Search

Background: Tocilizumab, an interleukin-6 (IL-6) antagonist, is being evaluated for the management of covid-19 pneumonia. The objective of this study was to assess the effectiveness of Tocilizumab in severe covid-19 pneumonia. Methods: This was a retrospective, observational, single centre study performed in 121 patients diagnosed with severe covid-19 pneumonia. 83 patients received standard of care treatment whereas 38 patients received tocilizumab along with standard of care. Tocilizumab was administered intravenously at 8mg/kg (upto a maximum of 800mg). The second dose of Tocilizumab was given 12 to 24 hours apart. The primary outcome measure was ICU related and hospital related mortality. The secondary outcome measures were change in clinical status of patients measured by WHO (World Health Organisation) 7 category ordinary scale, changes in interleukin-6 (IL-6) levels, secondary infections and duration of ICU stay. Results: Tocilizumab was administered between 3-27 days after the patient reported symptoms ( a median of 10.9 days ) and between the 1st to 3rd day of ICU admission (median of 2.1 days) . In Tocilizumab group, 16(42.1%) of 38 patients died in ICU whereas in standard of care group, 27(32.53%) of 83 patients died. The difference in clinical status assessed using WHO (World Health Organisation) 7 category ordinary scale at 28 days between Tocilizumab group and standard of care group was not statistically significant (odds ratio 1.35, 95% confidence interval 0.61 to 2.97, p = 0.44). Conclusion: Tocilizumab plus standard care was not superior to standard care alone in reducing mortality and improving clinical outcomes at day 28.

Background: Bipolar disorder is a chronic psychological disorder, and lithium remains the mainstay of therapy. Lithium toxicity can be acute or chronic and the effects may be disabling or life-threatening. The presence of risk factors can increase the chances of lithium toxicity in a patient on long-term lithium therapy. We hereby report a case of chronic lithium toxicity in a patient with a known case of bipolar disorder. Case Presentation: A 44-year-old female patient with a known case of bipolar disorder presented with altered sensorium, seizures, and renal insufficiency. On admission, the patient was severely dehydrated and the serum lithium level was 3.43 mEq/L. Hemodialysis was performed and she improved gradually. Conclusion: Lithium has constantly proven to be beneficial in lowering suicide rates in bipolar disorder patients over the years since its approval. However, its use is limited due to the risk of toxicity. The chances of developing toxicity are higher in patients on long-term lithium therapy. Patients with high risk factors for toxicity should be monitored frequently as the effects of lithium toxicity can be fatal.

This study describes the development of a low-cost fluorescence assay for detecting homocysteine (Hcy) without the interference of cysteine and glutathione using carbon quantum dots. Herein nitrogen-doped carbon quantum dots (NCDs) were synthesized from citric acid as the carbon source and urea as the dopant using a one-pot microwave-assisted method. The obtained NCDs were incorporated with folic acid (FA) by the direct ex situ addition method and were used as a fluorescence probe to detect Hcy. The probe exhibited a fluorescence turn-on response with increased Hcy concentration up to 50 μM with a limit of detection of 2.276 μM. The point of care detection of Hcy using the probe was also tested with a paper-based assay strip.

New antibiotics should ideally exhibit activity against drug-resistant bacteria, delay the development of bacterial resistance to them and be suitable for local delivery at desired sites of infection. Here, we report the rational design, via molecular-docking simulations, of a library of 17 candidate antibiotics against bone infection by wild-type and mutated bacterial targets. We screened this library for activity against multidrug-resistant clinical isolates and identified an antibiotic that exhibits potent activity against resistant strains and the formation of biofilms, decreases the chances of bacterial resistance and is compatible with local delivery via a bone-cement matrix. The antibiotic-loaded bone cement exhibited greater efficacy than currently used antibiotic-loaded bone cements against staphylococcal bone infections in rats. Potent and locally delivered antibiotic-eluting polymers may help address antimicrobial resistance.

Cancer epigenetic mechanisms support the acquisition of hallmark characteristics during oncogenesis. EZH2 - an important histone methyltransferase that writes histone H3 lysine 27 trimethylation marks - is known to be dysregulated in cancer cells. However, the interactions between EZH2 and miRNAs that form a complex network of cross-talk and reciprocal regulation that enable cancer cells to acquire hallmark characteristics have been relatively poorly appreciated. The specific functions of EZH2 appear to be regulated by a vast array of miRNAs, which direct EZH2 toward regulation over the development of specific hallmark characteristics. This review discusses recent advances in the understanding of EZH2, focusing on its collaboration with miRNAs to orchestrate oncogenesis. These epigenetic processes promote the evasion of apoptosis/cell cycle arrest, cellular dedifferentiation and the establishment of a tumor microenvironment that facilitates local cancer cell invasion, anti-cancer drug resistance and evasion of the immune response.Cancer epigenetics involves cellular processes that ensure that gene expression changes that enable cancer cells to outcompete their neighboring normal tissues are passed on from one cancer cell to the next. One key epigenetic player is called EZH2, which is an enzyme that transfers methyl (CH

Social media platforms (SMPs) have become a popular portal for the acquisition and dissemination of dentistry-related information. The study aims to identify the pattern and influence SMPs for education and practice among dental trainees and professionals.A cross-sectional study involving dental trainees and clinical professionals was conducted based on a structured 20-item survey instrument among dental trainees and professionals. The validated questionnaire was circulated among six dental training institutions in India through the internet-based application Google form and achieved a response rate of 60%. The questionnaire focused on identifying the usage of social media in disseminating dentistry-related content. The data from responders were extracted, sorted, and analyzed for descriptive analysis of various factors.The survey revealed the most common SMP used for dentistry-related content as YouTube. The second most commonly used SMP was Facebook for professionals whereas it was Instagram for younger trainees. There was a highly significant difference between professionals and trainees concerning their sources of new information and the most commonly used SMP for dental education (p 0.001).There is a growing consensus among young dental trainees and professionals on SMPs being an effective open access knowledge center. The survey results call for the need for a scientific journal and dental schools to have verified pages in social media to act as flagbearers of evidence-based dental practices. The potentials of SMPs in providing open access information collection to wider viewership across the globe and being a digital archive in attractive audio-visual forms can be used to strengthen the conventional educational model and improvise clinical practice.

The hydrophobicity of most of the anticancer drugs offers a great challenge in selecting a system for their effective transport. Here comes the importance of micelles that offers a hydrophobic core for incorporating these drugs. In this study, Hyaluronic Acid coated Pluronic mixed micelle loaded with Paclitaxel and Curcumin was designed and evaluated its anticancer activity in MCF-7 cells. Pluronic F127 (PF127) and Pluronic P123 (PP123) were taken for preparing the mixed micelles. The targeting ligand folic acid (FA) was conjugated to one end of PP123 forming FA-PP. The end hydroxyl groups of PF127 were oxidized to aldehyde groups resulted in PF-CHO. Mixed micelles were prepared from PF-CHO and FA-PP and the end aldehyde groups were used for coating the micelles with hyaluronic acid. The material was characterized using FTIR, H1NMR, DLS, FE-SEM and TEM. The coated micelles showed spherical shape with drug loading efficiency of 50.15 and 65.05% for Paclitaxel and Curcumin, respectively. In vitro drug release was studied at pH 5.5 and 7.4. Dual drug-loaded material showed higher in-vitro anticancer activity than free Paclitaxel and Curcumin. The results suggested that synthesized mixed micelle with dual drugs showed great potential for targeted delivery to MCF-7 cells.

Epidermal growth factor receptor (EGFR) mutations typically occur in exons 18–21 and are established driver mutations in non-small cell lung cancer (NSCLC)1–3. Targeted therapies are approved for patients with ‘classical’ mutations and a small number of other mutations4–6. However, effective therapies have not been identified for additional EGFR mutations. Furthermore, the frequency and effects of atypical EGFR mutations on drug sensitivity are unknown1,3,7–10. Here we characterize the mutational landscape in 16,715 patients with EGFR-mutant NSCLC, and establish the structure–function relationship of EGFR mutations on drug sensitivity. We found that EGFR mutations can be separated into four distinct subgroups on the basis of sensitivity and structural changes that retrospectively predict patient outcomes following treatment with EGFR inhibitors better than traditional exon-based groups. Together, these data delineate a structure-based approach for defining functional groups of EGFR mutations that can effectively guide treatment and clinical trial choices for patients with EGFR-mutant NSCLC and suggest that a structure–function-based approach may improve the prediction of drug sensitivity to targeted therapies in oncogenes with diverse mutations.

The spliced human papillomavirus 16 (HPV16) E1C RNA is associated with high-grade precursor lesions and cervical cancer. This qualifies E1C as a biomarker for high-grade lesions in HPV-based cervical cancer precursor screening. Here, we aimed to characterize the biological activity of HPV16 E1C RNA. In HEK-293T cells overexpressing HPV16 E1C RNA, we detected 9 kDa E1C protein in the cytoplasm using immunological assays with a newly generated E1C-specific monoclonal antibody or in mass spectrometry only after proteasome inhibition with MG132, indicating instability of the E1C protein. In HPV16-transformed cervical cancer cell lines in which the level of endogenous E1C RNA is much lower, E1C protein was not detected even after proteasome inhibition. Transient E1C overexpression in HEK-293T cells, co-transfected with a firefly luciferase reporter gene under the control of the HPV16 upstream regulatory region (URR), activated the HPV16 URR by 38%. This activation was also present when E1C translation was abolished by mutation. However, a construct expressing a random RNA sequence with similar GC content and 45% homology to the E1C RNA sequence also stimulated URR activity, indicating that special E1C RNA motifs might be responsible for the activation. In HPV16-transformed cell lines W12-episomal (W12-epi), W12-integrated HPV (W12-int), CaSki and SiHa stably overexpressing E1C RNA from lentiviral transduction, levels of endogenous HPV16 RNAs E6*I and E7 remained unchanged, while E1^E4 levels were significantly reduced by 20–30% in W12-epi, W12-int and CaSki cells. Overall, our study shows that E1C RNA is active and might contribute to transformation independent of the E6*I or E7 pathways. However, E1C overexpression resulted in only subtle changes in HPV16 RNA expression and very low copies of endogenous E1C RNA were detected in cervical cancer cell lines. This could weigh towards a less prominent role of E1C RNA in natural HPV transformation.

Ansa pectoralis is the loop of communication between medial and lateral pectoral nerves, seen anterior to the second part of axillary artery. It carries C7 bres from the lateral cord to the medial pectoral nerve and supplies sternocostal part of pectoralis major muscle. Its damage can cause weakness of the sternocostal part of pectoralis major muscle. Section of the ansa pectoralis is done as a treatment modality to reduce spasm of pectoralis major after strokes. It is also used as nerve graft. There are only few articles which describe the anatomy of Ansa pectoralis. We conducted a dissection study in 36 pectoral regions of embalmed human cadavers to nd out the number, location, formation and branches of Ansa pectoralis. During dissection of the pectoral region, the formation of Ansa was seen to be of four different types. 72.2%(26 out of 36) was either between inferior or deep branch of lateral pectoral nerve and medial pectoral nerve or between the inferior lateral pectoral nerve and medial pectoral nerve (type A). In 6 cases (16.7%) it was between trunk of the lateral pectoral nerve and medial Pectoral nerve (type B). In 3 cases (8.3%), it was arising from lateral cord itself (Type C). In one case (2.7%) it was found to be arising from trunk and inferior branch of lateral pectoral nerve (Type D). The communicating loop was on the axillary artery in about 52.8% percentage of specimens, distal and plastered to the deep surface of pectoralis minor muscle in the 30.5% and multiple in 16.7%. The anatomy of Ansa pectoralis shows many variations. These are important while planning surgeries in pectoral region like breast augmentation, pectoral nerve blocks and harvesting pectoral nerve grafts.

A lot of videos on root canal treatment in children are available on YouTube™ but no quality checks are present. Addressing this is critical so that parents and dentists know why root canal in children is important including the explanation of procedural steps regarding treatment undertaken.The aim of this study is to analyze and grade YouTube™ videos on root canal treatment in children and assess whether it provides beneficial information for patients and dentists.Variables such as number of views, duration (minute), days since upload, number of comments, number of likes, number of dislikes, interaction index, and viewing rate were tabulated for selected 57 videos.Selected videos were statistically analyzed using a 15-point scoring system and evaluated using SPSS software. Finally, the obtained data sets were classified as low-, moderate-, and high-content videos. Fisher's exact test was used to compare between proportions.Based on the tabulated variables, most of the videos were low (n = 31) and moderate content (n = 24), which dentists mostly uploaded. There was no statistical significance between the video types and content score groups (P0.05). The most frequently mentioned issues were procedure (84.21%), obturating materials (75.44%), and etiology (63.16%). The least mentioned subjects were indications (24.56%) and importance (22.81%).From this study, YouTube™ videos on root canal treatment in children were of low and moderate quality. Hence, high-quality videos are essential for providing awareness among patients and dentists.

Background: The benefit of chemotherapy combined with immunotherapy in EGFR-mutant lung adenocarcinoma (LUAD) patients whose tumor developed resistance to EGFR tyrosine kinase inhibitors (TKIs) is not thoroughly investigated. The goal of this retrospective cohort study is to assess the clinical efficiency of immunotherapy alone or in combination with chemotherapy in a real-world setting. Methods: This retrospective cohort study enrolled LUAD patients with EGFR sensitive mutations whose tumor had acquired resistance to EGFR TKIs and received systemic treatment with chemotherapy (chemo; n = 84), chemotherapy combined with immunotherapy (chemoIO; n = 30), chemotherapy plus bevacizumab with or without IO (withBev; n = 42), and IO monotherapy (IO-mono; n = 22). Clinical progression-free survival (PFS) and overall survival (OS) were evaluated. Associations of clinical characteristics with outcomes were assessed using univariable and multi-covariate Cox Proportional Hazards regression models. Results: A total of 178 patients (median age = 63.3; 57.9% females) with a median follow-up time of 42.0 (Interquartile range: 22.9–67.8) months were enrolled. There was no significant difference in PFS between chemoIO vs. chemo groups (5.3 vs. 4.8 months, p = 0.8). Compared to the chemo group, patients who received withBev therapy trended towards better PFS (6.1 months vs. 4.8; p = 0.3; HR 0.79; 95% CI: 0.52–1.20), while patients treated with IO-mono had inferior PFS (2.2 months; p = 0.001; HR 2.22; 95% CI: 1.37–3.59). Furthermore, PD-L1 level was not associated with PFS benefit in the chemoIO group. Patients with EGFR-mutant LUAD with high PD-L1 (≥50%) had shorter PFS (5.8 months) than non-EGFR/ALK LUAD patients who received chemoIO (12.8 months, p = 0.002; HR 0.22; 95% CI: 0.08–0.56) as first-line treatment. Chemotherapy-based therapy rendered similar benefit to patients with either EGFR exon19 deletion vs. L858R in the LUAD. Conclusions: This retrospective analysis revealed that immunotherapy provided limited additional benefit to chemotherapy in TKI-refractory EGFR-mutant LUAD. Chemotherapy alone or combined with bevacizumab remain good choices for patients with actionable EGFR mutations.

Traditional nursing education has relied on the treatment of 1 real patients in actual clinical setting .But with rising number of nursing colleges with no proper parent hospital to practice, the clinical training on real patients has become obsolete.These new nurses are given traditional three to five days induction training on theoretical aspects like institutional policy and nursing care assuming that they have recently gained clinical knowledge. But their competency is usually not assessed on recruitment which becomes a patient safety factor later on. Hence, Objective Structured Practical Examination (OSPE) – a mandate tool was adopted to assess the impact of induction on the performance of newly recruited nurses

In this cross-sectional study on 80 students, of classes 9 to 12, it was revealed that excessive use of smart phone had ill effects on mental and physical health of users. Only a suitable intervention by school nurse by way of counselling to students, parents and teachers appears to be an appropriate measure to restrain the smart phone usage by students.

Introduction: Entrapment of the lateral femoral cutaneous nerve (LFCN) of thigh results in meralgia paresthetica (MP). Standard electrophysiological tests for MP are technically demanding and unreliable. We aimed to study the role of pain-related evoked potentials (PREP) in the diagnosis of MP. Methods: Patients with MP and normal volunteers were included. PREP was recorded by stimulating the skin over the lateral thigh 20 cm below the anterior-superior iliac spine and recording from the cortex at Cz. Results: A total of 28 subjects and 56 LFCNs were studied. 36 nerves had MP and 20 were normal. The mean PREP latency was 118 (8) ms among normal controls and 164 (10.8) ms in MP. The optimal cut-off point for the diagnosis of MP was 134 ms. Area under receiver operator characteristic curve was 0.97; sensitivity was 91.7% and specificity was 100%. Conclusion: PREP is reliable and easy to use electrophysiological test in establishing the diagnosis of MP.

Complete arch fixed implant-supported prostheses have gained substantial popularity as a treatment option for patients with edentulism or a failing dentition. While YouTube is a leading source of health-related information videos, the usefulness and quality of videos on YouTube about complete arch fixed implant-supported prostheses are unclear.The purpose of this study was to evaluate the quality of videos on complete arch fixed implant-supported prostheses and assess their usefulness for the general population as an educational resource.An electronic search for "complete arch fixed treatment using dental implants" was conducted on YouTube on October 10, 2021. The videos in English with a duration between 4 and 20 minutes were considered for the analysis. A total of 89 videos were subjected to quantitative analysis by using a usefulness score. Additionally, to evaluate video quality, 5-point global quality scale (GQS) criteria were applied. A 1-way analysis of variance (ANOVA) was used to compare mean scores among different subgroups. The Pearson correlation analysis investigated the relationship among the usefulness score, GQS score, and video demographics, which include video content, source, type (academic or nonacademic), total views, and upload days (the days since the video was uploaded to YouTube) (α=.05).The mean number of views for the 89 selected videos was 193 321 with a mean daily upload of 1241. The mean ±standard deviation usefulness score was 1.55 ±1.35, with 78.7% of the videos rated poor, 20.2% moderate, and 1.1% excellent. The majority of videos included procedures involved (44.9%) and advantages (41.9%), and the least discussed topics were contraindications (7.9%) and prognosis and survival (6.7%). The GQS scoring had a mean score of 1.98 ±0.78 out of a total score of 5. While statistically significant differences were not found among the video source, total views or upload days, and usefulness score (P.05), significant differences were found between the type of videos and usefulness score (P.001).The majority of videos on complete arch fixed implant-supported rehabilitation were rated as poor in usefulness for patient education. Quality videos on implant-supported fixed rehabilitation were lacking on YouTube (GQS score 1.50), with most videos consisting of marketing or promotional content rather than unbiased educational information.

Objectives Evaluate the use of induction chemotherapy (IC) in oropharyngeal cancer (OPC) and its impact on subjective functional outcomes using a validated MD Anderson Symptom Inventory‐Head and Neck (MDASI‐HN) survey tool. Methods A single institution retrospective review of OPC patients who received IC, including reasons given for using IC, regimens employed, responses, and patient‐reported outcomes (PRO). The latter included pain, distress, dysphagia, xerostomia, and feeding tube placement and dependency. PRO's were assessed using the validated MD Anderson Symptom Inventory‐Head and Neck (MDASI‐HN) conducted at baseline, during treatment, and at six‐month follow up. Results One hundred and twenty‐five patients were evaluable. They were more likely to have large primary and/or bulky or low neck nodal disease as a reason for IC. A taxane‐containing regimen was most common. Primary tumor response was seen in 83.2% and the nodal response in 81.6%. Pain and xerostomia improved with IC, dysphagia was not adversely affected with IC. These symptoms all increased with consolidation chemoradiotherapy (CRT) but returned to baseline by 6 months post treatment. Feeding tube placement did not increase with IC but did with CRT, most patients were no longer feeding tube dependent at 6 months. Conclusion This retrospective review of subjective functional outcomes, especially swallowing and feeding tube dependency, using the MDASI survey tool in 125 oropharyngeal cancer patients with large primary tumors and/or bulky adenopathy treated predominantly with platinum‐taxane based induction chemotherapy showed that such outcomes were not adversely impacted. While not standard, such approach may be beneficial in such patients. Level of Evidence 2., HPV‐positive oropharyngeal cancer typically has a good survival prognosis. Standard treatment with radiation and chemotherapy, while curative, can produce long term dysfunctional outcomes. Induction chemotherapy has not been shown to improve overall survival but is occasionally used in patients with high stage and/or aggressive disease. we looked at the impact of induction chemotherapy on subjective functional outcomes.

Background There is paucity of data evaluating the efficacy and safety of very high-dose furosemide continuous infusions (≥40 mg/h) for volume removal. This infusion is a novel strategy of loop diuretic administration that may add valuable data to current literature. Methods and Results This was a retrospective chart review. Patients were eligible for inclusion if prescribed a very high-dose furosemide infusion (defined as ≥40 mg/h, up to 240 mg/h) from April 1, 2017, to January 1, 2019, at Thomas Jefferson University Hospital. Data collected included the change in cumulative urine output, net urine output, incidence of acute kidney injury, occurrences of hypotension, electrolyte abnormalities, body weight, and ototoxicity. Twenty-two patients were included in this analysis. The median change in 24-hour urine output from before to after very high-dose continuous furosemide infusion increased from 1193 mL at 24 hours before infusion initiation to 3518 mL at 24 hours after infusion initiation (P Conclusions Very high-dose furosemide continuous infusions provide a significant increase in diuresis without worsening renal function, disturbing electrolytes, or increasing the risk of ototoxicity. Further studies are necessary to examine the efficacy and safety of this novel strategy.

Aim:Vestibular schwannomas (VS) are benign slow-growing tumours treated either with microsurgery or stereotactic radiosurgery (SRS) or both. The aim of this study was to correlate the outcome factors—tumour control and adverse factors—facial nerve function and hearing loss with patient and treatment factors.Materials and methods:A retrospective review of the records of 98 patients with 99 VS treated from June 2007 to June 2014, all patients receiving Linear Accelerator (LINAC)-based SRS.Results:Median follow-up period was 5·6 years (range: 1–12 years). The response to treatment was stable disease in 37 (37·4%), regression in 46 (46·5%), asymptomatic minimal progression in 9 (9·1%) and symptomatic progression in 5 (5%) and unknown in 2 (2%) patients. There was no evidence of SRS induced tissue damage on magnetic resonance scans for any. Hearing preservation rate after SRS was 92%. The patients who developed worsening of facial function were predominantly in the cohort that had prior surgery.Findings:SRS is an effective modality to treat VS lesser than 3 cm in size. Tumour control rate was 95% with a median follow-up period of 5·6 years. The complication rates were 8% each for facial function worsening and worsening of hearing. Prior surgery was a statistically significant factor that affected facial nerve function deterioration.

Background: Diabetes is one of the major health problems worldwide that can be effectively managed by good self-care activities like medication adherence, exercise, monitoring of blood glucose, foot care and diet. Objectives: The study assessed the self-care activities of diabetic patients using summary of diabetes self-care activities scale (SDSCA) and the variables (Age, gender, educational level, socioeconomic status (SES)) associated with it. Methods: A cross-sectional descriptive study was undertaken in 400 Type 2 diabetic patients. Self-care practices of the patients were evaluated by using SDSCA and correlation with variables were determined statistically. Results: Among 400 diabetic patients about 215 (53.75%) had an average score of self-care. Self-care was poor in 184 (46%) subjects, and only 1 subject (0.25%) scored good. Blood sugar monitoring was the highest (100%) followed by medication adherence (92.75%) whereas inadequate levels of self-care were reported in foot care (1.5%), and physical activity (31.5%) domains. A significant positive correlation was found between self-care practices and socio-demographic variables such as age (r=0.298, p=0.000), income (r=0.490, p=0.000) occupation (r=0.433, p=0.000), education (r=0.582, p=0.000), and Socio-Economic status (r=0.599, p=0.000). Conclusion: The study revealed higher level of adherence to self-care activities in terms of blood sugar monitoring and medication taking behaviour in the current setting, but self-care in other domains such as foot care is critically low. Age, education and Socio-Economic status seems to affect the self-care practice by the patients. Keywords: Diabetes, Diabetes self- care, Diabetic foot care, Summary of diabetes self-care activities (SDSCA) score.

OBJECTIVES To explore the feasibility of a nurse-driven telephone triage intervention to improve the symptom experience of patients with cancer receiving treatment in the ambulatory setting. SAMPLE A SETTING 90 patients in three ambulatory centers (breast, head and neck, and sarcoma) receiving active treatment at a National Cancer Institute-designated comprehensive cancer center. METHODS A VARIABLES Patients received 4-18 triage calls from a nurse during a period of as many as six months dependent on their diagnosis and treatment. Feasibility was defined as the completion of 70% of triage calls. Symptom experience was measured using the MD Anderson Symptom Inventory. RESULTS The overall call completion rate was 78%. Interference (p = 0.002) and severity (p < 0.001) scores were significantly different among patients in the three centers and gradually decreased over time. IMPLICATIONS FOR NURSING Outcomes suggest that a telephone triage intervention is feasible to support patients receiving treatment. Future research can evaluate whether proactive triage affects symptom intensity during the course of the treatment trajectory.

Topoisomerases, the ubiquitous enzymes involved in all DNA processes across the biological world, are targets for various anticancer and antimicrobial agents. In Entamoeba histolytica, the causative agent of amebiasis, we found one of seven unexplored putative topoisomerases to be highly upregulated during heat shock and oxidative stress, and also during the late hours of encystation. Further analysis revealed the upregulated enzyme to be a eukaryotic type IIA topoisomerase (TopoII) with demonstrable activity in vitro. This enzyme is localized to newly forming nuclei during encystation. Gene silencing of the TopoII reduces viability and encystation efficiency. Notable susceptibility of Entamoeba TopoII to prokaryotic topoisomerase inhibitors opens up the possibility for exploring this enzyme as a new antiamoebic target.

Objective: The study was an attempt to discover a lead molecule to treat helminthiasis using Vitex trifolia. Linn (V. folia Linn) through sterile effect, in vitro and in silico evaluation. Methods: The antibacterial activity was done by Kirby-Bauer disc diffusion method in three different concentrations of extract and in vitro anthelmintic activity was carried out by petri dish and organ bath method. Further, the in silico docking studies were carried out by 11 phytoconstituents against phosphoethanolamine methyltransferase (4FGZ) using Auto Dock 4.2, it was working based on the principle of Lamarckian genetic algorithm. In docking studies, three important parameters such as binding energy, inhibition constant and intermolecular energy are determined. Results: The extracts showed an antibacterial effect in three different concentrations. At 16 mcg/disc a significant effect was observed when compared to blank and ciprofloxacin 5 mcg/disc. The anthelmintic activity in the petri dish method, means paralyzing time of Pheretimaposthuma with the dose of 25, 50 and 100 mg/ml were 13.78, 5.79 and 4.57 min respectively and Piperazine citrate (10 mg/ml) showed paralysis in 21.58 min. In the organ bath method, the time for paralysis of the worm was recorded on a slow-moving Sherrington rotating drum and the study report showed that paralyzing time was decreased at increasing concentrations of the extract. The results of in silico studies exhibited a binding energy of-10.25kcal/mol, inhibitory constant (Ki) 30.91nM, intermolecular energy,-10.84kcal/mol for abietatriene-3-ol which is lesser than the standard ligand phosphoethanolamine (-6.03kcal/mol, 38.29µM,-7.82kcal/mol) respectively. Conclusion: The study reports conclude that the active constituents in V. folia Linn having better anthelmintic activity, thus the active constituents may be optimized and make way to a new moiety for the treatment of helminthiasis.

Introduction: Oral submucous fibrosis (OSMF) is a potentially malignant disorder whose etiopathogenesis is still under investigation. Studies have reported altered serum iron levels in patients with OSMF. Hence, iron has been proposed to play an important role in the incidence and progression of the disease. This study was undertaken to understand the role of iron in the etiopathogenesis of OSMF by estimating haemoglobin and serum iron indices (serum iron, Total iron binding capacity [TIBC], percentage transferrin saturation and serum ferritin) in subjects with OSMF. Materials and Methods: Study group comprised of patients with histopathologically confirmed OSMF (n = 30). Age and sex matched subjects with clinically normal mucosa were selected as control group (n = 15). Hemoglobin, serum ferritin, serum iron, and TIBC were estimated (Siemens Dimension RXL Max Integrated chemistry system™). Statistical analysis used: SPSSv16 was used for statistical analysis. Independent sample t test was performed to compare the values between the study group and control group. ‘p’ value less than 0.05 was considered to be statistically significant. Results: There was a significant decrease in the haemoglobin, serum iron percentage transferrin saturation, serum ferritin levels and an increase in TIBC levels in the study (OSMF) group when compared to the control group (P < 0.001). TIBC levels showed a significant (P< 0.001) increase in the study group. Among the study group 44% were in an anemic state as per the hemoglobin values. Conclusion: The findings of the present study suggest that, iron deficiency state is prevalent among patients with OSMF. This deficiency of iron has an important role in the pathogenesis and progression of this disease.

Oral Squamous Cell Carcinoma (OSCC), a grave debilitating disease besides causing structural abnormalities, it harms patient’s quality of life as well. Several pathological parameters can predict the survival and prognosis of OSCC. Cell Cannibalism (CC), a distinctive morphological feature have already been explored and proved in various malignancies. However, cannibalistic cells are often ignored during routine histopathological assessment of head and neck OSCC and have not been extensively studied. The authors present a case report of a 64-year-old, female, OSCC patient with uncontrolled diabetics, in which we observed many cannibalistic cells on slide evaluation. On further examination a Histologic Tumour Thickness (HTT) of 8 mm and a depth of invasion of 6 mm was noted, which again can foretell an adverse prognosis. Subsequently, patient was referred and managed at a cancer center but a regular postoperative evaluation was scheduled in the institute for better patient care. Interpreting and understanding these risk factors and being more empathetic towards the patient, will not only help in postoperative evaluation but also ensure a better quality of life thereafter.

DC fast charging reduces the time for charging electric vehicles, however, it requires large power demand from the grid during each EV charging. DC fast charging is random in nature. At peak load demand periods of the distribution network, the energy requirement may become as high as five times the normal peak load, due to DC fast charging loads. This paper proposes a load management strategy for integrating fast charging infrastructure with the grid. An energy management system with a charge scheduling algorithm is proposed to control the charging rate of the electric vehicles in the DC fast-charging station, effectively decreasing the stress on the grid during peak load. The results of the load management strategy are compared with rulebased system and DC fast charging station devoid of any energy management system. The main contribution of the paper includes an optimized energy management system framework for a DC fast charging station connected to a low voltage distribution network. The performance of the centralized energy management system is tested on a given network – peak charging power due to fast charging on the grid is reduced, the voltage constraints are satisfied (confined within ± 5% band of the system base voltage), and voltage deviation is minimized, without integrating additional ESS or PV system.

Bibliometric analysis is the quantitative analysis of measurable citation information of a journal. It unveils research topics, publishing trends, assess research impact, and productivity.The purpose of this study was to conduct a bibliometric analysis to identify and analyze the top 50 most cited articles published in theClarivate Analytics' Web of Science was used to search and identify the 50 most cited scientific papers of JCD. Each article was then cross-matched with Google Scholar and PubMed databases and the mean citation was derived. In addition, citation density for each article was derived to negate the age of publication factor.Shapiro-Wilk test and Kolmogorov-Smirnov test were done to detect departures from normality. For testing and determining correlations among several variables, the Spearman rank test was performed.The top 50 most-cited articles received a total of 6263 (Google Scholar), 323 (PubMed), and 2056 (Web of Science) citations. Major topics of interest in the top 50 most-cited articles were dental material science (Bibliometric analysis of top-cited articles gave valuable insights into journal's research history and progress of the journal concerning dissemination of scholarly work.

Aim of the study:To assess the relapse-free survival (RFS) and the factors influencing local recurrence in patients with desmoid fibromatosis (DF) treated at our centre and to determine the role of post-operative radiotherapy (RT) in improving local control.Methods:A retrospective analysis of 51 patients treated for DF from January 2004 to December 2013 was undertaken. The RFS was calculated using the Kaplan–Meier curve. Univariate analysis was done to assess correlation with tumour size, site, the extent of surgery, margin status and adjuvant RT with RFS.Results:The median age was 28 years with a male:female ratio of 1:3. The most common location of the tumour was anterior abdominal wall (47%). The median tumour size was 10 cm. Wide local excision was done in most patients. Complete resection with negative margin was achieved in eight patients. Post-operative RT was indicated for 43 patients of whom 19 received RT. At a median follow-up of 37 months, RFS in the complete resection with margin negative group was 100%. RFS for the patients with positive or close margins who received RT was 79% and for those who did not receive RT, it was 87%.Conclusions:Complete excision with negative margins gives the best local control in DF. The benefit of post-operative RT could not be ascertained.

Objective: To assess the rationale use of benzodiazepines among various departments in a multi-speciality hospital. Methods: A prospective study was conducted with a sample size of 200 for a period of six months. Data was collected from patients based on inclusion and exclusion criteria. Naranjo Adverse Drug Reaction Probability Scale and Drug Interaction Probability Scale (DIPS) were used as a study tool to measure the causality of adverse drug reactions and drug interactions. Based on the dosage of various benzodiazepines DDD was calculated and compared with WHO Anatomical Therapeutic Chemical (ATC) classification Defined Daily Dose (DDD). Results: BZD’s were mostly prescribed in males (74.5%) and married patients (86.5%) were more exposed to benzodiazepines compared to others. Lorazepam (70.1%) was found to be the most commonly used drug, mainly prescribed for sedation, followed by anxiety. DDD was calculated and majority of patients had DDD in accordance with WHO standard. Based on cost analysis, Clobazam was found to be the high cost and Lorazepam being the low-cost drug. The results of drug utilization evaluation of benzodiazepines study were compiled and reported to the respected department physician and their feedback was collected. Conclusion: The study showed a rational utilization of benzodiazepines and the negative outcomes of BZDs can be reduced by providing drug-related information to the prescribers and consumers.