Global prevalence and effect of comorbidities and smoking status on severity and mortality of COVID-19 in association with age and gender: a systematic review, meta-analysis and meta-regression

A COVID-19 patient often presents with multiple comorbidities and is associated with adverse outcomes. A comprehensive assessment of the prevalence of comorbidities in patients with COVID-19 is essential. This study aimed to assess the prevalence of comorbidities, severity and mortality with regard to geographic region, age, gender and smoking status in patients with COVID-19. A systematic review and multistage meta-analyses were reported using PRISMA guidelines. PubMed/MEDLINE, SCOPUS, Google Scholar and EMBASE were searched from January 2020 to October 2022. Cross-sectional studies, cohort studies, case series studies, and case-control studies on comorbidities reporting among the COVID-19 populations that were published in English were included. The pooled prevalence of various medical conditions in COVID-19 patients was calculated based on regional population size weights. Stratified analyses were performed to understand the variations in the medical conditions based on age, gender, and geographic region. A total of 190 studies comprising 105 million COVID-19 patients were included. Statistical analyses were performed using STATA software, version 16 MP (StataCorp, College Station, TX). Meta-analysis of proportion was performed to obtain pooled values of the prevalence of medical comorbidities: hypertension (39%, 95% CI 36-42, n = 170 studies), obesity (27%, 95% CI 25-30%, n = 169 studies), diabetes (27%, 95% CI 25-30%, n = 175), and asthma (8%, 95% CI 7-9%, n = 112). Moreover, the prevalence of hospitalization was 35% (95% CI 29-41%, n = 61), intensive care admissions 17% (95% CI 14-21, n = 106), and mortality 18% (95% CI 16-21%, n = 145). The prevalence of hypertension was highest in Europe at 44% (95% CI 39-47%, n = 68), obesity and diabetes at 30% (95% CI, 26-34, n = 79) and 27% (95%CI, 24-30, n = 80) in North America, and asthma in Europe at 9% (95% CI 8-11, n = 41). Obesity was high among the ≥ 50 years (30%, n = 112) age group, diabetes among Men (26%, n = 124) and observational studies reported higher mortality than case-control studies (19% vs. 14%). Random effects meta-regression found a significant association between age and diabetes (p < 0.001), hypertension (p < 0.001), asthma (p < 0.05), ICU admission (p < 0.05) and mortality (p < 0.001). Overall, a higher global prevalence of hypertension (39%) and a lower prevalence of asthma (8%), and 18% of mortality were found in patients with COVID-19. Hence, geographical regions with respective chronic medical comorbidities should accelerate regular booster dose vaccination, preferably to those patients with chronic comorbidities, to prevent and lower the severity and mortality of COVID-19 disease with novel SARS-CoV-2 variants of concern (VOC).

Long-term Outcomes of Intensive Inpatient Care for Severe, Resistant Obsessive-Compulsive Disorder: Résultats à long terme de soins intensifs à des patients hospitalisés pour un trouble obsessionnel-compulsif grave et résistant

OBJECTIVE

A substantial proportion of severely ill patients with obsessive-compulsive disorder (OCD) do not respond to serotonin reuptake inhibitors (SRIs) and are unable to practice cognitive behavioral therapy (CBT) on an out-patient basis. We report the short-term (at discharge) and long-term (up to 2 years) outcome of a multimodal inpatient treatment program that included therapist-assisted intensive CBT with adjunctive pharmacotherapy for severely ill OCD patients who are often resistant to SRIs and are either unresponsive or unable to practice outpatient CBT.

METHODS

A total of 420 patients, admitted between January 2012 and December 2017 were eligible for the analysis. They were evaluated using the Mini International Neuropsychiatric Interview, the Yale-Brown Obsessive Compulsive Scale (YBOCS), and the Clinical Global Impression (CGI) scale. All patients received 4 to 5 therapist-assisted CBT sessions per week along with standard pharmacotherapy. Naturalistic follow-up information at 3, 6, 12, and 24 months were recorded.

RESULTS

At baseline, patients were mostly severely ill (YBOCS = 29.9 ± 4.5) and nonresponsive to ≥2 SRIs (83%). Mean duration of inpatient stay was 42.7 ± 25.3 days. At discharge, there was a significant decline in the mean YBOCS score (29.9 ± 4.5 vs. 18.1 ± 7.7, P < .001, Cohen's d = 1.64); 211/420 (50%) were responders (≥35% YBOCS reduction and CGI-I≤2) and an additional 86/420 (21%) were partial responders (25% to 35% YBOCS reduction and CGI-I≤3). Using latent class growth modeling of the follow-up data, 4 distinct classes were identified, which include "remitters" (14.5%), "responders" (36.5%), "minimal responders" (34.7%), and "nonresponders" (14.6%). Shorter duration of illness, better insight, and lesser contamination/washing symptoms predicted better response in both short- and long-term follow-up.

CONCLUSION

Intensive, inpatient-based care for OCD may be an effective option for patients with severe OCD and should be considered routinely in those who do not respond with outpatient treatment.

The National Mental Health Survey of India (2016): Prevalence, socio-demographic correlates and treatment gap of mental morbidity

BACKGROUND

Recognizing the need for good quality, scientific and reliable information for strengthening mental health policies and programmes, the National Mental Health Survey (NMHS) of India was implemented by National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, in the year 2015-2016.

AIM

To estimate the prevalence, socio-demographic correlates and treatment gap of mental morbidity in a representative population of India.

METHODS

NMHS was conducted across 12 Indian states where trained field investigators completed 34,802 interviews using tablet-assisted personal interviews. Eligible study subjects (18+ years) in households were selected by a multi-stage, stratified, random cluster sampling technique. Mental morbidity was assessed using MINI 6. Three-tier data monitoring system was adopted for quality assurance. Weighted and specific prevalence estimates were derived (current and lifetime) for different mental disorders. Mental morbidity was defined as those disorders as per the International Statistical Classification of Diseases, Tenth Revision Diagnostic Criteria for Research (ICD-10 DCR). Multivariate logistic regression was conducted to examine risk for mental morbidity by different socio-demographic factors. Survey was approved by central and state-level institutional ethical committees.

RESULTS

The weighted lifetime prevalence of 'any mental morbidity' was estimated at 13.67% (95% confidence interval (CI) = 13.61, 13.73) and current prevalence was 10.56% (95% CI = 10.51, 10.61). Mental and behavioural problems due to psychoactive substance use (F10-F19; 22.44%), mood disorders (F30-F39; 5.61%) and neurotic and stress-related disorders (F40-F48; 3.70%) were the most commonly prevalent mental morbidity in India. The overall prevalence was estimated to be higher among males, middle-aged individuals, in urban-metros, among less educated and in households with lower income. Treatment gap for overall mental morbidity was 84.5%.

CONCLUSION

NMHS is the largest reported survey of mental morbidity in India. Survey estimated that nearly 150 million individuals suffer from one or the other mental morbidity in India. This information is to be used for planning, delivery and evaluating mental health programming in the country.

Emotion Dysregulation and Early Trauma in Borderline Personality Disorder: An Exploratory Study

BACKGROUND

Borderline personality disorder (BPD) research is in its nascent stage in India though studies have estimated its prevalence in psychiatric conditions. Trauma experiences and emotion regulation difficulties are well documented in BPD in the international literature. Thus, it is imperative to examine the role of trauma experiences and their relation to emotion dysregulation in BPD in the Indian context.

MATERIALS AND METHODS

This study used both self-report and semistructured interview data from 34 adults with BPD who presented for outpatient or inpatient psychiatric treatment and compared them with a gender-matched control group. The tools used were the International Personality Disorder Examination, Kessler-10, Early Trauma Inventory Self Report-Short Form, modified-Positive And Negative Affect Scale, Cognitive Emotion Regulation Questionnaire, and Difficulties in Emotion Regulation Scale (DERS).

RESULTS

The BPD group reported higher negative affect, increased use of maladaptive emotion regulation strategies and a deficit of adaptive strategies, after depression scores were controlled for. General abuse, physical punishment, and emotional abuse were significantly higher in the BPD group. The high occurrence of childhood emotional abuse and negative affect in BPD patients emerged as a major correlate accounting for 68.4% of the variance in DERS scores.

CONCLUSIONS

Although we obtained results similar to the western literature on BPD pathology, sociocultural factors such as family and economic conditions, cultural differences in symptom expression of BPD, and treatment forms used in India warrant further research.

Examining the initial usability, acceptability and feasibility of a digital mental health intervention for college students in India

Generalised anxiety disorder (GAD) is prevalent among college students in India; however, barriers like stigma, treatment accessibility and cost prevent engagement in treatment. Web- and mobile-based, or digital, mental health interventions have been proposed as a potential solution to increasing treatment access. With the ultimate goal of developing an engaging digital mental health intervention for university students in India, the current study sought to understand students' reactions to a culturally and digitally adapted evidence-based cognitive behavioural therapy (CBT) for GAD intervention. Specifically, through theatre testing and focus groups with a non-clinical sample of 15 college students in India, the present study examined initial usability, acceptability and feasibility of the "Mana Maali Digital Anxiety Program." Secondary objectives comprised identifying students' perceived barriers to using the program and eliciting recommendations. Results indicated high usability, with the average usability rating ranking in the top 10% of general usability scores. Participants offered actionable changes to improve usability and perceived acceptability among peers struggling with mental health issues. Findings highlight the benefits of offering digital resources that circumvent barriers associated with accessing traditional services. Results build on existing evidence that digital interventions can be a viable means of delivering mental healthcare to large, defined populations.

New-wave behavioral therapies in obsessive-compulsive disorder: Moving toward integrated behavioral therapies

New-wave behavioral therapies in obsessive-compulsive disorders (OCDs) comprise of third-wave therapies and newer cognitive therapies (CTs). This review covers outcome studies published in English until December 2017. A total of forty articles on mindfulness-based CT, metacognitive therapy, acceptance and commitment therapy, and danger ideation reduction therapy in the form of single-case studies, case series, open-label trials, two-group comparison studies, and randomized controlled studies were included. Results show that studies on these therapies are limited in number. Methodological limitations including lack of active control groups, randomized controlled trials, small sample sizes, and short follow-up periods were also noted. However, the available literature demonstrates the feasibility and utility of these therapies in addressing the issues unresolved by exposure and response prevention (ERP) and cognitive behavior therapy (CBT). These therapies were often combined with traditional ERP and CBT based on the profile and response of the client; hence, it is unclear whether they can be used as standalone therapies in the larger segment of the OCD population. Supplementary use of these strategies alongside established therapies could provide better utilization of resources. In view of the need for such integration, further research is warranted. The use of sound methodologies and establishing the mechanism of action of these therapies would assist in choosing the techniques for integration.

Assessment of caries status among schoolchildren according to decayed-missing-filled teeth/decayed-extract-filled teeth index, International Caries Detection and Assessment System, and Caries Assessment Spectrum and Treatment criteria

BACKGROUND

Detection and evaluation of dental caries is of epidemiological importance. Its early detection is important to commence appropriate treatment planning. Cavitated, noncavitated, and initial lesions of dental caries can be detected by various indices.

OBJECTIVES

The objective of the study was to assess the caries experience in schoolchildren using decayed-missing-filled teeth (DMFT)/decayed-extracted-filled teeth (deft), International Caries Detection and Assessment System-II (ICDAS-II), and Caries Assessment Spectrum and Treatment (CAST) systems.

MATERIALS AND METHODS

An epidemiological survey was carried out among 1550 schoolchildren (37,644 teeth) between the age ranges of 4 and 14 years. American Dental Association type III examination was performed using plane mouth mirrors and community periodontal index probes using DMFT/deft, ICDAS II, and CAST indices.

RESULTS

Out of 37,644 teeth examined, 2,718 teeth had shown caries. Caries experience with DMFT/deft index was 5.54%. Highest score of DMFT was observed in deciduous dentition period (59.02%). Overall prevalence of dental caries with ICDAS and CAST system was 6.7% and 6.95%, respectively. The highest percentage of noncavitated lesions (ICDAS - 2.26% and CAST - 3.9%) and greater prevalence of caries among deciduous teeth (ICDAS - 53.2% and CAST - 58.7%) was observed with both ICDAS and CAST systems.

CONCLUSION

A high prevalence of noncavitated lesions and less number of sealants and restorations indicates the lack of awareness for prevention and treatment of oral diseases, which suggests a strong need for preventive and operative treatments.

Ethical gaps in conducting research among adult survivors of child sexual abuse: a review

Although there have been numerous studies, especially in the last few decades, on the impact of child sexual abuse (CSA) on adult survivors, there is a dearth of studies focusing on the ethical aspects of research in this area. Against this background, we reviewed the literature published between January 2000 and December 2016 on the reporting of ethical guidelines followed in research on adult survivors of CSA. We conducted a PubMed (MEDLINE) and Google Scholar search to find published research, using the keywords: "child sexual abuse", "adult survivors", "research", "guidelines" and "ethics". Our findings suggest that no particular assessment method is superior in terms of disclosure of information or reduction of distress. The use of developmentally appropriate educative materials, sensitisation, and debriefing sessions have shown some benefit in reducing distress. There is a lack of legal or social consensus on mandatory legal reporting of information provided by adult survivors of sexual abuse, with most researchers working on the premise that adults have the freedom of choice. Often, a constraint among researchers is the lack of structured training or supervision in sensitive research, which may negatively impact both the participant and the researcher. Institute ethics boards and institutions currently lack the framework to consider protocols and facilitate research, and this poses serious obstacles to fostering research. In this situation, ongoing research needs to focus on ethical aspects. Together with this, we recommend certain ethical practices drawn from various studies that may be employed for participants, researchers, and institutional ethics boards.

Interepisodic Functioning in Patients with Bipolar Disorder in Remission

BACKGROUND AND OBJECTIVES

Patients with bipolar disorder (BD), despite recovering symptomatically, suffer from several functional impairments even in remission. The actual causes of impaired functioning are less known.

MATERIALS AND METHODS

The study aimed to examine the clinical and psychosocial determinants of functioning in patients with BD in remission. A cross-sectional single-group design was adopted (n = 150). Participants meeting the study criteria were screened with Mini-International Neuropsychiatric Interview Scale. The selected participants were administered various tools to assess the level of functioning and the clinical, psychosocial determinants of functioning.

RESULTS

The clinical characteristics of the sample included early age of onset of illness, presence of precipitating factors, fewer episodes, minimal comorbidities, history of psychotic episodes, family history of mental illness, good medication adherence, and low depression and mania scores. Psychosocial factors included higher stress and moderate social support and self-esteem in the sample. Poor functioning patients had a history of longer hospital stay and had greater scores on depression, mania, stress, and maladaptive coping styles than better functioning patients.

CONCLUSION

Higher depression, mania, stress, and maladaptive coping strategies were related to poor functioning, while higher medication adherence, self-esteem, and social support were related to better functioning.

Cone Beam Computed Tomography Evaluation of Hand Nickel-Titanium K-Files and Rotary System in Primary Teeth

PURPOSE

The purpose of this study was to compare canal transportation, centering ability, and removed dentin thickness (RDT) using hand nickel-titanium (NiTi) K-flex files and rotary systems in primary molars and using cone beam computed tomography (CBCT).

METHODS

This study was conducted on 20 primary maxillary and 20 primary mandibular molars, which were randomly divided into two groups to be instrumented with hand NiTi K-flex files and a rotary system. Pre- and post-instrumentation slices were taken at three predetermined levels using CBCT to evaluate all the parameters by using Digital Imaging Communications in Medicine (DICOM) software. The results were statistically evaluated.

RESULTS

Rotary instruments caused significantly less canal transportation and showed more centering ability than hand NiTi instruments at all levels and in all directions, except at the cervical level in the mesiodistal direction, where the hand group showed significantly superior results. The hand NiTi K-flex files removed significantly more dentin than rotary instrumentation at all levels and in all directions, except at the apical level in the buccodistal direction, where no significant difference between the two groups was observed.

CONCLUSION

Rotary files showed less canal transportation, more conservation of tooth structure, and superior centering ability compared to hand nickel-titanium K-flex files.

Effectiveness of first-aid training on school students in Singur Block of Hooghly District, West Bengal

Objective:

First aid is the helping behavior and initial care provided for an acute illness or injury. Students have the potential for changing the health scenario of the society if properly groomed and educated. The objective of the study is to evaluate the effectiveness of educational intervention on the first aid among middle school students of a rural school in West Bengal.

Materials and Methods:

A total of 230, 6^th and 7^th standard students were given a self-administered questionnaire for assessing their baseline knowledge about management of common injuries followed by educational intervention with a systematically devised teaching module during February to March 2016. Post intervention evaluation of their knowledge acquisition was done after 2 weeks with same questionnaire.

Results:

The baseline knowledge on the management of selected injuries was found to be insufficient among the study subjects. Paired t-test was performed to compare the pre- and post-test scores of knowledge and attitude of the students about first aid, and there was a significant change in knowledge from pretest score (mean = 1.50, standard deviation [SD] =0.47) to posttest score (mean = 6.53, SD = 1.30). To quantify the effectiveness of health education, effect size (Cohen's d) was derived. For knowledge score, Cohen's d was 5.14 with large effect size indicating highly effective impact of the training program. Significant change was also noticed regarding attitude regarding first aid as evident from increase in pretest score (mean = 1.19, SD = 0.96) to posttest score (mean = 3.17, SD = 1.03); Cohen's d was 1.88 with medium effect size.

Conclusion:

Inculcating first-aid training in the school curriculum can be a fruitful investment in ensuring proper and timely management of illnesses and injuries not only for the school children but also for the community at large.

Subclinical depression in Urban Indian adolescents: Prevalence, felt needs, and correlates

BACKGROUND

Subclinical depression in adolescents constitutes a risk factor for future clinical depression and hence warrants examination. However, there is a paucity of research that documents subclinical depression among adolescents in India.

OBJECTIVES

(a) To investigate the prevalence of subclinical depression in urban school-going adolescents; (b) to investigate the problems and felt needs of these adolescents; (c) to examine depression-related variables; and (d) to examine the relationships between socio-demographic and depression-related variables.

MATERIALS AND METHODS

Eight hundred adolescents (ages 13-18 years) of English-medium schools of Bangalore city were assessed using standardized self-report measures.

RESULTS

Academic difficulties were the most frequently reported problem, followed by interpersonal issues. Of the sample, 18% adolescents were identified as endorsing subclinical depression. Adolescents in the present study scored higher on measures of depression and negative cognitions than their Western counterparts. In addition, girls were found to be at higher risk for experiencing depressive symptoms and negative cognitions, lower social problem-solving skills, and more problematic interpersonal relationships as compared to boys.

CONCLUSION

Identification of subclinical depression constitutes an important goal, as it places an adolescent at risk of considerable vulnerability and impairment.

Evaluation of palatal rugae pattern in establishing identification and sex determination in Nalgonda children

BACKGROUND

Establishing individual identification of a decedent only by dental means is a mammoth task in forensic odontology. Palatal rugae's uniqueness, its resistance to heat, and stability throughout life have been proved by its use as an alternative aid in individual identification where comparison of fingerprints and other records is difficult.

AIMS AND OBJECTIVES

The aim of the present study was to analyze the role of palatal rugoscopy in personal identification and sex determination of Nalgonda pediatric population.

MATERIALS AND METHODS

The study group consisted of 100 children having mixed dentition within the age range of 8-11 years, residing in Nalgonda district. Palatal rugae pattern, shape of the incisive papillae, length of the median palatal raphae, and shape of the dental arches were analyzed using Chi-square and Mann-Whitney tests between males and females.

RESULTS

Wavy and curved patterns appeared to be most prevalent in both males and females but with no significant difference. The number of primary rugae in females and secondary rugae in males, on left side of the palate, was significantly more than their counterparts (P < 0.05). When rugae unification was observed, diverging type was significantly more in males than in females. Parabolic dental arch form, elliptical type of incisive papilla, and medium length of median palatal raphae was observed in majority of the subjects.

CONCLUSION

The present study hypothesizes the uniqueness of the rugae in personal identification as no two palates showed similar type of rugae in either of the genders. The rugae pattern also contributes minimally towards sex determination as there was no significant difference observed between the two variables.

Clinical Evaluation of Conventional Radiography, Radiovisiography, and an Electronic Apex Locator in Determining the Working Length in Primary Teeth

PURPOSE

This study's purposes were to: (1) compare the accuracy of conventional radiography (CR), radiovisiography (RVG), and the Root ZX mini apex locator (EAL) in determining the working length in primary teeth; and (2) determine the effect of wet/dry conditions on the accuracy of the EAL.

METHODS

Twenty-two children (six to 15 years old), with 41 root canals of primary teeth with or without resorption indicated for extraction, were selected. CR and RVG were used to determine the working length, followed by EAL, according to the manufacturer's instructions in both dry and wet fields (saline). Following extraction of the teeth, the actual working length was determined under stereo microscope (2X). The data was tabulated and statistically analyzed using one-way analysis of variance and student's t test.

RESULTS

The highest percentage of accurate working length measurements within the acceptable range of ±0.5 mm were for EAL (95.1 percent), followed by RVG (75.6 percent) and CR (75.6 percent). There were no statistically significant differences between the three techniques (P>0.05), and the readings obtained by the apex locator were not affected by resorption or the medium (wet/dry).

CONCLUSIONS

The Root ZX mini apex locator showed the most promising results, followed by radiovisiography and conventional radiography.

The Feasibility, Acceptability, and Efficacy of Delivering Internet-Based Self-Help and Guided Self-Help Interventions for Generalized Anxiety Disorder to Indian University Students: Design of a Randomized Controlled Trial

BACKGROUND

Generalized anxiety disorder (GAD) is one of the most common mental disorders among university students; however, many students go untreated due to treatment costs, stigma concerns, and limited access to trained mental health professionals. These barriers are heightened in universities in India, where there are scant mental health care services and severe stigma surrounding help seeking.

OBJECTIVE

To evaluate the feasibility, acceptability, and efficacy of Internet-based, or "online," cognitive behavioral therapy (CBT)-based unguided and guided self-help interventions (using the programs GAD Online and Lantern, respectively) to reduce GAD symptoms in students with clinical and subthreshold GAD and, ultimately, reduce the prevalence and incidence of GAD among the student population.

METHODS

Students will be recruited via 3 colleges in Hyderabad, India, and referred for a campus-wide online screening. Self-report data will be collected entirely online. A total of 300 qualifying students will be randomized in a 1:1:1 ratio to receive GAD Online, Lantern, or to be in a wait-list control condition, stratified by clinical and subthreshold GAD symptomatology. Students will complete a postintervention assessment after 3 months and a follow-up assessment 6 months later, at which point students in the wait-list control condition will receive one of the programs. The primary outcome is GAD symptom severity at 3 months postintervention. Secondary outcomes include GAD caseness at 9 months, other anxiety and depression symptoms, self-efficacy, and functional measures (eg, sleep, social functioning) at 3 and 9 months, respectively. Primary analyses will be differences between each of the intervention groups and the wait-list control group, analyzed on an intention-to-treat (ITT) basis using mixed-design ANOVA.

RESULTS

The study commenced in February 2015. The sample was recruited over a 3-week period at each college. The trial is expected to end in December 2015.

CONCLUSIONS

This trial will be the first to evaluate the use of Internet-based CBT programs compared with a wait-list control group for the treatment of GAD among students in Indian universities. If effective, these programs have the potential to reduce the mental health care treatment gap by providing readily accessible, private, and cost-effective evidence-based care to students with GAD who do not currently receive the treatment they need.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02410265 http://clinicaltrials.gov/ct2/show/NCT02410265 (Archived by WebCite at http://www.webcitation.org/6ddqH6Rbt).

Dentigerous Cysts of Maxillofacial Region– Clinical, Radiographic and Biochemical Analysis

Background Dentigerous cyst is the second most common type of odontogenic cysts that encloses the crown of an unerupted tooth by expansion of its follicle due to the collection of cystic fluid. In view of the capability of these lesions attaining a marked size if not diagnosed early and treated properly, the present study was done based on the clinical and radiographic presentation of the dentigerous cyst in addition to the analysis of the cystic contents.Objective The present study reported 14 cases of dentigerous cysts (DC) with their incidence and relative distribution of the maxillofacial region along with the clinical and radiographic features and biochemical analysis of cystic fluid.Method The study was conducted at Sri Govind Tricentenary Dental College, Hospital and Research Institute, Gurgaon, Haryana for a period of one year and six months. A detailed case history and thorough clinical examination was done for the patients who were provisionally found to have odontogenic cysts. Necessary radiographs, aspiration of the cystic fluid and incisional biopsy were performed to the 14 patients who were provisionally diagnosed with dentigerous cysts (DC) after obtaining the informed consent and the cystic fluid was subjected to biochemical analysis.Results Majority of the affected patients with DC were in their second decade and showed more predilection for mandible with a male predominance. The area of predilection was third molar region in the mandible and it is the canine region in maxilla. All the cases were associated with impacted teeth and majority showed expansion of the buccal/labial cortical plate. The various biochemical variables (total protein content, albumin, globulin and albumin: globulin ratio) were also assessed in the present study.Conclusion The awareness of protean features of DC evident through this study is essential for the general as well as specialty practitioners for the accurate diagnosis and proper treatment planning of these non cancerous but potentially destructive lesions and also opens new avenues for further research.Kathmandu University Medical Journal Vol.13(1) 2015; 8-11

Crystal structure of ATP-binding subunit of an ABC transporter from Geobacillus kaustophilus

The ATP binding cassette (ABC) transporters, represent one of the largest superfamilies of primary transporters, which are very essential for various biological functions. The crystal structure of ATP-binding subunit of an ABC transporter from Geobacillus kaustophilus has been determined at 1.77 Å resolution. The crystal structure revealed that the protomer has two thick arms, (arm I and II), which resemble 'L' shape. The ATP-binding pocket is located close to the end of arm I. ATP molecule is docked into the active site of the protein. The dimeric crystal structure of ATP-binding subunit of ABC transporter from G. kaustophilus has been compared with the previously reported crystal structure of ATP-binding subunit of ABC transporter from Salmonella typhimurium.

Hand schuller christian disease: a rare case report with oral manifestation

Langerhan's Cell Histiocytosis (LCH) is disorders which include abnormalities that result from abnormal proliferation of langerhan's cells or their precursors. LCH is clinically classified into three types-eosinophilic granuloma, Hand Schuller Christian disease and Abt-Letterer- Siwe disease. It is usually manifested in childhood as well as in adulthood. The clinical manifestations are the result of the accumulation and infilteration of the langerhan cells in organs and tissues. Here is a rare case report of 6-year-old boy with extraoral manifestation of exopthalmic right eye and oral manifestation of mobility of teeth and with typical radiological findings. Basing on the clinical, radiological and histopathological examination the diagnosis of Hand Schuller Christian Disease was given.

Crystal structures of type IIIH NAD-dependent D-3-phosphoglycerate dehydrogenase from two thermophiles

In the L-Serine biosynthesis, D-3-phosphoglycerate dehydrogenase (PGDH) catalyzes the inter-conversion of D-3-phosphoglycerate to phosphohydroxypyruvate. PGDH belongs to 2-hydroxyacid dehydrogenases family. We have determined the crystal structures of PGDH from Sulfolobus tokodaii (StPGDH) and Pyrococcus horikoshii (PhPGDH) using X-ray diffraction to resolution of 1.77Å and 1.95Å, respectively. The PGDH protomer from both species exhibits identical structures, consisting of substrate binding domain and nucleotide binding domain. The residues and water molecules interacting with the NAD are identified. The catalytic triad residues Glu-His-Arg are highly conserved. The residues involved in the dimer interface and the structural features responsible for thermostability are evaluated. Overall, structures of PGDHs with two domains and histidine at the active site are categorized as type IIIH and such PGDHs structures having this type are reported for the first time.

Effect of yoga on the Myofascial Pain Syndrome of neck

Myofascial Pain Syndrome (MPS) refers to pain attributed to muscle and its surrounding fascia, which is associated with “myofascial trigger points” (MTrPs). MTrPs in the trapezius has been proposed as the main cause of temporal and cervicogenic headache and neck pain. Literature shows that the prevalence of various musculoskeletal disorders (MSD) among physiotherapists is high. Yoga has traditionally been used to treat MSDs in various populations. But there is scarcity of literature which explains the effects of yoga on reducing MPS of the neck in terms of various physical parameters and subjective responses. Therefore, a pilot study was done among eight physiotherapists with minimum six months of experience. A structured yoga protocol was designed and implemented for five days in a week for four weeks. The outcome variables were Disability of Arm, Shoulder and Hands (DASH) score, Neck Disability Index (NDI), Visual Analogue Scale (VAS), Pressure Pain Threshold (PPT) for Trigger Points, Cervical Range of Motion (CROM) - active & passive, grip and pinch strengths. The variables were compared before and after the intervention. Finally, the result revealed that all the variables (DASH: P<0.00, NDI: P<0.00, VAS: P<0.00, PPT: Left: P<0.00, PPT: Right: P<0.00, Grip strength: left: P<0.00, Grip strength: right: P<0.01, Key pinch: left: P<0.01, Key pinch: right: P<0.01, Palmar pinch: left: P<0.01, Palmar pinch: right: P<0.00, Tip pinch: left: P<0.01, Tip pinch: Right: P<0.01) improved significantly after intervention.

Back pack injuries in Indian school children: risk factors and clinical presentations

The use of backpack increased substantially among the school children. Studies have shown that carrying a backpack cause to develop different symptoms of musculoskeletal disorders among the carrier of the backpack. In India there are fewer studies available in literature which explains the musculoskeletal discomfort among the school children. This study aimed at to find out the prevalence of different musculoskeletal problems among the school children. In a retrospective study data were collected for twenty two students. The main diagnostic criteria were pressure mark (redness or swelling) over neck and shoulder corresponding to the straps of the backpack, stooping posture while carrying the back pack, pain or stiffness in the neck, upper back and shoulders predominantly while carrying the back pack and absence of these symptoms during school holidays. Results revealed that pain in the upper back (40%), neck (27%) and shoulder (20%) were most prevalent body regions followed by forearm and wrist pain (7%) and low back (6%). Results further revealed that all the students participated in this study have a pressure mark over shoulder. 54.55% of the children were diagnosed with myofascial pain and rest with thoracic outlet syndrome.

Filicide as a part of extended suicide: An experience of psychotherapy with the survivor

The tragedy of maternal filicide and extended suicides has occurred throughout history. Maternal filicide-suicide perpetrators most often suffer from depression, suicidality, or psychosis. Interventions in such cases are not commonly reported in the psychiatric settings, and the components of psychotherapeutic approach and its efficacy are also not known. Here we present a long-term therapy carried out with a 36-year-old married lady, with the complaints of low mood, suicidal ideation, severe guilt feelings, and depressive cognitions. There was positive family history of depression, past history of dysthymia, suicidal attempt, and severe marital discord. Therapy was carried out for a period of 9 months with follow-up for 4 years and addressed existential issues and grief with the components of existential therapy, grief therapy, narratives, religious beliefs, and interpersonal acceptance. The case highlights the need for blending of multiple approaches to meet the challenges such cases can pose.

4-(Thio-phen-2-yl)-2-[4-(tri-fluoro-meth-yl)phen-yl]-2,3-di-hydro-1,5-benzo-thia-zepine

In the title compound, C20H14F3NS2, the seven-membered thia-zepine ring adopts a slightly distorted twist-boat conformation. The mean plane of the five-membered thio-phene ring fused to the thia-zepine ring is twisted by 32.3 (3) and 55.6 (4)° from the benzene and phenyl rings, respectively. In the crystal, inversion dimers linked by pairs of weak C-H⋯N inter-actions are observed.

Musculoskeletal disorders in caregivers of children with cerebral palsy following a multilevel surgery

The patients of cerebral palsy need assistance for their self activities which expose the caregivers to different risk factors of musculoskeletal disorders. But there is a scarcity of studies revealing the prevalence and the risk factors present among the caregivers of the cerebral palsy children. This lead to formulate a study to identify prevalence and risk factors among the caregivers of cerebral palsy children. Result revealed that most of the caregivers among both the groups were female (63.4% and 69.3%). The common age group of the children who underwent multilevel surgery was at the age group of 6 - 10 years. It has been observed that among the study group 56.5% were totally cooperative children. The Caregiver Strain Index value showed there is no significant difference among both the groups. Regional body pain of shoulder, elbow, upper back, lower back and ankle revealed a higher prevalence among the study group. Clinical diagnosis revealed prevalence of MPS, FMS and TOS among the study group were 27.6%, 24.5% and 23.0% respectively. Study further revealed that cooperativeness of the child was significantly associated with lower back pain, MPS, FMS and TOS among the study group.

2-(3,4-Di-meth-oxy-phen-yl)-4-(thio-phen-2-yl)-2,3-di-hydro-1,5-benzo-thia-zepine

In the title compound, C₂₁H₁₉NO₂S₂, the seven-membered thia­zepine ring adopts a slightly distorted twist boat conformation. The dihedral angle between the benzene rings is 67.4 (2)°. The mean plane of the thio­phene ring is twisted by 59.3 (2) and 87.7 (2)° from the mean planes of the benezene rings. In the crystal, inversion dimers linked by pairs of C—H⋯O hydrogen bonds generate R₂²(20) loops.

Evaluation of the Efficiency and Effectiveness of Three Minimally Invasive Methods of Caries Removal: An in vitro Study

BACKGROUND

Many chemomechanical caries removal (CMCR) agents have been introduced and marketed since 1970s, with each new one being better and effective than the previously introduced. Papacarie and Carisolv are new systems in the field of CMCR techniques. These are reportedly minimally invasive methods of removing carious dentin while preserving sound dentin.

AIM

To compare the Efficiency (time taken for caries removal) and effectiveness (Knoop hardness number of the remaining dentin) of caries removal by three minimally invasive methods, i.e. hand excavation and chemomechanical caries removal using Carisolv and Papacarie.

MATERIALS AND METHODS

Thirty recently extracted human permanent molars with occlusal carious lesions were divided randomly in three equal groups and bisected through the middle of the lesion mesiodistally and excavated by two methods on each tooth.

RESULTS

Statistically significant difference was present among three methods with respect to time and knoop hardness values (KHN) of the remaining dentin.

CONCLUSION

The Efficiency of Hand method is better compared to CMCR techniques and effectiveness of CMCR techniques is better than Hand method in terms of dentin preservation so the chances of maintaining vitality of the pulp will be enhanced. How to cite this article: Boob AR, Manjula M, Reddy ER, Srilaxmi N, Rani T. Evaluation of the Efficiency and Effectiveness of Three Minimally Invasive Methods of Caries Removal: An in vitro Study. Int J Clin Pediatr Dent 2014;7(1):11-18.

Prevalence of Malocclusion among 6 to 10 Year old Nalgonda School Children

BACKGROUND

To evaluate the prevalence of malocclusion among 6 to 10 year old children of Nalgonda District.

MATERIALS & METHODS

A total of 3000 children were examined, out of which 2135 children (1009 boys and 1126 girls) who fulfilled the inclusion criteria were included. The selected sample was examined for Class I, Class II, Class III molar relationship, lower anterior crowding, cross bite (anterior and posterior), open bite, and pseudo class III [edge to edge bite] discrepancies after obtaining the written consent from the concerned school authorities. The collected data was tabulated and statistically analysed using chi-square test.

RESULTS

Among the selected sample, 648 (30.35%) children had minor tooth alignment discrepancies. Angle's Class I molar relation with and without minor discrepancies was observed in 78.6%, Class II in 13.9%, Class III in 7.8% of the subjects surveyed. Lower anterior crowding in 11.8%, anterior cross bite in 4.5%, posterior cross bite in 3.75%, openbite in 3% and Pseudo class III [edge to edge] in 5.97% was noticed among the studied population. There was no statistical significant difference observed gender wise.

CONCLUSION

In the current study, 52% of the studied population had malocclusion with a higher prevalence of Angle's Class I molar relation with lower anterior crowding. How to cite this article: Reddy ER, Manjula M, Sreelakshmi N, Rani ST, Aduri R, Patil BD. Prevalence of Malocclusion among 6 to 10 Year old Nalgonda School Children. J Int Oral Health 2013; 5(6):49-54 .

2-(4-Fluoro-phen-yl)-4-(thio-phen-2-yl)-2,3-di-hydro-1,5-benzothia-zepine

In the title compound, C19H14FNS2, the seven-membered thia-zepine ring adopts a slightly distorted twist boat conformation. The dihedral angle between the benzene rings is 53.6 (1)°. The mean plane of the thia-zepine ring is twisted by 34.3 (7)° and 36.6 (7)° from the benezene rings. A C-H⋯F interaction generates stacking of molecules along the ab plane.

7-Bromo-3,3-dibutyl-8-meth-oxy-2,3-di-hydro-1,5-benzothia-zepin-4(5H)-one

In the title compound C18H26BrNO2S, the thia-zepine ring adopts a boat conformation. The dihedral angle between the mean planes through the benzene ring and the four C atoms making up the basal plane of the boat is 35.8 (2)°. In the crystal, inversion dimers linked by pairs of N-H⋯O hydrogen bonds generate R 2 (2)(8) loops.

3-Methyl-1,5-diphenyl-4,5-dihydro-1H-pyrazole

In the title compound, C16H16N2, the dihydro-pyrazole ring adopts a shallow envelope conformation, with the C atom bearing the phenyl group displaced by 0.298 (2) Å from the other atoms (r.m.s. deviation = 0.015 Å). The dihedral angles between the four near coplanar atoms of the central ring and the N- and C-bonded phenyl groups are 13.49 (13) and 82.22 (16)°, respectively.

Growing Up with a Parent having Schizophrenia: Experiences and Resilience in the Offsprings

BACKGROUND

Parental mental illness has been found to have an impact on offsprings in their emotional, social, and behavioral aspects of life.

AIMS

To examine the experiences of offsprings of a parent having schizophrenia and to study their resilience.

MATERIALS AND METHODS

A sample of 45 adults with one parent diagnosed with schizophrenia was selected using purposive sampling. Subjects were assessed using socio-demographic data sheet, semi-structured interview schedule, and Connor-Davidson Resilience Scale.

RESULTS

The experiences perceived by them as different from children of healthy parents included negative experiences in social (49%) and emotional aspects (40%), lack of support from the parent who is ill (40%), and burden (66%) in various areas. Majority of the offsprings were satisfied with the parenting received (70%). About 60% of them reported medium resilience, and 24% and 15% reported high and low resilience, respectively. Majority of those with medium and high resilience had supportive relationship with other family members. Social support was the most frequently reported factor that helped them to cope with difficulties.

CONCLUSIONS

Growing up with a parent having mental illness can have negative impact on offsprings. However, it can also have positive effects in terms of developing resilience in the presence of good support system.

Behavioural and psychological management of somatic symptom disorders: an overview

The number of patients who seek help at primary and secondary care for somatic symptoms which cannot be explained by any known medical condition is enormous. It has been proposed to rename 'somatoform disorders' in DSM-IV as 'somatic symptom disorders' in DSM-5. This is supposed to include disorders such as somatization disorder, hypochondriasis, undifferentiated somatoform disorder, pain disorder and factitious disorder. The reason for the renaming and grouping is that all these disorders involve presentation of physical symptoms and/or concern about medical illness. In the literature, there is considerable variation adopted with respect to diagnosis and in the approaches adopted for intervention. However, the common feature of these disorders is the chronicity, social dysfunction, occupational difficulties and the increased healthcare use and high level of dissatisfaction for both the clinician and the patient. A number of behavioural and psychological interventions for somatic symptoms have been carried out at primary, secondary and tertiary care settings and recently there have been more attempts to involve the primary care physicians in the psychological interventions. This review aims at giving an overview of the components of the behavioural and other psychological interventions available for addressing medically unexplained somatic symptoms and to present their efficacy.

Hemorrhagic ascites: are we missing endometriosis?

Peritoneal tuberculosis, carcinomatosis and pancreatic ascites are often considered as differential diagnosis of hemorrhagic ascites. Endometriosis can rarely present as hemorrhagic ascites and closely mimic these conditions. When this occurs without common clinical features of endometriosis, it can create a diagnostic challenge to the treating physician. We present three patients with endometriosis who presented with hemorrhagic ascites; two of them did not have gynecological symptoms or significant pelvic disease. These patients were evaluated several times in many centers and even received multiple courses of anti-tuberculous treatment. The diagnosis was made by histologic examination of parietal peritoneum obtained by laparoscopy or laparotomy. The diagnosis was missed possibly because of the atypical presentation, lack of clinical suspicion and incomplete assessment. In conclusion, this potentially treatable condition should be considered as a differential diagnosis for hemorrhagic ascites in a premenopausal woman.

Suicidal risk and childhood adversity: a study of Indian college students

BACKGROUND

The study was undertaken in response to reported increase in deaths due to suicide and suicidal behaviors in the youth.

AIM

The objectives of the study were to assess childhood adversity and suicidal risk and to study the relationship between adverse childhood experiences and suicidal risk, in Indian students.

METHOD

A cross sectional study design was conducted with 436 undergraduate students in the age range of 18-25. Suicidal risk was assessed using Scale for Suicidal Ideation and Beck's Hopelessness Scale. Parental Bonding Instrument and Early Trauma Inventory-Self Report (Short Form) were used to assess adverse childhood experiences.

RESULTS

Suicidal risk in terms of suicidal ideation and hopelessness was reported by 15% and 9%, respectively. Physical abuse is the most common form of early trauma, experienced in both males and females. Males experienced significantly more traumatic experiences in all domains. Affectionless control, which is considered as the pathogenic form of parent child bonding, is widely reported. A moderate degree of association exists between suicidal risk and early exposure to trauma. Higher suicidal ideation, hopelessness and trauma are reported in respondents with affectionless parental control and neglectful parenting.

CONCLUSION

The study provides evidence of correlation between suicidal risk and childhood adversity in the Indian setting.