Introduction: The optimal performance of a healthcare organization is one of the effective factors in increasing the efficiency and productivity of nurses and thus reducing their burnout. The aim of this study was to investigate the role of organizational management on nurse burnout based on experiences from Iranian nurses working in psychiatric wards. Materials and Methods: This qualitative study was conducted on 15 nurses working in psychiatric wards selected through purposive sampling. Data collection was done through in-depth semi-structured interviews in psychiatric wards in Ahvaz (southwest of Iran) and Tehran. Data analysis was done through conventional content analysis. Results: The findings included one main category and three subcategories. The main category was “Providing care at an inadequate organization,” and the three sub-classes namely “Shortages of human resources,” “Shortage of physical resources,” and “Impact of management approaches to care provision” were extracted. Conclusion: The results of this study showed that inadequate supply of equipment and human resources along with ineffective managerial approaches in the organization could lead to mental and emotional exhaustion, negative attitudes toward the profession, decreased and poor service quality, employee turnover, and early retirement of nurses in psychiatric wards. Therefore, by adopting appropriate policies in their programs, paying special attention to the physical and mental health of nurses, and addressing their problems, managers of healthcare organizations can motivate and sustain the human resources within the organization.

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Recently, Dr Deben Dutta who was volunteering at a tea estate in the Assam state of India was beaten to death by a strong mob of 250 persons. Earlier a junior doctor was grievously injured leaving a fracture in skull by a similar furious mob at NRS Medical College Kolkata, the capital city of West Bengal. Not long ago policemen were seen assaulting a doctor on duty in the CCTV in Bihar. A yet another video showed a politician slapping a senior professor. Such incidences are not uncommon in India these days where doctors have become punching bags for everyone. There are multiple dimensions to this issue, however, the main reason is overcrowding, often leading to inhuman situations but often overlooked. Doubling and tripling (more than one patient on one bed) of beds is a norm. Three patients on one bed is common visual at public hospitals. There is a demand of stringent punishment (12 years) for any citizen for attack on doctors. A new act cannot suspend fundamental rights guaranteed under the constitution of India. State has primary duty to protect the right to live with human dignity as fundamental rights of each citizen, both doctor/patients alike under article 21 of the constitution.

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Aim: To evaluate and correlate the prevalence of Candida species, salivary flow rate, pH, and buffer capacity of oral cavity in subjects with leukoplakia, tobacco pouch keratosis, and healthy controls. Materials and Methods: In this prospective study, a total of 25 cases of leukoplakia, 25 of tobacco pouch keratosis, and 50 of healthy controls were studied. Sabouraud's dextrose agar (SDA) for the identification of Candida and HiCrome Candida differential Agar for the species identification of Candida were used. Calculation of salivary flow rate, pH, and buffer capacity was done with Saliva-Check Buffer kit (GC). Results: The prevalence of Candida carriage obtained was considerably greater in the study group associated with smokeless tobacco use. Non Candida albicans Candida species predominated over Candida albicans in speciation among study groups on HiCrome agar and Candida albicans predominated among control groups. Statistically significant values were obtained by comparing the salivary flow rate, pH, and buffer capacity between the study groups and control groups. Conclusion: The present study indicated Candida prevalence was seen more in study group than healthy control groups, suggesting increased Candida in smokeless tobacco users. The prevalence of Non Candida albicans Candida species among leukoplakia and tobacco pouch keratosis indicates that there is pervasiveness of significant Non Candida albican Candida species in relation to salivary flow rate and buffer capacity. Therefore, the choice of antifungal treatment promptly must deal with not only resistance but, similarly, with the transformation in predominance from Candida albicans to Non Candida albicans Candida species. The numbers of sample study were considerably less to conclude such result hence, numbers of studies should be performed at larger scale in the particular area.

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Background and Aims: Globally, breast cancer is one of the major public health problem. In Indian women, breast cancer is now the most common cancer, having recently overtaken cervical cancer in this respect. Breast Cancer though on the rise among Indian women, they still do not perceive themselves at risk. Poor awareness about the disease, its risk factors and the absence of population-based screening contribute to delayed diagnosis. The aim of this study is to assess knowledge and practice of breast cancer in general and breast self-examination (BSE) amongst urban accredited social health activist in Ahmedabad, Gujarat. Methods: The study was conducted in three phases: pre-intervention phase, intervention phase, and post-intervention phase during 2018. A total of 104 ASHA participants were included and awareness about breast cancer and practices of breast self-examination was assessed through interviewing two different groups at two points of time: Control and Intervention group at the base line and end line. Interventional breast health education was administrated through lectures, charts and silicon breast model for the basic knowledge of the breast cancer. The data had been analyzed by using software Epi info. Results: There was a significant improvement in knowledge regarding breast cancer and breast self-examination among the intervention group from pre- to post-test. An overall increase in the awareness of breast cancer 33%, Method of doing BSE of 54% and 42% of BSE practice was observed in the study group after intervention. Conclusion: A significant changes were observed in the knowledge. However, the behavior change requires reinforced training in regular interval.

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Background/Aim: Hypertension (HBP) is a chronic disease that has become a public health problem, which has been attributed to numerous risk factors. However, despite numerous HBP management and behavioral treatment guidelines, HBP is poorly controlled among patients due to insufficient care. We conducted this study to identify the prevalence of self-management behaviors and to explore factors affecting self-management behaviors for controlling HBP among hypertensive patients. Methods: We conducted a survey using the Hypertension Self-Care Profile (HBP-SCP) and the Hill-Bone Adherence Scale among diagnosed HBP patients attending the Family Medicine clinics of King Saud Medical City in Riyadh, Saudi Arabia in January 2019. All patients of Saudi nationality aged 18 years and above were included in the study. Results: A total of 187 patients responded to the survey, 95 (50.8%) males and 92 (49.2%) females. Only 93 patients (49.7%) monitor their BP at home, and 68 (36.4%) always measure their BP. Ninety-one patients (48.7%) said that measuring their BP is not important. The most common reason for not taking the anti-HBP medications is they forget to take the medications in 87 (46.5%) of patients. Seventy-two patients (38.5%) did not restrict salt intake, and 51 patients (27.3%) had no time for exercise. More than half of the patients (51.3%) were not motivated to regularly exercise and 56.7% were motivated to limit salt-intake. Confidence to exercise, check BP at home, and eat low-salt foods were also low at 52.4–53.5%. Significant factors including gender, age, BMI, duration of HBP, and presence of cardiac disease were found to be related toward behavior, motivation, and confidence to self-care. Conclusion: Compliance, behavior, motivation, and self-care among hypertensive patients visiting the primary care clinics in our representative population are low. Various factors were found to be related to poor behavior, poor motivation, and less confidence to do home BP monitoring, to exercise more, restrict salt intake, and value the control of HBP. There is a need for health practitioners to assess self-care activities and blood pressure control, and educate patients the importance of HBP monitoring and teaching practical techniques to boost their confidence and motivation to achieve a better behavior, self-care, and compliance to management.

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Aim: The aim of this study was to determine the prevalence of restless legs syndrome (RLS) and Pittsburgh Sleep Quality Index (PSQI) in patients with type 2 diabetes mellitus (T2DM) attending primary healthcare. Subjects and Methods: This is a cross-sectional study and participants were between 25 and 70 years old who visited the diabetes and endocrinology department of Mega Medipol University Teaching Hospital, Istanbul. The diagnosis of RLS was performed according to the International Restless Legs Syndrome Study Group consensus criteria. The RLS and PSQI instruments were conducted on 871 patients with T2DM. Good sleep quality was defined as PSQI score <5. RLS severity was assessed by the Restless Legs Syndrome-6 Scales (RLS-6). The scale development and validation was carried out using Rasch measurement model. Results: The prevalence of RLS was 22.8% including 60.3% of females and 39.7% of males. This study showed significant differences between RLS and no RLS patients with respect to their age (years), body mass index (BMI) (kg/m²), physical activity, smoking habit, sheesha smoking, income, and sleeping quality with PSQI. Also, the analysis presented that statistically significant differences between both RLS and no RLS reported sleep complaints including difficulty falling asleep, inadequate sleep, anytime fatigue, and leg discomfort. There were statistically significant differences between RLS and no RLS patients regarding hypoglycemia, numbness in legs, retinopathy, neuropathy, nephropathy high blood pressure, depression, stroke, anemia, diabetic foot, ulcer, arthritis, respiratory disease, metabolic syndrome, and coronary heart disease. Furthermore, there were statistically significant differences between RLS and no RLS concerning the number of sleeping hours, wake-up time (AM), sleeping time (PM), BMI (kg/m²), HbA1c, vitamin D, calcium, creatinine, fasting blood glucose, low-density lipoprotein, triglyceride, uric acid, and systolic and diastolic blood pressure (mmHg). Conclusion: This study confirms positive relation and high prevalence of RLS among patients with T2DM visiting primary healthcare. The results suggest that physical activity is associated with a better perception of functional capacity and pain in diabetic patients with RLS, and thus a more active lifestyle should be encouraged.

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Introduction: Type 2 diabetes mellitus is a heterogeneous group of metabolic disorders of disturbance of carbohydrate, fat, and protein metabolism causing macrovascular (like coronary artery disease) and microvascular (kidney damage) complications. Microalbuminuria is the first manifestation of injury to glomerular filtration barrier and carotid intima-media thickness (IMT) of common carotid artery serves as an excellent marker for early lesion of atherosclerosis. Method: A cross-sectional observational study was carried out over a period of 1.5 years in PGIMER, DR. RML Hospital, New Delhi. Patients with type 2 diabetes mellitus, aged between 35 and 60 years, were investigated for uric acid (UA), urine albumin levels, and common carotid IMT during this period. Patients on drugs that affect serum UA level, patients with acute illness, patients with serum creatinine >1.5 mg/dL, or with coronary artery disease were excluded from study. Result: Prevalence of hyperuricemia was found to be high (46%) in type 2 diabetic patients. It was also higher in females (73.7%) than males (25.8%). There was positive correlation between serum UA concentrations with logarithm of urine albumin excretion (P < 0.023) and carotid intima-media thickness (IMT) (P < 0.027). Plaque index also showed a positive correlation with UA (P < 0.019). However, there was no positive correlation with UA and other variable such as age, duration of diabetes, systolic blood pressure, diastolic blood pressure, HbA1c, lipid profiles, urea, and creatinine. Conclusion: Serum UA concentration thus serves as an early marker of renal dysfunction and cardiovascular diseases in type 2 diabetic patients.

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Background and Aims: Medical vandalism has become a major matter of concern in today's world. The number of violent mob attacks on doctors and other medical personnel is on the rise. This trend is having a negative impact on the proper functioning of healthcare system thus affecting the quality of care and treatment. The aim of this study is to assess the awareness and opinions of the stakeholders in healthcare facilities about vandalism in today's medical practice. Methods: A cross-sectional survey study was conducted in Acharya Vinoba Bhave Rural Hospital among 360 participants, comprising of nurses, patient's relatives, security personnel and non-medical staff in the Emergency Care Units and wards. A detailed questionnaire was prepared and used to assess the opinion of the subjects covering various aspects of medical vandalism such as prevalence of vandalism, experiences of vandalism at work, various factors causing medical vandalism, initiatives taken by the respondents to curb vandalism and awareness about various laws implemented by the government that help prevent vandalism. Results: Majority of the participants were of the opinion that medical vandalism was prevalent in India. Overcrowding of patients, inadequate skilled healthcare providers and occurrence of sudden death in casualty are among the major factors that trigger vandalism. This issue has been on the rise in both government and private setups, and nurses seem to be the major victims of such cruelness. 80% of the subjects admitted that verbal abuse was more common than physical abuse. Conclusion: Although violence against all healthcare professionals has been recorded since historical times, the current scenario of the country is disturbing. Immediate measures need to be taken to curb vandalism. Various laws need to be implemented to strictly punish those who create violence. Likewise, institutions must ensure the availability of adequate staff and facilities to reduce events that make the bystanders aggressive.

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Background: *Soluble urokinase-type plasminogen activator receptor (suPAR) is a new biomarker, which is increased in conditions associated with inflammatory immune cell activation. In low resource, densely populated countries, there is a need for a quick test for triage and prognosticating in the emergency department. Materials and Methods: *A pilot, observational study was conducted wherein all consenting adult patients (>18 years) presented to casualty with acute medical illnesses were included. Detailed clinical history, examination, and suPAR quick tests were done and patients were categorized into five groups based on the emergency severity index (ESI) triage algorithm. Patients with suPAR level more than 5.5 ng/mL were advised hospitalization and those below were advised follow-up. All patients were followed-up after 3 days. Results: Total 190 patients (20–80 years), 80 males and 110 females participated. ESI triage 1, 2, and 3 had suPAR levels > 5.5 ng/mL and ESI triage 4 and 5 had suPAR level of <5.5 ng/mL. In ESI-1, 29 patients were admitted in ICU and 16 left against medical advice (LAMA) and on follow-up mortality was 96% (P = <0.05). In ESI-2, all patients were admitted in high dependency units and on follow-up they still needed hospitalization. In ESI-3, 22 patients admitted in ward and 24 went LAMA, on follow-up all improved except LAMA patients who required hospitalization (P – <0.05). Patients in ESI-4 and 5 did not require admission (P = <0.001).Conclusion: *suPAR can reliably be used in the emergency department to prognosticate and triage.

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Background and Aims: Watching 3D images are known to induce more ocular, systemic fatigue and discomfort, which can be referred to as '3D asthenopia', than watching two-dimensional (2D) images. This study was designed to determine the stereo acuity levels among college students and compare it with the hours of use of digital technology. Methods: University students in the age group of 18-25 years were screened for visual acuity for distance and near. Refraction was done to find the presence of refractive errors. Those students who had no vergence or accommodation dysfunction and orthophoria were only included in the study. Stereopsis was assessed using random dot stereo acuity chart. The stereo acuity results were grouped as either normal (20 arc seconds or better), Borderline (25 arc seconds to 40 arc seconds) and reduced stereopsis (50 arc seconds to 400 arc seconds). Students were also questioned about the hours of use of digital media. Results: The average age of the 246 participates was 20 ± 1.9 years with 78 (32%) were males and 168 (68%) were females. 7% of the population was found to be myopic in our study. The hours of use of digital technology ranged from 0-9 hours a day. Only 13.1% of the student's population met the normal level of stereopsis (20 arc seconds). Around 44.3% of the study population was found to have borderline stereopsis. Also 42.6% of the study population, reduced stereopsis was found. Among the reduced stereo acuity levels, we found stereoacuity levels as low as 100-200 arc seconds were found in nearly 17.6% of the study population. Conclusion: It is very much evident from this study that a large group of college students are not enjoying the highest level of binocular vision, which in turn can have a negative impact on their academic performance.

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Background and Aims: Dental anxiety has been found to be a significant problem faced by patients undergoing extractions. Anxious patients tend to avoid dental care ultimately leading to complications. Treatment of anxious patients can be very challenging to the dentists, prolonging the treatment duration. There has been various methods to reduce anxiety of which non pharmacological ways include music and aroma therapy. Music has been known to reduce fear, stress and is a form of meditation and relaxation. Hence effect of music on the reduction of anxiety levels for patients undergoing extractions were assessed. The aim of this study is to assess the effect of music therapy on dental anxiety levels of patients undergoing extractions. Methods: 50 patients visiting the outpatient department of Saveetha Dental College for dental extractions were randomly selected and allocated to Test group and Control group. The test group (N = 25) were subjected to music during extractions and Control (N = 25) were not exposed. Dental anxiety levels and hemodynamic changes namely systolic pressure, diastolic pressure and heart rate were assessed before and after extraction. The data was collected and analyzed using SPSS software with Paired t Test. Results: The study showed that the control population had elevated hemodynamic changes with regard to systolic, diastolic blood pressure and heart rate, of which the diastolic pressure rise was significant. In the test population, there was fall in the hemodynamic changes with respect to systolic diastolic blood pressure and heart rate, all of which were statistically significant. This was evident in the modified dental anxiety scale as well. Conclusion: Music seems to be a psychological and spiritual way to calm oneself down. Hence music therapy can be used as an anxiolytic agent for stressful dental procedures.

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Introduction: In Healthcare industry the patient's perception of quality of service positively influences patient satisfaction, which in turn influences choice of healthcare provider and when the patient is dissatisfied with the care provided it leads to discharge against medical advice. Objectives: Therefore the purpose of this study is to identify the complex reasons for discharge against medical advice (DAMA). Further this study intends to find out the major diagnostic categories in terms of discharge against medical advice. Methods: The study conducted was descriptive in nature and involved in analyzing the reasons for discharge against medical advice among patients in emergency department. There were 91 patients out of total 200 patients who visited emergency department discharged against medical advice. Data collected through interview scheduling and questionnaire. Results: It was found that almost every patient were aware about the costs related in DAMA. Old age patients who are above 60 years of age constituted more (46%). 31 percent of DAMA patients left the hospital for affordability issue, 8 percent preferred other hospital for known physicians, 2 percent preferred other hospital for accessibility. Around 50 percent of patients who left against medical advice were due to Financial Constraints, 26 percent were not willing to proceed with the treatment, and others are due to distance, no progress and other personal reasons. Conclusion: Study concludes that every effort should be made to encourage the patient to stay under the care of the physician. To increase awareness of the patients regarding the dangers and consequences of leaving the hospital, effective communication should be established and strengthened between patients, physician and other medical staff.

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Background: Measles is one the leading cause of morbidity, mortality, and disability among under-five children worldwide with India contributing to half of the burden. Hence, Measles-Rubella (MR) campaign was launched to vaccinate all the children between 9 months and 15 years. The current study was done to find the prevalence and factors related to vaccine hesitancy in the MR campaign 2017 in rural Puducherry. Methods: This was a mixed-method study conducted with a quantitative part involving cross-sectional survey done among parents of children aged between 9 months and 15 years to determine the proportion of MR vaccine hesitancy and qualitative part involved in-depth interviews to explore the barriers and facilitating factors for the MR vaccine hesitancy. Results: Among 461 participants, the prevalence of vaccine hesitancy for the MR campaign was 14.1% (95%CI: 11–17.6%). In adjusted analysis, only mother's age (aPR–2.27) was the significant predictor of vaccine hesitancy. In qualitative analysis, major facilitating factor for campaign was the role played by the doctors in spreading awareness regarding the importance of vaccine and trust by parents on doctors. Major hindering factors were inadequate knowledge regarding campaign, rumors spread about the safety of vaccine, sudden planning, and under preparedness at health system level. Conclusion: The current study found that almost one-fifth of the parents were hesitant to give vaccination to children. Social media rumors, lack of knowledge among parents, and inadequate time in planning were major reasons for vaccine hesitancy. Hence, countries should undertake training and education of healthcare workers to empower them to address the vaccine hesitancy.

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The present study has reviewed and put insights on the reports and recent literatures confined to the effects of bisphosphonate (BP) medication on orthodontic tooth movement (OTM). Pharmacological anchorage control plays a vital role in orthodontic treatment planning to the required patients. BPs inhibit bone resorption by involving increased activity of mineral adsorption on the bone surfaces where BPs tend to target osteoclasts. The present study reviewed on the latest report and examined cases relating to the impact of BPs in OTM. Clinical implication, chemical formulation, and mode of action of BPs have been discussed. This reviewspecifically focused on various kinds of BPs used in medication for bone adsorption in OTM therapy. Furthermore, it tries to explore the rare adverse and side effects of BPs observed based on the literatures. A systematic literature search was attempted in the Medline database (PubMed) using appropriate keywords, such as orthodontic tooth movement, bisphosphonates, and manual hand look was more overdone. On the basis of reports examined, BP treatments in OTM have posed an increased trend toward the benefit and interfere with osteoclastic resorption. In many cases, they may be advantageous for mooring strategies and encourage long-term planned randomized controlled trials to evaluate conceivable benefits and antagonistic impacts of BP treatments for OTM, before initiating remedial use.

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One of the main causes of adults' disability during their working age is multiple trauma. The process of medical care of patients who are injured seriously is still a challenging job. The primary treatment of these patients in the emergency medicine departments is the most required choice after the wilderness first aid and also would be very required before definitive care in the hospital. The main aim of emergency medicine departments is quick recognition and treatment of injuries which pose severe threat to patients' life in appropriate order of priority. The procedure of primary evaluation in emergency medicine department with the help of medical routine examination and ultrasonography is based on the concept of focused assessment with sonography in trauma (FAST) for identifying spontaneous intraperitoneal hemorrhage. Emergency patients who suffer from massive hematothorax, serious lung and heart traumas, and penetrating traumas to the chest would undergo thoracotomy and patients who have few symptoms of perforated hollow viscous will undergo emergency laparotomy. Based on the trauma severity, emergency treatment could be the way to fast recovery of the structure of injured organ and its function. The subsequent goal, in the acute phase, will concentrate on preventing and stopping bleeding and secondary injuries like painful compartment syndrome or intra-abdominal infections (IAIs). However, the main aim of emergency medicine department in taking care of severely injured patients is the management of airway, protecting circulation and breathing, identification of neurologic problems, and whole body clinical examination with the help of healthcare providers.

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Osteoarthritis (OA) as the most frequent form of knee arthritis is one of the most annoying complications amongst old peoples. There are different pharmacological and non-pharmacological remedies which could be applied for treatment of knee OA. It's while, significant side effects mostly in patients who are older are the dangerous limiting factors. Integrative, supplementary, traditional remedies have been applied from long time ago in treatment of such chronic diseases like OA. Various topical and oral remedies have been presented in treatment of OA worldwide. In spite of the fact there are multiple remedies for reduction symptoms of patients who suffer from disorders and related inabilities which could enhance their life quality. Remedies which have been applied for a long time for treatment of OA have newly discovered to induce injury to some patients. On the other side, additional knowledge about alternative and supplementary remedies is a main way for enhancing health of patients who suffer from OA disorders. Zingiber zerumbet (Z. zerumbeton) is a kind of herb of the ginger family and is a natural compound with various biomedical characteristics like anti-proliferative, anti-inflammatory, and antioxidant effect. However, Z. zerumbet could be applied for reduction of OA symptoms because of its circulatory stimulant and anti-inflammatory effects. Anyway, up to now there is not any methodical literature review for evaluating the Z. zerumbet clinical effectiveness productiveness in treatment of OA. The main aim of the current study is to review scientific resources around therapeutic effectiveness of Zingiber zerumbet in treatment of adverse symptoms of OA disorder.

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Pemphigus Vulgaris is an autoimmune disease that causes severe blistering of the skin and mucous membrane which are fragile and breaks away leaving erosions that are extremely painful. Here we report a case of a patient suffering from pemphigus vulgaris with typical oral manifestations. We have reported the effect of treatment after two consecutive recalls at an interval of 1 week where the patient got 100% relief from her previous signs and symptoms.

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Pulmonary mucoepidermoid carcinoma (MEC) is an uncommon tumor constituting only 0.1% to 0.2% of all lung carcinoma. It is classified under “salivary gland type” tumors in the World Health Organization (WHO) classification of lung cancers. It generally carries a better prognosis than the more common small cell and nonsmall cell lung carcinomas. It is pathologically classified into high-grade and low-grade tumors. High-grade tumors are usually unresectable at presentation. However, surgery is the mainstay of treatment, which aims at surgically negative margins for a complete cure. In our patient, pulmonary MEC presented with intrathoracic mass with pericardial effusion. It came out to be low-grade neoplasm, which was treated with platinum-based doublet chemotherapy and responded well with near-total disappearance of tumor, like a vanishing lung tumor.

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Cardiovascular (CV) risk factors like diabetes and hypertension are poorly controlled in both rural and urban India. This study was designed to identify the reasons for suboptimal control in a semiurban population in India. A total of 70 participants from the Study to Expand Heart Associated Treatments (SEHAT) trial, conducted in West Bengal, India. We qualitatively examined perspectives regarding CV risk factor control using focus group discussions based on the theory of reasoned action. Qualitative content analysis was used to analyze prevailing themes. Participants demonstrated a generalized knowledge of healthy lifestyle practices but lacked insight into disease-specific prevention methods. We further noticed significant gaps in the translation of existing knowledge into behavior. While personal and systemic barriers exist, factors like high patient motivation and a deep sense of trust in providers can potentially be harnessed to improve risk factor control in the community. We identified key facilitators and barriers to CV risk factor control in the community using a knowledge attitude behavior approach. Our findings provide direction for the development of community-based CV risk reduction models.

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To protect our masses, primary care institutes were developed in many countries, all over the globe. In the previous era, labour was valuable to produce crops and protect native countries from enemies as no substitute for raw labour was available to do these jobs. The scenario has changed after the era of automation. After the agricultural revolution, technological revolution took place. Hence, most of the manual jobs in agriculture sector and industry sector were automated. As a result, “new” type of jobs has emerged which was based, so far, on mainly of cognitive skills, e.g., learning, analysing, communication, and understanding human emotions. As the technology is advancing day by day, the role of humans as individual is becoming less and less except for some extraordinary persons or elite groups. Now the important question is, will elites and governments will go on valuing every human being even when it pays no economic dividends? Will the development of mass medicine/primary care will continue? Will governments/bureaucrats fund adequately for the protection of the health of these useless classes merely on the humanitarian ground? We assume that due to technological advancement and greater role of elite classes, the norm of shifting non-normal people to normality may not require any more, the previous practice of treatment (health for all concept) may not repeat in future and it is quite natural. Experiences from Japan highlight that society may prefer theses elites to the useless average class. The gap between the two classes regarding availing health facilities may widen further. This is because the government may focus more on the health of elites than common masses. One step further the government/ bureaucrat may try for immortality/divinity for this elite class, at any cost for maintaining supremacy over the poor masses.

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Background: Internet usage leads to psychological disturbances, social problems, and neuropsychological dysfunctions. Alhough there is no definite trend has been reported for the association of augmentation of cognitive function and internet use pattern. Method: The current work explored the neuropsychological profile among healthy, mild, and moderate users of internet in the age group of 18 to 30 years. Sixty subjects (20 healthy internet users, 20 mild internet users, and 20 moderate internet users) were screened for internet usage using internet addiction test. Background datasheet, NIMHANS comprehensive battery of neuropsychological tests, and Wechsler memory scale III (Indian adaptation) were administered in an individual setting. Results: It revealed that mild users have performed relatively better than healthy normal controls on mental speed, sustained attention, cognitive switch, and interference scores on Stroop test. Conclusions: It has implication for evolving psychological intervention for promotion of mild internet use for the promotion neuropsychological functioning as well as physicians at primary setting can educate users about benefits of mild use of the internet and other technology devices. It will help in the promotion of healthy use of technology.

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Context: Malnutrition in children is common globally and may result in both short- and long-term irreversible negative health outcomes. It is not a simple disease with single causative factor but it is a disease with multifactorial causation. Aims: 1) To estimate prevalence of malnutrition in underfive children using “Z” score. 2) To evaluate the role of epidemiological and maternal factors on the nutritional status of children. Settings and Design: Community-based cross-sectional study. Methods and Materials: Randomly 10 slums were selected and under five-year-old children and their mothers from urban slums were examined and interviewed. Statistical Analysis: Data was analyzed with SPSS ver 20 and appropriate tests were applied. Results: Four-hundred children were examined. According to Z score classification, 39.8%, 36.5%, and 24.8% of children are underweight, stunted, and wasted, respectively. Family size (P = 0.02, χ² = 7.7), initiation of breastfeeding (P = 0.009, χ² = 6.8), maternal education (P = 0.001, χ² = 13.9), underweight mothers (P = 0.05, χ² = 4.8), and maternal dietary intake (P = 0.03, χ² = 6.5) are significantly associated with underweight children. Similarly, stunted children show strong association with increasing age of child (P = 0.001, χ² = 18.1), birth weight (P = 0.006, χ² = 7.6), and not seeking medical opinion (P = 0.03, χ² = 7.0). Primary immunization (P = 0.05, χ² = 3.5), maternal education (P = 0.002, χ² = 12.4), employed mothers (P = 0.02, χ² = 4.9), and underweight mothers (P = 0.05, χ² = 5.3) are associated with wasting in children. Conclusions: This study reveals very high prevalence of malnutrition status among underfive children of urban slums of commercial capital of India. Various maternal and epidemiological factors affect child nutritional status.

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Objective: Tuberculosis (Tb) is a fatal infectious disease that primarily affects the pulmonary system and rarely occurs in other body organs including oral cavity. The aim of this study was to report all patients with primary manifestations of oral tuberculosis and to evaluate the clinical characteristics of oral tuberculosis lesions. All these patients were subsequently diagnosed with tuberculosis based on oral histological findings and referred for management and therapy. Materials and Methods: Twelve patients with oral lesions from the year 2010 to 2018 were histologically diagnosed as having tuberculosis, who did not give any history of the disease, following surgical biopsy. Clinical symptoms, auxiliary examinations, treatments, and outcomes were recorded and analyzed. Results: Oral TB was found in all 12 patients; 8 males and 4 females, with male to female ratio 8:4. Involved oral sites included the angle of the mandible (one case), right mandibular molar region (two cases), left mandibular molar region (four cases), gingiva (three cases), buccal mucosa (one case), and the tongue (one case). Oral TB patients in this series ranged in the age group of 6–65 years. All the lesions were suggestive of primary tuberculosis. The appearance of the affected mucosa in oral TB was variable. The most common manifestation was ulceration and swelling of the mucosa. Conclusion: TB should be considered in patients with oral ulcerations and swellings. A biopsy specimen for histological study, acid-fast stains, and cultures should be obtained for confirmation and differential diagnosis along with other conditions.

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Background: Musculoskeletal pain (MSP) in the neck, shoulder, and lower back is common widespread among medical students. The objective of this research is to estimate the prevalence of neck, shoulder, and low-back pains and to explore factors associated with MSP among medical students at Jizan University in southwest of Saudi Arabia. Methods: A cross-sectional, self-administered questionnaire-based study was conducted among undergraduate medical students of Jazan University. A total of 440 students were selected by random sampling. Descriptive statistics, a Chi-squared test, and logistic regression were performed to examine the prevalence, associations, and predictors of MSP. Results: The overall prevalence of MSP was (53.5%; 95% CI: 49.2–58.4). Neck pain was reported by 197 (44.8%) in the week prior to the study and by 268 (60.9%) in the year prior to the survey. Regarding shoulder pain, it was reported by 231 (52.5%) in the week prior to the study and 175 (39.8%) in the year prior to the study. Regarding low-back pain, it was reported by 147 (33.4%) in the week prior to the study and 270 (61.4%) in the year prior to the study. Factors associated with the risk of MSP include history of trauma (OR = 2.70; 95% CI: 1.36–5.36 depressive symptoms (OR = 1.94; 95% CI: 1.03–3.66) and report of psychosomatic symptoms (OR = 2.98; 95% CI: 1.71–5.18). Conclusion: In conclusion, the proportion of medical students with MSP was very high. Factors associated with the increased risk of MSP include history of trauma, depressive, and psychosomatic symptoms. Intervention program may help improving the musculoskeletal health of the medical students and to hence their quality of life.

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Objectives: To determine the relationship between maternal nutrition and their breastfed infants' anthropometric measures during the first 14 weeks after delivery. Methods: A prospective, observational study, comprising 200 mothers and their infants. The weight, length, and head circumference of the infants and the weight and dietary intake of the mothers were recorded at 6, 10, and 14 weeks. Results: The relationship between weight gain in babies and calorie intake at 6, 10, and 14 weeks were significant (P value < 0.05). The relationship between weight gain in babies and protein intake at 6 and 10 weeks was not significant (P value at 6 weeks = 0.896, P value at 10 weeks = 0.127) but was significant at 14 weeks (<0.05). Mothers' weight gain during 14 weeks was significant (P value < 0.05). When mothers were distributed into four groups according to their calorie and protein intake for comparison (median value: calorie-2034 kilocalorie, protein- 78.7 grams), the weight, length and head circumference gain in infants and mothers' weight were significantly higher in Group I and Group II compared to Group III and Group IV with P value < 0.05 at 6, 10, and 14 weeks. Conclusions: Calorie intake was low in mothers when compared to RDA recommendations. Infants showed lower weight, length, and head circumference gain than WHO Child Growth Standards. There is a direct relationship between the maternal diet and anthropometric measures of their infants. During postnatal period, mothers showed an increase in weight, rather than the decrease that is usually expected.

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Background and Purpose: Bipolar disorder is a common psychiatric disorder. The purpose of this study was to compare the effect of two postdischarge educational methods including multimedia and group discussion on family caregiving of patients with bipolar disorder. Methods: In this study, the families of 30 patients with bipolar disorder in Shiraz hospitals were studied and matched in terms of gender and age into two groups. One group received the group discussion and the other received the multimedia teaching method interventions. The demographic variables including age, gender, education, marital status, and relationship with the patient were collected. Data were analyzed using SPSS 18 software. Results: Most of the patients were male and most of their caregivers were female. The results showed that the pre and posttest mean and standard deviations of educational function (P = 0.007), caregiving function (P = 0.0004) and medication function (P = 0.04) of the group receiving the multimedia teaching intervention were significantly different. However, the pre and post-test mean and standard deviations of caregiving function (P = 0.2) and medication function (P = 0.3) of the group receiving group discussion did not show a significant difference. However, there was a significant difference in educational function of this group (P = 0.02). Conclusion: The use of multimedia method is more effective than the group discussion method and can be used as a tool to improve the caregivers of patients with bipolar disorder in Iranian society.

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Purpose: To assess the awareness of learning disabilities of children before and after the planned teaching program among primary school teachers. Research design: A pre-experimental, nonrandomized, one group pretest and post-test design were used. Materials and Methods: The accessible populations were all teachers working in private primary schools at Montfort Matriculation School, Chennai. Purposive sample technique was used to select the 40 samples. The instrument consisted of two sections—Part-I: demographical variables, Part-II: awareness questionnaire on learning disabilities in children. The collected data were grouped and analyzed using descriptive statistics and inferential statistics and a paired t-test was used to determine the difference between pretest and post-test in the group. Result: The study indicates that the majority of the primary school teachers had inadequate awareness regarding learning disabilities and 10% had moderate level of awareness, whereas in the post-test, 7.5% had moderate level of awareness and 92.5% had adequate level of awareness. There was a significant association between awareness of learning disabilities among primary school teachers. Conclusion: The planned teaching program is an effective method in enhancing the awareness of primary school teachers regarding the care of awareness of learning disabilities.

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Background: Breast lesions (BLs) are abnormal swellings within the breast. The importance lies in need to exclude breast cancer. Objective: Due to the role of ultrasound (US) imaging in evaluating of BLs, this study was conducted to evaluate the predictive value of US imaging for differentiating benign from malignant BLs and to assess the need of biopsy in BLs. Method: A retrospective review of diagnostic results of 134 patients with BLs. All patients underwent breast US imaging and US-guided biopsy for cytology or histopathology. The results of both were compared. Results: Out of 134 patients were included in this study, the mean age was 38.45 ± 15.82 years (range, 18–90 years), and all patients were female. BLs were benign in 99 cases (73.9%) and malignant in 35 cases (26.1%). Among 98 patients with BLs diagnosed benign with US, 96.9% were confirmed benign with biopsy results and only 3.1% were malignant. The overall sensitivity of US imaging for discriminating of benign BLs was 95.95%, with a specificity of 91.42%, and positive predictive value of 96.94%. The results revealed strong compatibility between diagnoses by US imaging and biopsy results (P < 0.001), the measure of agreement kappa = 0.866, and the Spearman's correlation coefficient = 0.866. Conclusion: US imaging is a highly valuable imaging method in differentiating benign from malignant BLs. It usually predicts the benign nature of BLs with excellent diagnostic accuracy. US-guided fine-needle aspiration and core-needle biopsies are not necessary in most cases of BLs.

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Introduction: Seizure is a common manifestation of the many neurological conditions faced by primary care physicians. This study aims to determine the prevalence, etiology, and predictors of immediate noncompliance of adult patients presenting with seizures to the department of emergency (ED). Materials and Methods: We conducted this study in the ED of CMC, Vellore from November 2015 to February 2016. Retrospective chart review was used to gather specific data regarding these consecutive cases. Results: During the study period, 477 patients presented with seizures. The prevalence of nontrauma seizures in the ED was 2.3% [Figure 1]. The mean age was 41.4 ± 17.25 years. There was a male predominance (63.1%). About 11.7% had active seizures at presentation to the ED and less than a quarter (21.8%) were determined to have status epilepticus. Nearly 41% had new-onset seizures with common etiologies being idiopathic generalized epilepsy (22.6%), metabolic causes (17.9%), acute febrile illnesses (14.42%), and space-occupying lesions (12.3%). Among those with a history of seizures (58.9%), 87.9% were advised regular medications but 58.5% of them were immediately noncompliant. Phenytoin (58.6%), sodium valproate (20.5%), and levetiracetam (18%) were the most commonly used antiepileptics with 23% on multidrug therapy. About 60% were discharged stable from the ED. Univariate analysis showed chronic alcohol consumption (OR: 2.78; 95% CI: 1, 7.7) and female sex (OR: 1.45; 95% CI: 1–2.5) to be predictors of immediate noncompliance to antiepileptics. Conclusion: Common etiologies of new-onset seizures in the ED are idiopathic generalized epilepsy, metabolic causes, and acute febrile illnesses. More than half the patients with a known seizure disorder are immediately noncompliant to the advised medications. Knowledge among primary healthcare physicians about the importance of emphasizing compliance will greatly reduce the burden of seizures.

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Background: Behavioral health (BH) problems frequently present in primary care settings. Despite high intervention needs, the majority of low-income, racially/ethnically diverse children and women do not receive necessary care. The current study examined utilization of BH care among low-income, racially/ethnically diverse pediatric and obstetric patients receiving services in an integrated patient-centered medical home (the Center) compared to patients receiving services in traditional settings. Methods: A retrospective review was performed on all consecutive Texas Children's Health Plan (TCHP) patients who received outpatient BH services between 2015 and 2017. Children and woman who utilized BH services at the Center were compared against those who utilized BH services via a traditional sitting outside the Center. Results: A total of 54,612 were identified. Of those, 3,559 (6.5%) patients were seen at the Center and 51,053 (93.5%) patients were seen in the traditional setting. A larger proportion of pregnant/postpartum women and African American and Hispanic/Latino children and women utilized BH services in the PCMH compared to the traditional setting. Results also indicated higher levels of BH service use for patients with behavior problems or anxiety disorders, and increased use of services provided by doctoral level psychologists in the PCMH. Conclusion: Findings support the benefit of integrated BH services in PCMH models for engaging traditionally marginalized populations in BH care.

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Background: To our knowledge, there is no international publication on risk factors of breast cancer among Kurdish women. There are several risk factors of breast cancer may differ in different geographical cultures. The aims of this study are to assess the established and probable risk factors of breast cancer among Iraqi Kurdish women as well as to investigate the effect of some Mediterranean food items on this issue. Materials and Methods: This retrospective case-control study was constructed in Sulaimanyah governorate-Iraq. Data were collected regarding socio-demographic characters, established risk factors, and dietary habits of 338 cases that were registered in Sulaimanyah Breast Center during January 2015-February 2019 with collection of same items for 338 age-matched controls. Results: The marriage was appeared to be a protective factor with (OR = 0.596, CI: 0.364-0.974, P = 0.039). Age at menarche ≥14 years has a protective effect with (OR: 0.326, P = 0.027) and 152 cases (45.0%) had menarche at ≤12 years compared to 56 controls (16.6%) with (P = 0.000). Numbers of children ≥ 3, regular exercise, and breastfeeding for >48 months duration have protective role. Consumption of fast foods and some Mediterranean foods weekly >2 times are risk factors, while taking stewed meat weekly one time, fish weekly ≥1 time, fruit daily>1 time and vegetables daily≥1 time, and black tea daily >3 cups have preventative effect on breast cancer. Conclusion: Among Kurdish women, some items of Mediterranean food have the same causative effect as fast food items. Marriages, consumption of stewed meat, fish, fruit, vegetables, and black tea may have preventative effect.

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Background: Medical termination for missed miscarriage with the use of 800 μg of vaginal misoprostol as a single agent is recommended as a cheap option before 14 weeks of gestation in developing countries. A few studies have looked at its efficacy. Methods: A prospective, observational study was done on women having medical termination with up to three doses of 800 μg vaginal misoprostol at 12 hourly intervals. The number of women who needed check curettage was collected. Ultrasound findings if done were collated. Follow-up was done telephonically at the end of first week, fourth week and sixth week. Results: The cohort comprised 145 women. The primary outcome was the need for curettage after expulsion of products following medical management and this was 49/145 (37.8%) of women. The induction expulsion interval was 36 hours. The mean endometrial thickness of the 113/145 women who had an ultrasound was 11 mm. The mean endometrial thickness in women who had check curettage was 18 mm. Persistent spotting was the only significant symptom at follow-up. Resumption of cycle at the end of the sixth week was seen in 105/132 (80.15%) of women who were followed up. Conclusion: Findings of our study showed the check curettage rate of 37.8%. However, the regime which we used, that is, 800 μg vaginal misoprostol at 12 hourly intervals had a long induction to expulsion interval of 36 hours. In all, 80% of women resumed normal cycles at the end of the sixth week. No significant complications were noted on follow-up.

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Background and Objectives: Perfect tooth shade selection is indispensable for successful esthetic dental restorations. Shade matching is a complex and multidimensional process that involves the cognitive ability of students. Hence, the aim of the present study was to assess and compare the shade matching ability of undergraduate dental students in various years of dental education. Methods: A cross-sectional study was conducted among 150 students enrolled in all five class years of the Bachelor of Dental Surgery course in a dental college in India. Each enrolled participant was presented with two exercises to assess shade matching ability. In the first exercise, basic shade matching ability of the students was assessed by a shade tab matching in a bench setting using Vitapan Classical shade guide. In the second exercise, the participants were asked to perform intraoral tooth color matching to evaluate their ability of shade matching in a clinical setup. Data was analyzed using SPSS version 21 and descriptive statistics were applied. Chi-square test was applied to find out significant differences among years of education. Results: For Exercise 1, 53 participants (35.30%) showed fair color matching ability in bench setting, 26.70% (n = 40) showed good ability, 22.70% (n = 34) demonstrated an excellent ability, whereas 15.30% (n = 23) had a poor ability of color matching. For Exercise 2, where clinical color matching ability of the students was analyzed, 34% (n = 51) obtained fair scores, 33.30% (n = 50) obtained good scores, 26% (n = 39) obtained excellent scores, whereas 6.70% (n = 10) of the participants had poor scores. Conclusion: This study showed that the clinical performance of dental students for shade matching improved as the years of dental education increased. Also, better outcomes were seen in clinical setting as compared to in vitro conditions.

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Introduction: In 2012, 8% of the 2.3 million work-related deaths globally were from chronic respiratory diseases (CRDs). This study was undertaken to estimate the prevalence of respiratory morbidity among the drivers and conductors of the public road transport network in Kochi. Methodology: A cross-sectional study was carried out in the public bus stand (South), Kochi between September 2015 and 2017 among bus drivers and conductors. The interview was conducted among 300 bus drivers and conductors using a locally adapted version of ATS-DLD-78-A questionnaire. Lung function assessment was done using a Mini Wright peak flow meter and a portable spirometer. Data were tabulated using MS Excel and analyzed using SPSS v20. Results: The prevalence of CRD among bus drivers and conductors was found to be 9.97% (95% CI 7.34–14.66) and chronic respiratory symptoms were found to be 19.2% (95% CI 14.58–23.82). On logistic regression, the independent predictors for the CRD were found to be working for more than 15 h/day (OR 2.815, 95% CI 1.26–6.28) and working for more than 4 days/week (OR 2.462, 95% CI 1.12–5.39). Conclusion: CRD exists as a public health problem affecting approximately one in ten bus drivers and conductors in Kochi city. Applying the logical principles of ergonomics by modifying duty hours may be considered.

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Objectives: This study was aimed to measure the prevalence and associated risk factors of antenatal depression (AD) among women attending antenatal clinics at primary care centers in the Ministry of Health in Al-Ahsa, Saudi Arabia. Materials and Methods: A cross-sectional study was conducted on 357 pregnant women attending antenatal clinics at primary care centers, Ministry of Health, Al-Ahsa, Saudi Arabia between April 1, 2018 and July 1, 2019. A self-administered questionnaire was used for collection of information including questions relevant to sociodemographic variables and a screening tool Edinburgh Postnatal Depression Scale (EPDS) was used to assess the probable depression. Results: The prevalence of AD among pregnant women in Al-Ahsa is 31.9%. We found a significant association (P < 0.005) between AD and factors such as difficulty in sleeping, having a smoker husband, having one previous pregnancy, and having postabortion psychological complications. Conclusion: It was observed that depression prevails among pregnant ladies in Al-Ahsa city. Hence, in the present study, we tried to rule out the factors that led to depression in pregnant ladies during our antenatal care. In addition, we found that there is a need to train the physicians for asking questions (only two simple PHQ-2 questions) for the screening of depression during antenatal care visite.

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Objective: The aim of this study was to explore the language difficulties encountered by Arabic dental students and dentists in some aspects of their dental education and to determine their attitude towards the Arabization of the medical curriculum. Materials and Methods: A web-based self-administered questionnaire with 14 multiple-choice questions was designed and distributed online via google forms in the Arabic language. The online link was sent randomly to Arabic dental students, dental academic staff, and dental practitioners. The survey questions explored language problems during reading, attending lectures and scientific conferences, preparing scientific researches, taking deferent exams, and the attitudes towards Arabization. Descriptive statistics and Chi-square tests were used to analyze the responses to the questions. Results: There were 378 respondents for this study. Nevertheless, paying high attention to the importance of English language as the global language of communication, (70.6%) of the respondents believed that studying in Arabic is a basic requirement for the Arabs. Near percentage agreed that mastering their mother tongue is much easier than to acquire another language, which further facilitates studying and improves understanding. More than (65%) of the subjects preferred a mixture of both languages for attending lectures, conferences, and exams. But (68.3%) said that they use English when they search for any subject related to dentistry. Conclusion: There has been a consensus on the need for receiving knowledge in the Arabic language, and the importance of studying the mother tongue for enhancing understanding and memorization. The results demonstrated that the idea of teaching some dental courses in Arabic is not impossible and it might be the key to improve dental study for the Arabs. Consequently, a majority stated that there were obstacles in teaching dentistry in fully Arabic language due to the dominance of English language internationally and the weak possibilities of Arabization and translation in the Arab world.

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Introduction: Sleep is normal human behaviour. However, the stress in daily life leads to altered sleep behaviour like insomnia, parasomnia, etc. Owing to possible side effects, mind–body interventions like music, yoga and meditation could be a better alternative intervention to pharmacological interventions for the condition. It is known that 432 Hz music to have some effect on the overall sleep quality though some knowledge gap does exist. The present study aims to find the effects of 432 Hz on sleep quality and sleep latency in a daytime nap among subjects with history of delayed sleep latency. Material and Method: Fifteen healthy male volunteers aged 18 to 40 years with history of delayed sleep latency were recruited for the study from a cohort of working staff and students at the institute, after due ethical clearance following the inclusion and exclusion criteria. All the subjects were subjected to sleep study with and without music intervention at the gap of 1 week. Sleep parameters recorded include sleep stages, electroencephalogram (EEG), electrocardiogram (ECG), electromyography (EMG), nasal airflow, thoracic movement, nasal saturation etc. Result: Outcome of the study shows some decrease in the mean sleep latency (P > 0.05) with significant increase in the energy of alpha waves (P < 0.01) at the sleep onset. Conclusion: It was concluded that 432 Hz music has some significant calming effect as reflected by increased alpha activities without any significant effect upon the sleep latency in the daytime naps.

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Background: Vulvovaginal candidiasis (VVC) is the second most common infection of the lower female genital among women passing through their productive age. Furthermore, Candida albicans is the most common VVC agents followed by, non-albicans Candida species. Nowadays, extensive studies are being conducted on alternative therapies and the use of herbal medicines. Objectives: The present study was conducted to compare the effect of curcumin and clotrimazole vaginal cream in the treatment of VVC. Methods: The present randomized controlled trial study was performed on 94 women passing through their productive age after their being diagnosed with VVC. The subjects were randomly divided into two groups, with one receiving curcumin-based vaginal 10% cream and the other receiving clotrimazole vaginal 1% cream. The treatment period was 1 week and a full 5 g applicator was used every night. Required follow-up was implemented 4–7 days after the end of treatment. Results: The results showed no significant differences between the two groups in terms of vaginal discharge, itching, vulvovaginal irritation, and vulvovaginal erythema (P > 0.05); however, the number of negative cultures in the group receiving curcumin was significantly lower in comparison with the other group, which received clotrimazole (P = 0.002). Conclusion: It seems that although curcumin could be effective in the treatment of clinical symptoms of VVC, it, quite similar to clotrimazole vaginal cream, did not affect vaginal culture.

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Introduction: Hyponatremia is associated with substantial morbidity and mortality. Correct estimation of their prevalence, incidence and risk factors, especially the diuretics in Indian patients is important in determining preventive strategies. Methods: This multistage mixed methods-based study was conducted in a high-volume cardiac care center to ensure the correct estimation. Patients receiving oral diuretics on an outpatient basis and those admitted to hospital for hyponatremia were enrolled. Results: The prevalence of hyponatremia was 27% while the incidence rate was 18% and 29% after 3- and 6-month of the diuretic therapy. The highest rates of hyponatremia were observed in warm season (45%, 111 in 247 patients). Multivariate logistic regression analysis revealed that low solute and nutritious intake and edematous state were negatively correlated with serum sodium levels. Neither diarrhea/vomiting nor diuretic use were found to be associated with hyponatremia. Conclusions: Diuretics use was not associated with hyponatremia in adults in this population cohort. However, elderly people on diuretics are comparatively more likely to have hyponatremia. However, a randomized parallel arm trial comparing diuretics with other antihypertensives be done to establish whether diuretics are associated with hyponatremia in this patient population.

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Background: The surge of the geriatric population has led to design research studies related to health problems in this age group worldwide. Bone marrow examination which is an important diagnostic tool for various diseases may vary in geriatric population in comparison to younger groups. The present study was, therefore, conducted to study the indications and morphological features of bone marrow examination in geriatric population in north Himalayan region of India. It was also intended to study if there is any variation in these findings from elderly populations in other parts of the world. Material and Methods: Study was conducted in an institute situated in north Himalayan Uttarakhand state of India over a period of two years including patients above 60 years of age who underwent bone marrow examination. Results: Total 156 cases underwent bone marrow examination with most common indication being suspicion of lymphoma (18.5%) followed by cytopenia (17.3%). Nutritional anaemia was most common pathological diagnosis in 16.6% cases. Diagnostic discordance between aspirate and biopsy was observed in 5.7% of total cases with non-Hodgkin's lymphoma (NHL) being the most common misdiagnosis on aspirate. Conclusion: Nutritional anaemia particularly iron deficiency anaemia is the most common diagnosis of bone marrow examination indicating the importance of nutritional therapy in the elderly population of this region. Bone marrow biopsy proves to be an important adjunct to aspiration in precise diagnosis with minimal complications. The awareness of bone marrow findings would not only be helpful to clinicians and pathologists but also provide valuable information to the policymakers to improve the quality of health in the geriatric population of this area.

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Objectives: Aim of this study was to characterize acute poisoning and snakebite cases and their outcome in the Emergency Department (ED). Methods: This was a prospective study done in the ED of a tertiary healthcare center. Study included 184 patients of acute poisoning and 16 cases of snakebite. Data regarding demographics, type, time, and mode of poisoning, lag time in reaching the hospital, initiation of treatment, first aid, in-hospital treatment, and comorbid illness were obtained. Data regarding requirement of antidote, duration of hospitalization, and outcome were also obtained. Results: Out of 200 cases, 181 (90.5%) were adults and 19 (9.5%) were of pediatric age group. Poisoning was common among males (57%) than females (43%). Majority (40%) were from the age group of 21–30 years. Out of 200, 115 (57.5%) poisonings were suicidal, 68 (34%) were accidental, and 17 (8.5%) were homicidal. Acute poisonings included corrosive 54 (27%), drug overdose 26 (13%), organophosphorus compounds 20 (10%), rodenticides 20 (10%), and symptomatic snakebite 16 (8%). Seventy-two (36%) were admitted with a median hospital stay of 6 days with 5 (2.5%) deaths. Logistic regression analysis revealed poorer outcome for 15–30 years age [OR 12.6 (1.6–97.5), P = 0.015], males [OR 2.5 (1.4–4.4) P = 0.04], patients coming from >30 km [OR 4.3 (1.5–12.1), P = 0.006]. Conclusion: Our study demonstrated an increased incidence of corrosive ingestion. With increasing rates of suicidal ingestions, there is a need for holistic approach to manage mental health issues at primary care level.

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Context: Role of toothbrush in decreasing oral microflora. Aims: To evaluate the effectiveness and compare the negative oral microbial flora of dental plaque after the use of a self-contaminated multiple use toothbrush and that of a single-use toothbrush. Settings and Design: Sixty healthy individuals without any systemic conditions. Methods and Materials: The study conducted with 60 participants who were free from any systemic or oral disease and without any adverse habits. In these participants, plaque samples were collected after 1 month use of a self-contaminated multiple use toothbrush. Each participant was given a set of 30 new toothbrushes and a toothpaste tube and instructed to use one toothbrush everyday and discard it after use. The plaque samples were collected on seven days interval and cultured on Mitis Salivarius agar. The colonies were identified and their count was recorded. Statistical Analysis Used: Student t test was applied. Results: Streptococcus mutans, S. sanguis, S. milleri, and Candida were identified from the samples. A highly marked decrease in their numbers was found after the use of a single-use toothbrush over multiple use toothbrushes. Conclusions: As a self-contaminated multiple use toothbrushes can aid microorganisms to grow rapidly into the oral cavity, it may be preferable to change the toothbrush as frequently as possible.

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Background: Pancytopenia, an important hematological presentation is associated with different causes, which may vary in different regions. Uttarakhand, a north Himalayan state of India lacks studies of pancytopenia and the prevalent causes present in this region. Therefore, the present study was conducted to study the clinico-hematological profile of pancytopenia in a tertiary care center in the Uttarakhand, a north Himalayan state of India. It was also intended to study if these causes showed any variation from other studies done in different regions of India. Materials and Methods: The present observational study was conducted in a tertiary care institute situated in Uttarakhand state of India over a period of 1 year and 8 month from June 2017 to Feb 2019 including all the cases of pancytopenia. Results: The most common cause of pancytopenia was megaloblastic anemia (25%), followed by aleukemic leukemia and hypoplastic/aplastic anemia (19.1% each). Visceral leishmaniasis also constituted an important cause of pancytopenia in this study (11.7%). Conclusion: The study concludes that megaloblastic anemia and aleukemic leukemia are the most common cause of pancytopenia. Although leishmaniasis is considered to be non-endemic in this region, it constitutes an important cause of pancytopenia here. The clinicians, especially the physicians practicing the primary care and pathologists, should be aware of the different causes of pancytopenia present in this Himalayan region of India; therefore, delay in diagnosis can be prevented along with unnecessary investigations.

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Introduction: Immunization is one of the most cost-effective measures in public health to date, preventing at an approximately 2 to 3 million fatalities in young children every year. As per recent World Health Organisation (WHO) bulletin, these lifesaving vaccines have been successfully averted around 20 million premature deaths and 500 million disease cases. Inspite of this progress the routine vaccine coverage is slow to rise as challenges still live for the underserved, inaccessible and vulnerable children. It is therefore essential to evaluate the coverage of immunization at periodic intervals and to take the required measures to enhance the vaccination status in the State Bihar. Aims and Objective: This study aims to find out the vaccination coverage in different Blocks of study area. Material and Methods: The study was community based cross sectional study which was conducted between January to March 2019 in the selected villages of 59 low performing blocks of Bihar. The study subjects were all the children aged 12-23 month old from selected low performing blocks of the Bihar. Results-Corrected FIC of the study was 90.85%. Close to nine percent (8.8%) children thou have started vaccination could not able to complete it. Rest of the beneficiaries are completely left out. The most common reason for incomplete immunization was unavailability of child on the day of vaccination followed by sickness of the child. Conclusion: The overall Immunization coverage of Bihar is less than the National Immunization coverage as per NFHS-4. This study shows higher rate of immunization as far as Corrected Immunization Coverage is concerned.

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Introduction: The knowledge of health professionals and trainees is of great importance as they could be very effective sources of motivation for the general population toward organ donation. So, a study was planned to improve the perceptions of students and faculty about organ donation. Materials and Method: A program-based educational intervention was implemented in a dental institute by a medical professional. It was attended by 168 participants, including interns, postgraduate students, and faculty members. A self-administered questionnaire consisting of 27 questions about knowledge, attitude, and practice (KAP) of organ donation was used. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) software Version 23, IBM. The difference in knowledge and attitude according to various demographic factors was determined by applying independent t-test and analysis of variance (ANOVA) test. A Chi-square test was used to assess the association between demographic variables and willingness to sign organ donor card. P < 0.05 was considered statistically significant. Result: The mean knowledge score of the study participants was 9.6 and the mean attitude score was 3.4 at the end of educational program. When association between willingness to sign organ card was assessed with age and gender, it was found that no such association existed. Statistically significant difference was found among males and females when compared for knowledge (P = 0.006) scores and among education group when compared for attitude (P = 0.0238). Conclusion: The present educational intervention for improving the perceptions of students and faculty about organ donation was successful as the study population was able to achieve sound knowledge and good attitude level.

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Introduction: Knee is the largest joint in the human body with a very complex anatomy. It is a mobile trochoginglymus (i.e. a pivotal hinge joint), which permits flexion and extension as well as a slight medial and lateral rotation. Since the knee supports nearly the whole weight of the body, it is vulnerable to both acute injury and the development of osteoarthritis. The anterior cruciate ligament (ACL) is an important ligament for the proper movement of knee joint. ACL injury commonly causes knee instability than injury to other knee ligaments. Conclusion: In our study, we found the following: 1. Patients suffering from road traffic accidents have the highest rate of development of ACL injury department of Jawaharlal Nehru medical collage sawangi. 2. Twisting injuries/trivial fall injuries/injuries from fall on ground give the second highest numbers of ACL injuries in rural population. 3. Men are more prone to have ACL injury than women in rural population. 4. Patients falling in the age group of 16-25 years of age are more prone to have ACL injuries in rural population.

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Dentistry as a profession is quite demanding and challenging and is also associated with occupational hazards like musculoskeletal disorders and stress-related problems. The practice of yoga has been proven to be efficacious in management of quite a lot of stress and lifestyle disorders. It strengthens one physically, mentally, and emotionally. Moreover, yoga can also be used in the management of dental patients for stress-related oral conditions like lichen planus, burning mouth syndrome, aphthous ulcers, etc., Yoga has also been found to have antiinflammatory, antianxiety effect, and also a lot of other beneficial effects. This review emphasizes on the relevance of yoga in the dental profession, from the practitioners, students, and patients viewpoint. Data pertaining to the subject was obtained after a thorough search of the PubMed literature and Google search engine.

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