Government Medical College

The recognition of health related quality of life began ever since WHO expanded the definition of health in 1948. This has resulted in the paradigm shift of health and disease from a medical model to a biopsychosocial model. Oral health too denotes not merely the absence of disease but the general well being so that the person can perform functions like eating, talking and smiling and also can contribute creatively to the society. Health related quality of life is a trade-off between how long and how well people live. To explain the concept various theoretical models have been proposed, of which the conceptual model of Wilson and Cleary 1995 is a comprehensive one. Even after much research and thousands of publications the definition of oral health related quality of life is still vague. But the patient's self perception about his oral health and related life quality are significant in clinical dental practice, dental education and research. It is widely shown that oral conditions can have varied impacts on daily living. To assess this, many measures or scales are available. They differ depending on the response format, number of items, context of use and the population in which it is applied. Patient reported outcome assessment is a less developed area in clinical dentistry and research and in future it has the potential to become the primary or secondary outcome measure in clinical interventional research.

Inflammatory periodontal disease caused by dental plaque is characterized by the clinical signs of inflammation and loss of periodontal tissue support. The mechanical removal of this biofilm and adjunctive use of antibacterial disinfectants and antibiotics have been the conventional methods of periodontal therapy. But the removal of plaque and the reduction in the number of infectious organisms can be impaired in sites with difficult access. The possibility of development of resistance to antibiotics by the target organism has led to the development of a new antimicrobial concept with fewer complications. Photodynamic therapy (PDT) involves the use of low power lasers with appropriate wavelength to kill micro organisms treated with a photosensitizer drug. PDT could be a useful adjunct to mechanical as well as antibiotics in eliminating periopathogenic bacteria.

Abstract The mechanical performance of short randomly oriented banana and sisal hybrid fiber reinforced polyester composites was investigated with reference to the relative volume fraction of the two fibers at a constant total fiber loading of 0.40 volume fraction (V f ), keeping banana as the skin material and sisal as the core material. A positive hybrid effect is observed in the flexural strength and flexural modulus of the hybrid composites. The tensile strength of the composites showed a positive hybrid effect when the relative volume fraction of the two fibers was varied, and maximum tensile strength was found to be in the hybrid composite having a ratio of banana and sisal 4 : 1. The impact strength of the composites was increased with increasing volume fraction of sisal. However, a negative hybrid effect is observed when the impact strength of the composites is considered. Keeping the relative volume fraction of the two fibers constant, that is, banana : sisal = 0.32 : 0.08 (i.e., 4 : 1), the fiber loading was optimized and different layering patterns were investigated. The impact strength of the composites was increased with fiber loading. Tensile and flexural properties were found to be better at 0.40 V f . In the case of different layering patterns, the highest flexural strength was observed for the bilayer composites. Compared to other composites, the tensile properties were slightly higher for the composite having banana as the skin material and sisal as the core material. Scanning electron micrographs of the tensile and impact fracture surfaces of the hybrid composites having volume fraction 0.20 and 0.40 V f were studied. The experimental tensile strength and tensile modulus of hybrid composites were compared with those of theoretical predictions. © 2005 Wiley Periodicals, Inc. J Appl Polym Sci 96: 1699–1709, 2005

BACKGROUND: Bronchiectasis is a common but neglected chronic lung disease. Most epidemiological data are limited to cohorts from Europe and the USA, with few data from low-income and middle-income countries. We therefore aimed to describe the characteristics, severity of disease, microbiology, and treatment of patients with bronchiectasis in India. METHODS: The Indian bronchiectasis registry is a multicentre, prospective, observational cohort study. Adult patients (≥18 years) with CT-confirmed bronchiectasis were enrolled from 31 centres across India. Patients with bronchiectasis due to cystic fibrosis or traction bronchiectasis associated with another respiratory disorder were excluded. Data were collected at baseline (recruitment) with follow-up visits taking place once per year. Comprehensive clinical data were collected through the European Multicentre Bronchiectasis Audit and Research Collaboration registry platform. Underlying aetiology of bronchiectasis, as well as treatment and risk factors for bronchiectasis were analysed in the Indian bronchiectasis registry. Comparisons of demographics were made with published European and US registries, and quality of care was benchmarked against the 2017 European Respiratory Society guidelines. FINDINGS: From June 1, 2015, to Sept 1, 2017, 2195 patients were enrolled. Marked differences were observed between India, Europe, and the USA. Patients in India were younger (median age 56 years [IQR 41-66] vs the European and US registries; p<0·0001]) and more likely to be men (1249 [56·9%] of 2195). Previous tuberculosis (780 [35·5%] of 2195) was the most frequent underlying cause of bronchiectasis and Pseudomonas aeruginosa was the most common organism in sputum culture (301 [13·7%]) in India. Risk factors for exacerbations included being of the male sex (adjusted incidence rate ratio 1·17, 95% CI 1·03-1·32; p=0·015), P aeruginosa infection (1·29, 1·10-1·50; p=0·001), a history of pulmonary tuberculosis (1·20, 1·07-1·34; p=0·002), modified Medical Research Council Dyspnoea score (1·32, 1·25-1·39; p<0·0001), daily sputum production (1·16, 1·03-1·30; p=0·013), and radiological severity of disease (1·03, 1·01-1·04; p<0·0001). Low adherence to guideline-recommended care was observed; only 388 patients were tested for allergic bronchopulmonary aspergillosis and 82 patients had been tested for immunoglobulins. INTERPRETATION: Patients with bronchiectasis in India have more severe disease and have distinct characteristics from those reported in other countries. This study provides a benchmark to improve quality of care for patients with bronchiectasis in India. FUNDING: EU/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis Consortium, European Respiratory Society, and the British Lung Foundation.

Biocomposites being environmentally-friendly alternative to synthetic composites are gaining increasing demand for various applications. Hence, biocomposite development should be integrated within a circular economy (CE) model to ensure a sustainable production that is simultaneously innocuous towards the environment. This review presents an overview of the state-of-the-art technologies for the adoption of the CE concept in biocomposite development. The study outlined the properties, environmental and economic impacts of biocomposites. A critical review of the life-cycle assessment of biocomposite for evaluating greenhouse gas emissions and carbon footprints was conducted. In addition, the opportunities and challenges pertaining to the implementation of CE have been discussed in detail. Recycling and utilisation of bio-based constituents were identified as the critical factors in embracing CE. Therefore, the development of innovative recycling technologies and an enhanced use of novel biocomposite constituents could lead to a reduction in material waste and environmental footprints. This article is one of the first studies to review the circularity of biocomposites in detail that will stimulate further research in enhancing the sustainability of these polymeric materials.

Oral diseases are the complex host responses composed of a broad array of inflammatory cells, and cytokines, chemokines, and mediators derived from the cells resident in the gingival tissues, as well as from the emigrating inflammatory cells. A chronic polymicrobial challenge to the local host tissues triggers this response, which under certain circumstances, and in a subset of the population, leads to the progressing soft and hard tissue destruction that characterizes periodontitis. The red complex has been proposed as a pathogenic consortium, consisting of P. gingivalis, T. denticola , and T. forsythia . This review has attempted to examine the virulence potential and determinants of these commensal opportunists.

Two categories of diabetes are recognized in the temperate zone--ketosis-prone diabetes requiring insulin and diabetes not requiring insulin. Another unique type of diabetes occurs in the tropics. It has two forms, both different from either form of temperate zone diabetes. Type J and pancreatic diabetes are both characterized by youth onset, antecedent malnutrition, substantial insulin requirement, and resistance to ketosis. In the tropical countries where they are found, both forms are associated with specific dietary practices, including a nutritionally marginal protein intake. The close association with low protein intake distinguishes this form of diabetes from that occurring in North America, Europe, and Oceania. The geographic distribution of malnutrition diabetes, in addition to being limited to the tropics, coincides regularly with the consumption of tapioca (cassava) or other foods that contain cyanide-yielding substances. Ingested cyanide is normally detoxified, principally, by conversion to thiocyanate. This detoxification requires sulfur, derived principally from amino acid sources. Studies in the rat indicate a remarkable ability to detoxify ingested cyanide, a reduction in urinary thiocyanate excretion when protein intake is lowered (especially during growth), production of marked hyperglycemia by either oral or parenteral cyanide, and the development of cyanosis and epidermal changes when there is prolonged exposure to cyanide. Both the association of malnutrition diabetes with food cyanogens and our laboratory observations support a role for cyanide in its pathogenesis.

Recent investigations suggest that gut microbiota affects the brain activity through the microbiota-gut-brain axis under both physiological and pathological disease conditions like Parkinson's disease. Further dopamine synthesis in the brain is induced by dopamine producing enzymes that are controlled by gut microbiota via the microbiota-gut-brain axis. Also alpha synuclein deposition and the associated neurodegeneration in the enteric nervous system that increase intestinal permeability, oxidative stress, and local inflammation, accounts for constipation in Parkinson's disease patients. The trigger that causes blood brain barrier leakage, immune cell activation and inflammation, and ultimately neuroinflammation in the central nervous system is believed to be due to the chronic low-grade inflammation in the gut. The non-motor symptoms that appear years before motor symptoms could be reliable early biomarkers, if they could be correlated with the established and reliable neuroimaging techniques or behavioral indices. The future directions should therefore, focus on the exploration of newer investigational techniques to identify these reliable early biomarkers and define the specific gut microbes that contribute to the development of Parkinson's disease. This ultimately should pave the way to safer and novel therapeutic approaches that avoid the complications of the drugs delivered today to the brain of Parkinson's disease patients.

Lymphomas constitute the third most common neoplasm in head and neck region arising from the lymphoreticular system. Malignant lymphomas are divided into Hodgkin's disease and non-Hodgkin's lymphoma (NHL). NHL comprises approximately 5% of head and neck malignancies and displays a wide range of appearances comparable with Hodgkin's disease. Hodgkin's and non-Hodgkin's lymphomas are seen in the head and neck region, but extranodal disease, with or without lymph node involvement, is more common among NHL patients. Extranodal involvement includes the areas such as Waldeyer's ring (i.e., the tonsils, pharynx, and base of the tongue), salivary glands, orbit, paranasal sinuses, and thyroid glands. There are several classification systems for categorizing NHL out of which WHO classification for lymphoid neoplasms is mostly followed. This review describes the pathogenesis of NHL and explains some of the important NHL (Marginal zone B-cell Lymphoma, follicular lymphoma, mantle cell lymphoma).

The mushrooming utilization of electronic devices in the current era produces electromagnetic interference (EMI) capable of disabling commercial and military electronic appliances on a level like never before. Due to this, the development of advanced materials for effectively shielding electromagnetic radiation has now become a pressing priority for the scientific world. This paper reviews the current research status of polymer nanocomposite-based EMI shielding materials, with a special focus on those with hybrid fillers and MXenes. A discussion on the theory of EMI shielding followed by a brief account of the most popular synthesis methods of EMI shielding polymer nanocomposites is included in this review. Emphasis is given to unravelling the connection between microstructures of the composites, their physical properties, filler type, and EMI shielding efficiency (EMI SE). Along with EMI shielding efficiency and conductivity, mechanical properties reported for EMI shielding polymer nanocomposites are also reviewed. An elaborate discussion on the gap areas in various fields where EMI shielding materials have potential applications is reported, and future directions of research are proposed to overcome the existing technological obstacles.

Electrospun polycaprolactone (PCL) tissue engineering scaffolds have been developed and used for a wide range of tissue engineering applications, where successful incorporation and conservation of the therapeutic activity of the embedded nanoparticles into scaffolds is critically needed for effective tissue engineering. Incorporation of pro-angiogenic nanomaterials to promote vascularization is a novel approach. Our group has well-demonstrated the potent pro-angiogenic properties of europium hydroxide nanorods (EHNs) using in vitro and in vivo systems. In the present study, electrospun PCL tissue engineering scaffolds containing EHNs were fabricated and characterized for various morphological and physico-chemical properties. Furthermore, biological studies showed enhanced cell growth and a greater density of endothelial cells grown on the scaffolds incorporated with EHNs (PCL-EHNs). The PCL-EHNs also exhibited good hemo-compatibility towards blood cells. Fluorescence microscopy and SEM observations showed good endothelial cell adhesion over these scaffolds. The PCL-EHNs demonstrated augmented growth of blood vessels in an in vivo chick embryo angiogenesis model. Furthermore, protein expression studies illustrated promoted angiogenesis of HUVECs on scaffolds in a VEGFR2/Akt mediated signaling cascade. Together, the above observations strongly suggest potent applications of EHN-incorporated PCL scaffolds in promoting angiogenesis/vascularization and their effective use in tissue engineering and vascular disease therapy.

BACKGROUND: Snakebite envenoming is an important medical emergency in Kerala, but the factors leading to complications have not been well studied. OBJECTIVES: To study the clinical characteristics, factors involved in complications and the outcomes in relation to timing of polyvalent snake antivenom (SAV) administration in patients with snakebite envenoming. METHODS: Patients were recruited from cases of snakebites admitted to the emergency care unit of Kottayam Medical College between May 2005 and December 2006. The manifestations of envenoming and complications were recorded. SAV was administered to cases with envenoming. Treated patients were analysed to determine the factors involved in complications and the outcomes in relation to the timing of SAV. RESULTS: 200 (34%) of 586 cases with snakebites had envenoming; 58% were men, 52% were aged 31-50 years and 93% were outdoor bites. The species of snake was identified in 34.5% of the venomous bites. 93.5% had signs of local envenoming. Regional lymphadenitis occurred in 61%. The mortality rate was 3%. Capillary leak syndrome, respiratory paralysis and intracerebral bleeding were the risk factors for mortality. Those who received SAV early (bite to needle time <6 h) had more severe local envenoming than those who received SAV late (bite to needle time >or =6 h), but the latter group were more likely to suffer complications. 39.5% had complications, with acute renal failure being the most common (25.5%). Those who received SAV late had a higher risk of developing acute renal failure. Higher rates of complications were seen in those with severe coagulopathy (OR = 8.0), leucocytosis (OR = 3.7) and those who received SAV late. CONCLUSIONS: Early administration of SAV reduces the risk of complications. The presence of leucocytosis and severe coagulopathy can predict adverse outcomes.

In the last decades, Guide Tissue Regeneration (GTR) technique has been applied for the treatment of various periodontal defects such as intrabony defects, furcation involvements and localized gingival recession defects. From early days of using membranes with the simple aim of minimizing toxic response in the host, membranes have come a long way. Third generation membranes not only act as barriers but also as delivery devices to release specific agents. Many clinical trials have focused on using membranes as delivery devices for antibiotics and growth factors. In this article we take a brief look at the evolution of barrier membranes and future avenues with regard to third generation membranes.

Hospitals are the most widely used means by which a sick person gets medical check-ups, disease diagnosis and treatment recommendation. This has been a practice by almost all the people over the world. People consider it as the most reliable means to check their health status. The proposed system is to create an alternative to this conventional method of visiting a hospital and making an appointment with a doctor to get diagnosis. This research intends to apply the concepts of natural language processing and machine learning to create a chatbot application. People can interact with the chatbot just like they do with another human and through a series of queries, chatbot will identify the symptoms of the user and thereby, predicts the disease and recommends treatment. This system can be of great use to people in conducting daily check-ups, makes people aware of their health status and encourages people to make proper measures to remain healthy. According to this research, such a system is not widely used and people are less aware of it. Executing this proposed framework can help people avoid the time-consuming method of visiting hospitals by using this free of cost application, wherever they are.

Recently, virtualization in wireless sensor networks (WSNs) has witnessed significant attention due to the growing service domain for Internet of Things (IoT). Related literature on virtualization in WSNs explored resource optimization without considering communication failure in WSNs environments. The failure of a communication link in WSNs impacts many virtual networks running IoT services. In this context, this paper proposes a framework for optimizing fault tolerance (FT) in virtualization in WSNs, focusing on heterogeneous networks for service-oriented IoT applications. An optimization problem is formulated considering FT and communication delay as two conflicting objectives. An adapted nondominated sorting-based genetic algorithm (A-NSGA) is developed to solve the optimization problem. The major components of A-NSGA include chromosome representation, FT and delay computation, crossover and mutation, and nondominance-based sorting. Analytical and simulation-based comparative performance evaluation has been carried out. From the analysis of results, it is evident that the framework effectively optimizes FT for virtualization in WSNs.

OBJECTIVES: To study the prevalence and risk factors for cardiac autonomic neuropathy (CAN) and the utility of prolongation of corrected QT interval (QTc) in the ECG to diagnose CAN in patients with diabetes mellitus. DESIGN AND SETTING: Cross-sectional study conducted among patients attending the diabetic clinic of a teaching hospital. METHODS: The prevalence of CAN among 100 patients with type 1 and type 2 diabetes mellitus was assessed by the five autonomic function tests by Eving's methodology. The CAN score in each patient and its relationship to the QTc interval were analysed. Possible influences of age, duration of diabetes and coexistent peripheral neuropathy on the occurrence of CAN also were studied. RESULTS: The prevalence of CAN was 60%. Univariate analysis showed a significant association between CAN and higher age (odds ratio (OR) 15.75), prolongation of QTc (OR 5.55), duration of disease over 10 years (OR 2) and peripheral neuropathy (p<0.001) in patients with type 1 diabetes. Significant risks for CAN among patients with type 2 diabetes were coexistent peripheral neuropathy (OR 14), prolonged QTc (OR 9.75), higher age (OR 7.2) and disease duration over 10 years (OR 1.92) in univariate analysis, but none of them showed independent risk in multivariate analysis. Disease duration over 10 years resulted in QTc prolongation in a significant numbers of cases with type 1 (p<0.001) and type 2 (p = 0.006) diabetes. The sensitivity, specificity and positive predictive value of QTc prolongation for the diagnosis of CAN were 77%, 62.5% and 77% in type 1 and 76.5%, 75% and 81.3% in type 2, respectively. Higher CAN scores correlated with longer QTc intervals (coefficient of correlation 0.73; p<0.001). CONCLUSIONS: The prevalence of CAN in diabetes mellitus is high. Higher age, longer duration of diabetes and peripheral neuropathy are significant risk factors. QTc interval in the ECG can be used to diagnose CAN with reasonable sensitivity, specificity and positive predictive value.

The classical heterocoupling of a 1-haloalkyne with a terminal alkyne catalyzed by copper salts in the presence of a base for the synthesis of unsymmetrical diynes is termed the Cadiot-Chodkiewicz coupling reaction. The diynes are of great importance due to their biological, optical and electronic properties. A number of modifications have been developed recently to improve the efficiency of Cadiot-Chodkiewicz coupling reactions in terms of selectivity and yield. This is the first review on the Cadiot-Chodkiewicz cross-coupling reaction which highlights the modern approaches and protocols developed for the synthesis and applications of unsymmetrical 1,3-diynes.

Cobalt-catalyzed C–H activation has gone through some major advancements in the past couple of decades.

Nickel-catalyzed C–H activation has become a predominant and ubiquitous research area in organic chemistry.

BACKGROUND: Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are a group of severe life threatening drug reactions. The drugs commonly implicated as the cause of these drug reactions vary depending on host factors and the prescription pattern of drugs in that particular area. AIM: The aim of the study was to find the drugs implicated as the cause of SJS/TEN in the patients admitted in the dermatology ward at the Medical College, Thrissur and to find the clinical outcome. METHODS: It was a retrospective study of 7 years from 1997 to 2004. The case records of all patients with a clinical diagnosis of TEN or SJS were studied in detail regarding the drugs implicated as the cause, the management and the clinical outcome. RESULTS: During the study period, 41 patients in the age group ranging from 12 to 72 years were treated as inpatients, of which 20 were males and 21 were females. The commonest drug implicated as the cause of SJS/TEN was carbamazepine (44%). The indication for carbamazepine was control of pain in more than 50% of the cases. Presence of a major systemic disease before the onset of SJS/TEN was associated with a bad prognosis. CONCLUSION: The increased use of carbamazepine, especially for control of pain, may be the reason for the increased incidence of SJS/TEN due to the same drug. Awareness about the drugs implicated in life threatening drug reactions will help physicians in preventing them by judicious use of the drugs.