Background: Antiplatelet therapy (APT) is an integral part of secondary stroke prevention. Noncompliance to APT is an important factor in stroke recurrence. In this study, we have evaluated the ...reasons for noncompliance to APT.
Objective: The aim of this study was to identify the various causes of nonadherence to APT in recurrent stroke patients.
Material and Methods: The study was conducted in a tertiary care hospital in south India with a huge stroke burden. The study period was from October 2017 to September 2018. A total of 60 consecutive patients of recurrent stroke who were nonadherent to antiplatelet therapy were evaluated for various factors that prevented compliance.
Results: During the 12-month study period among 604 ischemic stroke patients, 128 (21%) had recurrent strokes. Of this 128, 60 (46.8%) were due to discontinuation of APT. The main factor for nonadherence to APT was lack of awareness about the need for lifelong medication (41/60; 68.3%). 10 patients (16.7%) stopped treatment as they opted for alternative therapy and 4 (6.7%) discontinued antiplatelets due to side effects. A small proportion of the patients (3.3%) cited financial constraints and forgetfulness as the issue, while 1.7% had difficulty in finding assistance to administer medicine. 27 (45%) patients had recurrent stroke within 2-15 days of stopping APT.
Conclusions: The main reason for nonadherence to antiplatelet therapy is lack of awareness about the need for lifelong antiplatelet therapy. Stroke patients should be educated about the importance of lifelong antiplatelet therapy to prevent recurrent strokes.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background: The traditional Neurology exit examination in India has remained unchanged over the last few decades. In developed countries, objective evaluation methods have replaced the traditional ...ones. A need for such methods has not been explored in India. Objective: We aimed to study the perceptions and key recommendations of Neurology examiners on the existing examination pattern. Material and Methods: We conducted an online survey of examiners perceptions and recommendations using a set of 10 multiple-choice questions and an open-ended question. Results: 46 examiners provided completed responses suitable for analysis. Nearly equal proportions (30%) of the examiners had 10 years, 10-25 years and >25 years' experience. 92% were not satisfied with current system, 95% did not find adequate time for correction of theory scripts, 90% felt that theory questions were random, and 95% had legibility issues. 84% felt that the practical exams do not test true learning, 98% felt the examination stress impairs the performance and 85% felt that there are no objective criteria to pass the candidate. 83% felt the current system-needed changes. The key suggestions provided by the examiners to improve the system included objective assessments like MCQ, OSCE, OSLER and DOPS, inclusion of larger number of short answer type questions and periodic internal assessments of the candidates. Conclusions: A vast majority of examiners favoured changes to the current examination system and provided key recommendations. A larger study is needed to extrapolate these findings to the rest of India.
Presence of dye molecules in water causes various harmful effects for both human and aquatic species. Herein, we tried to remove two cationic dyes, namely Crystal violet and Brilliant green, from ...water by kaolinite clay mineral. The kaolinite clay mineral is further treated with 0.25 M and 0.05 M H
2
SO
4
to increase its adsorption capacity. The structural changes due to acid treatment were analyzed by XRD, zeta potential, FTIR, SEM, cation exchange capacity, BET surface area, and pore volume measurements. Kinetic data were analyzed by using five different kinetic models and the data fitted best to pseudo-second-order model. Langmuir isotherm showed best fit to the adsorption of both Crystal violet and Brilliant green. Acid–treatment has slightly increased the adsorption capacities for both the dyes. The Langmuir monolayer adsorption capacity of raw kaolinite was found to be 47.17 and 25.70 mg g
−1
for Crystal violet and Brilliant green, respectively, which increased to 49.50 and 50.51 mg g
−1
for 0.25 M and 0.50 M acid-treated kaolinite in case of Crystal violet and to 26.45 and 26.88 mg g
−1
in case of Brilliant green at 303 K. Crystal violet adsorption was exothermic with increase in ∆
G
values, whereas Brilliant green adsorption was endothermic in nature with decrease in ∆
G
in the temperature range 293–323 K. Reusability study showed the adsorbents could be successfully used up to 3rd cycle without much loss of adsorption capacity.
Control of blood pressure among hypertensives is a major challenge around the world. Interventions for improving hypertension control in India are very limited. This paper describes the protocol for ...a cluster randomized controlled trial of efficacy of behavioural intervention on control of hypertension among school teachers in Kerala.
A total of 92 schools are randomised to intervention and control group in Kerala. A baseline survey was conducted in all schools to assess the prevalence of hypertension and its risk factors among school teachers in Thiruvananthapuram district of Kerala state, India. Teachers in both sets of schools will receive a leaflet containing details on the importance of controlling hypertension. With the objective of improving control of hypertension, the intervention schools will additionally receive self-management education and behavioural intervention programs delivered by trained intervention managers along with measurement of weight, waist circumference and blood pressure. This intervention program will be developed based on the findings of the baseline survey and selected components of successful models of hypertension control from previous research done in similar settings. The intervention will be given for 3 months after which a post-survey will be conducted among teachers of both control and intervention schools. The primary outcome is change in control of hypertension and secondary outcome is the change in behavioural risk factors of hypertension both in the control and intervention groups.
This is the first comprehensive study looking at the efficacy of behavioural intervention on hypertension control among school teachers in Kerala, India. This study is likely to provide an upper estimate of behavioural intervention on hypertension control since teachers are reported to have one of the highest compliance rates of behavioural intervention.
This trial was prospectively registered with the Clinical Trials Registry of India CTRI/2018/01/011402 on 18 January 2018.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Staphylococcus aureus
biofilms are the pathogenic factor in the spread of infection and are more pronounced in multidrug-resistant strains of
S. aureus
, where high expression of proteases is ...observed. Among various proteases, Serine protease (SspA) and cysteine protease Staphopain B (SspB) are known to play a key role in the biofilm formation and removal of biofilms. In earlier studies, we have reported Dibenzyl (benzo d thiazol-2-yl (hydroxy) methyl) phosphonate (DBTMP) exhibits anti-
S. aureus
and anti-biofilm properties by elevating the expression of the protease. In this study, the effect of DBTMP on the activities of SspA, and SspB of
S. aureus
was evaluated. The SspA and SspB genes of
S. aureus
ATCC12600 were sequenced (Genbank accession numbers: MZ456982 and MW574006). In
S. aureus
active SspA is formed by proteolytic cleavage of immature SspA, to get this mature SspA (mSspA), we have PCR amplified the mSspA sequence from the SspA gene. The mSspA and SspB genes were cloned, expressed, and characterized. The pure recombinant proteins rSspB and rmSspA exhibited a single band in SDS–PAGE with a molecular weight of 40 and 30 KD, respectively. The activities of rmSspA and rSspB are 32.33 and 35.45 Units/mL correspondingly. DBTMP elevated the activities of rmSspA and rSspB by docking with respective enzymes. This compound disrupted the biofilms formed by the multidrug-resistant strains of
S. aureus
and further prevented biofilm formation. These findings explain that DBTMP possesses anti-
S. aureus
and anti-biofilm features.
Euryale ferox Salisbury ( E. ferox ) is an environmentally and economically important wetland macrophyte. This paper investigates the adsorption of a carcinogenic dye, basic fuchsin in the aqueous ...phase onto the hard shell of Euryale ferox seeds so as to establish the thrown away residue as a novel, efficient, bio-friendly and economically low-cost alternative adsorbent against other expensive adsorbents. Characterization of the bioadsorbent was carried out by TGA, SEM, FTIR and Zetasizer analyses. Zeta potential analysis showed good stability of the biomaterial around neutral pH. The operating variables such as adsorbent amount, adsorbate concentration, contact time, pH and temperature were optimized in a batch system. The maximum biosorption capacity of E. ferox was found to be 19.48 mg g −1 which could remove as much as 97.4% of the dye from an aqueous solution of concentration 40 mg L −1 at 298 K. Isothermal and kinetic data fitted best to Freundlich and pseudo second order models respectively. The thermodynamic study revealed the exothermic and spontaneous nature of the adsorption process.
India has the second largest diabetic population (61 million) and tobacco users (275 million) in the world. Data on smoking cessation among diabetic patients are limited in low and middle income ...countries. The objective of the study was to document the effectiveness of diabetic specific smoking cessation counseling by a non-doctor health professional in addition to a cessation advice to quit, delivered by doctors.
In our parallel-group randomized controlled trial, we selected 224 adult diabetes patients aged 18 years or older who smoked in the last month, from two diabetes clinics in South India. Using a computer generated random sequence with block size four; the patients were randomized equally into intervention-1 and intervention-2 groups. Patients in both groups were asked and advised to quit smoking by a doctor and distributed diabetes specific education materials. The intervention-2 group received an additional diabetes specific 30 minutes counseling session using the 5As (Ask, Advise, Assess, Assist and Arrange), and 5 Rs (Relevance, Risks, Rewards, Roadblocks and Repetition) from a non-doctor health professional. Follow up data were available for 87.5% of patients at six months. The Quit Tobacco International Project is supported by a grant from the Fogarty International Centre of the US National Institutes of Health (RO1TW005969-01).The primary outcomes were quit rate (seven day smoking abstinence) and harm reduction (reduction of the number of cigarettes / bidis smoked per day > 50% of baseline use) at six months.
In the intention to treat analysis, the odds for quitting was 8.4 95% confidence interval (CI): 4.1-17.1 for intervention-2 group compared to intervention-1 group. Even among high level smokers the odds of quitting was similar. The odds of harm reduction was 1.9 (CI: 0.8-4.1) for intervention-2 group compared to intervention-1 group.
The value addition of culturally sensitive diabetic specific cessation counseling sessions delivered by non-doctor health professional was an impressive and efficacious way of preventing smoking related diabetic complications.
Clinical Trial Registry of India (CTRI/2012/01/002327).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The patterns of concordant and discordant comorbidities of hypertension and their association with hypertension control were ascertained in this cross-sectional study. A total of 402 adults with ...hypertension were identified from the baseline survey of a randomized controlled trial for hypertension control among school teachers in Kerala. Chronic conditions were captured and categorized into concordant and discordant comorbidities. Nearly 57% of teachers with hypertension reported multimorbidity. Concordant morbidity was reported by 44% and discordant by 21% of participants. The odds of hypertension control was higher among those who reported at least one discordant morbidity (odds ratio OR: 2.76, 95% confidence interval CI:1.69-4.49) and those who reported at least one concordant morbidity (OR: 2.08, CI: 1.37-3.16), compared to their counterparts. Hypertension control was higher for those who reported any comorbidity (OR: 2.37, CI: 1.51-3.71) compared to those who did not report any. Well-designed large-scale mixed methods studies are required to thoroughly explore multimorbidity and its relationship with hypertension control in India.
A bacterium isolated from the activated sludge of an oil refinery of Assam, India retained efficient bioflocculating activity through production of the bioflocculant when it was grown on a crude oil ...amended medium void of any other carbon source. The bioflocculating activity gained from the optimized medium broth was 86.2%, which could be enhanced up to 89.1% with the purified bioflocculant. During the course of the bioflocculant production, the bacterium utilized about 77% of the petroleum hydrocarbons after incubation for 168 h when the activity was found to be the highest. The bioflocculant was efficient in flocculating Ni
2+
, Zn
2+
, Cd
2+
, Cu
2+
and Pb
2+
. The bioflocculant was characterized as a glycoprotein complex by biochemical tests, FT-IR, SEM-EDX and LC/MS analyses. The bioflocculant showed negligible cytotoxicity on testing with the L292 cell line indicating the tremendous possibility of its use in bioremediation.
A bacterium isolated from the activated sludge of an oil refinery of Assam, India retained efficient bioflocculating activity through production of the bioflocculant when it was grown on a crude oil amended medium void of any other carbon source.
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![Dibenzyl (benzo [d] thiazol...](http://api.summon.serialssolutions.com/2.0.0/image/issn/XR4PS5YY4K/0302-8933/small "Dibenzyl (benzo [d] thiazol-2-yl (hydroxy) methyl) phosphonate (DBTMP) showing anti-S. aureus and anti-biofilm properties by elevating activities of serine protease (SspA) and cysteine protease staphopain B (SspB)")
