Histoplasma capsulatum Infection in an Allogeneic Hematopoietic Stem Cell Transplant Patient Receiving Voriconazole Prophylaxis

Histoplasma capsulatum infection is a rare complication in the allogeneic stem cell transplant patients. Minimal guidance exists on how to appropriately manage histoplasmosis in these patients. We report a patient who developed Histoplasma pneumonia while receiving voriconazole prophylaxis at a therapeutic trough level. The patient experienced significant clinical improvement after initiation of itraconazole pharmacotherapy. We recommend a lower threshold for evaluation for histoplasmosis in allogeneic hematopoietic stem cell transplant recipients who live in endemic regions, regardless of their antifungal prophylactic regimen

Economic liberalisation targeted programmes and household food security

"Although there is little consensus on the impact of trade liberalization on poverty and food security, it is nevertheless widely acknowledged that there is a need for governments to establish safety-nets to guard against any potentially harmful effects on the poor and vulnerable sections of society. Against this background, programs aimed at achieving food security and reducing poverty gain increased importance in the reform era. This study aims to evaluate several such programs that are currently in place in the country from the point of view of their impact, efficiency and financial sustainability. The purpose is to determine how these programs may be improved and propose appropriate policy options for reform, while also keeping in mind the new challenges that might lie ahead. Specifically, the study evaluates the Public Distribution System (PDS), Public Works Programs, and certain food-based direct intervention programs such as the Integrated Child Development Scheme (ICDS) and Tamil Nadu Integrated Nutrition Program (TINP), with a view to suggest how they can be made more cost effectiveness and better targeted." From Author's Executive SummarySafety nets ,

Fixed Functional Distal Shoe Appliance for Bilateral Loss of Deciduous Molars

Pediatric dentistry aims at preserving the deciduous teeth till its normal time of exfoliation as it maintains the integrity of the dental arches. Premature loss of deciduous teeth might lead to a wide range of implications such as the mesial migration of the erupting permanent first molars as well as the supra eruptionof the opposing dentition. In such cases the intra alveolar type of space maintainer is given however such an appliance may not fulfill all the needs. So, modification of these conventional designs will be required. This paper describes a new design for distal shoe appliance in cases of bilateral loss of primary first and second molars prior to the eruption of the permanent mandibular first molars

N-{1-[(3-Bromo­prop­yl)amino­carbon­yl]eth­yl}-2-(2-nitro­benzene­sulfonamido)propionamide

In the title compound, C15H21BrN4O6S, all three NH groups are involved in inter­molecular N—H⋯O inter­actions which, together with two inter­molecular C—H⋯O contacts, lead to a continuous anti­parallel β-sheet structure. There are no π–π inter­actions between mol­ecules, and two C—H⋯π inter­actions primarily govern the linkage between sheets

Genetic and environmental influences on sleep quality in middle‐aged men: a twin study

Poor sleep quality is a risk factor for a number of cognitive and physiological age-related disorders. Identifying factors underlying sleep quality are important in understanding the etiology of these age-related health disorders. We investigated the extent to which genes and the environment contribute to subjective sleep quality in middle-aged male twins using the classical twin design. We used the Pittsburgh Sleep Quality Index to measure sleep quality in 1218 middle-aged twin men from the Vietnam Era Twin Study of Aging (mean age = 55.4 years; range 51-60; 339 monozygotic twin pairs, 257 dizygotic twin pairs, 26 unpaired twins). The mean PSQI global score was 5.6 [SD = 3.6; range 0-20]. Based on univariate twin models, 34% of variability in the global PSQI score was due to additive genetic effects (heritability) and 66% was attributed to individual-specific environmental factors. Common environment did not contribute to the variability. Similarly, the heritability of poor sleep-a dichotomous measure based on the cut-off of global PSQI>5-was 31%, with no contribution of the common environment. Heritability of six of the seven PSQI component scores (subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, and daytime dysfunction) ranged from 0.15 to 0.31, whereas no genetic influences contributed to the use of sleeping medication. Additive genetic influences contribute to approximately one-third of the variability of global subjective sleep quality. Our results in middle-aged men constitute a first step towards examination of the genetic relationship between sleep and other facets of aging.Accepted manuscrip

Relationship marketing and service quality in Bank Muscat Oman (Sayarati Loans)

Sultanate of Oman is one of the prominent GCC Countries with a population of around 3 million.With assets worth over USD 15 billion, Bank Muscat (SAOG) is the leading financial services provider in Oman with a strong presence in Corporate Banking, Retail Banking, Investment Banking, Treasury, Private Banking and Asset Management. This paper looks into the “RELATIONSHIP MARKETING AND SERVICE QUALITY IN BANK MUSCAT OMAN (Sayaratti Loans)”.The quality of customer service is the key indicator of the performance of the different branches of the Bank.Banks in the current scenario is increasingly showing its interest in satisfying a customer wants.Given the profit figures on board as targets Banks need to also look into the special needs of the customer’s perspective, any lacuna in service quality to be looked into seriously.The car loans popularly known as Sayaratti loans are taken as the product for study.The findings of the study say that there is a significant relationship between the age and the overall customer satisfaction levels and there is no significant relationship between the age and the service quality by the bank

Awareness regarding eye donation among stakeholders in Srikakulam district in South India

Background There is a huge need for the availability of transplantable donor corneas worldwide to reduce the burden of corneal blindness due to corneal opacity. Voluntary eye donation depends on the awareness levels of various stakeholders in the community. This study aimed to assess the awareness level regarding eye donation among various stakeholders in Srikakulam district in the state of Andhra Pradesh, India. Methods 355 subjects were selected from the district using multi stage random sampling. A pre tested semi structured questionnaire was used to collect information regarding each individual’s awareness, knowledge, and perception regarding eye donation. Each response was scored individually and a total score was calculated. Univariate and multivariate regression analysis was used to determine the factors associated with willingness towards eye donation and increased awareness levels. Results Of the 355 subjects interviewed, 192 (54%) were male and 163 (46%) were female. The mean age of the stakeholders was 35.9 years (SD ±16.1) and all the study subjects were literate. Ninety-three percent of subjects were aware of the concept of eye donation. Knowledge levels were similar among the teaching community and persons engaged in social service, but lower among students (p < 0.05). Among the stakeholders, there was considerable ambiguity regarding whether persons currently wearing spectacles or suffering from a chronic illnesses could donate their eyes. Older age group (p < 0.001), female gender (p < 0.001) and education (p < 0.001) were associated with increased knowledge levels. 82% of the subjects were willing to donate their eyes and this was unaffected by gender or geographical location (rural vs urban). Conclusions Awareness levels and willingness to donate eyes are high among the stakeholders in Srikakulam district in India. The services of stakeholders could be utilized, in conjunction with other community based eye donation counselors, to promote awareness regarding eye donation among the general population

Assesment of Postoperative Analgesic Effects of Intramuscular Tramadol Administration and Intraperitoneal Bupivacaine following Laparoscopic Cholecystectomy

Background: For postoperative pain relief after laparoscopic surgeries, intramuscular or intravenous non-steroidal anti-inflammatory drugs and opioids, infiltration at the incision site with local anesthetics, intraperitoneal infiltration of local anesthetics with adjuvants, epidurals and nerve blocks were in use. The study was aimed to assess the efficacy of intramuscular Tramadol and intraperitoneal instillation of bupivacaine on postoperative analgesia, postoperative nausea, and vomiting following laparoscopic cholecystectomy. Methods: This study included 60 American Society of Anesthesiologists (ASA) I and ASA II patients of aged 18-60 years who were scheduled for laparoscopic cholecystectomy under general anesthesia. 60 patients were classified randomly into two groups equally: Group T received 100 Mg of intramuscular tramadol and Group B received intraperitoneal instillation of 30 ml of plain bupivacaine. Time duration, postoperative pain, haemodynamics, nausea, vomiting, and time taken to rescue analgesia were noted. Results: The time for onset of analgesia was 6.51 ± 2.41min in group T and 7.61 ± 2.19 min in group B (p=0.039). The duration of analgesia was 2.37 ± 0.67 hours in group T and 3.65 ± 0.79 hours in group B (p=0.002). VAS Score was significantly lower in Group T than Group B at 1hr, 2hr, 4hr and 6hr (p <0.05). Intraperitoneal bupivacaine showed a significant reduction in postoperative pain for the first 6 hours postoperatively (P<0.05), and time taken to rescue analgesia requirement was prolonged (P<0.05). The rescue analgesia consumption of Paracetamol was 1.5 grams in group-B and 2.5 grams in group T (P<0.05) in 24 hr post-surgery. Nausea and vomiting were observed in 2 cases, and shoulder pain in one case in group T. Conclusion: Bupivacaine is effective in reducing postoperative pain, and it prolongs the requirement time for rescue analgesia after LC surgery. It also required less consumption of rescue analgesic without fluctuations in hemodynamic