Tuberculosis of bilateral sacroiliac joints with bilateral psoas abscess: an unusual presentation

Infectious diseases usually affect the sacroiliac joint unilaterally. Out of all tuberculosis cases, bone tuberculosis is reported in 3-5% of cases. The purpose of this case report is to draw attention to the diagnostic challenge of bilateral tuberculous sacroiliitis with psoas abscess, as this clinical picture is very rare. Tuberculosis of the sacroiliac joint is often missed due to vague symptoms. More often, patients are examined in the supine position, thereby overlooking the sacroiliac joint. Involvement of the sacroiliac joint is rare, but exact numbers are not available. Our case report shows a complication of skeletal Tb that a psoas abscess may develop, causing nonspecific symptoms.

Viral Hepatitis in Dentistry – An overlooked contributor to disease burden and occupational hazard in India

Introduction: Dental professionals are considered to be at high-risk for contacting blood-borne pathogen transmissions. Thus, making it necessary for dentists to be aware on prevention, transmission and management of viral hepatitis. Objective: One day training programs for upskilling dental fraternity were conducted on 11th November 2019 and 11thFebruary 2020. Program also evaluated the Knowledge, Attitude, and Practices (KAP) of dentists regarding infection control practices and oral manifestations of viral hepatitis. Methods: One-day training program viz. “Viral hepatitis in Dentistry” under project Programmed Approach to Knowledge And Sensitization on Hepatitis (PRAKASH) was organized and a cross-sectional study using 20-item-self-reported questionnaire was conducted among participating professionals from six states of India. Identifying information was removed during statistical analysis. Results: Total of 625 dental professionals were trained; of which 470 participated in the KAP study i.e. response rate was calculated to be 75% (470 out of 625). Females represented about 73.2% of the sample(n=470). Sample comprised of experts from all the branches of dentistry. Almost 97% of responders were from private dental institutes or clinics. Mean knowledge score was found to be 4.71 ± 2.04, however when compared with age, knowledge in older professionals > 25 years was higher at 5.00 + 2.10 than participants’ aged<25, 4.57 ± 2.00 (p value = 0.03). Participating professionals seems to be following precautionary practices regarding viral hepatitis in dental clinics in a comparable manner irrespective of their age i.e. mean practice score of 6.81 ± 1.82 in professionals’< 25 years of age and mean practice score 6.81 ± 1.67 in trainees > 25 years. Conclusion: Study raised concerns regarding poor knowledge about infection prevention control and management of viral hepatitis in dental settings. Limited interventions in terms of capacity building programs for dentists on viral hepatitis, highlight the necessity of continued education through such training programs

NON-ORTHOGONAL SIGNAL-BASED OPTICAL COMMUNICATION SYSTEMS USING FUZZY LEARNING FOR INTERFERENCE CANCELLATION

Non-orthogonal signal-based systems are a type of communication system that uses signals that are not mutually perpendicular (i.e., not orthogonal) to transmit information. These types of systems can increase the spectral efficiency of communication systems by allowing for more data to be transmitted in the same bandwidth. Groups of signals with non-orthogonal waveforms can increase spectral efficiency, but they also increase the potential for interference. Spectrally efficient frequency division multiplexing (SEFDM) is a well-studied waveform that was originally proposed for use in wireless systems but has since found application in millimeter wave communications at 60 GHz, optical access network architecture, and long-distance optical fiber transmission. However, non-orthogonal signal-based systems are also more susceptible to interference from other sources, which can degrade the quality of the transmitted signal. To address this problem, this paper suggests using fuzzy learning techniques to cancel out interference and improve the signal-to-noise ratio. Fuzzy learning is a type of machine learning that uses fuzzy logic (FL) to handle uncertainty and imprecision in data. By using FL techniques to cancel out interference, the non-orthogonal signal-based optical communication (OC) system could potentially achieve better performance in noisy environments. Overall, this research topic has the potential to contribute to the development of more efficient and reliable OC systems that can operate in challenging environments

Comparative efficacy versus effectiveness of initial antiretroviral therapy in clinical trials versus routine care

BACKGROUND: The applicability of clinical trial findings (efficacy) to the routine care setting (effectiveness) may be limited because of study eligibility criteria and volunteer bias. Although well-chronicled in many conditions, the efficacy versus effectiveness of antiretroviral therapy (ART) remains understudied. METHODS: A retrospective study of the University of Alabama at Birmingham 1917 Clinic Cohort evaluated ART-naive patients who started ART from 1 January 2000 through 31 December 2006. Patients received ART through clinical trials or routine care. Multivariable logistic and linear regression models were fit to evaluate factors associated with virological failure (virological failure was defined as a viral load \u3e50 copies/mL) and change from baseline CD4+ cell count 6 and 12 months after ART initiation. Sensitivity analyses evaluated the impact of missing data on outcomes. RESULTS: Among 570 patients starting ART during the study period, 121 (21%) enrolled in clinical trials, and 449 (79%) received ART via routine care. ART receipt through routine care was not associated with viral failure at either 6 months (odds ratio [OR], 1.00; 95% confidence interval [CI], 0.54-1.86) or 12 months (OR, 1.56; 95% CI, 0.80-3.05) in primary analyses. No statistically significant differences in CD4+ cell count responses at 6 and 12 months were observed. CONCLUSIONS: Although marked differences in efficacy versus effectiveness have been observed in the therapeutic outcomes of other conditions, our analyses found no evidence of such divergence among our patients who initiated antiretroviral therapy for human immunodeficiency virus infection

Maintainence Treatment of Opioid Dependence with Tramadol

Background: Although tramadol has been used in the management of acute withdrawal in patients with opioid dependence, its use for maintenance treatment as a harm reduction approach has not been assessed systematically. This case series describes patients with opioid dependence who were treated with tramadol for long-term maintenance. Methods: Patients with opioid dependence who received treatment at the National Drug Dependence Treatment Centre of All India Institute of Medical Sciences, New Delhi, were included in the study. Patients who received at least 6 months of tramadol and had follow-up adherence of more than 80% were included in the case series. Results: A total of 25 cases were included, all of whom were males. The types of opioids being taken at the time of initiation of tramadol were natural opiates (poppy husk and raw opium), followed by heroin. The median dose of tramadol at initiation and maintenance was 300 mg/day. Nineteen patients were able to achieve complete abstinence to other opiates on tramadol. Conclusion: Tramadol may be an effective option in the long-term management of patients with opioid dependence. Further studies are required for establishing the efficacy of tramadol for agonist management of patients with opioid dependence

Initial psychological impact of COVID-19 and its correlates in Indian Community: An online (FEEL-COVID) survey

BACKGROUND: The pandemic of Corona Virus (COVID-19) hit India recently; and the associated uncertainty is increasingly testing psychological resilience of the masses. When the global focus has mostly been on testing, finding a cure and preventing transmission; people are going through a myriad of psychological problems in adjusting to the current lifestyles and fear of the disease. Since there is a severe dearth of researches on this issue, we decided to conduct an online survey to evaluate its psychological impact. METHODS: From 26th to 29th March an online survey (FEEL-COVID) was conducted using principles of snowballing, and by invitation through text messages to participate. The survey collected data on socio-demographic and clinical variables related to COVID-19 (based on the current knowledge); along with measuring psychological impact with the help of Impact of Event–revised (IES-R) scale. RESULTS: There were a total of 1106 responses from around 64 cities in the country. Out of these 453 responses had at least one item missing; and were excluded from the analysis. The mean age of the respondents was around 41 years with a male female ratio of 3:1 and around 22% respondents were health care professionals. Overall approximately one third of respondents had significant psychological impact (IES-R score > 24). Higher psychological impact was predicted with younger age, female gender and comorbid physical illness. Presence of physical symptoms and contact history predicted higher psychological impact, but did not reach statistical significance. CONCLUSION: During the initial stages of COVID-19 in India, almost one-third respondents had a significant psychological impact. This indicates a need for more systematic and longitudinal assessment of psychological needs of the population, which can help the government in formulating holistic interventions for affected individuals

Understanding the correlates of successful abstinence in a randomized double blind placebo controlled trial of varenicline for smokeless tobacco dependence in India

Background Rates of smokeless tobacco(ST) use in India are very high and associated with grave health consequences. Research on effective ST cessation approaches is a priority. In a randomized double blind placebo controlled trial of varenicline for ST dependence in AIIMS, India, biochemically confirmed end-of-treatment(EOT) abstinence was greater for varenicline versus placebo(25.2% vs. 19.5%), but this was not statistically different(AOR = 1.6, 95% CI = 0.84-3.1, p = .15). Here, we studied the correlates of successful abstinence in this trial as such an evidence-base is crucial to optimize treatment strategies. Methods 237 ST users who were randomized to receive either varenicline(12 weeks, 1 mg, twice per day) or placebo were included in this analysis. Socio-demographics, ST use parameters (age of initiation, duration, chews per day, and FTND-ST scores), abstinence related parameters, baseline urinary cotinine levels, and treatment adherence were analyzed. Multivariate analysis, using biochemically confirmed point prevalence abstinence as the dependent variable, was done to predict the odds of quitting at EOT. Results Participants were predominantly males(97%) and mean age was 34.2(SD± 9)yrs. Using logistic regression on the whole group, baseline urinary cotinine and number of 24 hour quit attempts in the past significantly(p < 0.05) predicted cessation at EOT. The odds of abstinence increased with unit decrease in urinary cotinine levels(Exp(B) = 0.86) and unit increase in number of 24 hour quit attempts (Exp(B) = 0.66). In the varenicline arm average chews per day(Exp(B) = 0.91) and baseline depression scores using HAM-D also significantly predicted successful quitting. Greater adherence increased EOT cessation rates for varenicline (39% vs. 18%, p = .003) but not for placebo (28% vs. 14%, p = .06). Conclusions This has implications for optimizing treatment planning at a program level, especially in resource poor countries. Strategies to enhance treatment adherence and address depression would be important

Evaluation of a training workshop on tobacco cessation: capacity building initiative in India

Background The World Health Organization's (WHO) Tobacco Free Initiative highlights the role of health care professionals such as nurses, pharmacists, counselors and related support staff, in implementing smoking-cessation services. However, to be competent in providing smoking-cessation interventions, they need to establish and demonstrate knowledge, skills, and confidence in this field. Methods Pre-Post quasi-experimental design was used in this study to test the effectiveness of the educational training program. A total of 90 healthcare professionals, including nurses, nursing trainees, psychology trainees, social workers and trainees attended the workshop. Seventy six completed the pre-post assessment as a part of the one day workshop at All India Institute of Medical Sciences, New Delhi. The tool developed by the researchers included twenty questions evaluating the knowledge, attitude and skills related to Tobacco cessation activities. Each item in the questionnaire had a score of one for correct and zero for incorrect responses. Paired sample t-test was performed to compare the scores on above parameters. Ethical approval was obtained from Institute Ethics Committee. Results The participants were predominantly females (80.26%) with professional experience of up to 3 years (Mean = 1.68; SD ± 0.84) in various healthcare related activities. There was a statistically significant improvement in total scores after the workshop as compared to before (Mean change: 2.86; t = 8.71, p< 0.001). The improvement was statistically significant in both knowledge related (t = 7.46, p< 0.001) and attitude/ skills related scores (t = 2.94, p=0.004). The level of professional experience and previous attending workshops could not statistically predict change in scores. Conclusions The workshop proved to be an effective approach in enhancing knowledge and imparting attitudinal changes in the healthcare professionals. Continued educational programs should be organized for capacity building in Tobacco cessation activities

Knowledge, attitude, and practice toward prevention and management of COVID-19 among indian nurses: A cross-sectional study

Background: To plan suitable policy against COVID-19 pandemic, it is important that the nurses have updated knowledge related to prevention, diagnosis, treatment, and management of COVID-19 and have an optimistic attitude and good practices in managing the patients during the pandemic crisis. Thus, we conducted a study on the knowledge, attitude, and practices (KAP) related to COVID-19 among Indian nursing professionals. Methodology: A cross-sectional study was conducted from April 22 to May 22, 2020 using a pretested 37-item-self-reported e-questionnaire among nursing professionals above 18 years of age, working in health-care setting across 25 states. The questionnaire consisted of four sections: demographic details, knowledge (26 items), attitude (6 items), and practice (5-itmes). KAP questionnaire was shared through e-mail, SMS, and WhatsApp groups. Results: A total of 1182 participants responded to the online survey with 94% completion rate. The study analyzed the data for 1110 nurses with a mean age of 30 ± 6.7 years and 68% being females. The mean KAP score was 16.82 ± 3.3, 9.77 ± 2.03, and 18.37 ± 3.29, respectively. Knowledge was significantly correlated with attitude (r = 0.1316) and practice (r = 0.1526). Practice and attitude were also found to be positively correlated (r = 0.4398). Good knowledge related to COVID-19 was significantly affected by age, gender, location, and type of facility (<0.01). Conclusion: The study raised concerns regarding poor knowledge, anxiety, and fear from COVID-19 duty affects the health-care workers (HCWs) performance and provides resistance in working. A comprehensive training program for HCWs focuses more in terms of infection, prevention, control, and management and maintaining good mental health is required