Nutrient X-Ray Energy Shift Studies in Wheat Plants and Soils

Aims: To check the effect of soil environment on chemistry of potassium and calcium nutrients in wheat plants with varying soil conditions. Study Design: Energy Dispersive X-ray Fluorescence (EDXRF) measurements on plant/soil samples. Study of fluorescent X-ray spectra and data processing to calculate shift in photo peak energies of nutrients. Place and Duration of Study: XRF laboratory, Nuclear science laboratories, Physics Department, Punjabi University, Patiala during December 2013-March 2014. Methodology: A pot experiment was performed on wheat plants grown on soils collected from different sites of six cities / town / village in Punjab, India. Low power X-ray tube set up for Energy Dispersive X-ray Fluorescence (EDXRF) measurements has been used to record the fluorescent X-ray spectra of wheat plants and soils for macro nutrient studies. SOLVER a powerful program included in Microsoft Excel for Windows was applied to predict nutrient X-ray energies with precision 10-4 of channel width. The shifts in peak energies were evaluated with reference to that of plant/soil from an environmentally protected ground site. Results: The shift in calcium photo peak energies was found higher than that of potassium photo peaks. In case of soils, the shifts are related to level of contamination of soils from sewage system, factory sites and road sides. The changes in soil nutrients’ chemical state lead to these shifts and accordingly from studied shifts, the height of the contamination level is approximated and correlated with the population life style of localities and environment of occupations on the soils like industries, farming and gardening etc. The shifts in nutrient photo peak energies in plants, generally, in opposite direction to that for soils signify the wheat plants’ quality to cope with stress conditions. Conclusion: Shifts in photo peak energies for nutrients can be used as tool to sense the contamination level of soil

Study of Depression, Anxiety and Stress among School Going Adolescents

Background: Adolescents; the bright hope of the future are characterized by many physical, emotional and developmental changes. However, during this stage, some of adolescents, experience anxious feeling, overwhelming sense of fear, depression and academic stress. Adolescents can experience various life stresses ranging from catastrophic or traumatic life events, persistent strain and daily hassles. Thus Present study was carried out to check the depression, anxiety and stress in this population. Material and Method: It is a cross-sectional study, in which 200 adolescents were taken; equally boys and girls using purposive sampling. Assessment was done using Depression, Anxiety and Stress Scale-DASS (Hindi Version). The statistical analysis was carried out using the SPSS Windows 16.0 software package. The analysis of the obtained data was done using various descriptive and inferential statistics. Results: The scores of students in all three domains of Depression, anxiety, and Stress scale were found to be remarkably correlated. It was seen that depression was significantly more common among the female students than the male students. Conclusion: Overall findings suggest that these adolescents are at high risk of developing depression and anxiety disorder. Adolescents with stress need to be identified early and interventions to reduce academic stress need to be provided which are likely to affect the occurrence and severity of depression and anxiety. Keywords: Adolescents, depression, anxiety, stres

MENTAL HEALTH AND QUALITY OF LIFE DURING COVID-19 PANDEMIC IN INDIAN POPULATION

Objective: As there is a dearth of researches targeting the Indian population on this issue, we decided to conduct a survey to assess the psychological impact of COVID-19 on mental health and quality of life of Indians. Methods: In this Cross-Sectional study, a total of 2245 participants above 16 y of age were included. Mental health variables were assessed via depression, anxiety and stress subscale (DASS-21), Insomnia Severity Index (ISI-7), Patient health questionnaire (PHQ-15), Quality of life (QoL-5) and social media exposure. Results: The multivariate logistic regression demonstrated female (OR-1.17, 95% CI: 0.99 to 1.38) had significantly higher depression scores whereas, housewife had higher depression (OR-1.68, 95% CI: 1.33 to 2.13), anxiety (OR-1.64, 95% CI: 1.15 to 2.35), insomnia (OR-1.32, 95% CI: 1.14 to 1.53), somatic symptoms (OR-1.76, 95% CI: 1.21 to 2.57). Front line workers had a higher psychological impact with increased scores of anxieties (OR-1.23, 95% CI: 0.79 to 1.53), stress (OR-1.82, 95% CI: 0.76 to 2.55), insomnia (OR-1.65, 95% CI: 1.31 to 2.09). Lower education level had significantly higher score in depression (OR-1.14, 95% CI: 0.73 to 1.32), insomnia (OR-2.42, 95% CI: 2.07 to 2.84), somatic symptoms (OR-2.59, 95% CI: 1.80 to 3.37). Poor physical health, social media exposure was significantly associated with heightened anxiety score. Conclusion: There is a need for psychological intervention as the dynamics and severity of COVID-19 is rapidly changing. These findings could guide the public health authorities to target and implement health measures to combat the pandemic

Role of p63 expression in non-proliferative and proliferative lesions of breast

Background: Breast lump among females, is a fairly common complaint. Breast lump have a variety of etiologies ranging from inflammatory to benign to malignant lesions. Myoepithelial markers are useful in helping to distinguish invasive carcinoma from benign proliferations with a similar morphological appearance, benign proliferative lesions and most pre-invasive lesions with an intact myoepithelium. Invasive carcinomas lack the myoepithelial cell layer that normally surrounds benign breast glands. p63 antibody is a myoepithelial cell marker that selectively stains nuclei. Also, it is negative in stromal, myofibroblastic and adipocytic cells. This makes p63 more specific and superior to other myoepithelial markers.Methods: The present study was done on a total of 151 cases of breast diseases, received in the form of core biopsy, tru cut biopsy, lumpectomy, and mastectomy specimens. Clinical history and examination findings of the patients were collected in all the cases. All specimens were routinely processed and stained with haematoxylin and Eosin (H and E) stain and only 50 cases were subjected to immunohistochemical staining for p63.Results: Out of total 151 cases, 09 were inadequate for evaluation, 96 cases benign and 46 malignant. In benign category, fibroadenoma was most common and infiltrating ductal carcinoma (NOS) was the most common in malignant category. Mean size of benign tumors was found to be less than that of malignant tumors. All malignant cases were negative for p63 expression. In the benign category, 88.6% cases showed positive expression for p63 while 11.4% were negative. Among the benign category, non-proliferative lesions were continuous positive, proliferative showed discontinuous positivity for p63.Conclusions: Myoepithelial markers are useful in helping to distinguish invasive carcinoma from benign proliferations with a similar morphological appearance, benign proliferative lesions and most pre-invasive lesions with an intact myoepithelium. Invasive carcinomas lack the myoepithelial cell layer while in the benign category, non-proliferative lesions are continuous positive, proliferative lesions show discontinuous positivity for p63

EVALUATION OF NEUROLOGICAL MANIFESTATIONS IN HUMAN IMMUNODEFICIENCY VIRUS-AIDS PATIENTS ADMITTED TO SOUTH INDIAN TERTIARY CARE HOSPITAL – A CROSS-SECTIONAL STUDY

Objective: The objective of the study was to describe, evaluate, and analyze neurological manifestation in human immunodeficiency virus HIV positive patients admitted to a tertiary care center. Methods: The study was a prospective cross-sectional study, in which 103 HIV patients were analyzed. All patients were interviewed face to face and evaluated by the investigator with particular reference to neurological manifestations. They were classified into various stages of HIV using the World Health Organization staging system. Results: The mean age in males was 37 (standard deviation [SD] 8.0) years and in females 35 (SD 7.0) years. A greater proportion of females were diagnosed in the asymptomatic state during screening, either during pregnancy or when the spouse was found to be positive. Headache was the most common neurologic symptom and fundus abnormalities were the most common neurological sign documented in patients. The mean CD4 counts in males are 156.5/mm3 and in females are 229.57/mm3 whereas the mean absolute leukocyte count in males is 1088.30/mm3 and in females is 1473.52/mm3. The CD4 counts showed a better correlation with the occurrence of neurological manifestations than absolute leukocyte count. Conclusion: Headache was a significant predictor of the occurrence of neurological complications (p=0.01). CD4 counts were significantly lower in patients with neurological complications and most of the neurological manifestations; on the contrary, all the opportunistic infections were documented in patients with CD4 counts below 200/mm3. Neurological complications did not show any correlation with the patient being on anti-retroviral therapy

Quality by Design: A new practice for production of pharmaceutical products

This is the advanced approach for development of pharmaceutical product with full range and specified limits of variables during procurements, storage and manufacturing process with a qualification, at desired level of quality within the limits of low and higher values of variables to ensures  the Pharmaceutical product Quality by design (QbD) of manufacturing a finished product. The Quality by Design is depicted and a portion of its components recognized and process parameters with quality characteristics are identified for every unit activity. Advantages, openings and steps engaged with Quality by Design of Pharmaceutical items are depicted. The point of the pharmaceutical advancement is to plan a quality item and it’s assembling procedure to reliably convey the proposed execution of the item. Quality can't be tried into items however quality ought to be worked in by outline. It incorporates the Quality target item profile, basic quality traits and key parts of Quality by Design. It likewise gives correlation between item quality by end item testing and item quality by Quality by Design. The establishment of Quality by Design is ICH Guidelines. It depends on the ICH Guidelines Q8 for pharmaceutical improvement, Q9 for quality hazard administration, Q10 for pharmaceutical quality frameworks. It moreover gives utilization of Quality by Design in pharmaceutical improvement and assembling of pharmaceuticals. Keywords: Quality by Design, Design Space, Target Product Quality Profile, Critical Quality Attribute

Usporedba dugotrajne primjene triju intrakanalnih lijekova na mikrotvrdoću i otpornost na lom korijenskog dentina: in vitro istraživanje

Objectives: The aim of this research was to evaluate the effect of long-term use of three intracanal medicaments on the radicular dentin microhardness and fracture resistance. Material and methods: A chemomechanical preparation was done using the Protaper rotary instruments up to F3. The teeth were stored in an incubator at 37°C at 100% humidity and were categorized in three groups by random allocation, namely: Triple Antibiotic Paste (TAP), Calcium hydroxide paste (Apexcal) and Ledermix. Following medicament application, the access openings of all teeth were sealed with 4 mm thickness of cavit. The samples were stored for periods of 1 week, 1 month and 3months. Two dentin cylinders measuring 5mm and 3mm were obtained from each sample. The cervical third was used for fracture resistance and the middle third was used for micro hardness evaluation. The microhardness testing was done using a Knoop microhardness tester, and the fracture resistance testing was done using the universal testing machine. Results: Calcium hydroxide showed maximally negative effect on the physical properties of radicular dentin compared to TAP (p= 0.0100 at one month and Ledermix (p=0.0001 at one month ). With an increase in the application time, there was an increased deterioration in the physical properties of radicular dentin. Conclusion: Long-term placement of calcium hydroxide, Triple Antibiotic Paste, and Ledermix (p= 0.0001at 3 months) significantly affects the microhardness and fracture resistance of radicular dentin.Cilj rada: Željelo se procijeniti kako dugotrajna upotreba triju intrakanalnh lijekova utječe na mikrotvrdoću i otpornost na lom radikularnog dentina.Materijal i metode: Kemomehanička preparacija obavljena Protaperovim rotirajućim instrumentima do F3. Zubi su zatim stavljeni u inkubator i čuvani na temperaturi od 37 °C u 100 posto vlažnom okružju te su slučajnim odabirom podijeljeni u tri skupine: trostruka antibiotička pasta (TAP), pasta od kalcijeva hidroksida (Apexcal), Ledermix. Nakon primjene lijekova svi su ulazni otvori zabrtvljeni 4 mm debelim slojem Cavita. Uzorci su zatim uskladišteni tjedan dana, mjesec dana i tri mjeseca. Od svakog uzorka uzeta su po dva dentinska cilindra debljine 3 i 5 mm. Za otpornost na lom korištena je cervikalna trećina, a za procjenu mikrotvrdoće srednja trećina. Mikrotvrdoća je ispitana testerom Knoop Microhardness, a otpornost na lom univerzalnim ispitnim uređajem. Rezultati: Kalcijev hidroksid najsnažnije je negativno djelovao na fizička svojstva radikularnog dentina u usporedbi s TAP-om (p = 0,0100 nakon mjesec dana) i Ledermixom (p = 0,0001 nakon mjesec dana). Kako se povećavalo razdoblje djelovanja, tako su se pogoršavala fizička obilježja radikularnog dentina. Zaključak: Dugotrajno korištenje kalcijeva hidroksida, TAP-a i Ledermixa (p = 0,0001 nakon 3 mjeseca) znatno utječe na mikrotvrdoću i otpornost na lom radikularnog dentina

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme