Use of iodine tincture in the management of wound dehiscence in operated mandibular fracture along with hardware salvage: a case report

Mandibular fractures are one of the most common facial fractures. Depending on the severity, they are treated either by closed reduction or open reduction and internal fixation. Hardware exposure is one of the postoperative complications associated with the latter. Data involving decision regarding removal or salvage of hardware in such cases is lacking. We present a case of wound dehiscence with hardware exposure in an operated mandibular fracture, which was managed by placing tincture iodine dressing, thus obviating the need for hardware removal

Gabapentin a pre-emptive analgesic in post-operative pain: a randomised double blind placebo controlled study

Background: Conventional analgesics, used in peri-operative period cause numerous adverse effects and are not free from interactions with co-administered drugs. Gabapentin has been shown to be effective in various types of neuropathic pain. The primary aim of this study was to evaluate gabapentin as a post-operative analgesic. The study also evaluates the analgesic requirement and safety of gabapentin in post-operative period.Methods: Forty patients undergoing elective laparoscopic cholecystectomy were randomized to receive gabapentin or a matching placebo. The patients of group I received gabapentin 600mg orally 2 hrs before surgery and 12hrs after the first dose. The patients in group II received a matching placebo. Patients in both groups received diclofenac sodium 75mg i.m b.i.d for pain. Additional doses were given on demand and recorded.Results: The present study found that gabapentin significantly reduced pain score and analgesic consumption as compared to a placebo for a period of 24 hours.Conclusions: Gabapentin in the doses used was found to be effective in postoperative pain in patients undergoing planned laparoscopic cholecystectomy. It was found to be safe and no serious adverse events were reported

Gabapentin pre-treatment for pressor response to direct laryngoscopy and tracheal intubation: a randomized, double-blind, placebo-controlled study

Background: Laryngoscopy and endotracheal intubation are associated with an increase in blood pressure (BP) and heart rate (HR). The present study was conducted to evaluate the role of gabapentin in attenuation of these hemodynamic changes.Methods: Forty patients undergoing elective laparoscopic cholecystectomy under general anesthesia with standardized premedication and anesthetics were randomized to receive gabapentin or a matching placebo. The patients of Group I received gabapentin 600 mg orally 2 hrs before surgery and patients in Group II received a matching placebo. Patient’s HR, systolic BP (SBP), diastolic BP (DBP), mean BP (MBP), were monitored before and after 1, 2, 5, and 10 mins of endotracheal intubation.Results: Comparison of SBP, DBP, and MBP at 1, 2, 5 and 10 mins after endotracheal intubation showed statistically significant attenuation in the gabapentin group when compared to placebo. Changes in the HR were not significant.Conclusion: Gabapentin 600 mg, given 2 hrs before induction is effective in attenuating the pressor response to laryngoscopy and tracheal intubation

Gabapentin for post-operative nausea and vomiting: a pilot study

Background: Gabapentin has been used in perioperative setting for the management of post-operative pain for surgery performed under general anaesthesia. Post-operative nausea and vomiting (PONV) even with the use of newer agents remains a major problem. The primary aim of this study was to see if gabapentin use decreased PONV.Methods: A total of 40 patients undergoing elective laparoscopic cholecystectomy under general anesthesia with standardized premedication and anesthetics were randomized to receive gabapentin or a matching placebo. The patients in Group I received gabapentin 600 mg orally 2 hrs before surgery and 12 hrs after the first dose. The patients in Group II received a matching placebo orally 2 hrs before surgery and 12hrs after the first dose. Patients in both groups received diclofenac sodium 75 mg i.m b.i.d for pain and ondensetron 4 mg i.v for PONV. Additional doses were given on demand and recorded. The treatment was double blinded.Results: The present study did not find significant reduction in PONV score and antiemetic consumption in gabapentin group when compared to a placebo for a period of 24 hrs.Conclusions: Gabapentin in the doses used was found to ineffective in post-operative nausea and vomiting in patients undergoing planned laparoscopic cholecystectomy with standardized pre-anaesthetic and anaesthetic medication

Design and development of the ‘POD Adventures’ smartphone game: a blended problem-solving intervention for adolescent mental health in India

Introduction: Digital technology platforms offer unparalleled opportunities to reach vulnerable adolescents at scale and overcome many barriers that exist around conventional service provision. This paper describes the design and development of POD Adventures, a blended problem-solving game-based intervention for adolescents with or at risk of anxiety, depression and conduct difficulties in India. This intervention was developed as part of the PRemIum for ADolEscents (PRIDE) research programme, which aims to establish a suite of transdiagnostic psychological interventions organised around a stepped care system in Indian secondary schools. Methods and materials: Intervention development followed a person-centered approach consisting of four iterative activities: (i) review of recent context-specific evidence on mental health needs and preferences for the target population of school-going Indian adolescents, including a multiple stakeholder analysis of school counselling priorities and pilot studies of a brief problem-solving intervention; (ii) new focus group discussions with N=46 student participants and N=8 service providers; (iii) co-design workshops with N=22 student participants and N=8 service providers; and (iv) user-testing with N=50 student participants. Participants were aged 12-17 years and recruited from local schools in New Delhi and Goa, including a subgroup with self-identified mental health needs (N=6). Results: Formative data from existing primary sources, new focus groups and co-design workshops supported a blended format for delivering a brief problem-solving intervention, with counsellors supporting use of a game-based app on ‘offline’ smartphones. User-testing with prototypes identified a need for simplification of language, use of concrete examples of concepts and practice elements to enhance engagement. There were also indications that participants most valued relatability and interactivity within real-world stories with judicious support from an in-app guide. The final prototype comprised a set of interactive and gamified vignettes and a structured set of problem-solving questions to consolidate and generalise learning while encouraging real-world application. Discussion: Findings shaped the design of POD Adventures and its delivery as an open-access blended intervention for secondary school students with a felt need for psychological support, consistent with an early intervention paradigm. A randomised controlled trial is planned to evaluate processes and impacts of POD Adventures when delivered for help-seeking students in low-resource school settings

App-based guided problem-solving intervention for adolescent mental health: a pilot cohort study in Indian schools

Background This paper describes the pilot evaluation of ‘POD Adventures’, a lay counsellor-guided problem-solving intervention delivered via a smartphone app in Indian secondary schools. Objective To test the feasibility and acceptability of POD Adventures for adolescents with a felt need for psychological support, and to explore the intervention’s effects on self-reported mental health symptoms, prioritised problems, stress and well-being. Methods We used a mixed-methods pre-post cohort design. Participants were self-referred from grades 9–12 in two coeducational government-aided secondary schools in Goa, India. The intervention was delivered in two formats, ‘mixed’ (comprising individual and small group sessions) and ‘group’ (small group sessions only). Findings 248 participants enrolled in the study and 230 (92.7%) completed the intervention. Outcomes at 4 weeks showed significant improvements on all measures that were maintained at 12 weeks. Large effects were observed on problem severity scores (4 weeks, d=1.47; 12 weeks, d=1.53) while small to moderate effects were seen on mental health symptoms, stress and well-being. 22 students completed qualitative interviews about their experience of the intervention. Participants found POD Adventures easy to use, engaging and helpful in solving their problems. They were satisfied with the guidance provided by the counsellor irrespective of delivery format. Conclusions POD Adventures was feasible to deliver with guidance from lay counsellors in Indian schools, acceptable to participants and associated with large improvements in problem severity and mental health symptom severity. Clinical implications POD Adventures has promise as an early intervention for adolescents with a felt need for psychological support in low-resource settings

A guided internet-based problem-solving intervention delivered through smartphones for secondary school pupils during the COVID-19 pandemic in India: protocol for a pilot randomized controlled trial

Background: “POD Adventures” is a gamified mental health intervention delivered via a smartphone app and supported by counsellors for a target population of secondary school students in India. This paper describes the protocol for a pilot randomized controlled trial of a remotely delivered version of the intervention in the context of COVID-19 restrictions. Objective: Our objectives are to assess the feasibility of research procedures and intervention delivery and to generate preliminary estimates of the effectiveness of the intervention to inform the sample size calculation of a full-scale trial. Methods: We will conduct a parallel, 2-arm, individually randomized pilot controlled trial in 11 secondary schools in Goa, India. This pilot trial aims to recruit 70 participants with a felt need for psychological support. Participants will receive either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes will be assessed at two timepoints: baseline and 6 weeks post randomization. Results: The first participant was enrolled on January 28, 2021, and 6-week assessment completed on April 4, 2021. Owing to a second wave of the COVID-19 pandemic in India, schools in Goa were closed on April 22, 2021. Trial participants are currently receiving the intervention or completing follow-up assessments. Conclusions: This pilot trial will help understand the feasibility of implementing and evaluating a remotely delivered digital mental health intervention in a low-resource setting. Our findings will be used to design future trials that can address difficulties of accessing psychosocial support in-person and support wider efforts to scale up evidence-based mental health interventions for young people. Trial Registration: ClinicalTrials.gov NCT04672486; https://clinicaltrials.gov/ct2/show/NCT04672486 International Registered Report Identifier (IRRID): DERR1-10.2196/3033

Ubiquitin activation is essential for schizont maturation in Plasmodium falciparum blood-stage development

Ubiquitylation is a common post translational modification of eukaryotic proteins and in the human malaria parasite, Plasmodium falciparum (Pf) overall ubiquitylation increases in the transition from intracellular schizont to extracellular merozoite stages in the asexual blood stage cycle. Here, we identify specific ubiquitylation sites of protein substrates in three intraerythrocytic parasite stages and extracellular merozoites; a total of 1464 sites in 546 proteins were identified (data available via ProteomeXchange with identifier PXD014998). 469 ubiquitylated proteins were identified in merozoites compared with only 160 in the preceding intracellular schizont stage, suggesting a large increase in protein ubiquitylation associated with merozoite maturation. Following merozoite invasion of erythrocytes, few ubiquitylated proteins were detected in the first intracellular ring stage but as parasites matured through trophozoite to schizont stages the apparent extent of ubiquitylation increased. We identified commonly used ubiquitylation motifs and groups of ubiquitylated proteins in specific areas of cellular function, for example merozoite pellicle proteins involved in erythrocyte invasion, exported proteins, and histones. To investigate the importance of ubiquitylation we screened ubiquitin pathway inhibitors in a parasite growth assay and identified the ubiquitin activating enzyme (UBA1 or E1) inhibitor MLN7243 (TAK-243) to be particularly effective. This small molecule was shown to be a potent inhibitor of recombinant PfUBA1, and a structural homology model of MLN7243 bound to the parasite enzyme highlights avenues for the development of P. falciparum specific inhibitors. We created a genetically modified parasite with a rapamycin-inducible functional deletion of uba1; addition of either MLN7243 or rapamycin to the recombinant parasite line resulted in the same phenotype, with parasite development blocked at the schizont stage. Nuclear division and formation of intracellular structures was interrupted. These results indicate that the intracellular target of MLN7243 is UBA1, and this activity is essential for the final differentiation of schizonts to merozoites

Deep Synoptic Array Science: Polarimetry of 25 New Fast Radio Bursts Provides Insights into their Origins

We report on a full-polarization analysis of the first 25 as yet non-repeating FRBs detected at 1.4 GHz by the 110-antenna Deep Synoptic Array (DSA-110) during commissioning observations. We present details of the data reduction, calibration, and analysis procedures developed for this novel instrument. The data have 32 $\mu$s time resolution and sensitivity to Faraday rotation measures (RMs) between $\pm10^{6}$rad m$^{-2}$. RMs are detected for 20 FRBs with magnitudes ranging from $4-4670$ rad m$^{-2}$. $9/25$ FRBs are found to have high ($\ge 70\%$) linear-polarization fractions. The remaining FRBs exhibit significant circular polarization ($3/25$), or are either partially depolarized ($8/25$) or unpolarized ($5/25$). We investigate the mechanism of depolarization, disfavoring stochastic RM variations within a scattering screen as a dominant cause. Polarization-state and possible RM variations are observed in the four FRBs with multiple sub-components, but only one other FRB shows a change in polarization state. We combine the DSA-110 sample with polarimetry of previously published FRBs, and compare the polarization properties of FRB sub-populations and FRBs with Galactic pulsars. Although FRBs are typically far more polarized than the average profiles of Galactic pulsars, and exhibit greater spread in polarization fractions than pulsar single pulses, we find a remarkable similarity between FRB polarization fractions and the youngest (characteristic ages $<10^{5}$ yr) pulsars. Our results support a scenario wherein FRB emission is intrinsically highly linearly polarized, and where propagation effects within progenitor magnetospheres can result in conversion to circular polarization and depolarization. Young pulsar emission and magnetospheric-propagation geometries may form a useful analogy for the origin of FRB polarization.Comment: 43 pages, 17 figure

Deep Synoptic Array Science: Implications of Faraday Rotation Measures of Localized Fast Radio Bursts

Faraday rotation measures (RMs) of fast radio bursts (FRBs) offer the prospect of directly measuring extragalactic magnetic fields. We present an analysis of the RMs of ten as yet non-repeating FRBs detected and localized to host galaxies by the 110-antenna Deep Synoptic Array (DSA-110). We combine this sample with published RMs of 15 localized FRBs, nine of which are repeating sources. For each FRB in the combined sample, we estimate the host-galaxy dispersion measure (DM) contributions and extragalactic RM. We find compelling evidence that the extragalactic components of FRB RMs are often dominated by contributions from the host-galaxy interstellar medium (ISM). Specifically, we find that both repeating and as yet non-repeating FRBs show a correlation between the host-DM and host-RM in the rest frame, and we find an anti-correlation between extragalactic RM (in the observer frame) and redshift for non-repeaters, as expected if the magnetized plasma is in the host galaxy. Important exceptions to the ISM origin include a dense, magnetized circum-burst medium in some repeating FRBs, and the intra-cluster medium (ICM) of host or intervening galaxy clusters. We find that the estimated ISM magnetic-field strengths, $B_{||}$, are characteristically larger than those inferred from Galactic radio pulsars. This suggests either increased ISM magnetization in FRB hosts in comparison with the Milky Way, or that FRBs preferentially reside in regions of increased magnetic-field strength within their hosts