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Background: Atopic dermatitis (AD) has a complex etiology that includes Th2 polarization, which is accompanied by the cytokines IL4, IL-5, IL-13, and IL-31, as well as Th17 and Th22, and in chronic lesions, Th1 cells. Tofacitinib inhibits Th1-, Th2-, and Th17-associated cytokines by selectively blocking JAK1 and JAK3 receptors. We conducted a multicentric, retrospective chart analysis to study the efficacy and safety of tofacitinib in patients with moderate to severe refractory AD. Materials and Methods: We included 16 adult patients (aged >18 years) with moderate to severe AD who had previously undergone systemic therapy with inadequate response. In the baseline, demographic data, previous treatment history, severity scores (eczema area and severity index [EASI] and SCORing Atopic Dermatitis [SCORAD]), and quality of life score (Dermatology Life Quality Index [DLQI]) were noted. Baseline blood investigations, including complete blood count, liver function test, renal function test, lipid profile, and interferon gamma release assay for tuberculosis, were done. Patients were followed up every month for 6 months that included documentation of severity scores, blood investigations, and DLQI. Any adverse events, if reported, were noted. Result: All 16 patients completed the 6-month trial. Our patients were previously treated with cyclosporine (n = 10), methotrexate (n = 3), or both (n = 3). The mean EASI scores improved from 23.38 ± 9.56 at baseline to 8.50 ± 7.57 at the end of 6 months. The mean SCORAD score improved from 41.25 ± 8.69 at baseline to 14.93 ± 7.82 at the end of 6 months. Quality of life also improved as the mean DLQI improved from 15.18 ± 2.73 at baseline to 5.31 ± 4.11 at the end of the study period. No severe adverse reactions were noted, but 3 patients experienced dyslipidemia and 2 patients had altered bleeding time. Conclusion: Tofacitinib is a safe and effective treatment option for recalcitrant moderate to severe adult AD.

Background: The global search for a safe, irreversible cure after lethal radiation exposure and cancer has not been successful since World War II. Nuclear warfare cannot be recreated in a laboratory. Simulation experiments require highly classified, expensive, and approved infrastructure. Chemotherapy and radiotherapy affect both healthy and damaged cells and often lead to cancer recurrence. A lethal dose of ionizing radiation (IR) is devastating because of instant, massive, and diffuse DNA breaks, chromosomal aberrations, tissue oxidation, and the cascading generation of free radicals, and it can cause cancer. People exposed to a nuclear attack directly cannot be cured. Methods: A formulation comprising aqueous extracts of leaves of Indian bael (Aegle marmelos) and Oxalis corniculate, roots of ginseng (Panax ginseng), custard apple (Annona squamosa) or sitaphal cotyledons, methi (Fenugreek) seeds, and lytic Newcastle disease virus (nonhuman) was used. A few doses of the formulation were injected intraperitoneally into lethally gamma-irradiated mice; mice were also injected with Ehrlich ascites carcinoma cells. Breast and cervical cancer cells were treated with this formulation in vitro. Results: We have developed a solution to the lasting problem. The formulation induced apoptosis in IR-damaged cancer cells by the developed formulation in vivo and in vitro, with no subsequent regrowth. No adverse effects were observed. The control ‘DF1’ Fibroblast cells did not exhibit any change after the drug administration. A possible explanation is the loss of defense responses in damaged cells, allowing the multiplication of the killer virus. Thus, people with cancer and those who escape the direct impacts of nuclear accidents may be saved. The lyophilized components can be stored at room temperature under field conditions. Conclusion: Successful treatment with herbs and virotherapy (a nanomedicine) can be delivered as tablets (a stable formulation) to remote areas, which may be a permanent solution to the prolonged search for the treatment of radiation exposure.

Context: Concerns about brolucizumab’s (Pagenax®) association with intraocular inflammation (IOI) limit its use despite its cost-effectiveness and efficacy. This multicentric study analyzes IOI incidence across 21 tertiary eyecare centers in India since its introduction in October 2020. Purpose: To determine the real-world incidence rate of IOI in Indian patients secondary to intravitreal brolucizumab across 21 tertiary eye care centers in India. Settings and Design: Retrospective multicentric, survey-based study. Methods: Data including number of patients treated, clinical indications, side effects encountered, and IOI case details was collected via Google Forms in 21 Indian tertiary eye care centers since October 2020. Mean, median, frequency, and standard deviation were calculated for statistical analysis. Results: All centers used pro re nata protocol for brolucizumab injections with a minimum injection interval of 8 weeks. The incidence of IOI was 0.79% (21 events out of 2655 eyes). Treatment indications included idiopathic polypoidal choroidal vasculopathy, neovascular age-related macular degeneration, diabetic macular edema, and off-label uses. IOI was experienced after the first injection (57%) in majority of cases with a median onset of 14 days (range: 1–65 days). IOI was mild in 28.5%, moderate in 33%, and severe in 38% of cases. Eighteen out of 21 IOI eyes recovered preinjection best corrected visual acuity or better. Conclusions: Our study found a lower IOI incidence (0.79%) with brolucizumab (Pagenax) in Indian patients compared to previously reported literature. IOI events were mostly mild to moderate, and post-treatment, most patients improved or maintained BCVA. Larger prospective multicentric studies with PRN dosing protocol are needed to confirm these findings.

A 4.1 kg male neonate with a diagnosis of double-inlet left ventricle with dextro-transposition of the great arteries was intubated shortly after birth due to respiratory insufficiency. The initial management consisted of a successful Stage I hybrid procedure. Persistent respiratory insufficiency led to cross-sectional imaging and bronchoscopy that demonstrated severe airway compression from a dilated main pulmonary artery. A Norwood procedure with Blalock–Thomas–Taussig shunt was performed at 1 month of age to relieve the airway obstruction. The patient was discharged home on room air at 2 months of age. This case highlights a unique single-ventricle anatomic variant with airway compression, which was successfully managed with deferred Norwood palliation.

Background: Inadequate water, sanitation and hygiene (WASH) may lead to an increase in water-borne diseases like diarrhoea. The objective of the study was to assess water, sanitation and hygiene in the urban slums of Patpur, Bankura and to determine the implications of WASH on the occurrence of diarrhoea among under-five (U-5) children. Materials and Methods: A cross-sectional observational study was conducted during January–March 2020 by interviewing persons involved in water collection from each of the 182 slum households of Patpur, by two-stage sampling using a pre-designed structured schedule and the core questions on drinking WASH for household surveys: 2018 update by UNICEF and WHO. For testing the association between categorical variables, a Chi-square test was done. Binary logistic regression and the Hosmer Lemeshow test were done to know the predictors of diarrhoea in U-5 children. A P value of < 0.05 was considered statistically significant. Results: The proportion of diarrhoea among U-5 children was 0.34. Limited drinking WASH services were found in 3.30, 45.05 and 24.18% of households, respectively. Mobile objects users for handwashing were 14.05 times more prone to diarrhoea in U-5 children than those who had fixed handwashing facilities at their dwellings, yards or plots. Feeding children without handwashing had 5.70 times increased chances of diarrhoea among U-5 children than those who washed their hands before feeding. Conclusion: Handwashing facilities (fixed, mobile object or no facility) and handwashing with soap and water before feeding the child significantly affected the occurrence of diarrhoea among U-5 children.

Background: COVID-19 pandemic demanded upgrading of laboratory medicine to limit morbidity, disability and mortality from moderate and severe SARS-COV-2 infections. Objective: To assess among moderate and severe COVID-19 patients, C-reactive protein (CRP), procalcitonin (PCT), ferritin, D-dimer, interleukin 6 (IL-6), lactate dehydrogenase (LDH), total and differential leucocyte count (TLC and DLC), neutrophil-to-lymphocyte ratio (NLR), absolute platelet count (APC), prothrombin time (PT), activated partial thromboplastin time (APTT) and international normalized ratio (INR) to find their interdependence and role in prognosis. Methods: This open label analytical cross-sectional noninterventional study evaluated array of independent biochemical, haematological and coagulopathy markers, viz. CRP, PCT, ferritin, D-dimer, IL-6, LDH, TLC, DLC, NLR, absolute platelet count, PT, APTT and INR on consecutive 100 patients with diagnosis of moderate and severe COVID-19 from July to August 2021. Results: In our study, on consecutive designated 100 cases (55 cases moderate and 45 cases severe), more severity were reported as the age progressed; gender difference was not noted. Among independent markers, CRP, PCT, ferritin, D-dimer, IL-6 and LDH had statistically significant relation in comparison with severity of the disease as Chi-square calculated value (P < 0.05). TLC, DLC and APC showed no significant relation in comparison with severity of the disease; NLR had highly significant relation. PT showed significant relation in comparison with severity, though APTT and INR did not show significant relation. Conclusion: Our research group felt that CRP, PCT, ferritin, D-dimer, IL-6, LDH and NLR should be in included in clinical practice guidelines to prognosticate COVID-19 cases. Furthermore, translational researches are needed at all levels of healthcare to improve validity for practices of primary care physicians.

Background: Lifestyle modifications and medication compliance are key strategies. Objectives: To evaluate the effect of community-based care delivered by trained primary healthcare providers in management of hypertension. Materials and Methods: A longitudinal study was conducted between two groups of newly diagnosed hypertensive patients to evaluate the impact of an educational intervention. Six blocks in a district were chosen with pairwise matching. All primary healthcare providers of one block in each pair were randomized to receive the intervention and the other was controlled. Next screening for risk factors, detection of hypertension, counseling, and follow-up care were provided. The patients within the control group received usual care as per clinician’s discretion. A total of 227 patients in the “study” group and 230 patients in the “control” group were recruited from 12 subcenters selected randomly. Data analysis was done by χ2 test, t test, and GLM analysis using SPSS 16. Results: Patients in the intervention blocks demonstrated a statistically significant mean reduction in SBP of 16.14 ± 0.82 and DBP by 11.65 ± 0.53 compared to 9.83 ± 1.02 and 7.68 ± 0.66, respectively, in the control blocks after adjusting for age, sex, and baseline blood pressure at one-year follow-up. Regarding lifestyle-related cardiovascular risk factors, statistically significant differences were found in favor of the intervention group. Conclusion: The study supports and reinforces the utilization of trained primary healthcare providers under the NPCDCS program in screening and promoting blood pressure control by preventive services to hypertensive patients in the community.

Background: Travel medicine is crucial in addressing the health risks associated with international travel, especially among young adults who are increasingly mobile. Despite the growth in global travel, studies indicate a lack of awareness and adherence to preventive measures among travellers. Objectives: To assess the knowledge, attitudes, and practices of medical and dental students regarding travel medicine. Methodology: A cross-sectional study was conducted among medical and dental students at Kasturba Medical College and Manipal College of Dental Sciences, Mangalore, India. A convenient sampling method was employed, and data was collected using a pre-tested semi-structured questionnaire. The questionnaire assessed participants’ knowledge, attitudes, and practices related to travel medicine. Data analysis was performed using SPSS v20.0. Results: A total of 195 students participated, with a majority being female (72.3%) and in the age group ≤20 years (48.2%). Most participants had traveled internationally (71.3%) for purposes such as holidays (51.3%) and returning home (44.6%). While awareness of travel medicine was high (75.4%), knowledge levels were predominantly poor (50.3%). Participants showed high-risk perception towards health threats during travel but demonstrated low adherence to pre- and post-travel health check-ups. Key sources of information included the internet/social media (41.0%) and family/friends (35.9%). Conclusion: Despite high awareness, medical and dental students exhibited poor knowledge and inadequate adherence to preventive measures related to travel medicine. There was a notable disparity between perceived importance and actual practice of pre- and post-travel health check-ups. Efforts should be made to enhance education and awareness regarding travel medicine among young adults to mitigate travel-related health risks effectively.

Background: Geriatric anemia is one of the neglected and undiagnosed health problems throughout the world leading to increased morbidity and mortality among this vulnerable age group. Anemia in elderly is often an indicator of an underlying co-morbid condition. Morphological pattern of anemia may reflect the underlying etiology and thus directs the appropriate way to management of the condition. Aims: To evaluate the severity and morphological pattern of anemia in geriatric age groups. Materials and Methods: Elderly individuals aged 60 years or older of either sex with Hb level

Background: Obesity is considered one of the risk factors for dermatophytosis and warrants systemic therapy. Itraconazole is the most commonly used antifungal, but owing to pharmacokinetic challenges, super-bioavailable itraconazole (SITZ) was approved globally, recently. For the management of dermatophytosis in obese patients, there are mixed opinions regarding the dosing of systemic antifungals. Materials and Methods: This study was conducted to compare the efficacy and safety of SITZ-130 mg once daily in glabrous tinea or dermatophytosis in obese and non-obese patients for a total duration of 10 weeks on 87 eligible patients. Efficacy and safety assessments were done at weeks 3 and 6 with follow-up at week 10 for relapse. The primary objective was to assess the proportion of patients achieving complete cure at week 6 with the assessment of safety, clinical, and mycological cure rates as secondary objectives. Results: Out of 87 patients, 80 were considered for analysis. At week 6, 22/35 (63%) and 33/45 (73%) patients in obese and non-obese groups were completely cured (P = 0.47). Similarly, there was no statistically significant difference for mycological and clinical cure in both the groups (P = 0.17 and P = 0.61, respectively). Four patients in the obese group (18% of completely cured), while one patient in the non-obese group (3% of completely cured), relapsed within 4 weeks of completion of treatment (P = 0.14). The therapy was well tolerated by both groups, with only one patient in the non-obese group experiencing pruritus. Conclusion: SITZ-130 mg once daily achieved desired and similar clinical response in obese patients as of non-obese patients suffering from dermatophytosis, and hence, a higher dose may not require in obesity.

Aim: The current study was conducted to evaluate the influence of frequently ingested beverages on the stability of suture materials. Materials and Methods: This research comprised of two kinds of chromic catgut, polyglactin 910 (4-0) absorbable suture materials. Every specimen was subjected to tying using a square surgeon's knot. Subsequent to pretensioning, 80 suture samples (40 of every material) were employed in this research. Every specimen was subjected to immersion in artificial saliva to replicate the oral atmosphere. Specimens were sunken in the acidic drink (Coca Cola) and tea for 10 min every day. Tensile strengths of the suture specimens were subjected to test at particular time periods: before immersion and 1, 7, and 14 days after immersion. Tensile strength evaluation of the suture specimens was performed employing the microtensile tester at a cross-head speed of 2.0 mm/60 s. Results: When subjected to exposure to acidic beverages, the tensile strength of chromic catgut suture before immersing was 25.14 ± 0.16, 25.02 ± 0.08 on the first day, 16.34 ± 0.23 on the seventh day, and 9.18 ± 0.28 on the fourteenth day. When the suture substance made contact with tea, the tensile strength before immersing was 24.48 ± 0.02, 24.14 ± 0.16 on the first day, 18.26 ± 0.11 on the seventh day, and 12.39 ± 0.14 on the fourteenth day. When subjected to exposure to acidic beverages, the tensile strength of polyglactin 910 sutures before immersing was 25.21 ± 0.02, 25.08 ± 0.01 on the first day, 18.12 ± 0.06 on the seventh day, and 10.06 ± 0.32 on the fourteenth day. When the suture substance made contact with tea, the tensile strength before immersing was 25.02 ± 0.14, 24.96 ± 0.04 on the first day, 20.48 ± 0.18 on the seventh day, and 14.10 ± 0.08 on the fourteenth day. The differences between the groups were statistically significant. Conclusion: In conclusion, polyglactin 910 exhibited a maintained strength superior than chromic catgut sutures subsequent to 14 days.

Administration of anaesthesia in post-COVID mucormycosis patients is a real challenge due to complications such as dyselectrolytemia, renal failure, multi-organ failure, and sepsis. The aim of this study was to evaluate the challenges and perioperative complications of administration of anaesthesia in terms of morbidity and mortality in patients undergoing surgical resection of post-COVID rhino-orbito-cerebral mucormycosis (ROCM). The present study was a case series, which was carried out on 30 post-COVID, biopsy-proven mucormycosis patients enrolled for ROCM resection under general anaesthesia, and all data were collected retrospectively for this series. The post-COVID mucormycosis patients had diabetes mellitus as the most common comorbidity (96.6%), and difficult airway was a common feature (60%) among them. Anaesthetic management of post-COVID mucormycosis patients is a real challenge due to associated comorbidities.

Background: The whole of humankind was shaken by the coronavirus disease 2019 (COVID-19) pandemic. The field of dermatology has been affected by the pandemic as well. This short review aims to highlight the dents which the COVID-19 pandemic made in overall dermatology as a subject. Methodology: To find relevant material, searches were conducted on PubMed and Google Scholar. The evaluation took into consideration review articles, clinical trials, retrospective studies, observational studies, and case–control studies. Results: As a result of the COVID-19 pandemic, the number of cases in the dermatology outpatient department condensed, and dermatological procedures became scarce. Many cutaneous signs were witnessed in patients suffering from COVID-19. The health-care providers also suffered from cutaneous rash while using personal protective equipment during patient care. Various treatment guidelines were modified, including the use of various immunomodulators used in dermatology. The use of the vaccine against COVID-19 disease elicited various cutaneous side effects as well. In addition, the teaching and learning methods were also dented in this pandemic and were subjected to transformation. Conclusion: Dermatology as a subject was not untouched by the consequences of this pandemic. The disease pattern, the treatment guidelines, the consultation methods, and every other aspect of dermatology were subjected to change during this pandemic.

Background: Rapid, unplanned, and unsustainable patterns of urban development can result in many emerging environmental and health hazards. One of the important public health problems of urban environment is regular exposure to dust and pollutants and consequence of such exposure in the form of changes in the pulmonary function. Being the immediate environment, indoor pollution poses a higher risk to human health than the ambient environment. Realistic personal exposure assessment gives the actual idea about the exposure status. Objectives: This study determined the household principal environmental exposures (Dust, SO2, NO2, and total volatile organic compound) among urban slum dwellers and assessment of the respiratory function to determine any possible relationship between those exposures and outcomes. The study also described the knowledge, attitude, and practice of these urban slum people regarding air pollution and its effect. Methods: A cross-sectional study was carried out among 442 urban slum people residing in the slums of the Kolkata Municipal area. Household environmental exposures were collected by standardized methods and outcome was observed by conducting a pulmonary function test. Finally, knowledge, attitude, and practice regarding air pollution were carried out with the help of a questionnaire-based survey. Results and Discussion: Almost all the pollutants exposure was associated with impairment of lung function. Younger age and female gender were statistically associated protective factors for the development of any lung disease. Those who had an overall good awareness regarding the means and effects of air pollution were found to be protected from developing lung disease. Using exhaust ventilation, relocation to inner side of slums, using personal protective measures, and adequate pollution awareness can help the slum citizens to overcome the problem.

Background: Priming solution used in cardiopulmonary bypass has different impact on body, primarily on the metabolic acidosis and electrolytes. This observational comparative study was done to find the metabolic effects of Ringer lactate and Plasmalyte-A as priming solutions for various metabolic parameters during adult cardiac surgery. Materials and Methods: In the present study, 52 subjects were included who received different priming solutions. Subjects were categorized into two groups. Group P received Plasmalyte-A as prime and Group R received Ringer lactate. From all these cases, samples were collected at predefined time durations, and results were compared between both groups. Observation and Results: A total of 52 patients were evaluated for the metabolic changes concerning different priming solutions. Group P included the subject who received Plasmalyte-A as pump prime (n = 26), and Ringer lactate was used as pump prime in Group R (n = 26). We compared various parameters such as pH: In Group R, a decrease in pH was statistically significant with P < 0.05 at 40 min of bypass (T40) and P < 0.05 at 6 h of postbypass (T6). Base Excess: The mean value in Group P was − 1.72 ± 2.18 and − 3.16 ± 2.48 and in Group R at 30 min of bypass (T30). A statistically significance was found between the two groups for this parameter (P < 0.05). Lactate and Strong Ions Difference: A statistically significant data were found between the two groups for this parameter throughout the bypass as well as postoperative hours with the P < 0.05. Conclusion: Plasmalyte-A is more favorable crystalloid solution as a pump prime fluid as it helped to maintain satisfactory metabolic parameters with less metabolic acidosis during adult cardiac surgeries.

Introduction: Irony comprehension (IC) has been described as a schizophrenia (SCZ) disease marker. High variability exists in the measurement of IC. We aimed to assess content and “known-groups” validity of an Indian, comic-based, computerized-IC task. Methods: A 15-story IC task was prepared. Content validity of the IC task stimuli was assessed by experts in mental health. Performance on the IC task was compared between 15 SCZ patients and 15 healthy controls (HC). Known-groups validity was assessed using discriminant function analysis. Results: Content validity of the IC task was optimum. Lower number of correct responses and longer reaction times for irony stimuli were seen in SCZ patients, compared to HC. Both these measures showed 100% accuracy in discriminating SCZ from HC, therefore, implying excellent “known-groups” validity. Conclusion: The newly designed IC task has good psychometric properties, in terms of content and “known-groups” validity.

Aim: To compare and analyze the clinical adequacy of two topical anesthetic gels, Precaine (8% lidocaine + 0.8% dibucaine) and Precaine B (20% benzocaine) in children before intraoral local anesthetic injections. Materials and Methods: This clinical study included thirty children who needed an inferior alveolar nerve block. They were divided into three groups: Group A: Precaine topical gel group, Group B: Precaine B topical gel Group, Group C: no anesthetic topical gel group (control group). These two effective topical gels were applied before giving intraoral local anesthesia, and afterward, the child's pain response was surveyed utilizing the Wong-Baker Faces Pain Rating Scale. The scores obtained were subjected to statistical analysis. Results: Intergroup comparison showed a significant mean difference between the control group and Precaine group (P > 0.05) as well as Precaine B group (P > 0.05). However, there is no significant difference obtained between Group A and Group B (P < 0.05). Conclusion: It is psychologically and clinically beneficial to apply a topical anesthetic agent before injecting any intraoral anesthesia. In this study, both anesthetic gels showed a nonsignificant difference in reducing inferior alveolar injection pain, but Precaine B shows more promising results than Precaine.

Paediatric facial fractures are relatively rare. The inherent elasticity of the bones with more of the cartilage than that of the mineralised bone accounts for this. The principles involved in the management of facial fractures are the same irrespective of the age of the patient; however, in children, the techniques used are necessarily modified by certain anatomical, physiological, psychological and feeding factors related to childhood and the parents. In an attempt to keep the treatment and fixation technique simple, the case, presented here, describes the management of a mandibular parasymphyseal fracture in a 16-month-old child with the use of a prefabricated adaptable surgical splint.

Objective: To determine the denture hygiene habits in complete denture wearers during Covid-19 lockdown in Assam state. Materials and Methods: In this study, a self-administered structured questionnaire was developed to know the attitude of the patients regarding denture hygiene. The study sample consisted of 150 subjects, which included 63 (42%) males and 87 (58%) females. Results: 50.7% of individuals said that they have knowledge about denture cleansing methods, while only 40% individuals clean their dentures once daily. After education through an online survey, most individuals started practicing three times or at least two times. After educating two members in the same family, all subjects were cleaning either twice or thrice. All subjects were either using brushing or combination methods. Conclusion: Poor condition of complete dentures seen in the population is mainly due to lack of knowledge and irregular cleansing habits. Dentists must give proper instructions and do regular follow-up regarding maintenance of denture hygiene.

Background: In the absence of any approved treatment or vaccine against novel Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2) infection, Non-Pharmaceutical Interventions (NPIs) are the cornerstone to prevent the disease, especially in a populous country like India. Objectives: To understand the effectiveness of NPIs reported in the contemporary literatures describing prediction models for prevention of the ongoing pandemic of SARS-CoV-2 specifically in Indian population. Methods: Original research articles in English obtained through keyword search in PubMed, WHO Global Database for COVID19, and pre-print servers were included in the review. Thematic synthesis of extracted data from articles were done. Results: Twenty-four articles were found eligible for the review - four published articles and twenty pre-print articles. Compartmental model was found to be the most commonly used mathematical model; along with exponential, time varying, neural network and cluster kinetic models. Social distancing, specifically lockdown, was the most commonly modelled intervention strategy. Additionally, contact tracing using smartphone application, international travel restriction, increasing hospital/ICU beds, changes in testing strategy were also dealt with. Social distancing along with increasing testing seemed to be effective in delaying the peak of the epidemic and reducing the peak prevalence. Conclusion: Although there is mathematical rationality behind implementation of social distancing measures including lockdown, this study also emphasised the importance of other associated measures like increasing tests and increasing the number of hospital and ICU beds. The later components are particularly important during the social mixing period to be observed after lifting of lockdown.

Background: Aphasia is one of those clinical conditions, where the role of affiliated professionals, mainly speech language pathologists (SLPs) is substantial in diagnostic assessments, therapy, and rehabilitation. There is no study to focus on neurologists, with respect to their perceptions and practices about aphasia, the disease, as well as the profession of SLP. Objective: To reach out to the neurologist community in India and learn about their perceptions and practices about the nature of the ailment and role of speech language therapy (SLT). Our premise was that observations and inferences from a questionnaire-based survey will be subsequently helpful in planning educational activities targeted to neurologists with more focus on specific gaps in perceptions and practices. Material and Methods: Three neurologists and two SLPs collaboratively developed the questionnaire. The aim was to probe the issues which were likely to have a bearing upon optimum service delivery to persons with aphasia by a dyad of neurologist and SLP. The survey was set in “Google Forms” and sent by “WhatsApp” and email to approximately 500 practicing neurologists in India. We employed a nonprobability sampling design for ease of administration with a combination of “chunk sampling” and “snowball sampling.” Telephonic reminders were made to almost all. Results and Discussion: We received 100 responses. The mean age of respondents was 50.64 (SD +/− 12.60) with a range of 28–78 years. The mean number of years of experience as a neurophysician was 19.88 (SD. +/− 12.72) with range of 1–47 years. Females were only 8%. Apparently, the proportion of neurologists working in large corporate and large public sector institutions from tier one and tier two cities was higher, who are more likely to have SLP and related rehabilitation facilities in their institutions and hence harbor more conducive attitudes to SLT in aphasia. The ground reality from tier three cities and small private and public sector hospital and solo practitioners may be somewhat worse than this. Many responses were in conformity with facts and in tune with desirable attitudes as per guidelines like aphasia being a detrimental factor in stroke recovery, doing assessment of handedness, paying attention to neuroimaging correlations and associated cognitive functions, not resorting to unnecessary pharmacotherapy, being aware about efficacy of SLT, and fairly good chances of recovery. However, many more answers highlighted a need for emphasis in Continuing Medical Education like not being aware about community burden of aphasia in comparison to a few better known neurological diseases, not paying attention to psychosocial aspects apart from biological ones in assessment and rehabilitation, not using a standardized and validated battery, not confidant about role of SLT in chronic stable aphasia and need for longer and intensive therapy, and being unconcerned for the value of advocacy for aphasia, like the role of Self-Help Groups. Conclusion: The thrust areas, pertaining to gaps in perception and practices identified through this study, can be viewed as “an in-time input.” We hope that changes in some of the perceptions and practices can be attained through an emphasis on education and training at multiple levels right from the undergraduate to the practicing physicians. A few more themes and domains will need advocacy actions targeted to different stakeholders.

Background: The geriatric depression scale – short form (GDS-SF) considered an important preliminary screening tool, requires translation in different regional languages and validation, to become of utmost use in Indian context especially in the field level. Objective: The current study aimed to evaluate the psychometric validity of the GDS-SF translated into Bengali among rural elderly population. Methods: The 15-item GDS-SF translated to Bengali language was administered to 206 Bengali speaking geriatrics selected maintaining predecided inclusion and exclusion criteria from villages under a rural block in West Bengal. Latent trait modelling was used to evaluate the psychometric properties of this translated tool. Differential item functioning (DIF) was assessed to measure invariance. Results: The mean age of the participants was 68.77 years (standard deviation 6.81 years). Majority being female (57.77%), Hindu (87.38%), from a joint family background (90.78%). The highest discrimination was observed with item 8 (coefficient 3.682, P < 0.001) followed by item 14 (coefficient 3.020, P < 0.001). Question 2 had least coefficient for difficulty (−1.344, P = 0.013) while item 15 had highest (0.775, P = 0.001). The questionnaire provided maximum information (discrimination) around mean value of latent trait. The total cutoff score of 5 was related nearly to mean latent trait (−0.111). Items 10 and 13 showed consistent DIF across different demographic groups. Conclusion: Psychometric properties of GDS-SF (Bengali) established overall construct and content validity of the tool in this community-based study. Despite some degree of DIF the tool can be used as a preliminary screening method in rural community.

Introduction: Contemporary neuro-imaging techniques have significantly advanced our understanding of the brain organization of language and the involvement of subcortical areas in aphasia. However, articles on sub-cortical aphasia, particularly in non-western languages, remain to be few and far between. We set out to explore aphasia typology in sub-cortical strokes among Bengali-speaking population with a focus towards providing a longitudinal view over a period of 3 months post-stroke. Methods: Bengali version of Western Aphasia Battery (BWAB) was used to assess and classify language dysfunction in our study participants. Conventional brain imaging techniques (CT scan & MRI) were used to detect and localize strokes. Uni-variate analysis for categorical variable (location versus aphasia typology) was performed using Chi square and Fischer's exact test (as applicable). Directional measures were calculated using lambda and Goodman-Kruskal tau (Range of -1 to + 1). Boot strapping was applied while calculating the directional measures because of inadequate numbers in some sub-sections the sample. Results: Frequency of sub-cortical aphasia was observed to be 29.80% (62/208) in the index study. Four location of strokes were associated with language dysfunction, of which putamen (53.23%) was the commonest followed by striato-capsular region (33.87%). Thalamus and peri-ventricular white matter (PVWM) strokes (6.45% each) were infrequent in our sample of sub-cortical aphasia. Global aphasia (30/62, 48.38%) was the most frequent type observed in acute phase while Broca's aphasia (23/53, 43.39%) dominated among the follow up cases. Aphasia recovery (with follow up AQ of 90.0 or more) was observed in 12 (22.64%) patients of whom majority (8/12) had striato-capsular strokes. Conclusion: The present paper illustrates the epidemiological aspects as well as longitudinal course aphasia following pure sub-cortical strokes.

Background: Light pollution is inappropriate or excessive use of artificial light. Nighttime sky radiance is an effective measure to study its effects on individual sleep quality. Objectives: The study is aimed to measure the effect of light pollution on the sleep quality and compare among people residing in selected rural and urban areas of West Bengal, India. Methods: A comparative cross-sectional study was conducted during September–October 2018 in 10 villages of Barasat II block and 10 wards of Kolkata Municipal Corporation. Two hundred and sixty-three participants from urban and 249 participants from rural areas were selected through multi-stage sampling. Data regarding sleep quality and other selected factors were geotagged along with the radiance data. Multi-level linear regression models were built. Results: The mean age of the participants from rural and urban areas were respectively 37.65 (±10.77) years and 38.10 (±11.02) years. Gender-wise the participants were distributed almost evenly in urban and rural areas. Among the urban and rural population, the observed mean global Pittsburgh Sleep Quality Index scores were 12.63 (±3.04) and 9.23 (±2.27), respectively. Poorer sleep quality was observed to be statistically significant with increasing level of exposure. Multi-level models show that, at an exposure of >40.0 nW/cm2/sr the adjusted coefficient was 11.52 (95% confidence interval [CI]: 9.65, 13.40) in the overall model and 12.84 (95% CI: 12.31, 13.37) for urban participants. Conclusion: The disturbance in sleep is associated with higher levels of night-time radiance of the sky strongly observed among the urban population.

Objectives : The main objective of the study is to characterize the effects of genetic abnormalities/syndromes (GA/S) on perioperative outcomes of cardiac surgeries involving repair of conotruncal heart defects (CTHD). Design : The study involves a single-center retrospective analysis of patients who underwent complete repair of CTHDs (tetralogy of Fallot [TOF], truncus arteriosus, interrupted aortic arch, and ventricular septal defect with coarctation) between January 2000 and December 2015. The primary outcome was the post operative length of stay (PLOS). The secondary outcomes were mortality, cardiac complications, hematologic complications, infections, and number of medications-at-discharge. Setting : Cardiac intensive care unit in a tertiary pediatric hospital in South Florida that performs around 300 open-heart surgeries a year. Subjects : A total of 177 patients with CTHDs who underwent cardiac surgeries in the stated time period were included in the final study cohort. Measurements and Main Results :Majority of patients had TOF (72.5%) and 46 (26%) had GA/S. The most common GA/S was 22q11 deletion (37%). PLOS was significantly increased in patients with GA/S (P < 0.05). Patients with GA/S were 4.5 times more likely to have a postoperative cardiac complication, 4.2 times more likely to have a postoperative infection, and received 1.6 times more medications at discharge than those without GA/S. However, GA/S was not associated with increased perioperative mortality. Black patients were three times more likely to have a longer PLOS than White patients. Conclusions : Perioperative outcomes in patients with GA/S suggested an increased residual cardiovascular disease and increased resource usage. Notably, this is the first study demonstrating the effect of race and ethnicity on PLOS in CTHD patients.

Background: Hypertension (HTN) is a leading cause of cardiovascular diseases and its control is poor. There is heterogeneity in levels of blood pressure control among various population subgroups. The present study was conducted within the framework of the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) in India. It aims to estimate the proportion of optimal blood pressure control and identify factors associated with uncontrolled HTN consequent to initial screening. Materials and Methods: We assembled a cohort of individuals with HTN confirmed in a baseline screening in sixteen urban slum clusters of Bhopal (2017–2018). Sixteen accredited social health activists were trained from within these slums. Individuals with HTN were linked to primary care providers and followed up for the next two years. Obtaining optimal blood pressure control (defined as SBP

Machine learning is in fact an application of Artificial Intelligence (AI) . It encompasses the use of algorithms in understanding the available information, i.e., data and analyzing it to arrive at an “intelligent” conclusion. Applications of AI in public health have already brought about a paradigm shift in the thinking for the provision of health care. With the global goal of universal health care, AI systems in public health can be considered very important in the resource-poor underserved areas to make a systematic arrangement for health-care delivery. The primary health care is cardinal to achieve universal health coverage. The AI systems can help the resource-contained and the grass-root level settings with remote access, algorithm-driven diagnostic aids, notification regarding emerging threats, and automated analysis of the health data in defined regions.

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.

Penetrating neck injuries due to arrowheads have become extremely rare in most of the nations. Although the basic principles of management remain the same as that of other penetrating injuries, certain extra precautions need to be taken while managing such cases. A 56-year-old man who suffered from an arrow injury to the neck had a lucky escape from any significant injury to vital structures. The patient underwent successful surgical removal of the arrowhead. Knowledge of the various principles of management of such injuries is key to a successful outcome.

Medical intervention procedures are never complication-free. Even after years of refinement in techniques and laying out protocols and checklists, errors do occur. Most of them are preventable, but not all of them. In such cases, efficient and timely diagnosis and management of complications is a key to a successful outcome. In this case series, we describe three situations of complications due to guidewire used in central venous cannulations and different approaches toward their successful management.

An aneurysm of the abdominal splanchnic artery is a relatively rare vascular disorder. Since it is characterized by nonspecific clinical manifestations, an aneurysm in this uncommon location is usually diagnosed following complications. A 55-year-old female presented with a pulsatile lump in her right iliac fossa. Contrast-enhanced computerized tomography diagnosed it as aneurysm of the superior mesenteric artery (SMA). However, on exploration, SMA was found to be free, and the aneurysm was seen to be arising from the ileocolic artery ending in the appendicular branches. Ligation followed by excision of the sac along with the cecum and appendix was done followed by ileoascending anastomosis. Isolated aneurysms of the SMA branches are rare. Most cases are diagnosed after the occurrence of complications. Due to the high risk of rupture and ligation, they can interrupt the circulation to the target organs, and therefore, surgery is indicated even in the absence of complications.

We describe the use of a novel interventional approach to the histopathologic diagnosis of a ventricular septal tumor using intraoperative ultrasound-guided trans-epicardial biopsy without the need for cardiopulmonary bypass in a 2-year-old child. This novel approach has not been previously reported. Multidisciplinary collaboration between cardiothoracic surgery, cardiology, cardiac imaging, and interventional radiology provided the ability to perform cardiac biopsy. This technique may be used in specific cases of cardiac tumors where tissue diagnosis is important, but surgical resection is deemed excessively risky or impossible.

Movement disorder, although rare, is increasingly being recognized as the initial presenting sign of the hyperglycemic state. Although chorea-ballism has frequently been reported among diabetics, monoballism is a very rare phenomenon. While myoclonus is common, diaphragmatic myoclonus is extremely rare. Moreover, diaphragmatic myoclonus as the initial presenting manifestation has never been reported before. Herein, we report an index case of a 62-year-old previously undiagnosed diabetic lady presented with acute onset constellation of multiple abnormal movements viz. monoballism, focal myoclonus, action myoclonus, and diaphragmatic myoclonus. All of them disappeared with achieving normoglycemia. This case underscores the importance of rapid capillary blood glucose testing in any patient presenting with acute onset abnormal movements. This approach can especially be rewarding as it helps in the rapid diagnosis of a reversible catastrophe and avoiding unnecessary costly investigations.

Jaw clonus, a fascinating, yet uncommon clinical sign, is suggestive of supranuclear lesions of the trigeminal nerve. It has previously been reported in association with amyotrophic lateral sclerosis. Hereby, we report an index case of jaw clonus in a patient of neuromyelitis optica spectrum disorder with subsequent osmotic demyelination syndrome with pseudobulbar palsy due to the involvement of pontine corticobulbar fibres.

Background: Overweight among adolescents has high prevalence on the eastern part of India, especially West Bengal. Objectives: The current study was conducted to estimate and compare the effects of different dietary habits and habits related to physical activity in the development of overweight and obesity among rural schoolgoing adolescents. Methods: A prospective repeated measures study was conducted on 645 schoolgoing adolescents from selected rural government-aided schools from June 2017 to December 2017. Dietary habits of the students and physical activity-related factors were the major predictors. Adjusting for the age and sex of the participants, effect of these factors on the development of overweight and obesity was analyzed by generalized estimating equations for 2 repeated measures, taken 6 months apart. Results: Most of the respondents were aged ≥16 years (56.90%), female (52.87%), Hindu (76.74%), from a nuclear family (76.74%), and studying in the secondary level (57.68%). There was a stark rise in proportion of overweight from 0.93% to 7.44%. The prevalence of unhealthy dietary habits was 68.99% at the baseline, and 66.82% on follow-up. The overall prevalence of inadequate physical activity increased to 48.68% from 47.91%. Female gender and older age group were at higher risk of being overweight or obesity. Overall fast food showed highest risk (3.04, 95% confidence interval [CI]: 1.86–4.95), while among the boys, it was with less vegetable consumption (4.64, 95% CI: 1.84–11.69). Conclusions: Strong evidence was generated of dietary practices being more rigidly related to overweight among the adolescents. Healthy dietary practices coupled with physical activity should be promoted to mitigate the risk of obesity.

Background: Monthly weight gain (weight velocity) is important in early infancy, with several factors affecting and interacting within the healthy-born children. The current study aims to estimate on the effects of different factors on the trend of weight gain during the first 6 months of life. Methods: A longitudinal (repeated-measures) study was conducted on the 42 nonlow birth weight healthy children born in selected rural areas during December 2016. Infant feeding attitude, effective breastfeeding, timely feeding, and episodes of diarrheal illnesses were the major predictors along with the age of the children on the weight velocity in a sex-dependent repeated-measures analysis using Generalized Estimating Equations. Results: Mothers of the children were mostly below the mean age of 20.1 years (60.905%), majority being homemakers (71.429%). Majority (73.809%) had a better infant feeding attitude. The mean birth weight for male infants was 2.941 (±0.299) kg and females 2.938 (±0.352) kg. Age of the child, birth weight, timely feeding, and episodes of diarrheal illnesses had statistically significant effect on monthly weight gain. Feeding breast milk only proved advantageous for males. Conclusions: Effectively, only breastfeeding, timely feeding, and prevention of diarrheal episodes were the most important recommendations at the field level.

BACKGROUND: For any effective vaccination strategy, the willingness of the beneficiaries and its contributing factors are important. This study was conducted among the health-care workers (HCWs) and community members to find the perceptions regarding the COVID-19 vaccine and understand the influencers and the barriers of vaccine acceptance. MATERIALS AND METHODS: A qualitative study was conducted from October 2020 to December 2020 in two primary care settings in an urban area. Eighteen in-depth interviews (IDIs) after taking consent were conducted with the help of IDI guide developed and validated beforehand by the experts. IDIs were done among the ten community members and eight HCWs selected conveniently. Data collection were continued till data saturation when no new information yielded from the interviews. Thematic analysis was performed. RESULTS: All the participants were hopeful about availability of the vaccine. The key influencers identified for promoting willingness to accept the vaccine among both the groups were opinion of the health-care providers, colleagues' and other people's acceptance of the vaccine, effectiveness of vaccine on other people, and perceived risk of the disease. Fear of adverse reactions was the most important barrier among all the respondents. The prevalent perception was that other preventive practices and vaccine together can only be the best solution to prevent COVID-19 illness. The HCWs perceived that acceptance of vaccine among the community members would be good overall but apprehended some initial difficulties. Mass campaign to promote COVID-19 vaccination and sensitization events are the need of the hour. CONCLUSIONS: Since opinion of health-care personnel emerged as an important influencer of vaccine acceptance, mass campaign and sensitization programs spearheaded by the health-care providers can bring about change by increasing the vaccine acceptance among the beneficiaries at large. Re-enforcement regarding practice of preventive measures should be made among the population irrespective of the vaccination status.

BACKGROUND: Healthy children are the foundation for a healthy and developing nation. Perceived behavioral control (PBC), comprising control belief and perceived power, is a person's perception of the ease or difficulty of performing the behavior of interest. For facilitating regular physical activity and regular healthy dietary practices among the adolescents, PBC is an important construct to develop and implement appropriate interventions. The aim is to assess PBC to perform regular physical activity and regular healthy dietary practices and measure their statistical relationship among the school-going adolescents in an urban area in West Bengal. MATERIALS AND METHODS: A school-based cross-sectional study was conducted among 251 adolescents aged 12–16 years after taking consent and assent for participation in the study. Data were collected with self-administered questionnaire on sociodemographic variables and the two domains of PBC, i.e., control beliefs and perceived power, related to regular physical activity and regular healthy dietary practices. Each PBC total score was calculated by multiplying control belief score and perceived power score for each respondent. Partial correlation coefficient was calculated between regular healthy dietary practices and regular physical activity. RESULTS: Among the total 251 responses analyzed, 34.7% and 27.5% students belonged to age group 14 and 15, respectively. It was observed that the mean (± standard deviation) score of PBC regarding regular healthy dietary practices was 100.7 (±27.7) and for regular physical activity was 106.0 (±21.4). The correlation between PBC of regular healthy dietary practices and regular physical activity was 0.421 and was statistically significant. CONCLUSION: In case PBC score over any behavior is higher, behavioral intention and ultimately chances of performing that particular behavior increases. Designing appropriate school-based health promotion strategies can lead to healthier children fostering regular healthy dietary practices and regular physical activity in their homes and communities.

Background: Unintentional injuries have become a major noncommunicable disease burden, especially among the adolescents. Objective: The current study was conducted to estimate the effect of different aspects of daily activities of adolescence for sustaining serious unintentional injuries in the past 1 year. Methods: A cross-sectional survey with multistage sampling with validated pretested questionnaire was done among the school-going adolescent boys in Kolkata. Poisson regression was used to model the counts of serious injuries. To account for the excess of zero in the outcome, zero-inflated Poisson regression was performed. Results: Among the participants, 73.5% did not report any serious unintentional injury sustained in the past 1 year, 11.9% reported to have sustained serious unintentional injury once in the past 1 year, and rest had more than one count. Statistically significant higher chance of sustaining an episode of injury was found among frequent users of motorbike (incidence rate ratio [IRR]: 1.183), frequently walking on roads (IRR: 1.910), and frequently crossing major roads on bicycle (IRR: 2.181) were observed. A statistically significant protective rate ratio was also obtained for those frequently obeying traffic signals while crossing roads (IRR: 0.493) and frequent users of bicycles (IRR: 0.384). Significantly lower rate ratio for sustaining a serious injury was observed with frequently getting into fight at home (IRR: 0.343) and getting beaten up at school (IRR: 0.595). Conclusions: The study revealed traveling in a car and obeying traffic rules were protective from sustaining serious injury. However, walking and participation in sports appeared to be risky, especially for sustaining another episode of serious injury.

Surgical management of unilateral iliac artery occlusion commonly involves a femorofemoral graft or an aortofemoral graft. We report two cases of atherosclerotic common iliac artery occlusion, one on the left and another on the right, wherein we did a crossover graft to the external iliac artery from the opposite common iliac artery through a single skin incision. The approach and graft placement in both the cases were completely retroperitoneal. Both these patients had an adequate recovery with complete relief of symptoms. This approach has the benefit of avoiding multiple incisions and incisions in the groin area, which tends to get infected easily and is associated with other complications such as lymphorrhea.

Stable angina is managed primarily through lifestyle advice, medication therapy, and coronary revascularization procedures. Some patients with refractory angina exhibit symptoms that are not optimally controlled with the optimal medication and revascularization options available. Enhanced external counterpulsation (EECP) is a technique that can be used to improve symptoms in chronic stable angina. However, the role of EECP has also been investigated following positive outcomes in patients with both angina and heart failure in multicenter studies. We performed a systematic review of the evidence of the clinical effectiveness of EECP. EECP has been approved by the United States Food and Drug Administration (FDA) for the management of refractory angina (Class IIb). About 200 hospitals across India have adopted this technique. EECP uses three sets of pneumatic cuffs that sequentially contract during diastole, increasing aortic diastolic pressure, augmenting coronary blood flow, and central venous return. EECP improves anginal symptoms and exercise tolerance, and reduces nitroglycerin use in patients with chronic, stable angina. EECP has also been shown to be safe and beneficial in patients with symptomatic stable congestive heart failure. It has been postulated that cardiac benefits of EECP are mediated through vascular endothelial growth factor, and nitric oxide-mediated vasodilatation and angiogenesis. In June 2002, the FDA also approved EECP therapy for heart failure patients. EECP is cost-effective if the observed quality of life benefits are assumed to continue throughout a patient's lifetime. However, there remain uncertainties around the long-term effects of the intervention.