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1.  Morphometric study of cricoid cartilages in Western India 
The Australasian Medical Journal  2011;4(10):542-547.
It is important to determine the size and proportion of the larynx as such information is useful in procedures such as intubation, endoscopy and surgical manipulations. Recent interest in the cases of subglottic stenosis and postintubational stenosis of the lower respiratory tract has led to renewed interest in ascertaining the measurements of the various laryngeal cartilages. The aim of the present study was to collect morphometric data of cricoid cartilage from a regional population.
Fifty laryngeal preparations from adult cadavers of Western India were assessed. Sections were prepared via dissection and the removed cricoid cartilages then measured and weighed.
The mean antero-posterior diameter (19.29±2.47) of the cricoid cartilage was greater than the average transverse diameter (18.33±2.26). The height of arch of cricoid cartilage was 6.54±1.23mm and height of lamina was 21.45±1.97mm. Mean weight of cricoid cartilage was 4.53±1.27grams. The shape of the cricoid cartilage was ovoid in 46% of cases, oval in 38%, pear shaped in 12% and narrow-oblong in 4% of cases.
Inter-subject variability in the dimensions of cricoid cartilages was observed. The large difference in almost all sizes and shapes of the cricoid cartilage makes it difficult to standardise the rigid stents used in these organs. Endotracheal tubes of the appropriate size should therefore be based on the measurements of individual patients. Clinicians should therefore be aware of morphological variations as they are of fundamental clinical importance.
PMCID: PMC3562875  PMID: 23386865
Cricoid cartilage; larynx; morphometry
2.  PACS Administrators’ and Radiologists’ Perspective on the Importance of Features for PACS Selection 
Journal of Digital Imaging  2014;27(4):486-495.
Picture archiving and communication systems (PACS) play a critical role in radiology. This paper presents the criteria important to PACS administrators for selecting a PACS. A set of criteria are identified and organized into an integrative hierarchical framework. Survey responses from 48 administrators are used to identify the relative weights of these criteria through an analytical hierarchy process. The five main dimensions for PACS selection in order of importance are system continuity and functionality, system performance and architecture, user interface for workflow management, user interface for image manipulation, and display quality. Among the subdimensions, the highest weights were assessed for security, backup, and continuity; tools for continuous performance monitoring; support for multispecialty images; and voice recognition/transcription. PACS administrators’ preferences were generally in line with that of previously reported results for radiologists. Both groups assigned the highest priority to ensuring business continuity and preventing loss of data through features such as security, backup, downtime prevention, and tools for continuous PACS performance monitoring. PACS administrators’ next high priorities were support for multispecialty images, image retrieval speeds from short-term and long-term storage, real-time monitoring, and architectural issues of compatibility and integration with other products. Thus, next to ensuring business continuity, administrators’ focus was on issues that impact their ability to deliver services and support. On the other hand, radiologists gave high priorities to voice recognition, transcription, and reporting; structured reporting; and convenience and responsiveness in manipulation of images. Thus, radiologists’ focus appears to be on issues that may impact their productivity, effort, and accuracy.
PMCID: PMC4090402  PMID: 24744278
Picture archiving and communication system; PACS; Analytical hierarchy process; AHP; RIS; Structured reporting; Voice recognition; Transcription; Open systems; Proprietary systems; Display quality; System continuity; Security; Backup; Recovery; Downtime prevention; PACS performance monitoring; Configuration; Upgrade; Cardiology images; Pathology images; System architecture and performance; User interface for image manipulation; User interface workflow management; Worklist management
3.  Staff Perception on Biomedical or Health Care Waste Management: A Qualitative Study in a Rural Tertiary Care Hospital in India 
PLoS ONE  2015;10(5):e0128383.
Health care or biomedical waste, if not managed properly, can be of high risk to the hospital staff, the patients, the community, public health and the environment, especially in low and middle income settings where proper disposal norms are often not followed. Our aim was to explore perceptions of staff of an Indian rural tertiary care teaching hospital on hospital waste management.
A qualitative study was conducted using 10 focus group discussions (FGDs), with different professional groups, cleaning staff, nurses, medical students, doctors and administrators. The FGD guide included the following topics: (i) role of Health Care Waste Management (HCWM) in prevention of health care associated infections, (ii) awareness of and views about HCWM-related guidelines/legislation, (iii) current HCWM practices, (iv) perception and preparedness related to improvements of the current practices, and (v) proper implementation of the available guidelines/legislation. The FGDs were recorded, transcribed verbatim, translated to English (when conducted in Hindi) and analysed using content analysis.
Two themes were identified: Theme (A), ‘Challenges in integration of HCWM in organizational practice,’ with the categories (I) Awareness and views about HCWM, (II) Organizational practices regarding HCWM, and (III) Challenges in Implementation of HCWM; and Theme (B), ‘Interventions to improve HCWM,’ with three categories, (I) Educational and motivational interventions, (II) Organizational culture change, and (III) Policy-related interventions.
A gap between knowledge and actual practice regarding HCWM was highlighted in the perception of the hospital staff. The participants suggested organizational changes, training and monitoring to address this. The information generated is relevant not merely to the microsystem studied but to other institutions in similar settings.
PMCID: PMC4449010  PMID: 26023783
4.  Complete oral rehabilitation in a case with severe dental fluorosis 
The authors have presented a technique of full occlusal rehabilitation in a case of severe dental fluorosis. In this technique, maxillary and mandibular anterior teeth were simultaneously prepared and restored first. This was followed by simultaneous preparation of maxillary and mandibular posterior teeth that were restored in canine guided occlusion. The technique and sequence followed here is unique and is not available in dental literature. This technique reduces number of appointments while fulfilling all objectives. Periodontal follow-up over 3 years was satisfactory. A restorative treatment protocol has been devised for fluorosis which will act as a guide for the dental practitioners.
PMCID: PMC4266849  PMID: 25516876
Occlusal rehabilitation; Dental fluorosis; Treatment protocol; Restorative management; Occlusal plane
5.  A simple technique to reduce evaporation of crystallization droplets by using plate lids with apertures for adding liquids 
This article describes the use of evaporation control lids that are fitted to crystallization plates to improve the reproducibility of trials using as little as 5 nl. The plate lids contain apertures which are large enough for the transfer of protein containing droplets, but small enough to greatly reduce the rate of evaporation during the time needed to prepare the plate.
A method is described for using plate lids to reduce evaporation in low-volume vapor-diffusion crystallization experiments. The plate lids contain apertures through which the protein and precipitants were added to different crystallization microplates (the reservoir was filled before fitting the lids). Plate lids were designed for each of these commonly used crystallization microplates. This system minimizes the dehydration of crystallization droplets containing just a few nanolitres of protein and precipitant, and results in more reproducible diffraction from the crystals. For each lid design, changes in the weight of the plates were used to deduce the rate of evaporation under different conditions of temperature, air movement, droplet size and precipitant. For comparison, the state of dehydration was also visually assessed throughout the experiment. Finally, X-ray diffraction methods were used to compare the diffraction of protein crystals that were conventionally prepared against those that were prepared on plates with plate lids. The measurements revealed that the plate lids reduced the rate of evaporation by 63–82%. Crystals grown in 5 nl drops that were set up with plate lids diffracted to higher resolution than similar crystals from drops that were set up without plate lids. The results demonstrate that plate lids can be instrumental for improving few-nanolitre crystallizations.
PMCID: PMC4259245  PMID: 25484231
crystallization; dehydration; vapor diffusion; high-throughput screening; acoustic droplet ejection; in situ X-ray data collection
6.  Endogenous lung surfactant inspired pH responsive nanovesicle aerosols: Pulmonary compatible and site-specific drug delivery in lung metastases 
Scientific Reports  2014;4:7085.
Concerns related to pulmonary toxicity and non-specificity of nanoparticles have limited their clinical applications for aerosol delivery of chemotherapeutics in lung cancer. We hypothesized that pulmonary surfactant mimetic nanoparticles that offer pH responsive release specifically in tumor may be a possible solution to overcome these issues. We therefore developed lung surfactant mimetic and pH responsive lipid nanovesicles for aerosol delivery of paclitaxel in metastatic lung cancer. 100–200 nm sized nanovesicles showed improved fusogenicity and cytosolic drug release, specifically with cancer cells, thereby resulting in improved cytotoxicity of paclitaxel in B16F10 murine melanoma cells and cytocompatibility with normal lung fibroblasts (MRC 5). The nanovesicles showed airway patency similar to that of endogenous pulmonary surfactant and did not elicit inflammatory response in alveolar macrophages. Their aerosol administration while significantly improving the biodistribution of paclitaxel in comparison to Taxol (i.v.), also showed significantly higher metastastes inhibition (~75%) in comparison to that of i.v. Taxol and i.v. Abraxane. No signs of interstitial pulmonary fiborisis, chronic inflammation and any other pulmonary toxicity were observed with nanovesicle formulation. Overall, these nanovesicles may be a potential platform to efficiently deliver hydrophobic drugs as aerosol in metastatic lung cancer and other lung diseases, without causing pulmonary toxicity.
PMCID: PMC4235800  PMID: 25403950
7.  Results from a dietary survey in an Indian T2DM population: a STARCH study 
BMJ Open  2014;4(10):e005138.
To assess the dietary total and complex carbohydrate (CHO) contents in type-2 diabetes mellitus (T2DM) participants in India.
We enrolled 796 participants in this cross-sectional, single-visit, multicentre, two-arm, single-country survey. Participants were enrolled from 10 specialty endocrinology/dialectology centres from five regions of India.
A total of 796 participants (Asian) were enrolled in this study (385, T2DM and 409, non-T2DM). Key inclusion criteria—male or female ≥18 years, diagnosed with T2DM ≥12 months (T2DM), and not on any diet plan (non-T2DM).
Study outcome
Primary outcome was to find out the percentage of total energy intake as simple and complex CHO from total CHO. Secondary outcomes were to find the differences in percentage of total energy intake as simple CHO, complex CHO, proteins and fats between T2DM and non-T2DM groups. The percentage of T2DM participants adhering to diet plan and showing glycaemic controls were also examined.
The mean (SD) of total calorie intake per day (Kcal) was 1547 (610, 95% CI 1486 to 1608) and 2132 (1892, 95% CI 1948 to 2316), respectively, for T2DM and non-T2DM groups. In the T2DM group (n=385), the mean (SD) percentage of total energy intake as total CHO, complex CHO and simple CHO was 64.1±8.3 (95% CI 63.3 to 64.9), 57.0±11.0 (95% CI 55.9 to 58.1) and 7.1±10.8 (95% CI 6.0 to 8.2), respectively. The mean (SD) percentage of complex CHO intake from total CHO was 89.5±15.3 (95% CI 88.0 to 91.1). The mean (SD) total protein/fat intake per day (g) was 57.1 (74.0)/37.2 (18.6) and 57.9 (27.2)/55.3 (98.2) in T2DM and non-T2DM groups, respectively.
Our study shows that CHO constitutes 64.1% of total energy from diet in T2DM participants, higher than that recommended in India. However, our findings need to be confirmed in a larger epidemiological survey.
Trial registration number
NCT01450592 & Clinical Trial Registry of India: CTRI/2012/02/002398.
PMCID: PMC4216859  PMID: 25361834
Carbohydrate Dietary; Diabetes Mellitus; Glucose Conrol
8.  Lumbosacral actinomycosis in an immunocompetent individual: An extremely rare case 
Actinomycosis is a gram positive commensal bacteria. In predisposed individuals like immunocompromised patients, it can cause myriad lesions involving virtually any organ of the body. Involvement of spinal cord with its compression is rare though. We are reporting here a case of 30-year-old immunocompetent male who presented with weakness of left lower limb. Radiologically differential diagnosis was tuberculosis or lymphoma of spinal cord. Histopathology showed actinomycotic colonies that were periodic Schiff (PAS) positive and revealed gram positive filamentous bacteria.
PMCID: PMC4279282  PMID: 25558150
Actinomycosis; immunocompetent; lumbosacral spine
9.  Airway pressure release ventilation: A neonatal case series and review of current pediatric practice 
The use of airway pressure release ventilation (APRV) in very low birth weight infants is limited.
To report the authors’ institutional experience and to review the current literature regarding the use of APRV in pediatric populations.
Neonates <1500 g ventilated using APRV from 2005 to 2006 at McMaster Children’s Hospital (Hamilton, Ontario) were retrospectively reviewed. Publications describing APRV in children from 1987 to 2011 were reviewed.
Five infants, 24 to 28 weeks’ gestational age, were ventilated using APRV. Indications for APRV were refractory hypoxemia (n=3), ventilatory dyssynchrony (n=1) and minimizing sedatives (n=1). All infants appeared to tolerate APRV well with no recorded adverse events. Current pediatric evidence regarding APRV is primarily observational. Published experience reveals that APRV settings in pediatrics often approximate those used in adults, thus deviating from the original guidelines recommended in children. Clinical outcomes, such as oxygenation, ventilation and sedation requirements, are inconsistent.
APRV is primarily used as a rescue ventilation mode in children. Neonatal evidence is limited; however, the present study indicates that APRV is feasible in very low birth weight infants. There are unique considerations when applying this mode in small infants. Further research is necessary to confirm whether APRV is a safe and effective ventilation strategy in this population.
PMCID: PMC3810052  PMID: 24093118
Airway pressure release ventilation; Pediatrics; Very low birth weight infant
10.  Clinical presentation, etiology, and survival in adult acute encephalitis syndrome in rural Central India 
Clinical neurology and neurosurgery  2013;115(9):1753-1761.
Acute encephalitis syndrome (AES) is a constellation of symptoms that includes fever and altered mental status. Most cases are attributed to viral encephalitis (VE), occurring either in outbreaks or sporadically. We conducted hospital-based surveillance for sporadic adult-AES in rural Central India in order to describe its incidence, spatial and temporal distribution, clinical profile, etiology and predictors of mortality.
All consecutive hospital admissions during the study period were screened to identify adult-AES cases and were followed until 30-days of hospitalization. We estimated incidence by administrative sub-division of residence and described the temporal distribution of cases. We performed viral diagnostic studies on cerebrospinal fluid (CSF) samples to determine the etiology of AES. The diagnostic tests included RT-PCR (for enteroviruses, HSV 1 and 2), conventional PCR (for flaviviruses), CSF IgM capture ELISA (for Japanese encephalitis virus, dengue, West Nile virus, Varicella zoster virus, measles, and mumps). We compared demographic and clinical variables across etiologic subtypes and estimated predictors of 30-day mortality.
A total of 183 AES cases were identified between January and October 2007, representing 2.38% of all admissions. The incidence of adult AES in the administrative subdivisions closest to the hospital was 16 per 100,000. Of the 183 cases, a non-viral etiology was confirmed in 31 (16.9%) and the remaining 152 were considered as VE suspects. Of the VE suspects, we could confirm a viral etiology in 31 cases: 17 (11.2%) enterovirus; 8 (5.2%) flavivirus; 3 (1.9%) Varicella zoster; 1 (0.6%) herpesvirus; and 2 (1.3%) mixed etiology); the etiology remained unknown in remaining 121 (79.6%) cases. 53 (36%) of the AES patients died; the case fatality proportion was similar in patients with a confirmed and unknown viral etiology (45.1 and 33.6% respectively). A requirement for assisted ventilation significantly increased mortality (HR 2.14 (95% CI 1.0–4.77)), while a high Glasgow coma score (HR 0.76 (95% CI 0.69–0.83)), and longer duration of hospitalization (HR 0.88 (95% CI 0.83–0.94)) were protective.
This study is the first description of the etiology of adult-AES in India, and provides a framework for future surveillance programs in India.
PMCID: PMC3786210  PMID: 23643180
Acute encephalitis syndrome; Viral encephalitis; Adults; Rural; Central India
11.  Diffeomorphic Sulcal Shape Analysis on the Cortex 
IEEE transactions on medical imaging  2012;31(6):1195-1212.
We present a diffeomorphic approach for constructing intrinsic shape atlases of sulci on the human cortex. Sulci are represented as square-root velocity functions of continuous open curves in ℝ3, and their shapes are studied as functional representations of an infinite-dimensional sphere. This spherical manifold has some advantageous properties – it is equipped with a Riemannian metric on the tangent space and facilitates computational analyses and correspondences between sulcal shapes. Sulcal shape mapping is achieved by computing geodesics in the quotient space of shapes modulo scales, translations, rigid rotations and reparameterizations. The resulting sulcal shape atlas preserves important local geometry inherently present in the sample population. The sulcal shape atlas is integrated in a cortical registration framework and exhibits better geometric matching compared to the conventional euclidean method. We demonstrate experimental results for sulcal shape mapping, cortical surface registration, and sulcal classification for two different surface extraction protocols for separate subject populations.
PMCID: PMC4114719  PMID: 22328177
Computational neuroanatomy; sulcal shape analysis; diffeomorphic mapping; magnetic resonance image (MRI); cortical surface registration
12.  Expression of Genes Encoding Enzymes Involved in the One Carbon Cycle in Rat Placenta is Determined by Maternal Micronutrients (Folic Acid, Vitamin B12) and Omega-3 Fatty Acids 
BioMed Research International  2014;2014:613078.
We have reported that folic acid, vitamin B12, and omega-3 fatty acids are interlinked in the one carbon cycle and have implications for fetal programming. Our earlier studies demonstrate that an imbalance in maternal micronutrients influence long chain polyunsaturated fatty acid metabolism and global methylation in rat placenta. We hypothesize that these changes are mediated through micronutrient dependent regulation of enzymes in one carbon cycle. Pregnant dams were assigned to six dietary groups with varying folic acid and vitamin B12 levels. Vitamin B12 deficient groups were supplemented with omega-3 fatty acid. Placental mRNA levels of enzymes, levels of phospholipids, and glutathione were determined. Results suggest that maternal micronutrient imbalance (excess folic acid with vitamin B12 deficiency) leads to lower mRNA levels of methylene tetrahydrofolate reductase (MTHFR) and methionine synthase , but higher cystathionine b-synthase (CBS) and Phosphatidylethanolamine-N-methyltransferase (PEMT) as compared to control. Omega-3 supplementation normalized CBS and MTHFR mRNA levels. Increased placental phosphatidylethanolamine (PE), phosphatidylcholine (PC), in the same group was also observed. Our data suggests that adverse effects of a maternal micronutrient imbalanced diet may be due to differential regulation of key genes encoding enzymes in one carbon cycle and omega-3 supplementation may ameliorate most of these changes.
PMCID: PMC4070585  PMID: 25003120
13.  Prevalence of Dyslipidemia in Urban and Rural India: The ICMR–INDIAB Study 
PLoS ONE  2014;9(5):e96808.
To study the pattern and prevalence of dyslipidemia in a large representative sample of four selected regions in India.
Phase I of the Indian Council of Medical Research–India Diabetes (ICMR-INDIAB) study was conducted in a representative population of three states of India [Tamil Nadu, Maharashtra and Jharkhand] and one Union Territory [Chandigarh], and covered a population of 213 million people using stratified multistage sampling design to recruit individuals ≥20 years of age. All the study subjects (n = 16,607) underwent anthropometric measurements and oral glucose tolerance tests were done using capillary blood (except in self-reported diabetes). In addition, in every 5th subject (n = 2042), a fasting venous sample was collected and assayed for lipids. Dyslipidemia was diagnosed using National Cholesterol Education Programme (NCEP) guidelines.
Of the subjects studied, 13.9% had hypercholesterolemia, 29.5% had hypertriglyceridemia, 72.3% had low HDL-C, 11.8% had high LDL-C levels and 79% had abnormalities in one of the lipid parameters. Regional disparity exists with the highest rates of hypercholesterolemia observed in Tamilnadu (18.3%), highest rates of hypertriglyceridemia in Chandigarh (38.6%), highest rates of low HDL-C in Jharkhand (76.8%) and highest rates of high LDL-C in Tamilnadu (15.8%). Except for low HDL-C and in the state of Maharashtra, in all other states, urban residents had the highest prevalence of lipid abnormalities compared to rural residents. Low HDL-C was the most common lipid abnormality (72.3%) in all the four regions studied; in 44.9% of subjects, it was present as an isolated abnormality. Common significant risk factors for dyslipidemia included obesity, diabetes, and dysglycemia.
The prevalence of dyslipidemia is very high in India, which calls for urgent lifestyle intervention strategies to prevent and manage this important cardiovascular risk factor.
PMCID: PMC4016101  PMID: 24817067
14.  Effect of Various Physical Stress Models on Serum Cortisol Level in Wistar Rats 
Background: Stress indicates the response or reaction of an organism to the environmental circumstances and their outcomes. Acute stress is well known to trigger several hormonal alterations in animals. An increase in glucocorticoid concentration can represent intensity of discomfort or distress experienced by an animal. The study was undertaken to evaluate the effects of various physical stress models on serum cortisol level in Wistar male rats.
Methodology: In this study six Wistar male rats weighing 150-200 gm were randomly selected. Animals were exposed to ‘forced swim test’ and ‘restraint test’. Their serum cortisol level was measured by ELISA test using alpha prime ELISA system before and after the tests respectively.
Results: Results were analyzed by students paired t-test. Serum cortisol level was significantly higher after forced swim test as well as after restraint test. When both the physical activities were compared, serum cortisol level was increased more after restraint stress than after forced swim test however, the difference was not significant statistically.
Interpretation and Conclusion: The rise in serum cortisol level was observed in both the physical activity models . Rise in serum cortisol level was significantly higher after restraint test than exposing them to forced swim test. This indicates that restraining the rats produced more stress than making them forcefully swim.
PMCID: PMC4003634  PMID: 24783129
Forced swim test; Restraint test
15.  Knowledge and awareness of diabetes in urban and rural India: The Indian Council of Medical Research India Diabetes Study (Phase I): Indian Council of Medical Research India Diabetes 4 
Representative data on knowledge and awareness about diabetes is scarce in India and is extremely important to plan public health policies aimed at preventing and controlling diabetes.
The aim of the following study is to assess awareness and knowledge about diabetes in the general population, as well as in individuals with diabetes in four selected regions of India.
Materials and Methods:
The study subjects were drawn from a representative sample of four geographical regions of India, Chandigarh, Tamil Nadu, Jharkhand and Maharashtra representing North, South, East and West and covering a population of 213 million. A total of 16,607 individuals (5112 urban and 11,495 rural) aged ≥20 years were selected from 188 urban and 175 rural areas. Awareness of diabetes and knowledge of causative factors and complications of diabetes were assessed using an interviewer administered structured questionnaire in 14,274 individuals (response rate, 86.0%), which included 480 self-reported diabetic subjects.
Only 43.2% (6160/14,274) of the overall study population had heard about a condition called diabetes. Overall urban residents had higher awareness rates (58.4%) compared to rural residents (36.8%) (P < 0.001). About 46.7% of males and 39.6% of females reported that they knew about a condition called diabetes (P < 0.001). Of the general population, 41.5% (5726/13,794) knew about a condition called diabetes. Among them, 80.7% (4620/5726) knew that the prevalence of diabetes was increasing, whereas among diabetic subjects, it was 93.0% (448/480). Among the general and diabetic population, 56.3% and 63.4% respectively, were aware that diabetes could be prevented. Regarding complications, 51.5% of the general population and 72.7% diabetic population knew that diabetes could affect other organs. Based on a composite knowledge score to assess knowledge among the general population, Tamil Nadu had the highest (31.7) and Jharkhand the lowest score (16.3). However among self-reported diabetic subjects, Maharashtra had the highest (70.1) and Tamil Nadu, the lowest score (56.5).
Knowledge and awareness about diabetes in India, particularly in rural areas, is poor. This underscores the need for conducting large scale diabetes awareness and education programs.
PMCID: PMC4056139  PMID: 24944935
Asian Indians; awareness; diabetes; Indian Council of Medical Research India Diabetes; India; knowledge; rural; South Asians; urban
16.  Diagnostic and Prognostic Utility of a DNA Hypermethylated Gene Signature in Prostate Cancer 
PLoS ONE  2014;9(3):e91666.
We aimed to identify a prostate cancer DNA hypermethylation microarray signature (denoted as PHYMA) that differentiates prostate cancer from benign prostate hyperplasia (BPH), high from low-grade and lethal from non-lethal cancers. This is a non-randomized retrospective study in 111 local Asian men (87 prostate cancers and 24 BPH) treated from 1995 to 2009 in our institution. Archival prostate epithelia were laser-capture microdissected and genomic DNA extracted and bisulfite-converted. Samples were profiled using Illumina GoldenGate Methylation microarray, with raw data processed by GenomeStudio. A classification model was generated using support vector machine, consisting of a 55-probe DNA methylation signature of 46 genes. The model was independently validated on an internal testing dataset which yielded cancer detection sensitivity and specificity of 95.3% and 100% respectively, with overall accuracy of 96.4%. Second validation on another independent western cohort yielded 89.8% sensitivity and 66.7% specificity, with overall accuracy of 88.7%. A PHYMA score was developed for each sample based on the state of methylation in the PHYMA signature. Increasing PHYMA score was significantly associated with higher Gleason score and Gleason primary grade. Men with higher PHYMA scores have poorer survival on univariate (p = 0.0038, HR = 3.89) and multivariate analyses when controlled for (i) clinical stage (p = 0.055, HR = 2.57), and (ii) clinical stage and Gleason score (p = 0.043, HR = 2.61). We further performed bisulfite genomic sequencing on 2 relatively unknown genes to demonstrate robustness of the assay results. PHYMA is thus a signature with high sensitivity and specificity for discriminating tumors from BPH, and has a potential role in early detection and in predicting survival.
PMCID: PMC3953552  PMID: 24626295
17.  Differential Regulation of Hepatic Transcription Factors in the Wistar Rat Offspring Born to Dams Fed Folic Acid, Vitamin B12 Deficient Diets and Supplemented with Omega-3 Fatty Acids 
PLoS ONE  2014;9(2):e90209.
Nutritional status of the mother is known to influence various metabolic adaptations required for optimal fetal development. These may be mediated by transcription factors like peroxisome proliferator activated receptors (PPARs), which are activated by long chain polyunsaturated fatty acids. The objective of the current study was to examine the expression of different hepatic transcription factors and the levels of global methylation in the liver of the offspring born to dams fed micronutrient deficient (folic acid and vitamin B12) diets and supplemented with omega-3 fatty acids. Female rats were divided into five groups (n = 8/group) as follows; control, folic acid deficient (FD), vitamin B12 deficient (BD) and omega-3 fatty acid supplemented groups (FDO and BDO). Diets were given starting from pre-conception and continued throughout pregnancy and lactation. Pups were dissected at the end of lactation. Liver tissues were removed; snap frozen and stored at −80°C. Maternal micronutrients deficiency resulted in lower (p<0.05) levels of pup liver docosahexaenoic acid (DHA) and arachidonic acid (ARA) as compared to the control group. Pup liver PPARα and PPARγ expression was lower (p<0.05) in the BD group although there were no differences in the expression of SREBP-1c, LXRα and RXRα expression. Omega-3 fatty acids supplementation to this group normalized (p<0.05) levels of both PPARα and PPARγ but reduced (p<0.05) SREBP-1c, LXRα and RXRα expression. There was no change in any of the transcription factors in the pup liver in the FD group. Omega-3 fatty acids supplementation to this group reduced (p<0.05) PPARα, SREBP-1c and RXRα expression. Pup liver global methylation levels were higher (p<0.01) in both the micronutrients deficient groups and could be normalized (p<0.05) by omega-3 fatty acid supplementation. Our novel findings suggest a role for omega-3 fatty acids in the one carbon cycle in influencing the hepatic expression of transcription factors in the offspring.
PMCID: PMC3938654  PMID: 24587285
18.  The Zebrafish GenomeWiki: a crowdsourcing approach to connect the long tail for zebrafish gene annotation 
A large repertoire of gene-centric data has been generated in the field of zebrafish biology. Although the bulk of these data are available in the public domain, most of them are not readily accessible or available in nonstandard formats. One major challenge is to unify and integrate these widely scattered data sources. We tested the hypothesis that active community participation could be a viable option to address this challenge. We present here our approach to create standards for assimilation and sharing of information and a system of open standards for database intercommunication. We have attempted to address this challenge by creating a community-centric solution for zebrafish gene annotation. The Zebrafish GenomeWiki is a ‘wiki’-based resource, which aims to provide an altruistic shared environment for collective annotation of the zebrafish genes. The Zebrafish GenomeWiki has features that enable users to comment, annotate, edit and rate this gene-centric information. The credits for contributions can be tracked through a transparent microattribution system. In contrast to other wikis, the Zebrafish GenomeWiki is a ‘structured wiki’ or rather a ‘semantic wiki’. The Zebrafish GenomeWiki implements a semantically linked data structure, which in the future would be amenable to semantic search.
Database URL:
PMCID: PMC3936183  PMID: 24578356
19.  Physical activity and inactivity patterns in India – results from the ICMR-INDIAB study (Phase-1) [ICMR-INDIAB-5] 
The rising prevalence of diabetes and obesity in India can be attributed, at least in part, to increasing levels of physical inactivity. However, there has been no nationwide survey in India on physical activity levels involving both the urban and rural areas in whole states of India. The aim of the present study was to assess physical activity patterns across India - as part of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study.
Phase 1 of the ICMR-INDIAB study was conducted in four regions of India (Tamilnadu, Maharashtra, Jharkhand and Chandigarh representing the south, west, east and north of India respectively) with a combined population of 213 million people. Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) in 14227 individuals aged ≥ 20 years [urban- 4,173; rural- 10,054], selected from the above regions using a stratified multistage design.
Of the 14227 individuals studied, 54.4% (n = 7737) were inactive (males: 41.7%), while 31.9% (n = 4537) (males: 58.3%) were active and 13.7% (n = 1953) (males: 61.3%) were highly active. Subjects were more inactive in urban, compared to rural, areas (65.0% vs. 50.0%; p < 0.001). Males were significantly more active than females (p < 0.001). Subjects in all four regions spent more active minutes at work than in the commuting and recreation domains. Absence of recreational activity was reported by 88.4%, 94.8%, 91.3% and 93.1% of the subjects in Chandigarh, Jharkhand, Maharashtra and Tamilnadu respectively. The percentage of individuals with no recreational activity increased with age (Trend χ2: 199.1, p < 0.001).
The study shows that a large percentage of people in India are inactive with fewer than 10% engaging in recreational physical activity. Therefore, urgent steps need to be initiated to promote physical activity to stem the twin epidemics of diabetes and obesity in India.
PMCID: PMC3974063  PMID: 24571915
Prevalence; Physical activity; INDIAB; India; South Asians; Asian Indians; Exercise; Sedentary; Diabetes
20.  Road traffic accidents in hilly regions of northern India: What has to be done? 
Road traffic accidents (RTA) are responsible for 1.2 million deaths worldwide each year. RTA will become the 3rd largest contributor to the global burden of diseases after ischemic heart diseases (IHD) and depression. We conducted a retrospective study on RTA in a tertiary center in the hilly district of Uttarakhand in India.
The number of RTA, pattern of RTA, the number of patients killed and injured, the pattern of injury causing death and disability, the severity of accidents, and the type of disability were noted from December 2009 to November 2011. The accident severity was calculated as the number of patients killed per 100 accidents. The methods for reducing the incidence of RTA were observed, and the role of policy makers was studied.
The majority of deaths and disabilities in Uttarakhand were due to road traffic accidents in the hilly districts of the states. The most common cause of RTA was driving fault followed by defective roads.
Proper designing of roads and minimizing the fault of drivers are essential to prevent road traffic accidents in hilly regions.
PMCID: PMC4129877  PMID: 25215159
Road traffic accidents; Hilly regions; India
22.  C-Shaped Canal in Maxillary First Molars: A Case Report 
C-shaped configuration in the upper maillary first molar is an extremely rare appearance (0.12%). This case reports management of the tooth with such a configuration as well as depiction of its internal morpholgy and external morphology through spiral computed tomography and dentascan in the contralateral tooth with similar morphology. After careful clinical observation and confirmation through spiral computed tomography, it was concluded that the teeth had Melton category I configuration with fused roots.
PMCID: PMC4037260  PMID: 24910684
Dental Pulp Cavity; Molar; Spiral Computed Tomography
23.  Comparative evaluation of NovaMin desensitizer and Gluma desensitizer on dentinal tubule occlusion: a scanning electron microscopic study 
In this study, the effect of calcium sodium phosphosilicate (NovaMin) desensitizing agent, which is a powder-based system, and hydroxyethyl methacrylate and glutaraldehyde (Gluma desensitizer), which is liquid-based system, on dentinal tubule occlusion was analyzed by scanning electron microscope. The effects of the above two along with one control group were compared to determine the more effective method of sealing the dentinal tubules after initial application.
Twenty specimens were allocated to each of 3 groups: Control, Gluma desensitizer, and NovaMin. Two additional samples were also prepared and treated with Gluma and NovaMin; these samples were longitudinally fractured. The specimens were prepared from extracted sound human premolars and were stored in 10% formalin at room temperature. The teeth were cleaned of gross debris and then sectioned to provide one to two dentin specimens. The dentin specimens were etched with 6% citric acid for 2 minutes and rinsed in distilled water. Control discs were dried, and the test discs were treated with the desensitizing agents as per the manufacturer's instructions. The discs as well as longitudinal sections were later analyzed under the scanning electron microscope. The proportions of completely occluded, partially occluded, and open tubules within each group were calculated. The ratios of completely and partially occluded tubules to the total tubules for all the groups was determined, and the data was statistically analyzed using nonparametric tests and statistical significance was calculated.
NovaMin showed more completely occluded tubules (0.545±0.051) while Gluma desensitizer showed more partially occluded tubules (0.532±0.075). The differences among all the groups were statistically significant (P≤ 0.05).
Both materials were effective in occluding dentinal tubules but NovaMin appeared more promising in occluding tubules completely after initial application.
PMCID: PMC3891858  PMID: 24455439
Dentin sensitivity; Gluma desensitizer; NovaMin; Scanning electron microscopy
24.  Prevalence, Severity and Related Factors of Dental Caries in School Going Children of Vadodara City – An Epidemiological Study 
Objective: Among dental diseases, dental caries is an important dental public health problem in India which is irreversible in nature, and is predominantly a disease of childhood. Till date no study has been carried out in Vadodara. As baseline data of caries is required to improve oral health of children, the present study was undertaken to determine the pattern of dental caries in school children of Vadodara city in the mixed dentition period considering age, sex and dietary patterns.
Methods: An epidemiological cross sectional descriptive study was carried out among 1600 school children aged 6-12 years in Vadodara city. A closed ended questionnaire according to World Health Organisation 1997 methodology was used to collect the data. The children were examined for the presence of dental caries using decayed missing filled teeth/decayed missing filled surfaces and Decayed Missing Filled Teeth/Decayed Missing Filled Surfaces index. Related factors which predispose caries such as age, sex and dietary patterns were recorded.
Results: The prevalence of dental caries was 69.12%. The mean dmft/dmfs and DMFT/DMFS were 3.00/4.79 and 0.45/0.56 respectively. The prevalence was higher in deciduous teeth than in permanent teeth. Positive association was found between dental caries and age, sex, frequency of sugar consumption in between meals.
Conclusion: The study concludes that the prevalence and severity of dental caries in Vadodara city is high. So, in developing country like India, it is imperative to introduce primary prevention and increased restorative care for the purpose of both reducing the caries prevalence and maintaining those caries free children.
How to cite this article: Joshi N, Sujan SG, Joshi K, Parekh H, Dave B. Prevalence, Severity and Related Factors of Dental Caries in School Going Children of Vadodara City – An Epidemiological Study. J Int Oral Health 2013; 5(4):40-48.
PMCID: PMC3780368  PMID: 24155618
Epidemiology; Dental Caries; Prevalence; Severity; Risk Factors; Odd's Ratio
25.  Comparative Evaluation of Two Different Pit & Fissure Sealants and a Restorative Material to check their Microleakage – An In Vitro Study 
Background: The purpose of this study was to investigate and compare three different pit and fissure sealants with different composition to check their effectiveness for sealing ability and microleakage.
Materials & Methods: Total 120 therapeutically extracted premolars devoid of any caries, anomalies or morphogenic diversity were collected and distributed equally in three groups (40 in each). Group – I: Composite based Pit and fissure sealant, Group -II: Compomer- restorative material and GROUP-III: Glass ionomer cement based pit and fissure sealant. Samples were cleaned with slurry of pumice and etched with phosphoric acid etchant. After thorough washing and drying, teeth were treated and cured with three sealants having different composition followed by thermocycling and immersion in methylene blue dye for 24 hours. Teeth were then observed and score was given for microleakage. The sections were photographed to show score of "0", "1", or "2" microleakage and the data was statistically analyzed with the non parametric test (Kruskal Walis test).
Results: Composite material was found better for sealant material as it was showing significantly least microleakage as compare to Glass Inomer Cement and promising result with compomer.
Conclusion: Besides many inventions, researches and nano-technology implementation in dental materials, composite material is comparatively better than Glass Inomer Cement and compomer as sealant materials.
How to cite this article: Joshi K, Dave B, Joshi N, Rajashekhara BS, Jobanputra LS, Yagnik K. Comparative Evaluation of Two Different Pit & Fissure Sealants and a Restorative Material to check their Microleakage – An In Vitro Study. J Int Oral Health 2013; 5(4):35-39.
PMCID: PMC3780377  PMID: 24155619
Pit and fissure sealants; Stereomicroscope; Microleakage

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