous development strategies when designing yoga interventions in the future.

Nuclear magnetic resonance (NMR) metabolomics is a powerful analytical technique and a tool which has unique characteristics and capabilities for the evaluation of a number of biochemicals/metabolites of cancer and other disease processes that are present in biofluids (urine and blood) and tissues. The potential of NMR metabolomics in prostate cancer (PCa) has been explored by researchers and its usefulness has been documented. A large number of metabolites such as citrate, choline, and sarcosine were detected by NMR metabolomics from biofluids and tissues related to PCa and their levels were compared with controls and benign prostatic hyperplasia. The changes in the levels of these metabolites aid in the diagnosis and help to understand the dysregulated metabolic pathways in PCa. We review recent studies on in vitro and ex vivo NMR spectroscopy-based PCa metabolomics and its possible role as a diagnostic tool.

Background: Niramaya Health Insurance Scheme is offered for persons with disabilities (PwD) under the National Trust Act, 1999, since 2008. There is less awareness among health professionals, PwD, and caregivers about this. Aims: The aim of the study was to study the number of enrolled PwD in the Niramaya Health Insurance Scheme across the country since its inception. Methods: Annual reports of the National Trust were available in the public domain, and information obtained from the National Trust was used for analysis. Results: Total enrollments have steadily increased from 36,153 (2008–2009) to 96,716 (2018–2019). Madhya Pradesh state accounted for more than two-thirds of total enrollments in the year 2018–2019, and enrollments from many other states and union territories are lesser than 100. Conclusions: After a decade of its launch, less than a fraction of eligible PwD is enrolled in the scheme. Multipronged efforts are needed to promote the enrollment and utilization of the benefits of the Scheme.

Sacral surgeries are a relatively rare type of spine surgery associated with a significant amount of perioperative pain. The paraspinal interfascial or erector spinae plane block is currently being practiced with promising results in cervical, thoracic, and lumbar spine surgeries. It provides not only effective analgesia but also helps in reducing perioperative opioid consumption. Sacral multifidus plane block is one such variant of paraspinal blocks, which may have an equianalgesic profile. This case report describes a novel application of this block for providing perioperative analgesia in sacral spine surgery.

Acetabular fractures are uncommon types of pelvic fractures associated with restricted mobility due to severe pain. The high analgesic demands can be fulfilled by using multimodal analgesia incorporating regional analgesia. The choice of regional analgesia technique depends on the type of acetabular fracture and innervation of the affected components. We report a case series of five patients with acetabular fractures, in whom pre-emptive administration of pericapsular nerve group block provided effective analgesia to facilitate the sitting position for the neuraxial block.

Purpose: To evaluate the effectiveness of repeat trabeculectomy with Mitomycin C (MMC) in isolation or combined with phacoemulsification, and to identify risk factors for failure over 1 year. Methods: Retrospective review of 113 eyes of 113 patients (49 primary open angle, 27 primary angle closure, 37 secondary glaucoma) who underwent repeat trabeculectomy with MMC (isolated trabeculectomy 75 and phacotrabeculectomy 38). The primary outcome measure was intraocular pressure (IOP) at 1 year follow-up. Three IOP criteria were chosen to measure success A) IOP ≤21 mmHg and ≥20% reduction from baseline. B) IOP ≤17 mmHg and ≥20% reduction from baseline. C) IOP ≤14 mmHg. Results: Mean IOP decreased from 24.5 ± 8.8 mmHg to 16.4 ± 7.6 mmHg 1 year after repeat trabeculectomy. The mean number of medications reduced from 2.9 ± 1.0 to 0.6 ± 1.0. Complete success with trabeculectomy versus phacotrabeculectomy for criterion A was 60% vs 55.3%, criterion B 54.7% vs 50.0% and criterion C 40.0% vs 28.9%. IOP ≤14 mmHg was more likely with trabeculectomy than phacotrabeculectomy (P = 0.047). On regression analysis, duration between surgeries ≤4 years (P = 0.018) and secondary glaucoma (P = 0.046) were identified as risk factors for surgical failure with criterion A. Younger age (P = 0.042), fornix based flap (P = 0.058), and phacotrabeculectomy (P = 0.042) for criterion C. Conclusion: Repeat trabeculectomy with MMC is successful at lowering IOP and decreasing number of antiglaucoma medications. Low IOP levels are less likely with phacotrabeculectomy.

Introduction: Tele-yoga is a cost-effective method of teaching yoga using cloud technology to relay from one source (trainer's venue) to multi-point video conferencing centers (participants' homes). However, there is a need to assess the tele-yoga trainer and the training itself to ensure safety and effectiveness. Materials and Methods: The Tele-Yoga Trainers Assessment (TYTA) tool was developed through (a) review of existing tools, (b) key informant interviews, and (c) validation by experts. It was tested for its feasibility in six persons with common mental disorders. A trained yoga therapist conducted tele-yoga therapy sessions which was webcast from NIMHANS Integrated Center for Yoga to NIMHANS Center for Well-Being for the first 15 days and to the respective homes of the participants using “Skype” in the remaining 15 days. Participants were assessed on (a) mental well-being, (b) satisfaction with overall health and were administered the (c) TYTA tool on the 1st, 15th, and 30th day. Results: The TYTA was easy to administer for assessing the performance of the yoga trainer. The qualitative case reports of individual participants depicted that over 30 days, mental well-being and satisfaction with overall health improved trainer's performance. Conclusion: Tele-yoga therapy is feasible with minimum technology and availability of good internet access at the relay and reception site. The trainer must be assessed for his/her suitability and be provided guidelines for achieving desired outcomes.

Introduction: It is well known that the SARS-CoV-2 virus that causes COVID-19 could enter the human host through the oral cavity. In patients with periodontal disease, there is an increase of Furin, Cathepsin, and CD14+ CD16+ monocytes. The hypothesis stated here sheds light on the regular need of periodontal management to reduce inflammation and the levels of deleterious host enzymes and cytokines, which could pave the way for deadly viral diseases such as COVID-19. The Hypothesis: Patients with periodontal disease are at increased risk of SARS-CoV-2 infection due to elevated levels of Furin and Cathepsin in oral cavity and COVID-19 complications like cytokine storm could occur with increased frequency in patients with periodontal disease due to the significant increase of CD14+ CD16+ monocytes in blood. Evaluation of the Hypothesis: Oral and periodontal examination of patients with mild, moderate, and severe SARS-CoV-2 infection could shed light on the significant role played by periodontal disease in making an individual more prone to get SARS-CoV-2 infection by elevation of Furin and Cathepsin and the elevation of CD14+CD16+ monocytes and proinflammatory cytokines in the blood that could consequently worsen COVID-19 complications like cytokine storm. The blood counts of CD14+CD16+ monocytes need to be assayed in SARS-CoV-2 patients with and without periodontal disease to observe if periodontal disease as a coexisting condition elevates the proportion of CD14 CD16+ monocytes in SARS-CoV-2 patients. In fact, assessment of monocyte subsets in peripheral blood could be used as an immunosurveillance marker in SARS-CoV-2 patients. Hence, SARS-CoV-2 positive patients with chronic periodontal disease should be closely monitored for potential signs of a cytokine storm and its related complications.

Background and Aims: Regional anaesthesia techniques are a part of perioperative medicine that affects both perioperative and long-term outcomes. We have a paucity of the data on the usage and practices of plexus and peripheral nerve blocks (PNBs). To the best of our knowledge, this is the first effort to validate a survey for plexus and PNBs. Subsequently, this questionnaire could be used for the survey to look for the trends and disparities in PNB practices and further to develop a national registry in the future. Methods: Thirty questions were prepared after evidence-based search and reviewed by experts for suggestions. Changes were done and the questionnaire with the grading sheet was sent to 19 experts. The responses were analysed to calculate the content validity index (CVI) item-wise (I-CVI), scale-wise (S-CVI), and modified kappa statistics. The I-CVI of 0.78 and an S-CVI/average of 0.90 was taken as acceptable with more than six experts. Results: Fourteen experts out of 19 assessed and graded the questions as per the provided sheet and submitted suggestions through the mail. Question reframing, option reconsideration, and change from single to multiple choices were incorporated as per the suggestions of the experts. Mean I-CVI for relevance, simplicity, clarity, and ambiguity was 0.99, 0.98, 0.98, and 0.99, respectively. S-CVI/average was 0.98, 0.97, 0.98, and 0.99 for relevance, simplicity, clarity, and ambiguity, respectively. Conclusion: We conclude that this questionnaire has met the content validity criteria and can be used to study plexus and PNBs practices.

Background: The aim of this study was to evaluate the changes in body composition, central obesity (visceral and liver fat), and pro-inflammatory markers after bariatric surgery in obese Asian Indians with prediabetes and diabetes. Materials and Methods: This is 1-year follow-up study of 30 obese patients (BMI of 30–40 kg/m2) with prediabetes and diabetes who underwent bariatric surgery at tertiary diabetes center in South India. HbA1c, adiponectin, liver enzymes, ferritin, and high-sensitivity C-reactive protein (hs-CRP) were tested before surgery and at 6 and 12 months postoperatively. Body composition analysis and ultrasound hepatic fat grading were done before and at 6 and 12 months’ post-surgery. Results: The baseline HbA1c were 8.3 ± 1.8% which reduced to 6.1 ± 0.8% at 12 months. The percent body fat, visceral fat area, and slim lean mass reduced significantly at 12 months compared with baseline (P < 0.001). Hepatic steatosis and liver enzymes also significantly reduced at 12 months compared with baseline. hs-CRP and ferritin significantly reduced (P < 0.05) at 12 months post-op [2.9 ± 2.8 mg/L, 39 ± 29 ng/mL] compared with baseline [7.5 ± 3.5 mg/L, 61 ± 44 ng/mL], respectively. Serum adiponectin levels significantly increased from 26.4 ± 1.4 to 67 ± 3.5 ng/mL after the surgery. Conclusion: Bariatric surgery is effective in reducing total body fat and visceral fat area, hepatic steatosis with an improvement in liver enzyme levels after bariatric surgery. hs-CRP, ferritin, and adiponectin also significantly improved following surgery.

In India, General Hospital Psychiatry Units (GHPUs) are the backbone for mental health care. GHPUs have less stigma, facilitate inter-specialty collaboration, and provide integrated mental and physical healthcare. GHPUs offer a predominantly medical model of care and face multiple challenges in offering psychiatric rehabilitation, including a severe crunch of human resources. This article summarizes the basic concepts of psychiatric rehabilitation, possible rehabilitation interventions in resource-constrained settings, and interventions that can be delivered with the help of caregivers and frontline mental health workers. The article concludes with some of the pragmatic indigenous models of psychiatric rehabilitation at GHPUs.

Background: Mental health-care students experience stress and burnout during their training period. Yoga has been found to be helpful in improving one's mental health and well-being. Aim: The aim of this study is to develop and test the feasibility of a brief yoga module for postgraduate mental health-care students. Methods: Amixed method design was used. Phase 1 involved development and validation of the yoga module using the qualitative exploratory method. Phase II tested the feasibility of the module on a sample of 28 first-year postgraduate students. These students participated in a 15-day (30 min/day) brief yoga module for improving their well-being and cognition (mirror neuron activation [MNA] and tower of London task as assessed on day 0, day 15 (2 weeks), and day 30 (4 weeks). Qualitative feedback of the student volunteers was also recorded. Results: Significant improvement in the well-being scores was observed in the students who adhered to the yoga practice after 2 weeks and 4 weeks. Functional near infra-red spectroscopy (fNIRS) data indicated that adherents showed significant activation of left somatosensory region of the brain and deactivation in the right primary somatosensory region during the static and active phase of the MNA task, respectively. Adherent group showed significant improvement in reaction time during “Zero-Moves” tasks of Tower of London. The qualitative thematic analysis showed that the module helped improve the well-being and mental health of the students. Conclusion: The yoga program was found to have high need and medium to high feasibility. A systemic integration of student well-being-oriented interventions including yoga in the curriculum of postgraduate mental health-care courses is advocated.

Background: In India, blood units reactive by the initial screening assays are discarded. A significant number of these are falsely positive, leading to wastage of precious blood. Also of importance is the dilemma created when it comes to donor disclosure. Hence, it is important to evaluate the positive predictive value (PPV) of the initial screening assay to identify false-positive screening results and implement a more balanced algorithm for donor disclosure and counseling. The study was undertaken with an objective of comparing signal-to-cutoff ratio (S/Co) of positive results in HBV, HCV, and HIV screening of electrochemiluminescent (ECI) assay with the results of ID-NAT so as to predict a S/Co ratio of indicative of true positives. Methods: The retrospective study was conducted in the transfusion-transmissible infection Laboratory in a Regional Blood Transfusion Centre in South India. Consecutive blood donors from January 2015 to December 2019 were evaluated simultaneously for HBV, HCV, and HIV by ECI (Vitros 3600, Ortho Clinical Diagnostics) and ID-NAT (Procleix Panther System by Grifols), and the positive results either by one or both were analyzed. Results: A total of 163,596 voluntary donor samples were evaluated. In case of HBV, a S/Co ratio of 1000 predicts a true positive more than 94% of the time. In case of HCV, a S/Co ratio of 8 predicts a true positive more than 95% of the time. Finally, a S/Co ratio of 30 predicts a true positive as well as true negative 100% of the time in case of HIV. Conclusions: It is challenging to propose a standard S/Co ratio because the performance of each assay varies across laboratories. However, the study throws light on the role of the S/Co ratio in reducing the perplexity during donor notification.

Background and Objective: It is important to strengthen deceased donor organ transplant program to help the patients who do not have living kidney donor available. However, there are lots of challenges in deceased donor program. There are challenges to convince families of brain dead patients for organ donation, but transportation of organ as well as allocation is also difficult. One of the main challenges for transplant immunology laboratory is correct crossmatch technique which is sensitive as well as quick and easy to perform. The aim of this study is to evaluate the results of Luminex lysate donor-specific antibody (DSA) crossmatch (LumCross-match) testing for deceased donor renal transplant cases and correlate with graft dysfunction. Methods: We use Luminex lysate DSA crossmatch for human leukocyte antigen testing for deceased donor renal transplants. In 2 years, we had 177 deceased donations and 1184 crossmatches were done. Results: Total 342 patients received kidneys in 2 years. No hyperacute rejection was reported though 28 cases had signs of antibody-mediated rejection posttransplant. Conclusion: We found Luminex lysate crossmatch useful in deceased donor transplant program because of easy procedure, high throughput, more sensitive, and less laborious as well as for posttransplant monitoring.

The conduct of clinical trials is crucial to all research stakeholders and very challenging to the investigators, study teams, and participants during (coronavirus disease-2019) COVID-19 pandemic. The main challenges include difficulties in maintaining complete adherence to approved protocol, regulatory provisions applicable guidelines, recruitment of subjects, protection of rights, safety and well-being of trial subjects (participants), is of paramount importance. The CDSCO (Central Drugs Standard Control Organization), EMA (European Medicines Agency), and FDA (Food and Drug Administration) have come out with the guidelines on the management of clinical trials during the COVID-19. This article describes the process of conducting clinical trials at Department of Clinical Trials at Madras Diabetes Research Foundation (MDRF), Chennai, during the COVID-19 pandemic. Effective strategies taken at our site include compliance with scheduled visits of subjects, laboratory testing (investigations), administration of investigational product(s), assessment of safety and efficacy parameters, reporting of SAEs (serious adverse event). These strategies could be a useful reference to investigators, doctors, and research staff across hospital sites in India and elsewhere.

Context: Ventricular septal rupture (VSR) is a dreaded complication following myocardial infarction. Surgical repair of VSR is associated with significant early mortality. Variable outcomes in terms of early mortality and midterm functional status have been reported from different centers. Aims: In our study, we attempt to review the experience of decision making and surgical repair of postinfarction VSR, and to analyze the factors contributing to the early mortality and midterm outcome after repair. Materials and Methods: It is a retrospective study. Data were summarized retrospectively by frequencies and percentages for categorical factors, and means and standard deviations for continuous factors. Multivariate logistic regression, odds ratios, 95% confidence intervals, and P value were calculated for different variables to determine their independent effect on operative mortality. All surviving patients answered the EQ-5D Health Questionnaire. Results: Preoperative renal failure, left ventricular dysfunction (moderate and severe), and Killip class (III and IV) were significantly associated with early mortality after surgery. Small residual ventricular septal defect (VSD) was not found to affect the midterm quality of life. Conclusions: Early surgical repair benefits the patient by preventing early end-organ damage. The renal failure left ventricular dysfunction (moderate and severe) and Killip class (III and IV) adversely affect early outcomes after surgery. Small residual ventricular septal defect (VSD) does not affect the midterm quality of life.

Background: To test the feasibility and effectiveness of an audio-visual self-help audio-visual yoga manual on burden of Indian caregivers of persons with schizophrenia, living in the community. Methods: An earlier developed yoga program for caregivers of schizophrenia was remodeled into an audio-visual self-help manual in three languages and validated by mental health and yoga experts. 48 consenting primary family caregivers of outpatients with schizophrenia were screened, recruited, and allotted randomly to Yoga or Care as Usual Group. Participants in Yoga group were taught yoga from the self-help manual (1 session of 1 h every month for 5 months). The caregivers were asked to follow the manual for the remaining month at home. Assessments of burden, perceived stress, quality of life, and anxiety-depression were conducted by a rater blind to the group status at baseline and at the end of every month. Results: Post factoring for missing data, Repeatedmeasure ANOVA was conducted; which showed that there was no significant difference between the group that practiced the selfhelp yoga manual and the care as usual group. The caregivers who practiced yoga at home maintained an average of 50% attendance and “very well” level of yoga performance. Conclusion: The audio-visual self-help yoga manual was found to be feasible to use by the caregivers even though its effectiveness could not be ascertained due to high attrition.

The coronavirus disease (COVID-19) pandemic has been one of the greatest health challenges that humanity has witnessed in recent times. Diabetes mellitus is one of the most common noncommunicable diseases and its prevalence is very high in evlderly people. COVID-19 also has a worse prognosis in elderly people. Hence, most of the data, both nationally and internationally, have shown that people with uncontrolled diabetes have worse outcomes compared to people without diabetes. This article reviews the connection between diabetes and COVID-19 and suggests various precautions to be taken for people with diabetes, the management strategies for diabetes and lays down a strategic framework for managing people with diabetes and COVID-19.

Management of the difficult paediatric airway management may be associated with a high rate of complications. It is important that clinicians understand the patient profiles associated with difficult airway management, and the equipment and techniques available to effectively manage these children. The goal of this focused review is to highlight key airway management concepts when managing the paediatric difficult airway. This includes understanding the advantages and limitations of various airway equipment designed for children and reviewing the difficult airway algorithm with its unique considerations for the paediatric patient. Early recognition of known risk factors and thorough preparation may be helpful in reducing the risk of complications during difficult airway management in children.

Background: Until date, the proportion of nonclassic monocytes in type 2 diabetic mellitus patients with and without chronic periodontitis has not been evaluated based on glycemic control. The objective of this study was to compare the proportion of CD14+CD16++ monocytes in type 2 diabetic patients with and without chronic periodontitis. Materials and Methods: In this cross sectional study A total of sixty individuals with type 2 diabetes mellitus (n = 15/group) were recruited. Individuals were grouped based on glycosylated hemoglobin A (HbA 1c) values and the presence of chronic periodontitis; Group 1 (diabetes mellitus with good glycemic control), Group 2 (diabetes mellitus with poor glycemic control), Group 3 (diabetic mellitus with chronic periodontitis and good glycemic control), Group 4 (diabetic mellitus with chronic periodontitis and poor glycemic control). Fluorochrome-conjugated monoclonal antibodies against CD14, CD16, and human leukocyte antigen–antigen D related was used to analyze the proportion of nonclassic monocytes by flow cytometry. One-way ANOVA with Tukey's post-hoc test was used to assess the significant differences in monocyte subpopulations. The Pearson's correlation test was used to assess the relationship between hemoglobin A1c values and percentage of nonclassical monocytes. In both the above statistical tools, the value of P < 0.05 is considered as significant level. Results: Group 4 had the highest percentage of CD14+CD16++ monocytes 14.67% + 4.70%, followed by Group 3-9.73% + 0.60%, Group 2-9.32% + 2.03% and Group 1-5.92% + 0.63% (P < 0.001). Further, a statistically significant positive correlation between HbA (1c) levels and the proportion of CD14+CD16++ monocytes was observed. Conclusion: In the present study, we observed type 2 diabetes mellitus patients with poor glycemic control and chronic periodontitis showed more than two-fold increase in the proportion of nonclassic monocytes compared to type 2 diabetes mellitus patients with good glycemic control.

Providing perioperative care for patients with acute psychosis poses a unique challenge to the anesthesiologist. These patients are usually uncooperative, difficult to communicate with, and present with aggressive behavior. Such patients often have a history of substance abuse or chronic psychiatric illness and are on antipsychotic drugs. We report the successful perioperative management of a patient with acute psychosis, scheduled for open reduction and internal fixation of right humerus and clavicle fractures under regional anesthesia and conscious sedation.

Despite being scientifically unproven, aerosol boxes have quickly risen in popularity during the COVID-19 pandemic. They have been created in various shapes and sizes, as well as materials across the world. Aerosol boxes offer a transparent barrier between the patient and the healthcare personnel, during intubation and may prove to be useful when prescribed protection equipment such as masks and eyewear are unavailable. In this article, we undertake a brief overview of aerosol boxes in current practice.

Introduction: Although CDC has been the gold standard for many years, this assay is certainly not perfect and its use is associated with several problems. The Luminex anti-HLA antibody detection assay is reportedly more sensitive and specific. One of the test is Luminex DSA cross match which is more sensitive than CDC cross match. It is also considered cost effective tool to evaluate pre and post renal transplant cases. Material and Methods: We started Luminex based Donor specific antibody Cross Match tests (DSA Xm) with lysate by the end of 2009 along with CDC after standardization. This study is planned to evaluate the results of DSA Xm of last three years & also to observe antibody medicated rejections after renal transplant. Results: Total 3137 Luminex DSA Cross Match tests were done & 515 tests were positive cross match with negative CDC xm result. Out of 515 positive results 164 were positive for class I, 223 were positive for class II and 128 were positive for both class I & II. In the three years total 1129 renal transplants were done at various centers and total 42 cases of Antibody medicated rejections were reported. Out of 42 patients, 36 patients had pre transplant history of CDC negative & Luminex DSA xm positive. Conclusion: We evaluated our three year results of DSA Xm test and found a cost effective, sensitive and useful supplementary test to evaluate pre and post renal transplant cases.

Background: Platelet additive solutions (PAS) are crystalloid nutrient media used in place of plasma for platelet storage. They replace 60%–70% of plasma in platelet components, so the amount of storage plasma can be decreased. Platelets in PAS have lower risk for allergic transfusion reactions with equivalent clinical efficacy for controlling bleeding. Aim: The aim of this study is to evaluate the clinical and laboratory efficacy of PAS-platelets. Materials and Methods: A total of 1674 single donor platelet (SDP) were collected in PAS in the month of June to September 2016 by different apheresis systems. The quality control tests were done on 356 units in 4 months. Total number of SDP were processed with Amicus device (n = 232), Trima Accel (n = 84), and MCS+ (n = 40). The parameters analyzed were antibody titer of anti-A and anti-B, volume, platelet count, pH, bacterial contamination, and reporting of adverse transfusion reaction. Antibody titers were checked by tube technique, and platelet counts were checked by hematology analyzer Sysmex poch 100i. The swirling was checked manually, and pH was checked with pH strips. Results: Out of 356, 164 units were O group, 113 units were B group, 68 units were of A group, and the remaining 11 units were of AB Group. Anti-A and anti-B titer was significantly reduced in PAS-SDP and found 1:32 or less for all the units. All the units found negative for bacterial contamination. No transfusion reaction was reported of the units transfused. All other quality parameters for platelets also found satisfactory after implementing the additive solution. Conclusion: The ABO antibody titers were significantly reduced after addition of PAS. This facilitates the ABO incompatible SDP transfusion and helps in inventory management. The risk of allergic transfusion reaction decreases after reducing the amount of plasma from SDP units. Using PAS-SDP certainly improve the inventory management for platelets with no compromise on clinical and laboratory efficacy.

Alloimmunization is an adverse consequence of exposition to red blood cell antigens through transfusion, pregnancy, or transplantation. Alloimmunization to red cell antigens creates problem not only in immunohematological testing but also causes difficulty in finding compatible blood for those patients who develop multiple alloantibodies. Moreover, the development of multiple alloantibodies can significantly complicate transfusion therapy and/or provokes hemolytic transfusion reactions, the severity of which can vary from mild to extremely severe. We are presenting an interesting case with multiple alloantibodies. Patient's samples were investigated for antibody screening using commercially available three cell panels, and the antibody was identified using different lots of identification panel. Red cell phenotyping was done with minor blood group antisera. After workup, antigen-negative compatible blood was provided for transfusion.

The risk factors for abdominal wall hernia after surgery are an increase in body mass index, midline incision, incisional surgical-site infection, preoperative chemotherapy, blood transfusion, increasing age, female sex, and increasing thickness of subcutaneous tissue. Reconstructing the abdominal wall defect becomes a challenge in multiple risk factor patients. Many new mesh implants have been invented, but all fail in case of infections. We modified and re-evoked an old technique of fascia lata free graft reinforced with tensor fascia lata pedicled flap.

The venous anomaly of a persistent left superior vena cava (PLSVC) affects 0.3%-0.5% of the general population. PLSVC with absent right superior vena cava, also termed as "isolated PLSVC," is an extremely rare venous anomaly. Almost half of the patients with isolated PLSVC have cardiac anomalies in the form of atrial septal defect, endocardial cushion defects, or tetralogy of Fallot. Isolated PLSVC is usually innocuous. Its discovery, however, has important clinical implications. It can pose clinical difficulties with central venous access, cardiothoracic surgeries, and pacemaker implantation. When it drains to the left atrium, it may create a right to left shunt. In this case report, we present the incidental finding of isolated PLSVC in a patient who underwent aortic valve replacement. Awareness about this condition and its variations is important to avoid complications.

Introduction: Karnataka state has a total of 176 blood banks, with a total collection of around 650,000 units annually. From January 2014, all units under the Department of Health and Family Welfare services are tested at NAT Lab established at the Central facility and from September 2014, standalone Regional Blood Transfusion Centre was included in the State Government project. Aim and Objective: The aim of the study is to analyze the nucleic acid testing (NAT) for our donor population and demonstrate consolidation of blood transfusion service through a centralized testing center for NAT and also to assess safety benefits of implementing individual donor NAT (IDNAT). Materials and Methods: We collect nearly 40,000 units annually from voluntary donors with 30% repeat donations. The donors undergo strict predonation counseling, donor questionnaire, and medical examination. The units collected are tested for human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) by ECI using VItros 3600. All the units are tested by NAT at Central NAT Lab, screened by Procleix® Panther System by Grifols. Results: From September 2014 to March 2016, total 50,903 samples tested for NAT. Of 50,903 samples, 588 samples (1.15%) were reactive by Chemiluminescence including 265 for HBV, 188 for HCV, and 135 for HIV. Total NAT reactive samples were 254, out of this 11 reactive for HIV-1 (0.02%), 2 reactive for HCV (0.003%), 235 (0.46%) reactive for HBV. There was one HIV and 10 HBV infection cases that were not detected by serology but reactive by NAT. The yield detected is 0.021% or one in 5000. Conclusion: The IDNAT project has helped in preventing window period infections thus reducing the treatment cost and burden on healthcare. It has added benefits in blood safety and should be considered along with the basic quality assured blood transfusion system such as volunteer base for blood donation, provision of donor self-deferral, donor notification, and quality assured sensitive serological methods.

Routinely, Immunohematology Reference Testing Center receives samples with blood group discrepancy, presence of allo/autoantibodies, positive direct antiglobulin test (DAT), etc. We are presenting a case in which we not only resolved blood group discrepancy but also identified multiple alloantibodies reacting at different phases. A tricenarian female patient was diagnosed with chronic anemia with hemoglobin level below 7 g/dl. The patient had a history of blood transfusion and pregnancy as well. On blood grouping, the patient's forward grouping was “AB” and reverse was “O.” Indirect antiglobulin test was found to be positive while DAT and autocontrol were negative. After complete investigation, patient blood group was confirmed to be subgroup of AB along with anti-A1 antibody. Furthermore, a cold-reacting alloantibody with high thermal amplitude was detected along with one warm-reacting alloantibody.

Background: It is well-known that alloimmunization to red blood cell antigens resulting from the genetic disparities between donor and recipient is one of the risks of blood transfusion. The antibody screening cells are used to detect unexpected antibodies. The risk of alloimmunization is higher in patients who have received multiple blood transfusions such as thalassemia, other hematological disorders, renal failure patients on dialysis who receive blood transfusions, and females with bad obstetric history. Antibody screening test using 2–3 cells panel is not a mandatory pretransfusion testing in India and is performed routinely in limited blood centers. Materials and Methods: This bicentric study has been carried out to look at prevalence of antibodies in multi-transfused patients who have higher risks of alloimmunization such as patients who have received multiple blood transfusions such as thalassemia, other hematological disorders, renal failure patients on dialysis who receive blood transfusions, and females with bad obstetric history in the North as well as South India. The study was conducted at two blood centers, one regional blood transfusion of North India and one at South India. Totally, 4569 cases were analyzed and 258 patients were selected for antibody screening and identification. Results: Of total 4569 patients, 258 multi-transfused patients were studied. Among these, seven patients (2.71%) were found alloimmunized. The risk of alloimmunization was 2.90% in thalassemia, 0% in chronic renal failure patients, 3.77% in pregnant females with bad obstetric history, and 2.78% in other multi-transfused patients like cancer. Discussion: Regular monitoring through antibody screening and transfusion of blood matched for minor erythrocyte antigens are recommended in these patients.

Aim: The aim of this article is to present the usefulness of the nasolabial flap (NL flap) along with a detailed review of the factors that lead to its selection for the reconstruction of post-ablative oral floor defects. Materials and Methods: The records of patients who underwent the procedure between June 2009 and June 2011 were retrospectively analyzed. A total of 16 reconstructive procedures were performed. NL flap was selected for reconstruction in all the cases due patient related factors mainly associated medical comorbidities, resource constraints, and the relatively small size of defects, which precluded the use of free flaps. Results: None of the flaps were lost, 26% of patients had flap related complications. Most of the complications were minor and managed conservatively. Conclusion: Data from this study suggest that NL flap is a reliable option for reconstruction of the oral floor, in form as well as function, without esthetic compromise and has a major role even in this era of free flaps.

Introduction: Diabetes is one of the major health diseases in the world today. The efficacy of Yoga in the management of type 2 diabetes is well-established. The aim of this study was to assess the prevalence of type 2 diabetes among Yoga practitioners in two districts of India (one each in West and South of India). Methodology: In this cross-sectional field study, 155 Yoga practitioners from Pune and 192 from Ernakulam districts were assessed using the diabetes risk test and fasting blood sugar. The data collected were entered in a statistics software package and analyzed using the Pearson′s correlation analysis, t-test, univariate ANOVA, and linear regression to understand the predictors of risk for diabetes. Results: The overall prevalence of diabetes among Yoga practitioners in Central Pune was 3.6% (95% confidence interval [CI]: [0.01-0.04]). 18.9% of participants (95% CI: [0.16-0.19]) were diagnosed to be "at risk" for diabetes. In Ernakulam, the overall prevalence of diabetes among practitioners was 26% (95% CI: [0.05-0.06]) with 12% of practitioners (95% CI: [0.05-0.06]) diagnosed to be "at risk" for diabetes (prediabetic). Higher age and lesser duration of Yoga practice were significant predictors of diabetes. Conclusion: It is essential for every person above the age of 40 to undergo regular health check-ups and screening for diabetes and involve oneself in lifestyle modification programs such as Yoga for significantly long duration of time on a daily basis, to better manage diabetes.

Aim: The aim of this study was to define, decode, and append to the conceptual frame-work of the integrated approach to yoga therapy (IAYT). Materials and Methods: Four stakeholders who followed two in-patients with depression over a period of 2 weeks in the residential center "Arogyadhama" (of Swami Vivekananda Yoga Anusandana Samsthana, Bangalore, India) were interviewed before the start of the IAYT treatment and prior to discharge of the patient. The patients were also interviewed pre and post and were observed once during their session. The data from the audio recordings from eight in-depth interviews were transcribed manually and qualitative analysis was conducted. Results: The conceptual frame-work of IAYT depicts that patient related factors ("co-operation of patient," "patients awareness of his/her condition"), therapist related factors ("ability to guide," the "assistance to the patients," "explanation of the exercises") and treatment related factors ("combination of psychiatric or Ayurvedic medication with yoga," "counseling during the IAYT treatment," duration of treatment), play an integrated role in reaching the "aim of IAYT" and experiencing "improvements and changes." Conclusion: The IAYT is a holistic program and the ability of the patient to cooperate with and integrate the available factors (therapist related and treatment related) could enable best results.

Background: Nonspecific chronic low back (nCLBP) pain is prevalent among adult population and often leads to functional limitations, psychological symptoms, lower quality of life (QOL), and higher healthcare costs. The purpose of this study was to determine the efficacy of Iyengar yoga therapy on pain intensity and health related quality of life (HRQOL) with nCLBP. Aim of the Study: To compare the effect of Iyengar yoga therapy and conventional exercise therapy on pain intensity and HRQOL in nonspecific chronic low back pain. Materials and Methods: Experimental study with random sampling technique. Subjects/Intervention: Sixty subjects who fulfilled the selection criteria were randomly assigned to Iyengar yoga (yoga group, n = 30) and control group (exercise group, n = 30). Participants completed low back pain evaluation form and HRQOL-4 questionnaire before their intervention and again 4 weeks and 6 month later. Yoga group underwent 29 yogic postures training and exercise group had undergone general exercise program for 4 weeks. Statistics: Repeated measures analysis of variance (ANOVA) was used to analyze group differences over time, while controlling for baseline differences. Results: Patients in both groups experienced significant reduction in pain and improvement in HRQOL. In visual analogue scale (VAS) yoga group showed reduction of 72.81% ( P = 0.001) as compared to exercise group 42.50% ( P = 0.001). In HRQOL, yoga group showed reduction of 86.99% ( P = 0.001) as compared to exercise group 67.66% ( P = 0.001). Conclusion: These results suggest that Iyengar yoga provides better improvement in pain reduction and improvement in HRQOL in nonspecific chronic back pain than general exercise.

Background: Trataka, a type of yoga practice is considered to improve cognitive functions. The aim of this study was to test the effect of trataka on cognitive functions of the elderly. Materials and Methods: Elderly subjects were recruited based on inclusion and exclusion criteria (n = 60) and randomly divided using randomized block design into two groups: Trataka and wait list control group. Trataka (a visual cleansing technique) was given for a period of 1 month (26 days). The subjects in both groups were assessed on day 1 (pre- and postintervention in trataka group and after quiet sitting in control group) and on day 30 on Digit Span Test, Six Letter Cancellation Test (SLCT), and Trail Making Test-B (TMT-B). Results: Friedman′s test and Wilcoxon signed-rank test showed that at the 2 nd follow-up there was significant improvement in digit span scores (z = −3.35, P < 0.01) in the trataka group. SLCT scores (t = 5.08, P < 0.01) and TMT-B scores (t = −4.26, P < 0.01) improved immediately after the practice of trataka (when baseline compared to first follow-up). At 1 month follow-up, trataka group showed significantly better performance in the SLCT test compared to baseline (t = −3.93, P < 0.01) and TMT-B scores (t = 7.09, P < 0.01). Repeated measure analysis of variance (RM ANOVA) results also reiterated that there was significant interaction effect at the end of 1 month of trataka intervention as compared to control group on TMT-B and SLCT scores. Conclusions: The results of this study establish that Trataka can be used as a technique to enhance cognition in the elderly.

A central venous catheter (CVC) is inserted for measurement of haemodynamic variables, delivery of nutritional supplements and drugs and access for haemodialysis and haemofiltration. Catheterization and maintenance are common practices and there is more to the technique than routine placement as evident when a procedure-related complication occurs. More than 15% of the patients who receive CVC placement have some complications and infectious endocarditis involving the tricuspid valve is a rare and serious complication with high morbidity and mortality. Overenthusiastic and deep insertion of the guide wire and forceful injection through the CVC may lead to injury of the tricuspid valve and predispose to bacterial deposition and endocarditis. We report a case of tricuspid valve endocarditis, probably secondary to injury of the anterior tricuspid leaflet by the guide wire or the CVC that required open heart surgery with vegetectomy and repair of the tricuspid valve.

Inguinal hernia with appendix as content, classically called as Amyand's Hernia has been well documented in children. Undescended testis with an associated hernia is also not uncommon and is an indication for early orchidopexy. We report a case of undescended testis which presented as an irreducible right inguinal hernia, which on exploration was found to have an inflamed appendix.

Aim: To describe the possible barriers to yoga therapy for patients with schizophrenia in India. Materials and Methods: In a randomized control trial at NIMHANS, patients with schizophrenia (on stable doses of antipsychotics, 18-60 years of age, with a Clinical Global Impression-Severity score of 3 or more) were randomized into one of three limbs: Yoga therapy, physical exercise and waitlist. Of 857 patients screened, 392 (45.7%) patients were found eligible for the study. Among them, 223 (56.8%) declined to take part in the trial. The primary reasons for declining were analyzed. Results: The primary reasons for declining were (a) distance from the center (n=83; 37.2%); (b) no one to accompany them for training (n=25; 11.2%); (c) busy work schedule (n=21, 9.4%); (d) unwilling to come for one month (n=11; 4.9%), (e) not willing for yoga therapy (n=9, 4.0%); (f) personal reasons (n=3, 1.3%); (g) religious reasons (n=1, 0.4%). In 70 patients (31.6%), no reasons were ascribed. No patient refused citing research nature of the intervention as a reason. Conclusion: More than half of the patients eligible for yoga did not consent to the study. Logistic factors, such as the need for daily training under supervision in a specialized center for long periods, are the most important barriers that prevent patients with schizophrenia from receiving yoga therapy. Alternative models/schedules that are patient-friendly must be explored to reach the benefit of yoga to patients with schizophrenia.

Context and Aim: Yoga has been found to be effective in the management of stress. This paper describes the development of a yoga program aimed to reduce burden and improve coping of family caregivers of inpatients with schizophrenia in India. Materials and Methods: Based on the assessment of caregiver needs, literature review, and expert opinion, a ten-day group yoga program was initially developed using the qualitative inductive method of inquiry. Each day′s program included warm-up exercises, yogic asanas, pranayama, and satsang. A structured questionnaire eliciting comments on each day′s contents was given independently to ten experienced yoga professionals working in the field of health for validation. The final version of the program was pilot-tested on a group of six caregivers of in-patients with schizophrenia admitted at NIMHANS, Bangalore. Results: On the question of whether the program would help reduce the burden of caregivers, six of the ten experts (60%) gave a rank of four of five (very much useful). Based on comments of the experts, several changes were made to the program. In the pilot-testing stage, more than 60% of the caregivers assigned a score of four and above (on a five-point Likert scale, five being extremely useful) for the overall program, handouts distributed, and performance of the trainer. Qualitative feedback of the caregivers further endorsed the feasibility and usefulness of the program. Conclusion: The developed yoga program was found to be acceptable to caregivers of in-patients with schizophrenia.

Electromagnetic interference in pacemakers has almost always been reported in association with the cutting mode of monopolar electrocautery and rarely in association with the coagulation mode. We report a case of electrocautery-induced electromagnetic interference with a DDDR pacemaker (dual-chamber paced, dual-chamber sensed, dual response to sensing, and rate modulated) in the coagulating and not cutting mode during a spine procedure. We also discuss the factors affecting intraoperative electromagnetic interference. A 74-year-old man experienced intraoperative electromagnetic interference that resulted in asystole caused by surgical electrocautery in the coagulation mode while the electrodispersive pad was placed at different locations and distances from the operating site (This electromagnetic interference did not occur during the use of the cutting mode). However, because of careful management, the outcome was favorable. Clinicians should be aware that the coagulation mode of electrocautery can cause electromagnetic interference and hemodynamic instability. Heightened vigilance and preparedness can ensure a favorable outcome.

Current diagnostic modalities for early prostate cancer (PCa) lack sufficient sensitivity and specificity. Magnetic resonance spectroscopic imaging (MRSI) detects biochemical changes in tissues that may predate histological changes that can be diagnosed on a biopsy. Men with MRSI suggestive of malignancy but negative biopsy may thus be harboring cancer that manifests at a later date. We report the first case in our cohort of men with positive MRSI but negative initial biopsy who, 6 years after the initial MRSI, were detected to have PCa despite a "normal" prostate specific antigen (

Gorham′s syndrome (GS) is a rare disorder characterized by proliferation of vascular channels resulting in destruction and resorption of osseous matrix leading to bone loss. Bone loss leads to joint instability and problems during airway management and positioning for surgery. Respiratory involvement further complicates anaesthesia management. We report the anaesthetic care of a 21-year-old male patient of known GS for spine decompression and fusion in prone position. Airway management, induction technique, pathophysiology of the disease, drug selection and other concerns of anaesthesia for major spine surgery has been discussed reviewing the sparse literature available.