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Background: Poor dental health status has been suggested to negatively impact the food selection, ultimately leading to malnutrition. Objective: This study was undertaken to assess the association of dental health and nutritional status among elderly subjects in India. Methodology: A community-based cross-sectional study was conducted during 2015–2016 in district Nainital, Uttarakhand state, India. A total of 1003 elderly population were enrolled from 30 clusters (villages) identified using population proportionate to size sampling methodology. Information on sociodemographic profile and anthropometric measurements was collected. Body mass index (BMI) and Mini Nutritional Assessment scale (MNA) were calculated for assessment of nutritional status. A trained professional assessed the dental health status through physical examination. Dietary intake data was collected using 24-h dietary recall methodology. Results: We found that the prevalence of complete edentulism was 11%. Use of dentures was reported among only 9.6% subjects who were completely edentulous. Prevalence of underweight as defined by BMI and malnutrition as defined by MNA was higher among subjects with complete loss of teeth complete loss of teeth and chewing problems chewing problems and who did not wear dentures when compared with others. Subjects who wore dentures had significantly lower prevalence of malnutrition when compared with subjects who did not wear dentures. Conclusion: Dental health status was significantly associated with poor nutritional status among elderly subjects in India. There is a need for providing restorative dental healthcare services to elderly population to improve their nutritional status. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy is a significant problem in the elderly. The veteran population is unique in terms of better access to health-care services and higher educational qualifications. However, the studies to assess the burden and effects of polypharmacy in this cohort are rare. Hence, the research was done to find the prevalence of polypharmacy in the veteran population. Methods: In this cross-sectional observational study, we included veterans with more than 35 years visiting the medical outpatient department. All participants were interviewed about polypharmacy after taking informed consent. Results: Out of 394 patients included in the study, 110 were prescribed five or more medicines for their illnesses (27.91%: 95% confidence interval [CI] 21.1%-30%). More than 95% (377/394) of the study participants were unaware of the concept of polypharmacy. There was high compliance to treatment in veterans (97.46%, 95% CI 95.1%-98.6%). Conclusion: This study shows that the prevalence of polypharmacy is significant in veterans, including patients in their fourth and fifth decades of life, despite fewer morbidities. [ABSTRACT FROM AUTHOR]

Paediatric airway tumours can prove to be quite challenging for anaesthesiologists. We attempted to secure airway in a toddler with a large tongue haemangioma using total intravenous anaesthesia (TIVA) with dexmedetomidine and propofol while preserving spontaneous ventilation. [ABSTRACT FROM AUTHOR]

Introduction: Recently, an increasing trend in the prevalence of pediatric metabolic syndrome (PMS) among school-age children has been documented in different parts of India. There is lack of data on the prevalence of PMS and its associated risk factors among school-age children living in district Shimla, Himachal Pradesh. Hence, to fill in the gap in the existing knowledge, the present study was conducted. Methodology: A cross-sectional study was conducted during 2015-2016. Thirty clusters (schools) were identified from a list of all schools using population proportionate to size sampling methodology. From each school, 70 children in the age group of 10-16 years were selected. Data was collected on the sociodemographic characteristics, anthropometry, waist circumference, blood pressure, and physical activity. Fasting venous blood samples were collected for estimation of blood glucose, triglycerides, and high-density lipoprotein levels. Results: The prevalence of PMS using International Diabetes Federation classification was 3.3% and using modified-adult treatment panel classification criteria was 3.5%. Risk factors identified to be associated with PMS among school-age children were (i) male gender, (ii) high family monthly income, (iii) sedentary lifestyle, (iv) consumption of evening snack, (v) television/computer viewing, and (vi) motorized transportation for commuting to school. Conclusion: The PMS prevalence was 3.3% in school-age children residing in District Shimla. There is a need to formulate interventions to prevent and correct metabolic syndrome among them for reducing early onset of cardiovascular disease during adulthood. [ABSTRACT FROM AUTHOR]

The geriatric population is at a high risk of developing deficiencies of essential micronutrients such as minerals, vitamins, and trace elements and their related deficiency signs and symptoms. Scarce data is available on the dietary intake of essential micronutrients among geriatric subjects in India. Hence, to fill the gap in the existing knowledge, a community-based cross-sectional study was conducted during 2015-2016 in District Nainital, Uttarakhand State, India. A total of 255 geriatric subjects were enrolled from 30 clusters (villages) identified by using population proportionate to size sampling methodology. Data were collected on sociodemographic profile and dietary intake of essential micronutrients (24-h dietary recall, food frequency questionnaire) from all the geriatric subjects. A high percentage of geriatric subjects did not consume the recommended daily intake for essential micronutrients such as energy (78%), protein (78%), calcium (51%), thiamine (33%), riboflavin (64%), niacin (88%), vitamin C (42%), iron (72%), folic acid (72%), magnesium (48%), zinc (98%), copper (81%) and chromium (89%) adequately. Food groups rich in essential micronutrients such as pulses, green leafy vegetables, roots and tubers, other vegetables, fruits, nonvegetarian food items, and milk and milk products were consumed irregularly by the subjects. The overall intake of energy and essential micronutrients was inadequate among the geriatric population in India, possibly due to poor quality and quantity of the diet consumed. [ABSTRACT FROM AUTHOR]

Lipids are complex organic molecules that fulfill energy demands and sometimes act as signaling molecules. They are mostly found in membranes, thus playing an important role in membrane trafficking and protecting the cell from external dangers. Based on the composition of the lipids, their fluidity and charge, their interaction with embedded proteins vary greatly. Bacteria can hijack host lipids to satisfy their energy needs or to conceal themselves from host cells. Intracellular bacteria continuously exploit host, from their entry into host cells utilizing host lipid machinery to exiting through the cells. This acquisition of lipids from host cells helps in their disguise mechanism. The current review explores various mechanisms employed by the intracellular bacteria to manipulate and acquire host lipids. It discusses their role in manipulating host membranes and the subsequence impact on the host cells. Modulating these lipids in macrophages not only serve the purpose of the pathogen but also modulates the macrophage energy metabolism and functional state. Additionally, we have explored the intricate pathogenic relationship and the potential prospects of using this knowledge in lipid-based therapeutics to disrupt pathogen dominance. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the clinical efficacy of masking the odor of inhalational agents using fruit flavors on the anxiety behavior and compliance of children for inhalational induction.Methods: A prospective randomized double blind, placebo controlled study was conducted on 60 unpremedicated children in the age group of 4-12 y. Thirty children received anesthetic masks smeared with a flavor of child's choice while the other 30 children were induced using masks without flavor. Anxiety was assessed using modified Yale Pre-operative Anxiety Scale (mYPAS) in the pre-op room and during inhalational induction. Mask acceptance was graded by Induction Compliance Checklist (ICC). The cost-effectiveness of flavored anesthetic masks was compared to that of commercially available pre-scented masks.Results: The baseline anxiety in the two groups was comparable. The number of children demonstrating high levels of anxiety at anesthetic induction was similar in flavored and non-flavored mask groups (p 0.45). The compliance to mask induction was also equally good (p 0.99). The authors found significant difference in the cost of flavored mask (INR 56.45 per mask) as compared to commercially available pre-scented masks (INR 660 per mask).Conclusions: The authors observed a placebo effect that reduced the pre-op anxiety in the control group which probably made the quality of induction equivalent with flavored and non-flavored masks. Therefore, using a flavored anesthetic mask is cost-effective than using a commercially available pre-scented mask. [ABSTRACT FROM AUTHOR]

Background/Objectives Although skin disease and skin cancers cause significant morbidity and mortality in Australia, limited time is dedicated to dermatology teaching in most medical courses. The aim of this study was to define the current state of dermatology teaching in Australian medical schools with a view to developing a national core curriculum for dermatology. Methods An electronic questionnaire was circulated to the dermatology teaching leads and relevant medical program coordinators of the 18 medical schools in Australia. Results Replies were received from 17 medical schools. Dermatology was included as part of the core curriculum in 15 schools. Time set aside for dermatology teaching varied, as reflected by the number of lectures delivered (0-21, mean 5, median 3) and minimum clinics attended (0-10, mean 1.2, median 0). Only four medical schools had a compulsory clinical attachment in dermatology. Furthermore, satisfying requirements in dermatology was mentioned in the university examination regulations in only six schools. Certain core learning outcomes were addressed in most schools, including the structure and function of the skin, common conditions such as atopic dermatitis and psoriasis and cutaneous malignancies. However, there were important omissions, ranging from common problems like dermatophyte infections and drug reactions to the recognition of dermatological emergencies. Conclusions These results are a compelling impetus to improve current standards of dermatology teaching, learning and assessment. The introduction of a national core curriculum would provide guidelines for dermatology teaching in medical schools, enabling the more effective utilisation of available time for key learning outcomes. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of vitamin B12 and folate deficiencies among children residing at high altitude regions of Himachal Pradesh, India.Methods: A total of 215 school children in the age group of 6-18 y were included. Biochemical estimation of serum vitamin B12 and folate levels was undertaken using chemiluminescence immunoassay method. The consumption pattern of foods high in dietary vitamin B12 and folate was recorded using Food Frequency Questionnaire.Results: The median levels (interquartile range) of serum vitamin B12 and folate were 326 (259-395) pg/ml and 7.7 (6-10) ng/ml respectively. The prevalence of vitamin B12 and folate deficiency amongst school age children was found as 7.4% and 1.5% respectively.Conclusions: A low prevalence of vitamin B12 and folate deficiencies was found amongst children aged 6-18 y living at high altitude regions in India. This is possibly due to high frequency of consumption of foods rich in vitamin B12 and folate. [ABSTRACT FROM AUTHOR]

Background: National Family Health Survey (NFHS) documented that nearly 5.8 million children (6.4%) are undernourished in India which is l/3rd of the world's share. Objective: i) To assess the concomitant prevalence of severe wasting, severe stunting and severe underweight among children 6-59 months in a rural population of Northern India. Methods: A cross-sectional study was conducted in 2 blocks of district Meerut, Uttar Pradesh during 2013-2015. A total of 70 villages were included and all children in the age group of 6-59 months were covered by house to house visits. Data on socio-demographic profile and anthropometry was collected utilizing standards methods and equipment's. The Z-scores for weight-for-height (WFH), height-for-age (HFA), and weight-for-age (WFA) were calculated using WHO child growth standards. Results: A total of 19449 children in the age group of 6-59 months from house to house survey were approached. Out of 19449 children, 464 children were excluded due to erroneous age estimation; knock knees; physically handicapped and spinal deformities. Thus, 18985 children were enrolled for the present study. The weight, height and age were available for 18474, 18595 and 18983 children. The prevalence of severe wasting, severe stunting and severe underweight was found to be 2.2%, 16.2% and 12.2%, respectively. Concomitant presence of severe wasting, severe stunting and severe underweight was found in 0.9% (171/18,463) children. Conclusion: High prevalence of severe wasting, severe stunting and severe underweight was found in children from district Meerut indicating poor nutritional status. [ABSTRACT FROM AUTHOR]

Background: Optimal infant and young child feeding (IYCF) practices during first 2 years of life is the key to ensuring optimal growth and development of the infant. Improving IYCF practices have an important role in reducing morbidity and mortality amongst under 5 children in India. Material & Methods: The secondary data from National Family Health Survey (NFHS)-3 and NFHS-4 was analyzed. Objective: To assess the trend in IYCF practices during 2005 -- 2015 for 13 selected states of India. Results: It was found that over a decade, there has been an improvement in early initiation of breast feeding and exclusive breastfeeding for 6 months amongst infant in 11 out of 13 states. However, a reduction in the timely initiation of complementary feeding amongst children in the age group of 6-8 months has been observed in 9 out of 13 states. Conclusion: There is a need to strengthen the efforts to further improve the IYCF practices in India for reducing high rates of undernutrition in the country. [ABSTRACT FROM AUTHOR]

Perineural invasion ( PNI) occurring in non-melanoma skin cancers ( NMSC) is associated with an increased risk of locoregional recurrence and reduced disease-free survival. This necessitates early and accurate diagnosis, appropriate risk-stratification and a clear management strategy. The diagnosis of PNI is based on careful clinical assessment, imaging and histopathology. Surgery, preferably with margin control, and definitive or adjuvant radiotherapy ( ART) are established treatment strategies for PNI. Clinical uncertainty remains over the role of ART in incidental PNI. This review synthesises current literature to ascertain which clinicopathological features impart a higher risk to individuals with PNI in NMSC, in order to provide treatment algorithms, including the identification of patient subsets that are most likely to benefit from ART. This includes those with extratumoural PNI, involvement of larger-calibre nerves, tumour invasion beyond dermis, recurrent tumour or diffuse intratumoural spread. Patients with clinical PNI may be optimally managed by a multidisciplinary head and neck cancer service that is best placed to offer skull base surgery and intensity-modulated radiation therapy ( IMRT). The management options presented are stratified by histological subtype and a new classification of PNI into low-risk, medium-risk and high-risk groups. [ABSTRACT FROM AUTHOR]

The ability to use indirect cyanmethemoglobin method using 20 µl of dried blood spots (DBSs) on filter paper for the analysis of haemoglobin (Hb) levels could be an important diagnostic tool for areas that have limited access to laboratory facilities. We assessed the validity of a method for Hb estimation in which a single drop of whole blood was directly taken on the filter paper. We collected 124 DBSs containing 20 µl of blood (filter paper A) and single drop of whole blood (filter paper B) from subjects living in Nainital, Uttrakhand. Estimation of Hb was done by indirect cyanmethemoglobin method in both the filter papers. A correction factor for predicting value of Hb from DBSs of single drop of whole blood was established. The Bland-Altman plot suggested that the difference in Hb values obtained by the single drop of blood and 20 µl of DBSs was within the 1.5 SD limits, suggesting high validity of the correction factor. The estimation of Hb using single drop of whole blood on filter paper after applying the correction factor provides results similar to indirect cyanmethemoglobin method using 20 µl of blood. Hence, single drop of whole blood on filter paper can be used as an alternate method for estimation of Hb in large scale community surveys. [ABSTRACT FROM AUTHOR]

Wood frogs (Rana sylvatica) experience months of whole-body freezing during winter. Anoxia is one of the side stresses along with cell dehydration and hyperglycemia. Among multicellular organisms, communication and coordination is essential between neighbouring cells, particularly under stress conditions. Notch signaling is an effective communication channel between cells and regulates multiple pro-survival pathways. Signaling initiates when membrane-bound ligands Delta-like (DLL) or Jagged (JAG) interact with notch receptors. Activated receptor undergoes cleavage to release intracellular domain (NICD) in the cytoplasm. NICD translocates to the nucleus and forms a transcriptional complex with MAML and RBPJ that interacts with promoter regions and activates stress-specific genes. The role of notch signaling in enduring anoxia was assessed by studying the pathway components using immunoblots, TF-ELISA, and qPCR on treated samples of liver and heart. Bioinformatics tool Pymol was used to prepare structures based on available protein sequences for ligands, NOTCH receptor and the transcriptional complex. The results showed an increase in the levels of both ligands and receptors but decreased levels of RBPJ, suggesting an effective transmission of stress signal but suppressed gene transcription that goes in accordance with lowering energy expense required in energy crisis during anoxia. The study suggests Notch-independent activation of HES1 and HES5. Tissue-specific response of HES1, HES5, and MAML implies energy conservation and myocardial protection. The current study is the first analysis of the regulation of notch signaling in amphibians on encountering anoxic conditions that present multiple future directions. [Display omitted] • Notch1 and Notch2 represent stress specific role in anoxia/recovery. • DLL4-NOTCH1 signaling provides immune response in liver via macrophage activation. • Decreased levels of RBPJ suggest suppressed gene transcription to lower energy expense. • MAML and HES5 shows "functional switching" to activate MyoD for myocardial protection. • HES1 controls glucocorticoid regulated carbohydrate metabolism to conserve energy. [ABSTRACT FROM AUTHOR]