Virulence traits and novel drug delivery strategies for mucormycosis post-COVID-19: a comprehensive review

The outbreak of a fatal black fungus infection after the resurgence of the cadaverous COVID-19 has exhorted scientists worldwide to develop a nutshell by repurposing or designing new formulations to address the crisis. Patients expressing COVID-19 are more susceptible to Mucormycosis (MCR) and thus fall easy prey to decease accounting for this global threat. Their mortality rates range around 32-70% depending on the organs affected and grow even higher despite the treatment. The many contemporary recommendations strongly advise using liposomal amphotericin B and surgery as first-line therapy whenever practicable. MCR is a dangerous infection that requires an antifungal drug administration on appropriate prescription, typically one of the following: Amphotericin B, Posaconazole, or Isavuconazole since the fungi that cause MCR are resistant to other medications like fluconazole, voriconazole, and echinocandins. Amphotericin B and Posaconazole are administered through veins (intravenously), and isavuconazole by mouth (orally). From last several years so many compounds are developed against invasive fungal disease but only few of them are able to induce effective treatment against the micorals. Adjuvant medicines, more particularly, are difficult to assess without prospective randomized controlled investigations, which are challenging to conduct given the lower incidence and higher mortality from Mucormycosis. The present analysis provides insight into pathogenesis, epidemiology, clinical manifestations, underlying fungal virulence, and growth mechanisms. In addition, current therapy for MCR in Post Covid-19 individuals includes conventional and novel nano-based advanced management systems for procuring against deadly fungal infection. The study urges involving nanomedicine to prevent fungal growth at the commencement of infection, delay the progression, and mitigate fatality risk.

Alveolar type of rhabdomyosarcoma of maxilla-A case report

Rhabdomyosarcoma (RMS) is the most common sarcoma among children and accounts for 20% of soft tissue sarcomas. In children, close to 50% of rhabdomyosarcomas arise in the head and neck. RMS of the oral cavity is rare and is seen in only 10-12% of all head and neck lesions and the involvement of the jaws is extremely rare. Histopathologically, the various types are pleomorphic type, botryoid type, spindle cell type, embryonal, and alveolar type of RMS. The alveolar variant accounts for almost 30% of all rhabdomyosarcomas and tends to arise in patients of the age group 10-25 years. We present a case of orofacial RMS in a young adult who was referred to our Institution for the management of an odontogenic lesion of the maxilla. The clinicopathological aspects and poor survival rate as a consequence of delayed diagnosis are discussed. We dentists may misdiagnose it as an odontogenic tumour due to its location in the oral and maxillofacial region. Careful clinical history and examination and investigations may help to narrow down the diagnosis. Expert opinion and referrals to oral pathologists and oncologists are essential to arrive at early diagnosis and to initiate the treatment.

Investigation on NiWO4/PANI composite as an electrode material for energy storage devices

NiWO4/PANI was synthesized by an in situ chemical oxidative polymerization route. Incorporation of NiWO4 in a PANI matrix rendered high specific capacitance and salient morphological features.

Spiritual Care: Define and Redefine Self

Spiritual care is deep rooted in the traditional ancient system of medicine. However, due to lack of high grade evidences, practitioners of modern system of medicine are hesitant to inculcate spirituality in their clinical practice. This paper is an attempt to basic understanding of spiritual care therapy, current evidences for it and the challenges for incorporation in the allopathic system of medicine.

Electrochemical performance of l-tryptophanium picrate as an efficient electrode material for supercapacitor application

l-Tryptophanium picrate was synthesized and evaluated for its supercapacitor behavior and a 263 F g⁻¹ specific capacitance was achieved.

Clinical trials in dentistry in India: Analysis from trial registry

Introduction:

Evidence-based practice requires clinical trials to be performed. In India, if any clinical trial has to be performed, it has to be registered with clinical trial registry of India. Studies have shown that the report of clinical trials is poor in dentistry. Hence, the present study has been conducted to assess the type and trends of clinical trials being undertaken in dentistry in India over a span of 6 years.

Methodology:

All the clinical trials which were registered with the Central Trial Registry of India (CTRI) (www.ctri.nic.in) from January 1, 2007 to March 3, 2014 were evaluated using the keyword “dental.” Following information were collected for each of the clinical trials obtained from the search; number of centres (single center/multicentric), type of the institution undertaking the research (government/private/combined), study (observational/interventional), study design (randomized/single blinded/double-blinded), type of health condition, type of participants (healthy/patients), sponsors (academia/commercial), phase of clinical trial (Phase 1/2/3/4), publication details (published/not published), whether it was a postgraduate thesis or not and prospective or retrospective registration of clinical trials, methodological quality (method of randomization, allocation concealment). Descriptive statistics was used for analysis of various categories. Trend analysis was done to assess the changes over a period of time.

Results:

The search yielded a total of 84 trials of which majority of them were single centered. Considering the study design more than half of the registered clinical trials were double-blinded (47/84 [56%]). With regard to the place of conducting a trial, most of the trials were planned to be performed in private hospitals (56/84 [66.7%]). Most (79/84, 94.1%) of the clinical trials were interventional while only 5/84 (5.9%) were observational. Majority (65/84, 77.4%) of the registered clinical trials were recruiting patients while the rest were being done in healthy participants. From 2011, some of the postgraduate thesis trials had also been registered (2011-8; 2012-8; 2013-13; 2014-6). Inadequacy in reporting the method of randomization and allocation concealment was observed in 37/67 (55.2%) and 31/67 (46.2%) clinical trials respectively. A considerable number of postgraduate theses was also registered with CTRI in dentistry and majority of the clinical trials despite being completed are not yet published.

Conclusion:

The number of clinical trials in dentistry are low in India, and more focus should be placed by dental investigators regarding the reporting standards. Furthermore, researchers and trial sponsors should aim at publication of the research findings so that it is made publically available for use. A clear-cut need exists for an increase in both the quantity and quality of clinical trials in dentistry.

Substance abuse amongst the medical graduate students in a developing country

Background & objectives:

Substance abuse is found worldwide including among students. We carried out this study to estimate the prevalence of substance abuse among medical student studying in a medical college in north India.

Methods:

Using a validated questionnaire a cross-sectional survey was conducted among 230 undergraduate and postgraduate medical students in a private medical college.

Results:

The prevalence of substance abuse was 20.43 per cent (47/230) among medical students. An increase in substance abuse was observed in the latter years of medical education. A total of 43 of 47 (91.7%) students using these substances were aware of the ill effects. The most common reasons for substance use were relief from psychological stress (34/47, 72.4%) and occasional celebration (34/47, 72.4%). Of the 47 substance users, 28 (59.6%) made past attempts to quit the substance abuse.

Interpretation & conclusions:

Nearly one-fifth of medical students abuse at least one substance despite knowing the ill effects with the main predisposing factor being the psychological stress.

Health-Related Research Projects in Fiji and Papua New Guinea: A Cross-Sectional Analysis of Fiji and Papua New Guinea Health Research Portals

Evidence-based medicine and evidence-based public health rely on the best available evidence generated in a specific area for it to be implemented in healthcare practice. This study assesses the range of research studies conducted in Fiji and Papua New Guinea (PNG) islands by reviewing the types of studies now registered with the respective health research registry portals. We assessed all studies registered on the Fiji Health Research Portal (FHRP) and Papua New Guinea Health Research Portal (PNGHRP) since 2014 for the following details: year of registration; study type and participants; field of research; basic statistical analyses; and multicentric or single center study. A total of 99 studies were registered in the FHRP and 6 in PNGHRP during the period under review. Nearly, one fourth of the studies from Fiji and one third from PNG islands are studies evaluating various health policies without involving or collecting data from human subjects. All the registered studies in both the islands were observational (rather than experimental). A total of 58.2% of the registered studies in FHRP and 66.7% in PNGHRP were performed as student projects. A geographic scope of 21.2% of the proposed studies in FHRP and 33.3% in PNGHRP was limited to the respective islands. We conclude from the present analysis that there is a clear need for conducting more high-quality research in both Fiji and PNG in order to meet the health needs of the respective nations. More research focusing on health needs and contributing factors to both communicable and noncommunicable diseases are the need of the hour in both of these south Pacific islands.

Direct-to-physician and direct-to-consumer advertising: Time to have stringent regulations

BACKGROUND

Direct to physician advertisements and direct to consumer advertisement (DTCA) is a well-known marketing strategy of pharmaceutical companies. Studies from the West and also from the Indian sub-continent revealed several lacunae in such advertisements.

OBJECTIVES

The present study was carried out to understand the international and national scenario regarding the lacunae in drug advertisements and the opinion of both physicians and patients regarding DTCA.

METHODS

The present study was conducted after obtaining approval from the institutional ethics committee. Warning letters (WLs) issued to pharmaceutical companies by United States Food and Drug Administration (USFDA) and Therapeutic Goods Administration (TGA) due to discrepancies in the advertisements were analyzed for reasons that were grouped into one of the following categories: overstatement of efficacy; unapproved indication; lack of adequate directions to use; omission of adverse effects; misleading claims; advertisement made for an unapproved drug (investigational new product). Drug advertisements in Current Index of Medical Specialties (CIMS) April-July 2014 issue was also analyzed for lacunae depending on categories as mentioned above. Physicians and patients in a tertiary care medical college and hospital were administered a validated questionnaire exploring their views about crucial aspects of DTCA. Descriptive statistics was used for each of the categories.

RESULTS

A total of 93 WLs issued by USFDA and 36 by TGA were assessed. Majority of the WLs by USFDA were issued for omission of adverse effects (61/93, 65.6%) followed by misleading claims (54/93, 58.1%). Similarly, WLs by TGA were also mainly issued for the presence of misleading claims (35/36, 97.2%) followed by overstatement of efficacy (26/36, 72.2%) and CIMS evaluation had revealed that 78/92 (84.8%) advertisements omitted adverse effects, 20/92 (21.7%) had misleading claims, 9/92 (9.8%) had unapproved indications and 7/92 (7.6%) overstated the efficacy. With regard to the opinion regarding DTCA, 69.9% physicians had a patient discussing DTCA that was clinically inappropriate. One hundred (64.5%) out of 155 physicians opined that DTCA encourage patients to attend physicians regarding preventive healthcare. On the contrary, 82/155 (52.9%) physicians felt that DTCA would damage the same. Similarly, 69 out of the total 100 patients felt that drug advertisements aid them to have better discussions with their treating physicians. Surprisingly, a large majority (91/100) were of the opinion that only safe drugs are allowed to be advertised.

CONCLUSION

To conclude, from the findings of this study both the physicians and patients should be cautious and not overzealous while dealing with drug advertisements or promotional literature. More stringent scrutiny and issue of WLs or blacklisting of indulging pharmaceutical companies are mandatory by the regulatory agency to contain the same.

Pindborg tumor

Calcifying epithelial odontogenic tumor (CEOT), also known as Pindborg tumor, is a rare odontogenic epithelial neoplasm. So far, nearly 200 cases have been reported in the literature. We are reporting a case of CEOT in a 42-year-old male patient with painless bony swelling in the mandible. The clinical, radiographic, and histopathologic features are discussed with relevant references.

Pilot studies: Are they appropriately reported?

Introduction:

Pilot studies play a pivotal role in deciding whether a main study can be undertaken thereby helping in appropriate framing of time, cost and study methods. However, they cannot be employed for testing a hypothesis and are underpowered in detecting clinically significant differences between the treatment arms. Literature from the west has shown serious lacunae on the part of researchers in reporting pilot studies. The present study assessed the reporting quality of pilot studies published from India.

Materials and Methods:

All the journal articles with a pilot study design published in Indian Journals between January and December 2013 were identified through PubMed search and were assessed for the following: Reason for undertaking the pilot study; report about intention of further work; mention about sample size calculation; statement on other studies evaluating the same hypothesis published elsewhere; whether any hypothesis was tested in the present study; use of inferential statistics including the total number of statistical analyses performed and whether confidence intervals were reported; post-hoc power calculation; application of randomization and/or blinding; total number of study participants and presence of a control group.

Results:

A total of 93 articles were considered in the present study. None of these reported reasons for undertaking the present pilot study and intention to carry of carrying out further work depending on their results. Also, none of them discussed the feasibility of conducting such studies in the given set-up. A total of 69/93 (67.7%) studies tested a hypothesis and had employed at least one of the statistical tests to infer whether any significant difference exist between various groups. None of the 93 articles mentioned confidence intervals and calculation of the sample size despite all mentioning the presence of previous studies evaluating a similar hypothesis. Similarly, none of these studies mentioned post-hoc analysis of power and median (range) of times of statistical analyses performed includes 5 (0–57).

Conclusion:

Pilot studies have been poorly reported in Indian biomedical journals, and more attention is required from all the stakeholders of research; researchers, peer reviewers and journal editors

Growth, structure, spectral and optical properties of semiorganic crystal: Pyridine-1-ium-2-carboxylatehydrogenbromide

Pyridine-1-ium-2-carboxylatehydrogenbromide (PHBr) crystal was grown from aqueous solution by slow evaporation method. The calculated lattice parameters of single crystal X-ray diffraction have shown the triclinic crystal system with centrosymmetric space group of Pī. The interaction of functional groups and their importance in their application was identified by FTIR spectral analysis. The material is optically transparent and the grown crystal is having lower cut off wavelength as 294nm, thereby confirming the enhancement of non-linear optical (NLO) property and optical band gap of the PHBr have been determined as 2.49eV by UV-Vis-NIR studies. The (1)H NMR spectrum confirms the molecular structure and the presence of different kinds of protons.

Contradicting/negative results in clinical research: Why (do we get these)? Why not (get these published)? Where (to publish)?

Obtaining negative or contradicting results, whereas conducting a study has always been overlooked as inadequacies on the part of the researcher. Many-a-times, negative results are arrived at even after conducting the study with great care and effort. This cannot be considered, a flaw, always. Contradicting results may be arrived at because of various reasons and should be considered and published in order to arrive at a definitive result. Various journals are available which publish these contradicting results exclusively. It is the duty of the researcher to know in detail the cause and effect of these, considering the pros and cons. This article gives a bird's eye view of when, where and how to manage negative or contradicting results of a study.

Crystal growth, spectral, optical and thermal properties of semiorganic nonlinear optical material: picolinic acid hydrochloride

The bulk single crystal of 2-picolinic acid hydrochloride (PHCL) (a semi-organic nonlinear optical material of dimensions 25×15×10 mm(3)) was successfully grown by slow solvent evaporation technique. The XRD results revealed the cell parameters and the centrosymmetric nature of the crystal structure. FT-IR spectral study identified the functional groups, nature of bonding and their bond strength. The UV-Vis-NIR studies recognized the optical transmittance window and the lower cut off wavelength of the PHCL crystal and thus it could be performed as a NLO material. (1)H NMR and (13)CNMR spectra were correlated with the XRD standard for the molecular structure reveals harmony of the materials. Thermal properties of the crystal were studied by thermo gravimetric analysis (TGA) and differential thermal analysis (DTA); the derived kinetic parameter values support the intuitive association of picolinicacid and HCl leads to the spontaneous formation of PHCL with a first order reaction. The presence of a proton and a proton acceptor groups provide the necessary stability to induce charge asymmetry in the PHCL structure. The load dependent hardness values of the crystal were measured by microhardness testing.

Synthesis, growth, spectral and thermal properties of a new organic crystal: 2-carboxypyridin-1-ium trichloroacetate

A novel organic optical material complex of 2-carboxypyridin-1-ium trichloroacetate has been synthesized and crystals were grown from aqueous solution employing the technique of controlled evaporation. The crystal structure has been determined using single crystal X-ray diffraction studies. The single crystals were successfully grown by the slow evaporation method with dimensions 12 × 8 × 3 mm(3). FT IR spectral investigation has been carried out to identify the various functional groups present in the grown crystal. Molecular structure was confirmed by NMR spectral analysis. Melting point was found using thermal measurements.

Spectral, thermal and optical properties of adenosinium picrate: a nonlinear optical single crystal

A new organic nonlinear optical material adenosinium picrate (C10H14N5O4+, C6 H2 N3 O7-) was synthesized. The single crystal X-ray diffraction revealed the non-centrosymmetric crystal structure, which is an essential criterion for second harmonic generation. The crystalline nature of the grown crystals was confirmed using powder XRD techniques. Molecular structure was confirmed by NMR spectral analysis and functional groups were identified by FT-IR spectral analysis. The optical transmittance window and the lower cutoff wavelength of the AP have been identified by UV-vis-NIR studies. Thermo gravimetric analysis (TGA) and differential thermal analysis (DTA) were used to study its thermal properties. Powder test with Nd:YAG laser radiation shows second harmonic generation.

Spectral, thermal and optical properties of L-tryptophanium picrate: a nonlinear optical single crystal

A new organic nonlinear optical material L-tryptophanium picrate was synthesized. From the powder XRD pattern the various planes of reflections were identified. The grown crystals were subjected to FT-IR and (1)H NMR spectral analyses to confirm the synthesized compound. Thermal properties of the crystals were investigated using thermo gravimetric (TG) and differential thermal analyses (DTA). The second harmonic generation (SHG) efficiency of the title compound was found using the modified experimental setup of Kurtz and Perry.

Treatment of an adult patient with a periodontally compromised skeletal Class II malocclusion

This article describes the treatment of an adult female with periodontally induced bone loss, excessive gingival display when smiling, vertical maxillary excess, a convex profile, a traumatic deep overbite, and severe lip incompetence. The therapy included four steps: (1) periodontal flap surgery and root planing with regular follow-ups; (2) leveling and aligning of the maxillary and mandibular arch with closure of all spaces, the extraction of mandibular first premolars, and retraction of the mandibular incisors; (3) LeFort I two-segment osteotomy with removal of the second premolars and a 5-mm impaction to reduce the excessive gingival display and permit autorotation of the mandible to decrease the facial convexity. To close the extraction space, the posterior segment was set 4 mm anteriorly and the anterior segment 3 mm posteriorly; and (4) postsurgical orthodontics for finishing and detailing. The treatment lasted 36 months; improved facial esthetics significantly; and resulted in a normal occlusion, overjet, and overbite.

Hepatoprotective effect of Pterocarpus marsupium against carbon tetrachloride induced damage in albino rats

Medicinal plants play a key role in human health care. Pterocarpus marsupium is one of the plants used in treatment of diabetes mellitus and the present study was aimed to assess hepatoprotective effect of the plant against CCl(4) induced hepatotoxicity. Wistar albino rats were divided into four groups. Group I was normal control group; Group II, the hepatotoxic group was given CCl(4) (2ml/kg body weight intraperitoneally); Groups III received CC1(4) + Plant extract (100 mg/kg b.w orally); Group IV received only the plant extract. Liver markers were assayed in serum and liver tissue. Levels of marker enzymes such as alanine transminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) and bilirubin were increased significantly in Group II. These enzymes were significantly decreased in Group III treated with plant extracts. The present investigation suggest that the plant had a good protective effect on CCl(4) induced hepatic injury.