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Abstract This study investigates the qualitative analysis of groundwater obtained from the Tonk district of Rajasthan to determine its suitability as potable water. Around 321 ground drinking water samples were collected and analysed for various physico-chemical characteristics including pH, electrical conductivity (EC), total dissolved solid (TDS), HCO3−, F−, Cl−, SO4 2−, NO3 −, Ca2+, Mg2+, total hardness (TH) and total alkalinity (TA) in Tonk district of Rajasthan (India). The groundwater in the region is a little alkaline and hard. The EC during the pre-monsoon period varies from 434 to 7271 µS/cm, while in the post-monsoon period, it ranges from 356 to 8871 µS/cm. TDS of samples ranged between 285 to 5090 mg/L in the pre-monsoon and 247 to 6140 mg/L post-monsoon seasons. Few samples have EC, TDS, and TH levels higher than the permissible limit, restricts its usage as drinking water. The water quality in the study area varies from soft-fresh to hard-brackish in both pre- and post-monsoon seasons. Anion concentrations in analysed samples followed the order: HCO3 − > Cl− > SO4 2− > NO3 − > F−. Notably, the Water quality index (WQI) results for all collected samples fall within the range of 4.55–96.83, indicating they are considered safe and suitable for drinking purposes. Water quality data was analysed by correlation study and geochemical processes. A strong correlation between the Water Quality Index (WQI) and fluoride levels is found in both seasons. The geochemical analysis shows that most of the samples are in the rock water interaction zone, with some in the evaporation zone due to the high content of chloride ions. The groundwater chemistry appears to be influenced by rock-water interaction and evaporation sedimentation. The molar ratio of Ca2+/Mg2+ denotes calcite dissolution and silicate weathering revealing enrichment of Ca2+ and HCO3 − ions in aquifer.

Background: Ovarian torsion accounts for 1%–6% of surgical treatment for adnexal masses. Its incidence rises during pregnancy but is rare, and there are varied predisposing factors. However, the etiology remains unknown. Materials and Methods: The cases of ovarian torsion over 2 years (2020–2022) at MGM Women’s Hospital, Kalamboli, Navi Mumbai, India, have been reported duly reviewed retrospectively. Results: Twelve of eighteen adnexal torsions occurred in the right adnexa (67%). Of the four pregnant patients, three had a right-sided adnexal torsion (75%). Right anticlockwise adnexal torsion was the most common entity noted. The most common types of ovarian cysts are dermoid cysts and serous cystadenomas, corresponding to this study, with 77.8% of the cases having either histopathological findings. Conclusion: Ovarian torsion is an urgent gynecological condition that needs prompt intervention. Modalities such as laparotomy, laparoscopy, or conservative management with detorsion can be the treatment of choice. Maximum adnexal torsion occurs on the right side. A large amount of right-sided adnexal torsion has rotation anticlockwise manner, whereas most left-sided adnexal torsion spin clockwise.

Background: Dermatophyte infections are one of the first known fungal infections of humankind and are most common throughout the world. The antifungal therapies over the past 30 years have improved, but the phenomenon of antifungal resistance is still of major concern. Combination therapies can show great promise in overcoming this problem to broaden the spectrum of activity, enhance the rate or extent of killing, and minimize the development of resistance. Objectives: To find out the therapeutic efficacy of itraconazole versus itraconazole with terbinafine for the treatment of dermatophytosis. Materials and Methods: A prospective study was conducted for a duration of 1 year on 64 patients diagnosed with dermatophytosis and was randomly divided into two groups. Group A was given oral itraconazole whereas Group B received oral itraconazole and oral terbinafine for 4 weeks along with levocetirizine daily for 2 weeks and miconazole 2% topically for 6 weeks. The measurability criteria were done on detailed clinical examination (itching, erythema, size, number, scaling, and margin) and through photographic assessment. Results: The mean difference and standard deviation of total scores for group A were 10.12 ± 4.09 and for group B were 9.94 and 3.75, respectively. The P value was not significant (P = 0.78). Out of 64 cases, 3 (5%) patients complained of gastric discomfort, 2 (3%) patients complained of nausea, and 1 (1%) of dizziness. Conclusion: This study revealed that there was a highly significant improvement in both groups with no significant difference in their clinical criteria.

Cutaneous Crohn's disease (CD) usually manifests with underlying inflammatory bowel disease (IBD) and may precede, present simultaneously, or even manifest years later to the IBD. Cutaneous involvement in CD may be due to metastatic or contiguous spread from the underlying focus. Cutaneous manifestations of CD may be specific with histopathologically consistent diagnosis or nonspecific reactive processes. Specific cutaneous findings may be considered sine qua non of the diagnosis. Hidradenitis suppurativa (HS) is a disease of follicular occlusion found to be associated with IBD, especially CD. The concurrence of cutaneous Crohn's (CC) without apparent bowel involvement and HS simultaneously or sequentially as two independent processes has rarely been reported. When either of the diseases clinically superimposes on the other, the judgment of the clinician regarding diagnosis is often jeopardized due to almost similar spectrum of cutaneous lesions in both diseases. Herein, we are reporting a rare clinical scenario where there is co-occurrence of CC without apparent bowel involvement and HS.

Background: Management of chronic spontaneous urticaria (CSU) is challenging because of its unpredictable course and negative influence on the quality of life. Second-generation antihistaminics are the first-line treatment. Levocetirizine, a time-tested antihistaminic, has proven efficacy in CSU. Bepotastine, which was previously used for allergic rhinitis and conjunctivitis, has recently been tried in urticaria. It may be a better alternative to levocetirizine because of its long-term safety. Objectives: The aim of this study was to compare the efficacy and safety of levocetirizine and bepotastine in CSU. Materials and Methods: A randomized, active-controlled, open-label, prospective, interventional study was conducted on 70 patients of CSU. After initial clinical assessment and baseline investigations, bepotastine and levocetirizine were prescribed to separate groups of 35 patients for a period of 12 weeks. Urticaria Activity Score (UAS) and Dermatology Life Quality Index (DLQI) were used for assessing the severity of disease. Follow-up visits were planned for evaluating clinical improvement and adverse effects. Results were compared using Mann–Whitney U test and Fisher's exact test. P < 0.05 was considered statistically significant. Results: The reduction in UAS and DLQI score in levocetirizine group was better than bepotastine group, and the results were statistically significant at 12 weeks (P = 0.0001). Incidence of adverse effects such as sedation and weight gain was higher in levocetirizine group at 12th week (P = 0.0003). Conclusion: The result of the study reveals the superiority of levocetirizine in terms of efficacy, i.e., reduction of UAS and DLQI scores. Bepotastine although slightly lower in efficacy shows better safety profile.

Tuberculosis (TB) may involve cutaneous tissue in approximately 0.1%–0.5% of the cases. There are various morphological presentations of cutaneous TB such as lupus vulgaris (LV), scrofuloderma, TB verrucosa cutis, and tuberculids. Usually, a single form is observed in an individual, but coexistence of the multiple forms has been rarely reported in the literature. These concurrences may be considered an interesting immunological phenomenon as two immunologically different poles are occurring simultaneously. We present a case of LV and scrofuloderma in the same patient at different sites.

Research on attitudes within higher education toward undocumented students has overlooked the views of postdoctoral scholars (postdocs). With the number of postdocs in the United States on the rise, this highly trained group matters for future leadership inside and outside of higher education. Since previous research has shown that individuals of minoritized races/ethnicities and non-U.S. citizens exhibit greater support for undocumented students (Garibay et al., 2016; Jach & Gloeckner, 2020), this study conducted individual interviews with 10 postdocs who identified as White U.S. citizens. Findings indicated postdocs with a personal or professional connection to undocumented students exhibited greater levels of support toward undocumented students. Those lacking these connections exhibited greater levels of White immunity (Cabrera, 2017) and what this study terms citizenship immunity. Postdocs also expressed a need for adult education to better support undocumented students yet articulated possible strategies for engaging in allyship, suggesting postdocs have the power to counteract negative rhetoric and work toward a more inclusive policy for undocumented students.

Today, information security world is witnessing frequent attacks on electronic records by the naive and professional hackers and crackers. Security of Patient’s Electronic Medical Record (EMR) in Hospital Management System is of paramount importance and so warrants immediate attention. In this research work, BlockChain containers running on multiple ports are proposed to be used for holding patient’s medical records. To perform this task effectively, a BlockChain framework named as “Medichain” was developed from scratch that contains all basic functionalities of a BlockChain to secure patient’s data. Each block of the BlockChain keeps a list of records of patient details. Users would be provided with an option of uploading the file containing the list of records as a JSON file, in a decisive, distributed and decentralized network. The proposed BlockChain Algorithm, consisting of cryptographic hash of the records, proof of work and a Merkle tree formulation, were simulated in Python. Results have been positive and encouraging.

Uterine malformations can result from various alterations in the normal development of Mullerian ducts that make up a diverse category of congenital anomalies. In most cases, the defect remains undiagnosed and exhibits the normal number of chromosomes. Very few malformations require any intervention after thorough investigations. The most frequently used classification by the American Society for Reproductive Medicine is comprehensive, but does not include cervical or vaginal malformations. The European Society of Human Reproduction and Embryology has postulated a consensus that precisely shows independent cervical malformations.

Background: Patients with recurrent urinary tract infections (rUTI) experience frequent exposure to antimicrobial regimens, leaving them at higher risk for developing antibiotic resistance. Little information on the prevalence of antibiotic resistance among patients with rUTI has been published. Although the IDSA recommends using a prior culture to guide empiric treatment, studies have not examined the predictive ability of a prior culture among patients meeting rUTI criteria. We constructed an antibiogram and evaluated test metrics, including sensitivity, specificity, and positive predictive value (PPV) and negative predictive values (NPV) of a prior culture (any organism), on predicting resistance (PPV) or susceptibility (NPV) of a future culture among patients with uncomplicated rUTI in an outpatient setting. Methods: We retrospectively extracted electronic health record data from outpatients aged ≥18 years who had an ICD-10 code for cystitis listed twice in 6 months or thrice in 12 months between November 1, 2016, and December 31, 2018. Patients sought care at either urology or primary care practices within an academic medical center in Houston, Texas. Patients with functional or structural abnormalities of the genitourinary tract, signs or symptoms of pyelonephritis, or pregnancy were excluded. Antibiogram data were reported for uropathogens with ≥30 isolates, and intermediate results were considered resistant. Test metrics and Bayes’ PPV and NPV were calculated using standard formulas. Results: We included 597 visits from 232 unique patients. Most were White (63%) and female (92%), and the cohort had a median age of 58 (IQR, 41–68). Among 310 rUTI episodes with a urine culture, 189 (61%) had at least 1 uropathogen isolated, and Escherichia coli (n = 130, 66%) was most common among all 196 uropathogens. E. coli isolates had >20% resistance to 10 of 18 antibiotics (Fig. 1). E. coli resistance to ciprofloxacin was 27.9%, resistance to nitrofurantoin was 5.5%, and resistance to trimethoprim-sulfamethoxazole was 38.0%. The PPVs for predicting resistance were highest for ceftriaxone (0.86; 95% CI, 0.60–0.96), ciprofloxacin (0.84; 95% CI, 0.63–0.94), and levofloxacin (0.84; 95% CI, 0.63–0.94). NPVs of resistance were highest for gentamicin (0.97; 95% CI, 0.83–1.00), ceftriaxone (0.94; 95% CI, 0.86–0.98), and cefepime (0.94; 95% CI, 0.84–0.98), whereas NPVs for cefuroxime, ciprofloxacin, levofloxacin, and nitrofurantoin were all >0.83. Conclusions: We detected considerable antibiotic resistance among patients with rUTI to commonly prescribed antibiotics. Prior urine culture susceptibility demonstrated moderate-to-high PPVs for predicting future resistance to ceftriaxone and fluoroquinolones as well as high NPVs for several cephalosporins and fluoroquinolones, which could inform empiric prescribing choices.

Prophylaxis against spontaneous bacterial peritonitis (SBP) is recommended for select patients with cirrhosis, but long-term antibiotic therapy has risks. We evaluated concordance with guideline recommendations in 179 veterans with cirrhosis; 55% received guideline-concordant management of SBP prophylaxis. Despite stable guideline recommendations since 2012, guideline adherence remains low.

Abstract Objectives: We characterized antibiotic prescribing patterns and management practices among recurrent urinary tract infection (rUTI) patients, and we identified factors associated with lack of guideline adherence to antibiotic choice, duration of treatment, and urine cultures obtained. We hypothesized that prior resistance to nitrofurantoin or trimethoprim–sulfamethoxazole (TMP-SMX), shorter intervals between rUTIs, and more frequent rUTIs would be associated with fluoroquinolone or β-lactam prescribing, or longer duration of therapy. Methods: This study was a retrospective database study of adult women with International Classification of Diseases, Tenth Revision (ICD-10) cystitis codes meeting American Urological Association rUTI criteria at outpatient clinics within our academic medical center between 2016 and 2018. We excluded patients with ICD-10 codes indicative of complicated UTI or pyelonephritis. Generalized estimating equations were used for risk-factor analysis. Results: Among 214 patients with 566 visits, 61.5% of prescriptions comprised first-line agents of nitrofurantoin (39.7%) and TMP-SMX (21.5%), followed by second-line choices of fluoroquinolones (27.2%) and β-lactams (11%). Most fluoroquinolone prescriptions (86.7%), TMP-SMX prescriptions (72.2%), and nitrofurantoin prescriptions (60.2%) exceeded the guideline-recommended duration. Approximately half of visits lacked a urine culture. Receiving care through urology via telephone was associated with receiving a β-lactam (adjusted odds ratio [aOR], 6.34; 95% confidence interval [CI], 2.58–15.56) or fluoroquinolone (OR, 2.28; 95% CI, 1.07–4.86). Having >2 rUTIs during the study period and seeking care from a urology practice (RR, 1.28, 95% CI, 1.15–1.44) were associated with longer antibiotic duration. Conclusions: We found low guideline concordance for antibiotic choice, duration of therapy and cultures obtained among rUTI patients. These factors represent new targets for outpatient antibiotic stewardship interventions.

Objective:. To estimate the relative risk of explantation in patients with skin and soft tissue infection onset within 90 days of hernia surgery, compared with days 91–365 and after 1 year. Background:. Infectious complications occurring after hernia repair with synthetic mesh require prolonged treatment, and eventual mesh explantation. Little is known whether early versus late onset infection is associated with differential risk of mesh removal, and whether treatment with long-term antibiotics or debridement are associated with mesh salvage. Methods:. This was a retrospective observational cohort study. We obtained data on all inguinal, umbilical, and ventral hernia repairs with implanted synthetic mesh performed in Veterans Affairs hospitals during 2008–2015. Participants without a 5-year infection after hernia surgery were excluded. Logistic regression estimated the association of mesh explantation with exposure to mesh-related infection during postoperative days 0–90, versus days 91–365 versus after 1 year. Additional covariates included any subsequent abdominal operation, antibiotic administration, and incision and drainage (I&D) or debridement procedures. Results:. One thousand eight hundred eighty-five patients underwent index hernia repair and developed a skin and soft tissue infection within 5 years. Infection onset during days 91–365 was associated with increased explantation risk (OR, 1.62; 95% CI, 1.04–2.48), as was increased antibiotic use (OR, 1.04; 95% CI, 1.03–1.05) and surgical treatments (OR, 3.74; 95% CI, 3.02–4.67). Subsequent abdominal operation was associated with lower explantation risk (OR, 0.46; 95% CI, 0.33–0.61). Conclusions:. Early infections may be more suitable for conservative management. Later-onset infections have lower probability of mesh salvage and should be considered for earlier explantation to save the patients prolonged courses of antibiotics and surgical interventions.

Introduction: Psoriasis and vitiligo are among the most common chronic skin diseases, which have a negative impact on the psychosocial well-being. Patients may experience social rejection and stigmatization. So, the aim of this present study is to assess and compare the self-esteem and quality of life (QoL) in patients with vitiligo, psoriasis and healthy controls and its relationship with age and gender. Materials and Methods: A cross-sectional and comparative study was conducted at a tertiary care hospital, Udaipur, Rajasthan, with a sample of total 150 cases, 50 each of psoriasis, vitiligo and healthy controls, aged between 18-64years. The assessment of all subjects was done for quality of life and self-esteem by using scales Short Form-36 (SF-36) and Rosenberg Self-Esteem Scale (RSES) respectively. Results: The results of our study showed that the self-esteem& quality of life was low in psoriatic patients when compared to vitiligo patients (p-0.000) and healthy controls (p-0.009). No relationship was found in patients of psoriasis and vitiligo between age and gender with regards to self-esteem and quality of life except poor social function domain of QoL, which was observed in middle age group (40-64years) patients of psoriasis. Conclusion: While evaluating and arranging treatment of psoriasis and vitiligo patients, these results in poor psychosocial functioning should be considered and along with dermatologic interventions, psychiatric approaches should also be included for a better outcome.

Background: Cutaneous adverse drug reactions (CADRs) comprise about 30% of all adverse drug reactions and observed in 2–3% of hospitalized patients by wide variety of offending agents. Aims: To study the clinical patterns, causative drugs and their association with autoimmune diseases in CADR patients. Materials and Methods: A total of 174 CADR patients who presented to the dermatology OPD over a period of 18 months (1 July 2015 to 31 Dec 2016) were considered for the study. Detailed history, clinical examination, hematological, and biochemical investigations were recorded. The venereal disease research laboratory test, HIV (ELISA), and histopathological examination were done wherever indicated. Results: The mean age of the patients with cutaneous drug eruptions was 40.2 years. Most of them (31.0%) were in the age group of 41–50 years. There were 93 (53.4%) males and 81 (46.5%) females with the M:F ratio of 1.5:1. The most common eruption observed was maculopapular rash in 33.3% followed by fixed drug eruption (17.2%) and lichenoid dermatitis' (11.5%). The drugs most commonly responsible for CADRs were antimicrobials (n = 68, 39%) with fixed dose combination of fluoroquinolones with nitroimidazoles (n = 42). We also noticed that a total of 42 patients out of 174 had comorbities in the form of diabetes (n = 27, 15.5%), hypothyroidism (n = 9, 5.1%), rheumatoid arthritis (n = 3, 1.7%), vitiligo (n = 2, 1.1%), and SLE (n = 1, 0.5%). Conclusion: Cutaneous ADR patterns and the drugs causing various reactions are changing every year, which may be because of the introduction of newer molecules and changing trends in the use of drugs. In our study, a significant relation of CADRs with autoimmune diseases (P value = 0.004) was also observed.

Natural killer cells of acute myeloid leukaemia patients lack cytotoxic activity. Here the authors show that these cells have elevated GSK3β, and that its inhibition prolongs survival of mice transplanted with human AML and stimulates NK cytotoxicity via increased adhesion of NK cells to their targets.

The purpose of this study is to understand the ways in which meditation practice can be used as an online pedagogical method based on adult learners' experiences with various forms of meditation practices. To arrive at this purpose, the researcher found it necessary to gather data about frequency of use, preferences, and related transformative experiences of the participants. Through qualitative inquiry, this study explored adult learners' perceptions, attitudes, and reflections on using meditative practices while engaged in asynchronous online learning. Participants utilized prerecorded online meditation videos and biofeedback devices designed for meditation which provided immediate feedback and analytics. The data collection methods included surveys, participants' meta-reflections, and a focus group interview. Data analyses included coding and constant comparative methods along with descriptive statistical analysis for the Likert-scale responses. Analyses led to themes describing participants' self-awareness, preferred meditation practices, barriers to meditation, and suggestions for incorporating meditation as an online pedagogical method.

Objective: To validate the use of electronic algorithms based on International Classification of Diseases (ICD)-10 codes to identify outpatient visits for urinary tract infections (UTI), one of the most common reasons for antibiotic prescriptions. Methods: ICD-10 symptom codes (e.g., dysuria) alone or in addition to UTI diagnosis codes plus prescription of a UTI-relevant antibiotic were used to identify outpatient UTI visits. Chart review (gold standard) was performed by two reviewers to confirm diagnosis of UTI. The positive predictive value (PPV) that the visit was for UTI (based on chart review) was calculated for three different ICD-10 code algorithms using (1) symptoms only, (2) diagnosis only, or (3) both. Results: Of the 1087 visits analyzed, symptom codes only had the lowest PPV for UTI (PPV = 55.4%; 95%CI: 49.3–61.5%). Diagnosis codes alone resulted in a PPV of 85% (PPV = 84.9%; 95%CI: 81.1–88.2%). The highest PPV was obtained by using both symptom and diagnosis codes together to identify visits with UTI (PPV = 96.3%; 95%CI: 94.5–97.9%). Conclusions: ICD-10 diagnosis codes with or without symptom codes reliably identify UTI visits; symptom codes alone are not reliable. ICD-10 based algorithms are a valid method to study UTIs in primary care settings.

Dyskeratosiscongenita (DKC) is a genetically heterogeneous disease of defective telomere maintenance that may demonstrate different patterns of inheritance. It is characterized by thetriad of dystrophy of the nails, leukokeratosis of the oral mucosa, and extensive net-like pigmentation of the skin. We report a case ofDKC who presented with a chief complaint of dysphagia.

BackgroundThe optimal regimen for perioperative antimicrobial prophylaxis is controversial. Use of combination prophylaxis with a beta-lactam plus vancomycin is increasing; however, the relative risks and benefits associated with this strategy are unknown. Thus, we sought to compare postoperative outcomes following administration of 2 antimicrobials versus a single agent for the prevention of surgical site infections (SSIs). Potential harms associated with combination regimens, including acute kidney injury (AKI) and Clostridium difficile infection (CDI), were also considered.Methods and findingsUsing a multicenter, national Veterans Affairs (VA) cohort, all patients who underwent cardiac, orthopedic joint replacement, vascular, colorectal, and hysterectomy procedures during the period from 1 October 2008 to 30 September 2013 and who received planned manual review of perioperative antimicrobial prophylaxis regimen and manual review for the 30-day incidence of SSI were included. Using a propensity-adjusted log-binomial regression model stratified by type of surgical procedure, the association between receipt of 2 antimicrobials (vancomycin plus a beta-lactam) versus either single agent alone (vancomycin or a beta-lactam) and SSI was evaluated. Measures of association were adjusted for age, diabetes, smoking, American Society of Anesthesiologists score, preoperative methicillin-resistant Staphylococcus aureus (MRSA) status, and receipt of mupirocin. The 7-day incidence of postoperative AKI and 90-day incidence of CDI were also measured. In all, 70,101 procedures (52,504 beta-lactam only, 5,089 vancomycin only, and 12,508 combination) with 2,466 (3.5%) SSIs from 109 medical centers were included. Among cardiac surgery patients, combination prophylaxis was associated with a lower incidence of SSI (66/6,953, 0.95%) than single-agent prophylaxis (190/12,834, 1.48%; crude risk ratio [RR] 0.64, 95% CI 0.49, 0.85; adjusted RR 0.61, 95% CI 0.46, 0.83). After adjusting for SSI risk, no association between receipt of combination prophylaxis and SSI was found for the other types of surgeries evaluated, including orthopedic joint replacement procedures. In MRSA-colonized patients undergoing cardiac surgery, SSI occurred in 8/346 (2.3%) patients who received combination prophylaxis versus 4/100 (4.0%) patients who received vancomycin alone (crude RR 0.58, 95% CI 0.18, 1.88). Among MRSA-negative and -unknown cardiac surgery patients, SSIs occurred in 58/6,607 (0.9%) patients receiving combination prophylaxis versus 146/10,215 (1.4%) patients who received a beta-lactam alone (crude RR 0.61, 95% CI 0.45, 0.83). Based on these associations, the number needed to treat to prevent 1 SSI in MRSA-colonized patients is estimated to be 53, compared to 176 in non-MRSA patients. CDI incidence was similar in both exposure groups. Across all types of surgical procedures, risk of AKI was increased in the combination antimicrobial prophylaxis group (2,971/12,508 [23.8%] receiving combination versus 1,058/5,089 [20.8%] receiving vancomycin alone versus 7,314/52,504 [13.9%] receiving beta-lactam alone). We found a significant association between absolute risk of AKI and receipt of combination regimens across all types of procedures. If the observed association is causal, the number needed to harm for severe AKI following cardiac surgery would be 167. The major limitation of our investigation is that it is an observational study in a predominantly male population, which may limit generalizability and lead to unmeasured confounding.ConclusionsThere are benefits but also unintended consequences of antimicrobial and infection prevention strategies aimed at "getting to zero" healthcare-associated infections. In our study, combination prophylaxis was associated with both benefits (reduction in SSIs following cardiac surgical procedures) and harms (increase in postoperative AKI). In cardiac surgery patients, the difference in risk-benefit profile by MRSA status suggests that MRSA-screening-directed prophylaxis may optimize benefits while minimizing harms in this selected population. More information about long-term outcomes and patient and societal preferences regarding risk of SSI versus risk of AKI is needed to improve clinical decision-making.

Introduction: Idiopathic Guttate Hypomelanosis (IGH) macules are hypo pigmented lesions occurring due to decreased functioning of melanocytes due to photosensitivity or persistent irritation of skin in middle aged and elderly. Aim: To find out the efficacy of placental extracts when used as an adjunct with 88% phenol for the treatment of IGH macules. Materials and Methods: A total of 40 patients were randomly divided into two groups (n=20 in each group), viz group P, (the control group, treated with only 88% phenol) and Group PP (study group, treated with Placental extracts along with 88% phenol). Spot peeling was done with 88% phenol in both the groups while group PP was advised to use placental extract at night for 3 months. Patients of both groups were assessed both subjectively and objectively after every session and at the end of 3 months of initiation of therapy. The statistical analysis was done using Chi-square test, Z-test and a p-value

BACKGROUND: Patterns of methicillin-resistant S. aureus (MRSA) nasal carriage over time and across the continuum of care settings are poorly characterized. Knowledge of prevalence rates and outcomes associated with MRSA nasal carriage patterns could help direct infection prevention strategies. The VA integrated health-care system and active surveillance program provides an opportunity to delineate nasal carriage patterns and associated outcomes of death, infection, and conversion in carriage. METHODS/FINDINGS: We conducted a retrospective cohort study including all patients admitted to 5 acute care VA hospitals between 2008-2010 who had nasal MRSA PCR testing within 48 hours of admission and repeat testing within 30 days. The PCR results were used to define a baseline nasal carriage pattern of never, intermittently, or always colonized at 30 days from admission. Follow-up was up to two years and included acute, long-term, and outpatient care visits. Among 18,038 patients, 91.1%, 4.4%, and 4.6% were never, intermittently, or always colonized at the 30-day baseline. Compared to non-colonized patients, those who were persistently colonized had an increased risk of death (HR 2.58; 95% CI 2.18;3.05) and MRSA infection (HR 10.89; 95% CI 8.6;13.7). Being in the non-colonized group at 30 days had a predictive value of 87% for being non-colonized at 1 year. Conversion to MRSA colonized at 6 months occurred in 11.8% of initially non-colonized patients. Age >70 years, long-term care, antibiotic exposure, and diabetes identified >95% of converters. CONCLUSIONS: The vast majority of patients are not nasally colonized with MRSA at 30 days from acute hospital admission. Conversion from non-carriage is infrequent and can be risk-stratified. A positive carriage pattern is strongly associated with infection and death. Active surveillance programs in the year following carriage pattern designation could be tailored to focus on non-colonized patients who are at high risk for conversion, reducing universal screening burden.

The efficacy of free radical scavenger – Vitamin E (VE) in salvage of ischaemic skin flaps was studied in an experimental rat skin flap model. The animals were divided into two groups – a control group (N=15) who did of receive VE and a test group (N=15) who received VE starting one week preoperatively. No significant difference was found in flap necrosis between the control group (38.365% ± 1.398% SEM) and the test group (35.288% ± 0.635% SEM), which received therapeutic dose of VE (100 mg/kg/day. 1 mg = 1.49 I.U). Further research is needed to establish the role of vitamin E as an agent of ischaemic skin flap salvage.

As the defining feature of Acute Myeloid Leukemia (AML) is a maturation arrest, a highly desirable therapeutic strategy is to induce leukemic cell maturation. This therapeutic strategy has the potential of avoiding the significant side effects that occur with the traditional AML therapeutics. We identified a natural compound securinine, as a leukemia differentiation-inducing agent. Securinine is a plant-derived alkaloid that has previously been used clinically as a therapeutic for primarily neurological related diseases. Securinine induces monocytic differentiation of a wide range of myeloid leukemia cell lines as well as primary leukemic patient samples. Securinine's clinical potential for AML can be seen from its ability to induce significant growth arrest in cell lines and patient samples as well as its activity in significantly impairing the growth of AML tumors in nude mice. In addition, securinine can synergize with currently employed agents such as ATRA and decitabine to induce differentiation. This study has revealed securinine induces differentiation through the activation of DNA damage signaling. Securinine is a promising new monocytic differentiation inducing agent for AML that has seen previous clinical use for non-related disorders.

A historical account is presented of adult education practice by exploring the lives of a few prominent men and women from the 19 century often not associated with the formal adult education 19th movement. These include Elizabeth Cady Stanton and Henry David Thoreau. This article seeks to provide a historical context for the adult education movement in the United States, to discuss some dominant values that seem to have guided the movement, and to examine current values that may be evident in contemporary adult education practice.