Introduction: Cross-infection or contamination are the major threats related to any medical profession. Microorganisms present in the dental clinic can cause cross-infection to the dentist, auxiliary staff and even towards the patients. Aims: The study was conducted to assess the level of atmospheric microbial contamination and composition of aerosols before, during and after dental treatment procedures in four clinical settings. Methods and Materials: The present study was conducted over a two-week period in a private dental college setting. An equal number of culture medium plates (blood agar) were placed 30 min prior to the initiation of work sessions in the selected area and 1 h after the working session began and after 2 h of cessation of the working period. After the collection of samples, the culture medium plates were incubated aerobically at 37°C in an incubator for 48 h. The number of colonies was expressed as colonies per media plate. After counting the colonies bacterial cell morphology was determined by a microscopic examination using a Reichert-Jung Series 150 light microscope. Statistical Analysis: Statistical analysis such as ANOVA test for mean values and post hock was done using statistical package for social sciences (SPSS). Results: It shows that colony count increased after the working session and which reduced by itself once the working session was concluded which was significant (P < 0.001). The highest increase in the mean colony count was found in the department of periodontology during the treatment sessions. In the blood agar plates, the S. epidermidis was found maximum 62%, micrococcus was 22%, diphtheroid was 10%, fungi 4% and the least S. aureus 2%. Conclusion: This study demonstrates that aerosols increase during and after work sessions and, therefore, increases the chance for infectious agent transmission in clinical settings.

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The National Medical Commission is being constituted through an act of parliament, the NMC Act 2019. This new medical education regulator will take over the role of the Medical Council of India which is being currently run on adhoc basis through a board of governors (BOG). As per the provision of the NMC Act 2019 under section 24 (1) (c), the Under Graduate Medical Education Board is mandated to to develop competency based dynamic curriculum for addressing the needs of primary health services, community medicine and family medicine to ensure healthcare in such areas. Similarly under section 25. (1) (j) the Post Graduate Medical Education Board is mandated to promote and facilitate postgraduate courses in family medicine. It is important to note that the recently announced (2019) and highly publicized new MBBS curriculum the word “family medicine' has not been even mentioned in the 600 pages document. Through repeated engagements in the form of RTIs, and written representations, it appears that the experts of the Medical Council of India in the past have either deliberately blocked the development of family medicine in India or do not have the basic scholarship within this domain, despite clear direction from NHP and parliamentary standing committee. This has largely happened because there was never any representation of practicing family physicians in the Medical Council of India. The presence of practicing family physicians on the National Medical Commission should be mandatory.

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Background: The last few decades have witnessed a number of innovative approaches and initiatives to deliver primary healthcare (PHC) services in different parts of India. The lessons from these initiatives can be useful as India aims to strengthen the PHC system through Health and Wellness Centers (HWCs) component under Ayushman Bharat Program, launched in early 2018. Materials and Methods: Comparative case study method was adopted to systematically document a few identified initiatives/models delivering the PHC services in India. Desk review was followed by field visits and key informant interviews. Twelve PHC case studies from 14 Indian states, with a focus on equity and “potentially replicable designs” were included from the government as well as the “not-for-profit” sector. The cases studies comprised of initiatives/models having the provision of PHC services, whether exclusively or as part of broader hospital services. The data was collected from May 2016 to March 2017. Results: The “political will” for government facilities and “leadership and motivation” for “not-for-profit” facilities adjudged to contribute towards improved functioning. A comprehensive package of services, functional 'continuity of care' across levels, efforts to meet one or more type of quality standards and limited “intention to availability” gap (or assured provision of promised services) were considered to be associated with increased utilization. A total of 10 lessons and learnings derived from the analysis of these case studies have been summarised. Conclusions: The case studies in this article highlights the components which makes PHC facilities functional and have potential for increased utilization. The article underscores the need for institutional mechanisms for health system research and innovation hubs at both national and state level in India, for the rapid scale of comprehensive primary healthcare. Lessons can be applied to other low- and middle-income countries intending to deliver comprehensive PHC services to advance towards universal health coverage.

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Background: Sustaining interest and promoting deep learning is a challenge in any teaching method. The purpose of the study is to find the perception of trainee doctors in Internal Medicine and teaching faculty on the usefulness of case-based learning (CBL) and to compare assessment knowledge outcome with didactic seminars. Methods and Materials: We developed and conducted a CBL teaching program on eight topics in infectious diseases. First group had CBL and second group had didactic seminars. In step 1, a clinical case was introduced in stages. Learning objectives were formulated and topics were divided among the trainees. At step 2, trainees shared what they had learnt from self-directed learning. Faculty summarized the case and learning points. In the seminar group, trainees made presentations on the given topics. Trainees who had CBL underwent a questionnaire survey. Multiple choice questions-based test was administered for both the groups. Results: The trainee doctors and staff overwhelmingly found CBL to be more interesting, stimulating, and useful compared to didactic seminars. There was no statistical difference in the test scores. Conclusions: CBL is a useful and interesting method of learning and should be employed more often in teaching for trainee doctors.

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Context: Dental personals are more prone to acquire infections through saliva and aerosols. Surgical masks (SMs) are used by dental professionals to reduce microorganism shedding from the mouth, nose, and face of the patient. Aims: This aim of the study is to assess the bacterial and fungal presence and their prevalence over the contaminated surgical mask in dental practice. Settings and Design: This study was conducted with sample size 240 used surgical masks collected from 130 dental personnel. Subjects and Methods: A cross-sectional questionnaire survey was conducted with analysis involved inoculation of external and internal surfaces in an enrichment media for isolation of bacteria and fungi. Group of isolated bacteria and fungi were preliminarily identified by morphology and using Gram's stain and lacto-phenol cotton blue mediums. Data were analyzed using paired t-test; the significant level of P < 0.050. Results: Microbiological analysis of samples revealed bacteria Staphylococci 26.35% as a predominant species followed by Pseudomonas 17.82% and Streptococci 15.50%. Aspergillus fungal species was also present in 6.97%. Mean ± SD of bacterial and fungal contamination on inside/outside area of the used masks was 48 ± 26 and 180 ± 110 cfu/ml/piece and 14 ± 6 and 32 ± 13 cfu/ml/piece, respectively, P < 0.001. The used surgical masks from dental department personnel working outpatient dental department had relatively higher bacterial and fungal contamination than the other dental departments. Conclusions: To reduce a load of microorganism contamination in the clinical environment, more awareness campaigns should be implemented in daily routine and air quality of dental departments should be improved with necessary protective measures.

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Objectives: To study the perception regarding common oral diseases and health seeking behaviour related to those diseases among rural population of central India. Methods: A cross sectional study was conducted in the rural areas of Wardha, Maharashtra on a population between the age group of 18 and above. Data was recorded by a self administered, structured questionnaire in this study. Questionnaire was based on oral health literacy and health seeking behaviour of participants. Results: Study included 700 participants, 343 males and 347 females. Dental problem was reported by 68% of participants. Toothache was the most common dental problem reported. Government hospitals were chosen by 19% of participants as treatment centre. Fear 24.3% was found to be the major reason for not visiting the dentist. Conclusion: Healthcare seeking behaviour among rural population towards oral diseases was poor. So efforts must be made to bring a change in this scenario.

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Mental health burden is a major health concern worldwide. In the last few decades, we are witnessing innovations that are successfully addressing gaps in the mental health service delivery in Indian context. This is an opportune time to explore existing innovative mental health initiatives in the country and integrate viable interventions to primary healthcare facilities to strengthen public mental healthcare delivery. The descriptive review of literature on innovative mental health programs in India was carried out. The initial search from google scholar and PubMed database yielded 1152 articles, of which 1114 were excluded that did not meet inclusion criteria. Full texts of 38 articles were reviewed and finally 22 studies were included for the study. Based on the review, most innovations are broadly summarized into five categories: (1) quality improvement mental health programs; (2) community-based mental health programs; 3) non-specialist mental health programs, 4) mobile-technology based mental health programs, 5) tele-mental health programs. These promising innovations in treatment and care can be customized as per the context for scale up and integrated into the primary healthcare system through District Mental Health Programme.The innovative approach not only makes mental health services more accessible and affordable but also empowering in nature by encouraging community members in early detection, prevention of mental illness and appropriate treatment referral to existing primary health care services.

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Acanthamoeba are ubiquitous free-living amoeba. Acanthamoeba infections cause necrotizing vasculitis, resulting in vessel thrombosis and cerebral infarction. Acanthamoeba CNS infections, though uncommon, are associated with high mortality. Diagnosis is difficult and often delayed. Here, we present two immunocompetent hosts with Acanthamoeba encephalitis with good outcomes.

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Objective: To study and profile complementary feeding practices and their determinants among children 6–23 months of age in an outpatient hospital setting in Central India: A cross-sectional study. Method: Total 464 Children, 6-23 months of age, visiting Well baby clinic and Immunization center at AIIMS Bhopal during February 2015 to June 2016, where parents had given consent for participation in the study were included. Children with congenital malformations affecting feeding, cerebral palsy, known chronic systemic diseases, were excluded. Result: Breastfeeding was initiated within 1 hour in 59.5%. Complementary feeds were given in 84% of children 6-8 month of age. Minimal dietary diversity as determined by WHO was received by 57% of children while minimal meal frequency was present in 86%. Minimal acceptable diet was received by 58% of children. Breastfeeding was continued in 86% children at 1 year of age and 41% children at 2 years of age. Bottle feeding was present in 26% of children. Multivariate regression analysis was done to correlate minimum acceptable diet and various variables affecting the feeding habits. Higher maternal education (adjusted OR: 4.03; 95% CI: 2.35–6.89) and income group (adjusted OR: 2.03; 95% CI: 1.11–3.72) were found to be significant. Joint families had better feeding practices when compared to nuclear families (adjusted OR: 1.72; 95% CI: 1.12–2.64). Homemaker mothers were able to feed their children in more appropriate way (adjusted OR: 3.33; 95% CI: 1.17–6.62). Conclusion: Well-educated homemaker mother, higher income group, and joint families help in establishing better complementary feeding habits in children less than 2 years. An understanding of the prevalent practices will be helpful in identification of areas that need to be focused upon and reemphasized during counseling the caregivers of the young children to improve their nutritional status, which will also reduce the burden of disease at primary care.

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Background: Complications of hormone therapy (as replacement) during menopause prompted us to research on alternative therapies including herbal therapy in this regard. Objectives: The effect of Salvia officinalis extract on symptoms of flushing, night sweat, sleep disorders, and score of forgetfulness in postmenopausal women on Namazi Hospital Bone Density Center in Shiraz 2015. Methods: In a double-blind randomized controlled clinical trial, 66 postmenopausal women complaining of menopausal symptoms were divided into two groups of intervention and control, respectively. The intervention group received S. officinalis tablets (containing 100 mg S. officinalis extract), with a dose of three tablets a day for 3 months, while the control group received placebo tablets with the same prescription order. MRS (Menopause Rating Scale) and PSQI (Pittsburgh Sleep Quality Index) questionnaires were completed at the beginning and end of the study. The checklists of hot flushing and night sweating were completed a week before the intervention and at weeks 2, 4, 6, 8, 10, 12 during the intervention. Finally, the data were analyzed through SPSS₁₈software, using paired t-test, ANOVA. A significant level of 5% was considered. Results: According to the paired t-test, the mean score of flushing, palpitation, sleeping disorders, muscle and joint aches, depression, nervousness, anxiety, and sexual desire and satisfaction significantly decreased by 1.6, 0.4, 1.6, 2.1, 1.4, 1.2, 1.6, and 0.8 units, respectively, in the intervention group compared to the control group (P < 0.001). Therefore, the mean score of PSQI significantly decreased by 3.8 units in the intervention group after the intervention (9.4 ± 3.7 vs 5.6 ± 1.9 (P < 0.05). Conclusions: Salvia extract improved menopausal symptoms such as flushing, night sweat, heart palpitations, muscle and joint pain, depression, anxiety, sleep disorders, and sexual desire.

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Objective: To determine the prevalence of MDR-TB and find out the incidence of drug resistance using molecular diagnostic method. Line probe assay (LPA) is based on the principle of multiplex PCR is used to detect MTB (Mycobacterium tuberculosis) complex as well as its sensitivity to rifampicin and isoniazid. Method: This is a hospital-based prospective observational study. The sputum of MDR-TB suspected patients was subjected to Ziehl-Neelsen staining and smear positive samples were analyzed by LPA. Decontamination and digestion of the samples was done using the NALC- NaOH method (as defined in RNTCP guidelines). DNA extraction was done from the decontaminated samples using Geno Lyse kit. After DNA extraction, detection of MTB complex and rifampicin and/or INH resistance was done with the help of line probe assay (LPA) using GenoType ® MTBDRplus version 2.0. Results: Out of the 156 smear-positive sputum samples, 140 samples had LPA valid results. The most common age group of positive TB samples in this study was 30-40 years (26.42%). Twenty-five samples (17.85%) were found to be rifampicin resistant and 22 (15.71%) samples were found resistant to isoniazid. Sixteen patients (11.42%) were detected MDR. Nine patients (6.42%) were monoresistant to rifampicin and six patients (4.28%) were monoresistant to isoniazid. “Sputum positive retreatment cases” had the highest detection rate for MDR TB. Conclusion: Line probe assay is an economical and time saving method for the detection of MDR-TB and serves as a lifesaving tool for early diagnosis and treatment. This calls for a widespread national use of this assay. The detection of around 10% ZN-positive patients, who were not showing MTB complex in LPA may be a hidden iceberg for non-tubercular mycobacteria.

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Introduction: Psychosocial rehabilitation is the process that facilitates opportunities for persons with chronic mental illness to reach their optimal level of independent functioning in society and for improving their quality of life. However, such psychosocial rehabilitation centers are limited in India. Aims: The present study assesses psychosocial rehabilitation centers (of urban day-care and rural residential rehabilitation center) operated by Ashadeep Charitable Foundation, a civil service organization and its effect on health outcomes of patients living with chronic mental illness. Materials and Methods: Records of 170 cases were retrieved for secondary analysis of demographic information, diagnosis, duration of stay, and health outcomes. Results: Rehabilitation activities included yoga, light physical exercises, group discussion, training for daily living skills, social skills, life skills, vocational training, individual, and family counseling. In addition, extensive outreach activities, mental health camps were also integral part of the rehabilitation activities. Patients who have accessed rehabilitation services were diagnosed with schizophrenia, psychosis, bipolar disorder, depression, and intellectual disability. The average duration of rehabilitation of patients (other than persons with intellectual disability) was ranged from three to four months. Out of those rehabilitated, 69% of them were successfully re-integrated with the family. Conclusion: Combination of pharmacological and psychosocial interventions are effective for re-integrate patients with mental illness to the family. This model of community-based rehabilitation has potential for scale-up.

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Introduction: Zinc deficiency is very much prevalent among pregnant women in developing countries. Zinc is required to maintain normal structure and function of multiple enzymes including those that are involved in foetal growth. Zinc deficiency increases risk of baby being born preterm, low birth weight, small for gestational age (SGA). Aims and Objectives: To compare serum zinc levels in small for gestational age babies with respect to appropriate for gestational age (AGA). Material and Methods: Out of total 200 newborn, hundred SGA newborn comprised the study group and hundred AGA newborn comprised the control group. Cord blood sample was collected immediately after birth and zinc levels were determined by atomic absorption spectrophotometry method. Results: The mean (±SD) serum zinc levels of study and control groups were 56.8 ± 40.6 μg/dl and 107.4 ± 72 μg/dl respectively and difference between two groups were found to be statistically significant. The mean serum zinc levels of preterm SGA group and term SGA group were 46.26 ± 22.54 μg/dl and 63.35 ± 47.47μg/dl respectively. Statistically significant difference was found in mean serum zinc levels between the two groups. Conclusion: SGA neonates have significant zinc deficiency as compared to AGA neonates. This zinc deficiency is even more pronounced in SGA newborns that are born preterm. This warrants the future investigation and necessary intervention on zinc supplementation during pregnancy and to preterm and SGA babies for better maternal and child health outcomes.

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Aims: The aim of the present study was to evaluate the knowledge and practices employed for infection control in dental laboratories. Materials and Methods: A preformed questionnaire comprised of 16 questions related to infection control measures was prepared. This questionnaire based survey was then conducted among dental technicians of 60 dental colleges in East India. Data were then recorded and analyzed. Results: Majority of impressions/prosthesis were carried in plastic bags (93.8%) by laboratory attendants to the laboratory. The responses revealed that majority of impressions were received after wearing gloves (54.6%) from dental attendant. Majority of dental technicians (78.1%) admitted in their responses that they are not aware of infection control measures taken in dental laboratory. Only 32.8% technicians were found to practice disinfection procedure after receiving impression/prosthesis in laboratory from dental operatory. Among protective wears, 70.3%, 95.3%, 32.8%, and 92.2% technicians were found to use gloves, Apron, eye shield, and face mask, respectively. Among all respondents, 59.3% were found to be vaccinated for hepatitis B vaccine. Conclusion: There is lack of knowledge and motivation among dental technician to practice infection control measures in dental laboratories of dental institutes in North India.

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Background and Aims: Despite tremendous considerable effort by health professionals to promote oral health to create beautiful smiles, gap between oral health knowledge and practice undoubtedly still remains. Thus the aim of this study was to assess the Oral health literacy level and its impact on socioeconomic and oral health status among adult population in Ghaziabad district. Methods: A total of 600 study subjects aged 18-64 years from all 4 blocks of Ghaziabad visiting various outreach programmes using a multistage random sampling technique were included in the study. A specially designed questionnaire assessed the demographic variables. Oral health literacy level (OHL) was assessed with help of a bilingually adapted Hindi OHL tool. Clinical examination was recorded using WHO (World Health Organization) Oral Health Assessment Form 2013. Results: The mean age of the study subjects was 43.9 ± 14.36 years. Majority 300 (50%) study subjects had inadequate oral health literacy level followed by Marginal oral health literacy level which was seen among 180 (30%) subjects and 120 (20%) subjects had adequate oral health literacy level. Oral health literacy level was slightly higher among females as compared to male subjects although the results were not statistically significant. A statistically significant difference was found between oral health literacy and oral health status as well as socioeconomic status. (P value ≤ 0.05). Conclusion: A significant association between OHL and oral health status was found stating Oral health literacy as an efficient role in influencing oral health outcome of any individual.

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Background: Depression among elderly population is a major public health issue affecting nearly 5% to 7% of the world's elderly. In the coming years, a major share will be contributed by developing countries like India. In the rural areas of Allahabad district of Uttar Pradesh, there is scarce data on the depression. Methodology: A community-based cross-sectional study was conducted in rural Allahabad. A total of 411 elderly persons were selected from 2 blocks—Jasra and Bahadurpur—through multistage random sampling method. Short form of geriatric depression scale (GDS) was used to assess depression. Results: The prevalence of depression among elderly was 19.7%. On binary logistic regression, depression had significant association with female sex [aOR = 2.4, 95% CI 1.1–5.1], having less-than-good relationship with family members [aOR = 2.7, 95% CI 1.2–6.0], not being cared for during illness by family members [aOR = 3.9, 95% CI 1.2-12.9], not being involved in leisure time activities [aOR = 2.5, 95% CI 1.3–4.9], and not regularly meeting relatives and friends [aOR = 4.7, 95% CI 1.9–11.6]. Conclusions: The prevalence of depression in elderly was high in rural areas of Allahabad. Female sex and social and family engagement are the important predictors of depression among them.

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Background and Aims: Recurrent Pregnancy loss (RPL) is a heterogeneous disease. The role of maternal factor is clear but the relationship between the paternal factors remains uncertain. It has been shown that increase the level of Reactive Oxygen Species (ROS) and decrease the antioxidant levels in men can lead to RPL. New researches show treatment with antioxidant can improved sperm parameter. The aim of the present study was to assess the effect of vitamin E plus Zinc therapy on sperm parameters and chromatin quality in couples with RPL. Methods: In this clinical trial study, 60 RPL patients were selected from RPL clinic. Standard sperm parameters were analyzed and then male partners were intake vitamin E and Zinc in antioxidant therapy plan for 90 days. After that, sperm parameters were analyzed again. Sperm chromatin assay was reviewed before and after vitamin E and Zinc therapy by cytochemical assay including aniline blue (AB), chromomycin A3 (CMA3), toluidine blue (TB). To assess DNA fragmentation index, TUNEL test was used. Data were analyzed and compared before and after treatment. Results: data analysis showed all sperm parameters significantly improved after treatment (P < 0.001). The number of AB⁺ and TB⁺ sperms were decreased significantly after vitamin E and Zinc therapy (P = 0.0001). Decrease in DNA fragmentation in post treatment group in comparison to pre-treatment was statistically significant. Conclusion: Supplemental of vitamin E plus Zinc may improve sperm parameters chromatin quality and decrease sperm DNA fragmentation in RPL patients.

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Ataxia telangiectasia is a rare neurodegenerative autosomal recessive multisystem disorder which has been reported only once in the dental literature. It is characterized by cerebellar degeneration, telangiectasia, immunodeficiency, and cancer susceptibility and radiation sensitivity. Till date, this disorder remains the only condition in dentistry in which diagnostic radiographs are not allowed. The present case report is aimed to discuss the management of ataxia telangiectasia in a pediatric patient.

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Sebaceous lymphadenoma is a rare, benign tumor of the parotid gland accounting for only 0.196% of all adenomas of the parotid gland. Our aim is to present a case of sebaceous lymphadenoma, which has been rapidly enlarging over a period of few months in an immunocompromised patient. This presentation is unusual for a benign salivary gland neoplasm. A 55-year-old female who is a known case of systemic lupus erythromatous, antiphospholipid syndrome, and lupus nephritis, which have been treated by cyclophosphamide, presented with a 2-year complaint of fluctuating painless right parotid swelling, over the last 3 months the swelling started to progressively increasing in size. Physical examination showed a 4 × 3 cm firm, nontender mass in the right parotid gland. The facial nerve was intact and no cervical lymphadenopathy. Fine-needle aspiration cytology (FNAC) revealed marked chronic inflammation and was not helpful for diagnosis. Right superficial parotidectomy was performed without complications and there was no recurrence after 24 months of careful follow-up. In patients presenting with a rapidly enlarging parotid mass associated with an intact facial nerve, the possibility of sebaceous lymphadenoma should be considered as an important differential diagnosis in addition to other benign tumors of the parotid gland. The role of FNAC in this neoplasm is controversial.

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Infective endocarditis (IE) is primarily a bacterial infection of the heart valves. The most common organisms implicated include Staphylococcus and Streptococcus species. However, with the advent of MALDI-TOF and molecular techniques, the reports of IE being caused by rare organisms are on a rise. Here we describe a case of IE due to Abiotrophia defectiva. This is the first report of simultaneous infection of both mitral and aortic valves by Abiotrophia defectiva from India. IE caused by Abiotrophia defectiva has been seen to be more severe, associated with higher failure rates and relapse. This emphasizes the accurate identification of nutritionally variant Streptococcus (NVS) species as the management of choice varies between Abiotrophia and Granulicatella.

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The oral health delivery strategies are taking back seat in the universal health coverage scheme in India. This paper highlights the personal experience of a dental professional from India as an educator, motivator, and collaborator to nullify or minimize social policy challenges faced by medical health providers in the administrative cadre to strengthen the oral care delivery model in the health services department in Kerala state. The author has nevertheless persisted with positive educational, motivational, and collaborative approaches with medical health providers in the administrative cadre, general cadre, and specialty cadre in the health services department in Kerala state to change the current climate.

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Introduction: Virtual clinic is a new concept in India. This summary describes that how a virtual clinic is transforming the healthcare scenario in rural India. Virtual clinic is based on a social business model, which may involve diverse stakeholders to promote primary care. Aim: This virtual e-clinic aims to expand health outreach in rural and hard-to-reach areas of India and provide primary health care services by connecting local practitioners and health workers visiting patients with qualified allopathic doctors in city through video conferencing technologies. Methodology: This was a cross-sectional study evaluating the feasibility and acceptance of virtual primary care. A convenient sampling method was used. Data on demographic profiles, morbidity patterns, and referrals were collected with proper consent. This virtual clinic comprises of smartphones, monitors, and assistive devices so that patient can interact with the doctors through video-conferencing and can have authenticated prescriptions with standardized protocols. The private organization who initiated the virtual care program had two centers at the beginning and gradually expanded them to 20 in Uttar Pradesh. Consultations charges were kept minimum to no-profit, no-loss. Data were collected from January 2019 to June 2010. Results: Total number of consultations made was 800. Out of 800 patients, 157 patients belonged to age group of ≥60 years. Mean age the patient was 56 ± 1.56 years, among them 421 (52.62%) were male. The participants actively engaged in clinical interactions and completed full sessions of consultations, which highlight the acceptability of the virtual care system and feasibility of effective patient-provider communication and service delivery using digital technologies. Conclusion: The concept of virtual primary care is becoming very popular in rural region where no qualified doctors are available. The initial results of this technological startup appears to be promising; however, it is necessary to evaluate the quality of care, health outcomes, potentials to integrate such innovations in existing primary care, and the legal as well as ethical issues in the future research.

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Young people with disabilities face numerous challenges, including poorer access to education, health services, employment opportunities, etc., than their peers without disabilities. Besides, they tend to face discrimination, stigma, social exclusion, and violence. There is a lack of efficient, accountable, and coordinated policy-level actions for these people in low- and middle-income countries. On the contrary, Swedish welfare policies toward ensuring social security benefits and services for people with disabilities promote their effective integration and equal participation in society. There is a pressing need for political commitment and actions to make our systems inclusive and sensitive for people with disabilities, especially in low- and middle-income countries.

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Background and Aims: The present study was conducted to assess failure rate of dental implant in medically compromised patients. Methods: This study comprised of 68 medically compromised patients of both genders who underwent dental implants 5 years ago (Group I). Equal number of healthy subjects was taken as control (Group II). Amount of bone loss around the implant over 1mm of bone loss in the first year and over 0.3 mm bone loss every subsequent year were considered as failures. Results: The age group of 30-40 comprised of 25 patients in group I and 35 in group II, 40-50 years had 27 in group I and 23 in group II and 50-60 years had 16 in group I and 10 in group II. Medically compromised patients were diabetes (25) with 30 dental implants followed by osteoporosis (16) with 17 dental implants, hypothyroidism (12) with 14 dental implants, organ transplant (10) with 12 dental implants and CVD (5) with 7 dental implants. Chi- square test was applied which revealed significant difference in patients (P < 0.05). In group I, there were 18 (22.5%) and in group II, there were 4 (5.56%) dental implant failures. The difference with chi- square test found to be significant P < 0.05). Conclusion: Among medically compromised conditions, higher failure rate was found in diabetes.

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Background: In India, from 1971 to 2011, the proportion of elderly population has increased from 5.3% to 8.6%. According to the National Sample Survey, 60^th round (2004), out of every 1000 elderly persons living in rural India, 40 were estimated to be diabetic, and 36 were estimated to be hypertensive. The objective of the study was to find the prevalence of diabetes and hypertension in elderly persons in a rural area of Ballabgarh, Haryana, and to assess the awareness, treatment, and control among them. Method: A total of 420 persons aged 60 years and above were selected by simple random sampling. House-to-house visit was done. A pretested interview schedule was administered. Blood pressure was measured using digital blood pressure machine. Two milliliters of venous blood was collected in vials for HbA1c estimation. Results: Of the 420 participants, 386 were available for blood pressure measurement, and 374 were available for HbA1c estimation. The prevalence of diabetes was 21.7%, and that of hypertension was 50.3%. Among diabetics, 45.7% were aware, of which, 94.6% were treated, and among them, 34.3% had their blood sugar under control. Among hypertensives, 58.8% were aware, of which, 96.5% were treated, and of the treated participants, 24.5% had controlled blood pressure. Conclusion: The high prevalence, low awareness, and low proportion of controlled diseased population highlights the importance of strengthening primary care and improving awareness about diabetes and hypertension among elderly persons in rural areas.

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Introduction: Urinary tract infections (UTIs) are a leading cause of morbidity amongst all age groups and most patients with uncomplicated UTI who visit the OPD are treated with empirical antibiotics without doing any culture analysis. Of all the oral antibiotics used in UTI, fosfomycin is well excreted in the urine and is being used for the treatment of UTIs with a single oral dose. Methodology: The current study was planned to determine the resistance amongst uropathogens to various oral antibiotics including fosfomycin isolated over a 4-year period (April 2015 to March 2019). Results: A total of 22,546 urine samples were received from OPD patients over 4 years and of these, 7,295 isolates were obtained from patients with uncomplicated UTI. About 82% of the isolates were gram-negative bacilli (GNBs). The most common isolate was E. coli 1023 (67.2%) followed by Klebsiella spp 254 (16.7%), and Pseudomonas spp 63 (4.1%). Of all the antibiotics tested, maximum sensitivity in the year 2018 was found to fosfomycin followed by nitrofurantoin for all the isolates tested. There was a statistically significant increase in the resistance pattern for almost all antibiotics tested in gram-negative bacteria (both Enterobacteriaceae and nil fermenters) whereas the increase in the resistance was not statistically significant in gram-positive cocci. Conclusion: It can be easily seen that the level of antibiotic resistance has been increasing even in the community with the rampant injudicious use of antibiotics in humans as well as livestock. As the level of resistance to fosfomycin is still low in the community, it can play a promising role in the treatment of infection in patients with uncomplicated UTI.

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India is a land of spices and medicinal plants. Ayurvedic medications and methods are commonly practised in India for curing several ailments. Lepidium sativum (garden cress) is an important herb that belongs to Brassicaceae family. It is believed that the plant has its origin in Ethiopia but is now cultivated throughout the world. The plant is well-known in Ayurveda for its beneficial properties it holds. The present study describes the fracture healing property of the methanolic and aqueous extract of Lepidium sativum seeds. For the study, 21 Charles foster rats were used. They were grouped into three groups each containing seven rats: control, methanolic, and aqueous group. Rats were anesthetized using ether vapors and fractures were induced in each rat from all the three groups using hand held three-point bending technique. The broken bone fragments were then stabilized using splints. The control group was administered with normal saline, along with food and water, post-fracture. The methanolic group was administered with the methanolic extract of Lepidium sativum seeds at dose of 400 mg/kg given orally, post-fracture along with food and water. The third group received aqueous extract of the seeds in doses of 550 mg/kg orally, along with daily food and water intake for a period of 8 weeks. The results were evaluated both radiologically and biochemically. X-rays were done on day 0, 2^nd week, and 4^th week post-fractures to look for the callus formation and serum levels for calcium, phosphorus, and alkaline phosphatases were evaluated on 0 day, 1 week, 2^nd week, 4^th week, 6^th week, 8^th week, and 10^th week post-injury. It was observed at the end of the study period that the methanolic group had significant callus formation starting at the 2^nd week itself post-fracture. The serum levels of calcium, phosphorus, and alkaline phosphatases at 4^th, 6^th, and 8^th weeks had significant P values in the methanolic group rats.

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Introduction: Dental caries is the most common chronic disease of childhood that interferes with normal nutrition intake, speech, and daily routine activities. Dental caries affects people of all ages with the highest priority risk group being school-going children. Hence, this cross-sectional study helps to determine the prevalence and to compare the dental caries experience among 5- to 12-year-old school-going children of Chandigarh using dft/DMFT and SiC index. Materials and Methods: The present study was conducted among 3354 school children in the age group of 5 to 12 years. The subjects were selected from four randomly selected schools in Chandigarh. Independent t-test and one-way analysis of variance were used to compare the mean difference at 5% significance level (P < 0.05). Results: The prevalence of dental caries was found to be 46.9% with a mean dft and DMFT score of 1.36 ± 2.16 and 0.28 ± 0.80, respectively. The SiC index score for primary and permanent dentition were 3.53 ± 2.53 and 0.85 ± 1.20, respectively. The dft scores declined progressively as the age advanced whereas the DMFT scores increased from 5 to 12 years. Conclusion: Caries prevalence was high in primary than permanent dentition. Comparison between dft/DMFT and SiC indices indicated there is a subgroup that presented with a higher caries rate.

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Background: A descriptive study was carried out due to absence of knowledge of relation between hygiene status of vendor and extent of contamination while simultaneously adding to the pool of similar studies, which would in turn help government formulate an appropriate policy. Methodology: A sample size of 80 fruit juices were collected from 55 vendors and cultured using CLED agar; relevant biochemical tests were run and isolates confirmed using Chromogenic Agar CPS3Id. The CFU of isolates obtained from one vendor were averaged to obtain average CFU for the vendor. The vendors were interviewed and investigator's observations were also recorded. Both were used to formulate an ingenious hygiene score scale, using which vendor hygiene score (VHS) was calculated. VHS and average CFU for the vendor were statistically analyzed and Spearman's rho was calculated along with the scatter plot. Results: Klebsiella sp. (59.05%) and non-Candida albicans (14.28%) are the major bacterial and fungal contaminant respectively. The median VHS is -9, which is unsuitable for consumption according to HSS. Spearman's rho was -0.736, suggestive of a statistically significant negative nonlinear correlation between VHS and extent of microbial contamination in street-vended fruit juices. Conclusion: The plethora of microbial contamination of street-vended fruit juices is a lucrative dimension for research in fruit juice microbiology to improve general public health, reduce disease mortality and morbidity, reduce economic losses, and to protect the general public from the risk of bioterrorism by stringent surveillance in background of limited employment opportunities and constrained livelihoods of the vendors.

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Introduction: A prospective randomized double-blind controlled trial was conducted to evaluate the latency and duration of pterygomandibular nerve block with a mixture of 1.8 ml 2% lignocaine with 1:80,000 epinephrine and 1 ml of 4 mg dexamethasone and its impact on postoperative sequelae after surgical extraction of impacted mandibular third molars. Materials and Methods: This study was conducted in 40 subjects referred to the department of oral and maxillofacial surgery; they were divided into 20 subjects each in group A and B with the age range of 18–72 years planned for elective surgical removal of unilateral impacted mandibular third molar. Each patient was randomly selected to receive anesthesia using 1.8 ml 2% lignocaine with 1:80,000 epinephrine in group A or 2.8 ml twin mix (1.8 ml 2% lignocaine with 1:80,000 epinephrine + 1 ml 4 mg dexamethasone) in group B. After injection of the anesthetic solution, the time to anesthetic effect, duration of anesthesia from initial patient perception of the anesthetic effect to the time when the effect subsides, need to reanesthetize the surgical site were recorded, and 10-point visual analog scale (VAS) was used to subjectively assess the overall pain intensity while injecting the study drug, during surgery, and in the postoperative period. Results: Mean VAS value for pain on local anesthetic injection was less in twin-mix group. The time of onset of the local anesthetic was significantly less for the study group T, 51.35 ± 7.15 s when compared with patients in study group C (P less than 0.0001). The duration of soft tissue anesthesia was longer for all the patients in the study group T. On comparative evaluation between study group C and study group T, patients in the control group had more severe swelling and reduction in mouth opening in the postoperative period. Conclusion: The addition of dexamethasone to lignocaine and its administration as an intraspace injection significantly shortens the latency and prolongs the duration of the soft tissue anesthesia, with improved quality of life in the postoperative period after surgical extraction of mandibular third molars.

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Background: Oral cancer is one of the most common forms of cancer in India. Majority of the patients are diagnosed at advanced stages, resulting in poor outcomes. Most of the oral cancers are preceded by visible lesions known as potentially malignant disorders (PMDs), which are amenable to early detection by screening. Oral visual examination is an established method of screening, and dentists have a unique opportunity to screen patients who come for various dental morbidities. Opportunistic screening is being recommended as a measure of cancer control. This study was conducted to assess the feasibility of opportunistic screening in a public health facility. Methods: Patients coming to the dental outpatient department (OPD) of a secondary care hospital were screened for oral cancer or PMD by a trained dental surgeon by visual inspection of the oral cavity. In-depth interviews were conducted with the dental surgeon and officer-in-charge of dental OPD to identify barriers and facilitators for screening. A feasibility model was used to assess the acceptability, implementation, practicality, and integration of opportunistic screening. Results: All patients attending dental OPD underwent screening. PMDs were detected in 0.5% of the new OPD attendees. Leukoplakia was found to be the most common lesion. Biopsy for suspected lesions was not conducted. The shortage of support staff was identified as a barrier to documenting risk factors. There was a lack of follow-up and referral linkages. Conclusion: Opportunistic screening for oral cancers is feasible at a secondary care public health care facility. However, a well-developed system for follow-up and linkage with referral sites is required.

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Introduction: Burn can happen in any area and causes dominant changes in the quality of normal tissues. The aim of present article is evaluation and comparison the effect of milk, natural honey, and combination of honey–milk on healing of burnt wound. Method and Material: A 4-week trial study was carried out on 10 Albino New Zealand rabbits. All dry burned wound was created on the back of the scapula by a 1 * 1 cm metal block. First group received honey dressing, second group milk dressing, third group honey–milk dressing, and the fourth group 5% sulfadiazine dressing. Sampling was performed at days 1, 10, and 20. Measurement of wound size was done in days 1, 7, 14, 21, 28. The obtained data and information were analyzed by two-way ANOVA and Duncan tests using SPSS. Results: Result show that combination of milk-honey dressing had most significant effect on the improvement of wound healing in the recipient rabbits after a 4-week study. The size of burn wound in four different group was: Honey milk combination 0.428 cm², honey 0.547 cm², milk 0.579 cm² and sulfadiazine 0.873 cm². Conclusion: All dressing can accelerate wound healing and have promotive effect on wound healing but the combination of honey–milk had the greatest effect. Honey, milk, and sulfadiazine had next grade of effectiveness.

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The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) in the first 6 months of a child's life by ensuring that the child receives only their mother's milk without adding any other food or drink, including water. Objectives: Assessing the obstacles that hinder the continued EBF of mothers working in primary health care (PHC) in Saudi Arabia, particularly in the Al-Ahsa region. Method: In this analytic cross-sectional study, 280 mothers working in PHC, who were conveniently selected, answered a self-administered questionnaire to evaluate the barriers in continuing breastfeeding. Results: In the study, 69.5% (P = 0.006) of these respondents reported that an early return to work was the most common barrier that prevented continued EBF, followed by 66% (P = 0.009) who responded that an unsupportive working environment had prevented them from exclusively breastfeeding. Inadequate breast milk from the mother is an obstacle identified by 43.5% of the study participants (P < 0.001), and about 42.5% (P <.001) of the mothers in the survey stated that breastfeeding takes a lot of time from the mother's daily routine, so the time constraints are an obstacle to continued EBF. In addition, 96% of the study participants reported that working environments in the field of PHC did not contain suitable places to breastfeed or pump breast milk; 77.5% of responses stated there were also no facilities for storage of milk expressed during working hours. A working mother could not benefit from breastfeeding breaks during the workday in 96.5% of the cases studied, and 60% of the women attributed the reason to the existence of a strict work schedule within the work environment. Conclusion: Nearly half of PHC working mothers in Al-Ahsa were exclusively breastfed their infants. Early return to work, deficient breastfeeding work support, insufficient breast milk and lack of time were the major barriers to EBF. Lack of nursing breaks, lactation places, and expressed milk storing facilities inside PHCCs are the major work-related barriers to continuity of EBF.

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Background: Child abuse and neglect is one of the foremost growing public health problems in India. In the current scenario, there is an increasing frequency of both the father and mother of a child to go to work which leads to a decrease in the quality time spent with their children. This unsupervised or unmonitored time plays a vital role in the child's growth and development as any form of abuse or neglect during this period may it be physical, emotional, or mental will cause a significant and far reaching consequence in the child. Thus, proper knowledge and awareness is required for early identification and intervention by the parents to prevent such untoward consequences. Aim: The aim of this study is to assess (i) the knowledge and awareness regarding child abuse and neglect among working parents in Chennai and (ii) to evaluate their understanding of the methods and steps taken in the identification and prevention of child abuse and neglect. Materials and Methods: Questionnaire consisting of 14 questions was distributed to 212 randomly selected working parents in Chennai, Tamil Nadu, India. Completed questionnaires were collected and subjected to data analysis. Results: Majority of the working parents were aware of the various parental and environmental factors that could result in child maltreatment and just nearly half of them had taken proper steps to prevent such untoward occurrence in their families. Conclusion: Proper steps have to be taken by the parents and each member of the society as a whole to prevent and reduce the incidence of child abuse and neglect. This study evaluated the understanding and attitude of the working parents toward physical child abuse, their knowledge on the emotional and psychological neglect, and the steps they are willing to take or have taken to prevent it in order to build a better future for the children.

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Introduction: Dental fear is one of the highly prevalent types of fear which deters patients from seeking dental cares. Aim: This study aims to assess the influence of a previous dental visit experience for seeking dental care among adults. Methodology: Young adults (n = 150, 15–26 years) with previous dental visit for care were selected randomly among outpatients' visit in tertiary dental teaching hospital. To assess the influence of previous experience of dental visit in seeking care, we self-administered a Post-traumatic Check List-Civilian Version [posttraumatic stress disorder (PTSD)], an Autobiographical Memory Questionnaire (AMQ), and a Dental Fear Survey (DFS). The relationship of negative and positive experience of previous dental treatment, dental fear, and symptoms of PTSD was assessed using Pearson's correlations. Spearman's rho was used to find out the correlation between the DFS and PCL-C and history of dental treatment undergone. Results: The mean score of the DFS and PCL-C was found to be 69.57 and 40.17, respectively. The characteristics of the most negative experience including physical reactions (P = 0.936), emotional intensity (P = 0.935), sight (P = 0.941), smell (P = 0.917), and sound (P = 0.911) of dental treatment showed a significant relationship with dental fear, whereas the characteristics of the most positive memory of dental treatment showed only a few statistically significant associations with dental fear. Most of the symptoms of PTSD also show significant associations (P < 0.05) with characteristics of the most negative memory. Spearman's correlation between the DFS and the PCL-C was also statistically significant, r (150) =0.365, indicating that dental fear is indeed associated with symptoms of PTSD. Conclusion: There is a significant association between the characteristics of the most negative experiences of dental treatment and increased dental fear in young adults, while positive experiences did not show the inverse relationship with dental fear.

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Background: A ground-level fall is one of the most common modes of injury sustained across all age groups. For older adults, ground level falls can result in multiple injuries and are associated with significant morbidity and mortality. Methodology: This retrospective observational study included all patients presenting with fall from a ground level to our emergency department (ED) from January 2018 to December 2018. Demographics, details of incident, severity of injury, and outcome were analyzed. Results: During the study period, 596 patients with a mean age of 40.9 (standard deviation [SD]: 25.9) years were included in the analysis. A quarter (23%) were aged less than 15 years, while the elderly (>60 years) comprised of 29.5%. Half the patients were triaged as priority 2 (53.8%). The lower limbs (36.6%), upper limbs (23.9%), and face (15.3%) were the body areas that were most commonly injured. The new injury severity score (NISS) was more than 8 in 28% of patients. Multivariate logistic regression analysis showed the elderly (>60 years) to have a higher odds (2.51 95% confidence interval [CI]: 1.57–4.02) of sustaining a fracture of a dislocation. One fifth of the patients (120/596; 20.1%) required hospital admission with only one fatality. Fifteen patients (2.5%) left the hospital against medical advice. Two-thirds (66.3%) required only conservative management, while 19.9% required major surgical intervention. Conclusion: A ground-level fall is a common mode of injury in children (<15 years) and the elderly (>60 years). The extremities and face are the most common areas of the body that are prone to injuries. Age-friendly infrastructure modifications at home, work places, and in public areas for elders and ensuring playground safety for children are the needs of the hour to decrease falls on level ground.

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Background: Pregnancy is associated with profound cardiovascular adaptation with altered cardiac autonomic balance. It can be studied by heart rate variability (HRV) which indicates beat to beat RR interval variation on ECG. Objective: We studied 5 min HRV in normal pregnant females divided by trimesters, compared to matched control. Methodology: We recruited 89 normal pregnant females and 30 age matched controls. Five minutes resting HRV was measured by Variowin HR, software-based instrument, by standard protocols to yield time-domain, frequency domain, and Poincare plot parameters. They were further compared between groups for difference. Results: Case groups (three based on trimesters) and control group were comparable. There was reduced HRV in case than control group, with statistical significance for all, more for frequency domain than time-domain or Poincare plot parameters. There was no pattern of HRV trend across three trimesters, but mostly second trimester was associated with major decline. Primipara revealed significantly reduced HRV than multipara, but anemia or working status was not significantly associated with HRV in case group. Conclusion: There is global HRV reduction in normal pregnancy across all trimesters, associated with primiparity. This indicates pregnancy as a significant risk with reference to altered cardiac balance and use of HRV as a good tool to assess the same.

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Introduction: Body dysmorphic disorder is defined as a preoccupation with apparent defects in patient's appearance which causes significant distress and impairment. This study was conducted in 186 students who attended premedical preparation classes with the mean age of 16.81 years with the primary motive of determining body dysmorphia among adolescent age group. Aim: The main objective of this study is to assess body dysmorphia among teenage adolescents and young adults. Methods and Materials: This cross-sectional study was conducted in premedical preparation class in January 2019. The student's ages range from 16 to 18 years with mean age being 16.81 years. Once verbal consent was obtained the students were asked to fill an anonymous predesigned questionnaire. Continuous variables were summarized as mean and standard deviations, whereas categorical variables were summarized as proportion (%). Statistical Analysis Used: All the data from the questionnaire were extracted and compiled in MS Excel and percentage and frequencies were applied as needed. Results: The mean age of the participants was 16.81+/- 0.82 years with almost equal percentage of females (52.13%) and males (47.84%). Our study shows that in general females are more dissatisfied from their body than males. Both sexes have different areas of concerns. In females, there is more discontent about body fat, facial hair, height, and complexion. In comparison in males the frustration is more regarding muscular body, acne, height, weight, and hair thinning. Despite differences in areas of concern both males and females show dissatisfaction with their body image. Conclusions: It has been concluded that there is a rising surgence of body dysmorphia in adolescents.

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Introduction: The recent study aimed to assess the root canal morphology of mandibular canines in the Syrian population depending on the cone beam computed tomography (CBCT) images. Materials and Methods: A total of 418 fully developed mandibular canines in Syrian individuals aged between 16 and 60 years were included. The presence of at least one mandibular right or left canine with fully developed roots was recorded in each image. The root canal configurations were classified according to the method of Vertucci. The mandibular canines were examined in sagittal, coronal, and axial dimensions. The CBCT images were evaluated by three endodontists with at least 9 years of clinical experience in endodontics. Data were analyzed with descriptive analysis and Chi-square tests using the Statistical Package for the Social Sciences (SPSS) software version 25 (SPSS Inc, Chicago, IL, USA). Results: Out of the 418 mandibular canines, 409 (97.85%) were single-rooted canines while only 9 (2.15%) were double-rooted canines. The most common type of Vertucci in single-rooted canines was Type I (1-1) in the percentage of 95.87% and the least type was Type V (1-2) in the percentage of (0.24%). The Chi-square tests showed no significant association between gender and number of roots (P = 0.64) and gender and root canal configuration in single-rooted canine (P = 0.194). Conclusion: Single-rooted with Type I canal configuration was the most common anatomy in mandibular canines in the Syrian population. Incidence of more than one root canal foramen at the end of the single root was detected in one case only.

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Background: Monitoring of a program is a continuous assessment of certain key indicators of it through periodic reports. The efficiency of a health program is assessed by comparing its achievements with the expectations. Methods: The study was conducted based on the annual TB report of India for the year 2018 in order to monitor (Revised National Tuberculosis Control Program) RNTCP performance in the Bihar State and its various districts. Results: Case notification rate of various districts Bihar was far below the national average of 138 per lakh. Considering treatment initiation, the performance of various districts of Bihar were less than national figures (79.0%). In newly diagnosed TB cases, the treatment success rate of Bihar was 73%. This performance was more compared to Uttar Pradesh (66.0%) but less compared to Jharkhand (92.0%), West Bengal (88.0%), and national data (79.5%). Considering human resources, the total human resources in the states of Bihar (61.9%) and Jharkhand (58.3%) were similar. However, in Bihar, there was a vast shortage of ground-level staff [i.e. (senior treatment supervisor) STS, (senior TB lab supervisor) STLS, (public-private mix) PPM Co-ordinator, and (TB health visitor) TBHV)]. Conclusion: It was found that Bihar was one of the less performing states in RNTCP with a vast shortage of ground-level staff and low overall treatment success rate compared to its neighboring states. Stringent monitoring and evaluation in every step of the program implementation should be done in order to improve RNTCP performance in Bihar.

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Introduction: Water is an essential nutrient which plays an important role in digestion, absorption of food and elimination of waste products by urine. Udaipur also known as 'City of Lakes' or even the 'Venice of East' due to its unique and beautiful lake system has an exceptional importance at national and international levels. The aquatic systems are mostly dominated by bacteria and fungi and in the natural environments micro-organisms have very specific roles with regard to the recycling of materials and purification of water. Presence of coliform bacteria in the water indicates the fecal pollution of water. Methods: Water from all the three lakes were included for the assessment of their water quality parameters. Biological parameters like MPN of coliforms and presence of bacterial and cyanobacterial contaminants were read. The MPN (Most Probable Number) of Coliform was determined by the Presumptive Coliform Count (Multiple Tube Method) in 100 ml of sample water. Conclusion: The coliform bacteria is the primary bacterial indicator for fecal pollution in water. The purpose of study was to make people aware about the bacterial load in water bodies. Based on this, categorical representation of water was unacceptable for the purpose of swimming and bathing.

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Objectives: The goal of this study was to determine the prevalence of tobacco smoking in healthcare students at a university in Riyadh, Saudi Arabia, along with environmental exposure and potential influential factors. Methods: This observational cross-sectional study was conducted at King Saud University from January-April 2019. It included 1,273 randomly selected male and female first- to fifth-year undergraduate healthcare students from all health colleges at the university. The study used a self-administrated questionnaire and descriptive data analysis. Associations between variables were tested using a Chi-square test with the statistical significance set at P value < 0.05. Results: Among the 1,273 respondents, the prevalence of tobacco product smoking was 13.7%. The prevalence was highest in the College of Applied Science (34.5%) and lowest in the College of Pharmacy (10.9%). Among those 18- to 21-year-olds, the prevalence was 43.1%, while it was 51.1% for the 22–25 age group and only 5.8% for those 26 or older. Common reasons for smoking cigarettes included having fun or passing time (45.2%) and relieving stress (33.3%). Among those who smoked a water-pipe (12.5%), the most common reason was to enjoy its flavors (42.1%). The prevalence of secondhand smoking at home was 31.7%, and environmental exposure was 42.5%. Conclusion: Tobacco consumption is a common problem among healthcare students including cigarette as well as the increasing consumption of water-pipe in addition to secondhand smoking. Along with proven strategies to promote smoking cessation, including smoke-free laws, improved access to effective quitting treatments and media campaigns are needed to reduce tobacco consumption.

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Background: Nonalcoholic fatty liver disease (NAFLD) is a condition characterized by the infiltration of fat in the liver cells. High levels of fat in the liver associated with increased risk of diseases like diabetes, high blood pressure and kidney disease, high cholesterol, metabolic syndrome. Aim and Objective: To determine the association between NAFLD and carotid intima media thickness (CIMT) among nondiabetic individuals. Materials and Methods: A total of 90 in-patients and outpatients (45 NAFL subjects and 45 patients with the normal liver as controls) with NAFL on abdomen ultrasound scan from Bangalore Baptist Hospital were included in our study. All the participants were subjected to a doppler study for carotid intima thickness and a blood sample (4 ml) was collected from all the subjects. Results: In this study, there is an elevated level of BMI, weight, dyslipidemia in NAFLD compared with controls. The present study suggests that cardiovascular risk factors such as increased carotid intima-media thickness occur more frequently among NAFLD patients compared to healthy individuals. Conclusion: We can conclude that NAFL has a significant association with higher cardiovascular risk in terms of carotid intima-media thickness, dyslipidemia, and hypoalphalipidemia. Lifestyle changes include weight loss, dietary changes, reduction of sedentary habits and physical exercise are recommended in the NAFL disease subjects with higher BMI and weight.

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Background: Final-year medical students are soon to be physicians who are expected to have sufficient knowledge about a life-threatening condition such as diabetic ketoacidosis (DKA); thus, the present study aimed to evaluate awareness and knowledge of medical students about DKA in a large Saudi University. Methods: An online survey was conducted using a convenience sample of 81 participants aged 18 years and above from Jazan region, Saudi Arabia. Awareness and knowledge about DKA were assessed using a prestructured questionnaire. Statistical analysis using the Statistical Package of Social Sciences (SPSS) included descriptive studies and Chi-square or Fisher's exact test, with the significance level set at P value < 0.05. Results: A total of 81 valid responses were analyzed (85.3% response rate), of which 51.9% were males. The mean age was 23.06 (Standard deviation 1.66 years). Regarding basic information about diabetes mellitus, most of the respondents correctly answered questions related to the system involved in diabetes, classic symptoms, glycemic control test, and the meaning of postprandial blood sugar. Also, students had a good knowledge regarding DKA definition and management. However, inadequate knowledge was found regarding electrolyte disturbance in DKA (59% of males vs. 30.8% of females P = 0.014) and fluid replacement in DKA patients (P < 0.05). Conclusion: The present study revealed that students had a good knowledge regarding basic information about diabetes and DKA definition and management. Students' knowledge was deficient regarding electrolyte disturbance and fluid replacement in DKA. Interventions using study seminars and workshops are warranted to increase knowledge about DKA among final-year medical students.

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Context: Diabetes is associated with several potential preventable complications like the efficacy of insulin pump over multiple daily insulin injections (MDI) in glycemic control. Aims: To assess the outcomes of insulin pump as compared to insulin injection therapy. Setting and Design: Case-control study conducted among adult type-1 diabetic patients using insulin pump therapy and alternative insulin injection therapy from the University Diabetes Center (UDC), King Saud University, Riyadh, Saudi Arabia during 1^st June–30^th October, 2017. Materials and Methods: Interview-based questionnaires were used on of 200 subjects using insulin therapy and control (conventional and MDI). Results of each were compared. Statistical Analysis Used: t- test was used for continuous variables and Chi-square test was used for categorical variables. P value less than 0.05 was considered statistically significant. Results: Patients on pump therapy showed a non-significant higher mean of hypoglycemic episodes per week and a lower mean of diabetic ketoacidosis (DKA) episodes per year as compared to the injection therapy patients 1.97 vs. 1.77 and 0.35 vs. 0.37, respectively. However, statistically significant differences were found between the pump and MDI, the pump and conventional, and the MDI and conventional when HbA1c levels were tested. Conclusion: Among adult patients with type-1 diabetes, insulin pump as compared to insulin injection was associated with better glycemic control. However, for acute complications, non-significant higher mean of hypoglycemic episodes per week and a lower mean of DKA episodes per year were reported in pump therapy as compared to the injection therapy patients.

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Background: A key setback of root canal treatment (RCT) is that most patients lack adequate knowledge about it. Understanding and identifying the factors that hinder or discourage patients from undergoing RCT is necessary to adequately address the issue. The review of literature shows that there is a paucity of data about the awareness and acceptance of RCT among patients in Indian population. Thus, the study was conducted with aim to assess patients' awareness of RCT among patients reporting in Desh Bhagat Dental College and Hospital, Mandi Gobindgarh. By surveying the patients, a broad patient perspective on the issue was sought. Materials and Methods: This survey was conducted with the help of prestructured questionnaire consisting of 15 questions, distributed to random 450 patients coming to the outpatient department of Conservative dentistry and Endodontics in Desh Bhagat Dental College and Hospital. The completed questionnaires were then analyzed to assess patients' experiences, concerns, and perceptions about RCT. Results: There is a lack of awareness among patients regarding RCT. Conclusion: It is important to create more awareness among the populace of our country about the significance of maintaining a healthy dentition and attendant sequel if not done so. More patients would consider having endodontic procedures if properly made aware of.

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Objectives: The recovery after stroke depends on the resolution of brain edema and neuroplasticity. The comorbidities associated with stroke such as type 2 diabetes mellitus (T2DM) may increase the chances of unfavorable outcome and delay the recovery from stroke and needs further investigation. Subjects and Methods: The study dealt with 208 patients. The neurological status of the patients was assessed by Glasgow Coma Scale and the severity of stroke was assessed by the National Institute of Health Stroke Scale. Patients were divided into two groups: T2DM in group 1 and without T2DM in group 2. We assessed functional improvement by Functional Independence Measure (FIM) Scale, quality of life by Stroke Specific Quality of Life (SSQOL) Scale, and serum levels of brain-derived neurotrophic factor (BDNF) for assessing neuroplasticity. Results: We observed lower levels of BDNF in diabetic stroke patients. There was significant improvement in FIM scale scores and SSQOL scale scores in non-diabetic stroke patients after 6 months (P < 0.05). The relative risk (RR) of poor functional recovery (FIM) in the diabetic group was 1.34 [95% confidence interval (CI) 1.0–1.8] and the odds ratio (OR) was 1.8 (95% CI 1.03–3.12). Diabetes is an independent risk factor for poor BDNF recovery (serum BDNF < mean value, i.e. 10.07 ± 3.8 ng/mL) (RR 2.40; 95% CI: 1.36–4.21 and OR 1.6; 95% CI: 1.15–2.13] and poor quality of life (RR 1.56; 95% CI: 1.13–2.16 and OR 2.83; 95% CI: 1.14–7.0). Conclusion: Diabetes is not only a risk factor for stroke occurrence but also delayed recovery after stroke.

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Most commonly prescribed drugs in pediatric dentistry are “Antibiotics.” Among Dentists, there is a trend toward overuse of antibiotics for nonindicated clinical conditions. This insufficient knowledge of the appropriate clinical indications for antibiotic prescriptions promotes the overuse of antibiotics and contributes to the emergence of antibiotic resistance among children. According to the various surveys done on the dental students, dentists and pediatric dentists on the antibiotic prescribing practices, overall, adherence to the professional clinical guidelines was low. There was a wide variation in dosages for all the antibiotics prescribed and for prolonged periods which were inconsistent with the recommendations. This paper reviews the current literature from the year 2000 to 2019. An electronic literature search was conducted in MEDLINE/PubMed, EBSCO host, and Google Scholar databases. The data was also collected manually from comprehensive textbooks. Some recommendations were also based on the opinion of experienced researchers and clinicians. Thus, this review aims at highlighting clinical indications, dosages, and duration of therapeutic antibiotic prescriptions for orofacial infections in the pediatric outpatients and at the same time creating an awareness, regarding the necessity of strictly adhering to the clinical guidelines for antibiotic prescriptions.

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Strongyloidiasis is frequently asymptomatic but can cause disseminated disease and variable presentations. Diagnosis is often delayed or misdirected either due to poor degree of clinical suspicion or clinical imitation of other gastrointestinal conditions. This infection is not infrequent and several cases from all over India have been reported barring few states from central India. We reviewed 166 cases published in English literature from India; from 2001 till 2018 including 2 recent cases from our institute. The mean age of presentation was 35 years with male female ratio of 2.8:1. The duration of disease at the time of presentation varied from 15 days to 10 years. Most important predisposing factor identified in the study was HIV (13.3%) and steroid therapy (6.6%). Most common modality of diagnosis was by stool microscopy (69.3%). Radiological investigations were ordered in 33.7% patients before stool microscopy. Ivermectin was the most common treatment regimen with cure rate of 97.6%. Better awareness and early clinical suspicion of the disease with stool microscopy and adequate therapy are necessary to improve the outcome. Strongyloidiasis is rather widely prevalent infection with variable symptomatology and calls for a close coordination from family physicians and microbiologists.

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Tumor markers are the substances produced in response to the presence of cancer either by the body itself or by the cancer cells. These markers mostly are the proteins that are produced at a greater rate by the cancer cells. Increased levels of these substances can be detected in urine, blood, or body tissues of the patients with certain types of cancer. These markers are useful in differentiating primary or secondary tumors. In few noncancerous conditions, these markers are often found to be elevated. For these reasons, the knowledge regarding these biomarkers has increased tremendously. This article classifies the different types of tumor markers and implicates their role in some diseases.

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This study was aimed to assess the prevalence of pulmonary thromboembolism in patients with nephrotic syndrome. An electronic search was conducted through nine electronic databases for selection of relevant articles reporting the prevalence of pulmonary thromboembolism in patients with nephrotic syndrome. National Institute of Health was used to assess the quality of each study. Meta-analysis was used to pool the results. Of total 2267 reports screened, we finally included 11 studies including five retrospective cohorts, four prospective cohorts, and two case series studies. Out of these, ten articles were eligible for meta-analysis. The overall prevalence was 7.93% with 95% CI of 4.27 to 14.73. However, a significant heterogeneity (P < 0.001) was observed with I2= 96% and τ2= 0.899. Moreover, Egger's regression test showed a significant risk of bias (P = 0.006). Patients with nephrotic syndrome are prone to pulmonary embolism, therefore early management is critical to decreasing mortality burden.

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India with 8.6% of tribal population is finding it difficult to bridge the gap that exists between tribal and non-tribal population in regards to healthcare. Tribal population suffers triple burden of disease; in fact it is quadruple, namely, communicable diseases, non-communicable diseases, malnutrition, mental health, and addictions complicated by poor health seeking behavior. With increasing needs, an Expert committee on Tribal health has given recommendations with the goal to bridge the current gap in the health status of tribal people latest by the year 2027. An entirely parallel health system has been proposed with key focus areas, governance, and financing. To summarize and report the present scenario in terms of disease burden, health-seeking behavior, healthcare delivery system, and a roadmap for the future along the importance of primary healthcare in achieving it. Mere establishment of more health facilities cannot overcome the poor health of tribal population and so the role of trained manpower to deliver quality healthcare, in which case the role of traditional healers, local Tribal boys and girls comes in handy. It is high time and states should act swiftly to assess the needs, priorities of their own tribal population and set goals, targets to achieve the same through proven public health strategies.

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Micronutrients' deficiency is a common phenomenon among a majority of the population residing in the low- and middle-income countries (LMICs) especially among women and children. Given the widespread prevalence of micronutrients' deficiency in LMICs, iron-fortified foods could be of potential benefits for both the mother and the development of fetus. Present study aims to provide the evidence on the impact of iron fortification on hemoglobin (Hb) concentration during pregnancy and evaluates the specific maternal and pregnancy outcomes. We conducted systematic review by using search engines such as PubMed, Cochrane Library, Medline, EMbase, and secondary references. Meta-analyses were performed to calculate summary estimates on Hb during pregnancy, low birth weight (LBW), and preterm births. The weighted mean difference (WMD) and relative risk (RR) were calculated using random-effects models. Sources of heterogeneity were explored through meta-regression. Eight studies were included for the final analysis. The overall pooled estimate of Hb showed a significant increase in the fortification group compared with the control group [WMD = 4.45 g/L; 95% confidence interval (CI) = 2.73, 6.17 g/L; I² = 83%, τ² = 6.80, ρ <0.00001]. There has been a notable reduction in iron deficiency anemia (IDA) among pregnant women with substantial heterogeneity. Meta-regression suggests that the duration of feeding was positively associated with the effect size. Present review provides an evidence for the substantial benefits of iron fortification during pregnancy for reducing preterm births and risk of LBW. The safety, efficacy, and effective delivery of iron fortification need further research. Systematic review registration: PROSPERO International prospective register of systematic reviews – CRD42018116931.

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Clostridium Difficile is the most common cause of hospital acquired and antibiotic associated diarrhoea, but it is important to note that this can be a colonizer. The rates of community carriage is not very well described in children. We hereby report a case of Community acquired Clostridium Difficile in an infant without antibiotic exposure.

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Human nocardiosis is primarily an opportunistic infection affecting immunocompromised patients, however, one-third of them are immunocompetent. CNS involvement is less commonly reported and associated with a grave prognosis. The majority of these patients are organ transplant recipients on immune suppressants. In the recent past, association of Nocardia asiatica with brain abscess has been reported in a few cases. We are reporting a case of isolated cerebellar abscess caused by N. asiatica in an immune-compromised adult with a review of relevant literature. A 53-year-old male presented with complaints of headache and vomiting for 14 days. There was no previous history of any comorbid illness. During presentation, he was having gait ataxia and radiology showed the right-sided cerebellar multiple lesions. Further hematological investigations revealed the patient to be HIV positive. The abscess was tapped and the pus culture showed Nocardia species. Antibiotics were started as per sensitivity and the patient did well at 3-month follow-up. Though rare, Nocardia should be kept as a differential in brain abscess patients. Owing to the different antimicrobial sensitivity patterns among Nocardia species, both appropriate speciation and susceptibility testing of uncommon species such as N. asiatica are required for their successful treatment.

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Spotted fever is a common rickettsial disease in India. It is caused by Rickettsia conorii, which demonstrates vascular tropism and causes endothelial injury. Ocular manifestations include multifocal retinitis and disc edema. Anterior uveitis as a presenting feature of spotted fever is uncommon. We present a 32-year-old man with spotted fever and bilateral anterior uveitis.

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We present a case of brain abscess in an immunocompetent child due to the dematiaceous fungus Microascus cinereus, an organism commonly found in soil and stored grains. The etiologic agent was demonstrated by direct microscopy and culture. The patient responded well to surgical excision of abscess along with a course of amphotericin B and voriconazole. Microascus species have emerged as significant invasive pathogens especially in the immunocompromised patients. To the best of our knowledge, this is the first reported case of brain abscess caused by M. cinereus in an immunocompetent individual with no underlying risk factors.

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Rhinosporidiosis is a type of nasal polypoidal growth arising from the mucosa of nasal cavity and often extending to nasopharynx. Occasionally, this growth may invade the lower airways and cause airway obstruction. The clinical presentation of such cases is often contradictory and airway management during induction of anesthesia requires caution to prevent potential life-threatening situations. A case of large pedunculated rhinosporidiosis involving the epiglottis and laryngeal inlet, with significant airway management challenge has been presented here. Clinical significance: Primary care physicians should be diligent in evaluating patients with rhinosporidiosis and look for signs of airway obstruction to rule out lower airway involvement.

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Radicular or periapical cysts are one of the most commonly occurring odontogenic cysts of the jaws. The present article reported a case of a 12-year-old female with the chief complaint of swelling and pain on the right lower back tooth region. The radiographic examination revealed the presence of a well-defined radiolucency surrounded by a corticated border with respect to the right mandibular 1^st, 2^nd and 3^rd molar. The case was managed by complete enucleation under general extraction with the extraction of right mandibular 1^st, 2^nd and 3^rd molar. The success of the surgery was apparent by the uneventful healing during the follow-up period and evidence of complete healing after 1-month follow-up. Early diagnosis of the lesion would have lead to a less aggressive treatment plan.

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A 55-years-old woman menopausal for the last 6 years discovered to have an endometrial thickness (ET) > 12 mm (suspected endometrial polyp) during routine evaluation in the gynaecology clinic using the transvaginal ultrasound (TVS). Departmental ultrasound confirmed the same TVS findings and suggested the presence of endometrial polyp as the main cause of the ET. Based upon the patient's risk factors (diabetic, hypertensive, obese with family history of endometrial cancer), a departmental decision was taken to proceed for diagnostic hysteroscopy and polypectomy after informed written consent. Large endometrial polyp and submucosal fibroid were found and excised during hysteroscopy. The histopathological results confirmed the intraoperative diagnosis of the endometrial polyp and submucosal fibroid. This report supports the American College of Obstetricians and Gynecologists recommendations and highlights that the TVS is not an appropriate screening tool for asymptomatic postmenopausal women. In addition, the ET > 4 mm in asymptomatic postmenopausal women does not need evaluation.

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A primary care visit is the first encounter of a patient with health care. In context to malignancies, breast cancer and primary ovarian lymphomas are NA clinically and morphologically different malignancies. The rare concurrence of breast cancer and non-Hodgkin lymphoma (NHL) does not warrant any routine surveillance through testing but we present a case of a 71-year-old female with the history of invasive ductal carcinoma of the breast in remission who was diagnosed with follicular carcinoma after an abnormal pelvic examination during her routine primary care visit. This highlights that a routine PC visit with a skilled physical examination can prove to be one of the most cost-effective tools for screening high-risk cancer patients in remission.

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Pyonephrosis is an uncommon condition that is associated with suppurative destruction of the renal parenchyma. Upper urinary tract obstruction by renal stones plays an important role in its aetiology. The majority of pyonephrosis is reported to be caused by aerobic bacteria but the role of anaerobes, especially black-pigmented gram-negative anaerobes, namely, Prevotella and Porphyromonas in renal infections, remain poorly defined. In view of the rarity of the event, a case of pyonephrosis by Prevotella disiens and Escherichia coli coinfection complicated by secondary peritonitis in an obstructive uropathy patient is hereby presented. An attempt is being made to review the literature on the infective aetiologies of renal abscess with special reference to anaerobes.

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Intracerebral hemorrhage (ICH) is frequent pathology in emergency department. Coagulopathy leading to ICH are rare. Intracerebral hemorrhage is a leading cause of mortality among patients diagnosed with chronic myelogenous leukemia (CML). In this report we discussed the case of a previously healthy male patient, who presented with fatal ICH, newly diagnosed with blast crisis in CML.

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The clinical presentation of celiac disease has evolved significantly over the last few decades. Previously defined as a malabsorption syndrome in pediatric patients, now it is considered an autoimmune disorder with diverse systemic manifestations among all age groups. We report a case of 56-year-old male presented with pedal edema and gradually progressive abdomen distention for the last 3 months. Serological evaluation and duodenal biopsy reports were suggestive of celiac disease. The patient was advised gluten-free diet, after 12 weeks, the patient became asymptomatic with the resolution of ascites and peripheral edema. According to the literature, there are few reports of protein-losing enteropathy as an initial presentation of celiac disease. The possibility of celiac disease should be considered even in the setting of atypical symptoms.

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Jaw clonus, a fascinating, yet uncommon clinical sign, is suggestive of supranuclear lesions of the trigeminal nerve. It has previously been reported in association with amyotrophic lateral sclerosis. Hereby, we report an index case of jaw clonus in a patient of neuromyelitis optica spectrum disorder with subsequent osmotic demyelination syndrome with pseudobulbar palsy due to the involvement of pontine corticobulbar fibres.

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Endoscopic biliary stenting is an established modality of managing benign and malignant obstructive disorders of biliary tract. Complications associated with biliary stents though uncommon are on the rise. We report a case of migrated biliary plastic stent presenting as gastro-inetstinal hemorrhage, which was managed successfully by endoscopic technique avoiding any major surgery.

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This is a case report of a 65-year-old female patient diagnosed with Grade II Follicular Lymphoma of the pelvic and abdomen was treated with a combination of R-CHOP chemotherapy and radiotherapy.

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The evaluation of Secondary hypertension is laborious, expensive and of low yield, though screening of reversible causes, is important to prevent target organ damage. Hypertension secondary to hydronephrosis is rarely described in clinical studies. We herein report a 37-year-old male with a history of resistant hypertension. Initial evaluation for a secondary cause of hypertension was negative. CT abdomen showed unilateral hydronephrosis (Right). After surgical correction, his blood pressure begins to normalize in 3 weeks with a reduction in antihypertensive drugs. The patient was off medications at 6 months of follow-up. The relief of obstruction was parallel to the normalization of blood pressure, which suggest a causal link between hydronephrosis and hypertension. Our case illustrates hydronephrosis as an important cause in the evaluation of hypertension.

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Radicular cysts associated with deciduous teeth are very rare. They constitute 0.5–3.3% of the total number of cysts in primary dentition. Radicular cysts involving deciduous teeth occur mostly in 3–19 years of age and has a male predominance. Enucleation with extensive removal of bone and vital teeth is preferred treatment for large radicular cysts and marsupialization can be preferred as a conservative approach to reduce morbidity. This paper presents a case report of a radicular cyst associated with a mandibular left deciduous first molar of a 7-year-old male child. The first premolar was displaced and the path of eruption was disturbed, horizontally placed below the first primary molar. The management comprised enucleation of the cystic sac and extraction of the involved permanent and primary teeth under general anesthesia.

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Intestinal tuberculosis has varied clinical presentations and often requires high index of suspicion for clinching the diagnosis. We report a case of an 18-year-old male who presented with abrupt onset of massive lower gastrointestinal bleeding and was diagnosed to have ileocecal tuberculosis. This case signifies the need to consider the possibility of intestinal tuberculosis as a cause of severe hematochezia among other etiologies to prevent mortality and morbidity.

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The healthcare industry worldwide is undergoing a radical transformation. An enthusiastic healthcare system of the Government of India (GOI) continually tries to tackle numerous challenges facing the system. The Rashtriya Swasthya Bima Yojana (RSBY) program has provided secondary level healthcare facilities to more than 36 million families across most states in India. This particular health insurance initiative was taken by the GOI with the purpose to safeguard the pitiable or marginalized Indian population or those households who are facing economic risks due to hospitalization and their everyday expenditures. RSBY provides affordable and accessible healthcare services along with insurance coverage for secondary care. However, it is limited to inpatient treatment or hospitalization. For outpatient coverage many strategies have been applied but low enrolment is still an existing flaw under this streamer. The present paper discusses various features of RSBY, outpatient projects undertook, and various obstacles that can be removed to integrate this insurance scheme with primary healthcare in India.

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Background: The habit of smoking and chewing tobacco is associated with various types of oral mucosal lesions and conditions, many of which pose a potential threat to cancer growth. The present study aims to evaluate the prevalence of potentially malignant lesions (PML) and oral cancer in North India and to identify the associated risk factors. Materials and Methods: A cross-sectional study was carried out in the Department of Oral Medicine and Radiology Rama Dental College Hospital and research center Kanpur over a period of 5 years with1,10,625 patients. Participants were divided into study group with a positive history of the chewing habit as well as oral lesions and control group who had a positive history of habits with no oral lesions. Detailed case history and clinical examination were carried out under visible light by trained professionals to assess any oral mucosal changes. Results: The study group consisted of 76.31% males and 23.69% females. In total, 84.34% participants in the study group were literate. However, 57.56% subjects were having oral submucous fibrosis, 23.7% were having leukoplakia, 13.12% were having Lichen planus, and 5.62% were having oral cancer. Conclusion: Results from the present study indicate that tobacco smoking, chewing of betel quid with and/or without tobacco chewing are the major risk factors for PML and oral cancer.

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Background: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that affects multiple aspects of an individual's life. It is characterized by attention deficit, hyperactivity, and impulsivity. As it is linked to various comorbidities, individuals and families often find it difficult to cope with it. Therefore, early diagnosis and intervention are vital. Aim: This study examined the ADHD awareness and knowledge of medical students and interns at Qassim University, Saudi Arabia. Method: For this cross-sectional study, the convenience sample consisted of male and female, fourth- to fifth-year medical students and interns. Descriptive and inferential statistics were computed, and the results were tested against a significance threshold of 0.05. Results: The majority of students demonstrated good awareness (83.9%) and fair levels of knowledge (48.2%) of ADHD. Age, academic year, and noncompletion of pediatric and psychiatric classes were associated with poor awareness. Odds ratios (ORs) for poor awareness were lower for the older (>23 years) and fifth-year students as compared with the younger and fourth-year students. Students who had not completed pediatric and psychiatric rotations demonstrated poor awareness. Conclusion: Medical students had a good awareness of ADHD; however, they had insufficient knowledge. As such, their knowledge must be improved, which can be achieved through the promotion of continuous education of students and primary health care physicians. The inclusion of the topic of ADHD in pediatric and psychiatric courses is necessary for advancing the knowledge of medical students on ADHD.

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Introduction: At present, laparoscopic surgery is a very common method, especially for the removal of the gallbladder, because pain and anxiety following surgery is a major problem in surgical operations. Various studies have demonstrated the effectiveness of gabapentin and dexmedetomidine in reducing pain intensity after surgery. The present study is aimed at examining the sedative and analgesic effects of gabapentin and dexmedetomidine in patients undergoing laparoscopic cholecystectomy. Methods: This was a double-blinded clinical trial involving 40 patients who were candidates for laparoscopic cholecystectomy. The patients were randomly allotted in two groups of dexmedetomidine (n = 20) and gabapentin (n = 20). Then, pain intensity based on the visual analog scale (VAS) and sedation level based on the Ramsay Sedation Scale (RSS) were measured at the curtained times. As the data were not normally distributed, the Mann–Whitney U test was used to analyze the data, and the significance level was set at 0.05. Results: Across the follow-up points, more reduction in pain intensity was observed in the dexmedetomidine group as compared with the gabapentin group. The available dissimilarities between these two groups in pain decrement at the recovery room and 3 h after being discharged from the recovery room were not significant (P ≥ 0.414). In addition, across all the time points, there was considerable growth in sedation in the dexmedetomidine group in comparison with the gabapentin group (P < 0.024). This finding indicated that dexmedetomidine was more effective than gabapentin in creating sedation. Conclusion: Compared with gabapentin, dexmedetomidine leads to more pain reduction after surgery and better sedation during and after surgery.

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Background: Low health literacy (HL) is associated with an extensive range of health outcomes. Objective: The present study was performed to inquire about the relationship between HL and glycemic control in gestational diabetes in order to design interventional future preventing programs. Methods: This cross-sectional study was performed on 104 Iranian pregnant women with gestational diabetes mellitus (GDM) referred from urban and rural areas to endocrinology clinic of Hamadan Beheshti Hospital, in 2017. Iranian Health Literacy Questionnaire (IHLQ) and a sociodemographic checklist were distributed among women. Correlation between HL and glycemic control was examined using SPSS. The significance level was set at P < 0.05. Results: Among women, 48.1% (50) were affected by uncontrolled diabetes and only 22% (11) had an adequate level of HL. An adequate level of HL were 50% and 22% in glycemic controlled and uncontrolled women, respectively. In univariate analysis, there was a significant relationship between diabetes control and adequate HL. So, problematic HL could increase the chance of uncontrolled diabetes more than three times (odds ratio: 3.5; CI: 1.5–8.3; P value: 0.004). Among all related variables, education and being housewife were considered as protective and risk factors for problematic HL, respectively. Conclusion: In conclusion, this study has provided evidence of limited HL and its relationship with low glycemic control in pregnant women with GDM. The problem was more serious in low educated, rural, housekeepers, and older-aged women. This deficit needs to be addressed by health planners and policymakers who are responsible for promoting the health of people and decreasing health inequalities community.

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Context: Smoking among the primary care physicians (PCPs) is detrimental to not only their own health but it may also affect their attitude and practice towards smoking cessation counseling. Aims: We aimed to assess the smoking behavior of primary care physicians and its effect on their patient smoking counseling practices. Subjects and Methods: A cross-sectional study was conducted among the primary care physicians (N = 261) working under the Ministry of Health in Riyadh city, Saudi Arabia during May to June 2018. The data was collected using a self-administered questionnaire that was based on global adult tobacco survey. The participants were selected through simple random sampling. Results: About 16% of PCPs were found to be current smokers while about 9.6% were ex-smokers. On binomial logistic regression current smoking was observed to be independently associated with gender, specialty, and years of work experience (P < 0.01). The practice of smoking cessation advice was found to be significantly associated with physicians' current smoking status after adjusting for other factors; PCPs who were non-smokers were 2.97 (95% CI 1.34-6.54) times more likely to always advice patients on cessation as compared to smoking colleagues. Conclusions and Implications: Smoking behavior of physicians was found to affect their patient smoking cessation counseling. This finding should be used in while planning and training staff for smoking cessation services in primary care settings.

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Context: Diabetes-related retinopathy (DR), the most common complication of diabetes mellitus (DM), is a severe and preventable cause of visual loss and blindness that has been reported to be the fourth leading cause of blindness among four million cases globally. Aims: This study aimed to evaluate the knowledge, attitudes, and practices of fourth- and fifth-year medical students concerning patients with DR. Methods and Materials: This cross-sectional descriptive study was conducted at a College of Medicine in Saudi Arabia, in November 2018, and comprised 153 fourth- and fifth-year medical students of both sexes. Participants were required to complete a previously validated hard copy questionnaire. Results: In total, > 50% of participants showed good knowledge of DR (poor participant knowledge, n = 65, 42.5%). We found 16 (10.5%) participants had poor attitudes to DR compared to 137 (89.5%) of participants with good attitudes, and 32 (20.9%) participants showed poor practices compared to 121 (79.1%) participants showing good practices. There was a statistically significant difference between the sexes and the level of practice (P = 0.021). Conclusions: More than 50% of participants in our study showed good knowledge concerning DR, with excellent attitudes and practices. Moreover, participants' age was identified as a significant factor affecting practice regarding DR. More targeted education is required to improve their knowledge base in regard to DR. Medical faculties have a significant role in the education of medical students to ensure greater awareness of DR.

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Aim: This study aimed to evaluate the glycemic control, quality of life (QOL), and sleep quality in type 2 diabetes mellitus (T2DM) patients who are treated with liraglutide and to investigate whether the QOL and sleep quality were correlated with the glycemic control of this population. Methods: A cross-sectional study was carried out on T2DM patients who were treated with liraglutide. Data on body weight and glycemic control were recorded while the QOL and sleep quality were assessed using the Short-Form Health Survey (SF-36), the 5-item World Health Organization Well-Being Index (WHO-5), and the Pittsburgh Sleep Quality Index (PSQI) questionnaires. Results: Eighty-four T2DM patients who initiated liraglutide with a mean age of 46.7 years were included in the study. The mean hemoglobin A1c (HbA1c) was 7.76% (standard deviation [SD] =0.62), and about 88.1% of patients had HbA1c > 7%. The PSQI score showed not too bad sleep quality (mean 4.3 ± 1.9). The mean WHO-5 score of the study population showed a “moderate” QOL (12.4 ± 3). Patients had lowest SF-36 score (mean = 52.3) in the subscale of “energy and fatigue.” There was a significant positive correlation between HbA1C and the “energy and fatigue” (r = 0.232, P = 0.034) but not with the other subscales. Conclusion: Patients with T2DM taking liraglutide have moderate sleep difficulty and QOL score. Nonetheless, none of these outcomes was significantly correlated with glycemic control. Further well-designed studies with long-term follow-up and larger population sizes are needed to confirm our findings.

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Aim: The present study aimed to evaluate peri-implant immunological parameters along with clinical and radiographic parameters amongst subjects vaping e-cigarettes and nonsmokers (NS). Two immunological parameters that were included were measurement of tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-1β. Materials and Methods: A statistically significant number of subjects were included in the study and further divided into two groups: Group-1: Vaping e-cigs (n = 47) Group-2: Nonsmokers (n = 45) A structured questionnaire was used at baseline for data collection related to demographic and peri-implant data of each individual. Baseline parameters included plaque index, bleeding on probing, probing pocket depth, and peri-implant bone loss (PI, BOP, PD, and PIBL, respectively) for those vaping e-cigs and nonsmokers with the aid of standardized digital radiographs. ELISA kit was used to assess immunologic parameters using sulcular fluid collected from peri-implant region (PISF). Results: Bleeding on probing (BOP) was found significantly high in nonsmokers compared to the vaping group. But probing depth greater than 4 mm and PIBL scores were significantly higher in the vaping group than nonsmokers. Mean concentrations of immunologic parameters were significantly higher in vaping group than in nonsmokers. TNF-α levels and IL-1β levels were found to have a positive correlation with bone loss around implants (PIBL). Besides, TNF-α also had a positive correlation with bleeding on probing in vaping group compared to nonsmokers. Conclusions: Owing to the effect of nicotine on the peri-implant tissue, levels of inflammatory mediators as detected by ELISA tests were found to be higher showing a greater amount of localized inflammatory tissue destruction and a compromised peri-implant area in vaping subjects. PISF concentrations were also found relatively higher than nonsmokers.

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Background: Early diagnosis and treatment of drug-resistant tuberculosis (TB) is crucial to halt the spread of drug resistance in the community. Aim: The aim of the study was to compare rapid diagnostic tests (GeneXpert and line probe assay, LPA) with conventional liquid culture for the diagnosis of drug-resistant TB and to assess the risk factors for it. Method: This cross-sectional study recruited 229 multidrug-resistant TB suspects who were sputum smear positive. They were evaluated by the rapid diagnostic tests and sensitivity, specificity, positive predictive value and negative predictive value were calculated for drug resistance detection as compared to liquid culture drug susceptibility testing. The risk factors for the development of drug resistance were also assessed and the P value of < 0.05 was considered significant. Results: In the final comparison, 193 samples were included. The sensitivity and specificity of GeneXpert for detection of drug resistance (rifampicin) was 100% (95% confidence interval, CI: 88.8–100%) and 99.4% (95% CI: 96.6–99.9%), respectively. Whereas sensitivity and specificity of LPA was 94.3% (95% CI: 80.8–99.3%) and 100% (95% CI: 97.7–100%), respectively. Only three discordant samples were observed. Defaulting to antitubercular therapy, contact with resistant TB, and disseminated disease were found to be significant risk factors for the development of drug-resistant TB with high statistical significance (P value < 0.05). Conclusion: Both rapid diagnostic tests have very high sensitivity and specificity for detection of drug resistance in sputum smear positive with the advantage of short turn-around time. Defaulting to antitubercular therapy, contact with resistant TB, and disseminated disease are significant risk factors for drug resistance.

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Introduction: Placenta accreta is the most common cause of bleeding leading to peripartum hysterectomy, and therefore, due to the importance of accreta in the mortality and morbidity of pregnant women, the correct diagnosis of the patient's final outcome is important. Therefore, this study aimed to evaluate the sensitivity, specificity, and accuracy of sonography diagnosis in the evaluation of placenta accreta by examining the two-dimensional (2D) and color Doppler sonography findings. Materials and Methods: Sonography was done for detection of accreta from pregnant women who were suspicious of placenta accreta in the third trimester of pregnancy. They were evaluated to confirm placenta histology for accreta and clinical examination after cesarean surgery at Maternity Ward, Ahvaz Imam Khomeini Hospital. Then they were evaluated as an overview and for the lack of accreta sonography findings. The data collected were analyzed by SPSS V 24. Results: About 58 patients (55.8%) of 103 pregnant mothers suspected of accreta with anterior placenta with an average age of 32.9 years after cesarean section were clinically extraordinarily positive and 45 patients (43.3%) were negative. The overall sensitivity and specificity of sonography for the detection of accreta placenta were 97.7% and 86.2%, respectively, which were most sensitive to diffuse and focal lacunar flow (100%) and the least sensitivity (33.3%) was observed for bladder wall interruption. Accuracy, positive predictive value, and negative predictive value of sonography for the diagnosis of accreta placenta with at least one diagnostic criteria were 91.2%, 84.6%, and 98.3%, respectively. Conclusion: Sonography, as an affordable and inexpensive diagnostic method, can be worthy by examining placenta for the detection of accreta, which can increase the diagnostic accuracy when combining 2D criteria with color Doppler.

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Introduction: Diabetes mellitus is a known risk factor for heart failure (HF); nevertheless, many HF patients remain undiagnosed. The National Institute for Health and Care Excellence in England updated their HF guidelines in 2018, replacing the use of fasting plasma glucose with glycated hemoglobin (HbA1c), in suspected HF investigation. This audit aimed to assess this update's uptake at a general practice partnership in Colchester, England. Materials and Methods: The audit cycle consisted of a two-round electronic record search, for approximately 29,000 patients registered at the partnership. From November 1, 2017 to November 1, 2018 for the first round and from November 1, 2018 to March 6, 2019 for the second round, patients who had their NT pro-brain natriuretic peptide levels measured for the initial investigation of suspected HF were included in the study. Interventions put in place after the first round included an oral presentation and an illustrated guide for the general practitioners (GPs). Results: One hundred and ten patients, 19 in cycle 1 and 91 in cycle 2, were identified and included in the analysis. At the first round, only 31.6% of the patients had their HbA1c level measured, while 36.8% had no diabetic investigation done. At the second round, the percentage of patients who had their HbA1c level assessed increased to 59.3%. A decrease from 36.8% of patients without diabetic status assessment to 20% was observed. Conclusions: Lack of awareness among GPs regarding this guideline update was identified and simple interventions achieved an increase in the guideline's uptake. Regular and complete audit cycles can help GPs adhere to up-to-date guidelines. Primary care can help other organizations such as pathology laboratories keep up to date with guidelines, while primary care technology can be amended in-house to help adherence to new guidelines. We recommend the National UK Heart Failure Audit considers auditing the use of HbA1c testing in inpatients investigated for new HF.

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Aim and Background: Dental practice is blooming in India with many conventional and advanced setups providing orthodontic services. Orthodontics as a specialty has come to the forefront, as awareness of orthodontic therapy has increased. It is important to classify any health practice to understand, compare, and research the implications of various organizational setups in the country. It should possess the ability to chart the similarities and distinctions between different setups for ease of communication and patient awareness. Presently, there is no defined system that classifies the type of orthodontic practice in the country. Lack of any classification of the organizational setups makes it impossible to categorize or compare the various setups for research purpose, recognition of the dental personnel and facilities provided. This article aims to propose a simple 3-stage classification to orthodontic practices in India. Technique: Three-stage classification of orthodontic practice in group, type, and subtype gives a comprehensive coverage to all types of orthodontic setups in India. The group explains the center in three levels based on the armamentarium and services provided. The type explains the center in five levels based on ownership and scope of providing care. Finally, the subtype explains the availability and qualification of the operating personnel. Conclusion and Significance: This classification aims to provide a tool for communication and recording the levels of orthodontic care possible at any given center. It also facilitates continued study of its impact on practice efficacy and patient awareness.

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Introduction: Digestive symptoms are common affecting more than 60% of the elderly people. Digestive enzyme deficiency and dysbiosis in the gastric fluid microbiota are the major contributors in the pathophysiology of indigestion. Therefore, therapeutic strategy targeting the gastric microbiota and digestive enzymes has the potential to treat indigestion. This study was conducted to evaluate the efficacy and tolerability of probiotic Bacillus coagulans GBI30,6086 along with digestive enzymes in improving indigestion in geriatric population. Methods: An open-labelled, randomized, prospective study was conducted in geriatric patients with complaints of indigestion. The study group (n = 25) received 5 ml of reconstituted probiotic syrup containing Bacillus coagulans GBI-30, 6086, and digestive enzymes daily and the control group (n = 25) received 5 ml of placebo syrup twice daily for 5 days and followed-up after 7 days. Results: Reduction in Modified Glasgow dyspepsia severity score from baseline to follow up was statistically significant in the study group when compared to the control group (P < 0.0001). Improvement in indigestion, abdominal pain, and flatulence was also greater in the study group compared to the control group. Conclusion: Bacillus coagulans along with digestive enzymes are effective in treating indigestion in geriatric patients. It is well tolerated and safe to be used in geriatric patients without any major adverse effects.

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Background: Endodontically treated teeth should be prosthodontically managed properly to add life to the teeth, and hence the main aim of this study was to explore awareness, attitude, and practice of dental practitioners toward management of endodontically treated teeth and factors associated with it. Materials and Methods: It was a cross-sectional, descriptive questionnaire study conducted among dental practitioners working in private clinics. The study was conducted in August 2019. The survey was conducted among 239 participants. In this study, a close-ended interview schedule was prepared for perception and practice of dental specialists. Results: Most of the dental professionals (31.79%) preferred full coverage crown for restoring the grossly decayed endodontically treated teeth. Awareness regarding prosthodontic management of endodontically treated teeth was better among specialists (13.75%) than bachelor's degree holders. Attitude was neutral among most of the study participants (46.86%) and practice scores toward prosthodontic management of endodontically treated teeth was good. Gender and degree were significantly associated (P = 0.02*) (P = 0.05*), (P = 0.00***) (P = 0.05*) with awareness and practice of study participants. Conclusion: A majority of study subjects in this study had moderate awareness, neutral attitude, and good practice regarding restoration of endodontically treated teeth.

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Introduction: Dengue fever is a common mosquito-borne viral disease which has reached alarming size in the past few years. It is endemic in more than 100 countries and significant differences were found in clinical profile and atypical manifestation. Aim of the Study: A retrospective observational study of clinical profile and atypical manifestations in patients with dengue fever. Materials and Methods: Serum samples were collected from clinically suspected cases of dengue fever and it was confirmed by NS1 antigen, IgM, and IgG antibody by ELISA. Clinical details and atypical manifestations were recorded. Observation: During the study period, a total of 2502 patients were suspected to have dengue infection, of which 464 (18.5%) samples were found to be positive for dengue viral infection. A majority of the cases were males [268 (57%)] when compared with females [196 (42%)]. Fever was the most common clinical presentation seen in all the patients, followed by headache (78.4%), myalgia (61%), body pain (49.3%), vomiting (40%), joint pain (31.5%), dry cough (19%), nausea (14%), abdominal pain (8%), diarrhea (5.6%), retro-orbital pain (04%), burning micturition (2.4%), and rashes (0.6%). Among atypical manifestations, hepatomegaly [32 (7%)] was the most common, followed by splenomegaly [23 (5%)], bradycardia [18 (4%)], meningitis [6 (1.2%)], hemoptysis [5 (1%)], acalculous cholecystitis [4 (0.8%)], and acute pancreatitis [2 (0.4%)]. The study of hematological parameters showed thrombocytopenia was present in 179 (38.5%) patients, followed by leukopenia [77 (17%)] and raised hematocrit [29 (6.2%)]. Conclusion: During ongoing epidemics, the clinical profile and atypical manifestations in clinically suspected dengue patients should be investigated early so that severe forms can be treated promptly.

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Background: Long-term abstinence in substance abuse patients is a great clinical challenge. A novel behavior modification program (BMP) for ensuring abstinence in substance abuse patients was being run in a tertiary care hospital in Jeddah, Saudi Arabia. The aim of this study was to evaluate the factors associated with the length of abstinence in substance abuse patients who were enrolled in this BMP. Methods: This was a record-based study, where patients were identified from the records of Al-Amal hospital. The study group consisted of adult male patients suffering from drug addiction, exposed to an initial detoxification treatment program and subsequently enrolled into BMP during the year 1424 Hijri, the reason of period selection that it was before the modification of inpatient BMP in the facility toward more outpatient one. Multiple stepwise regression with backward elimination was done to identify factors independently associated with length of abstinence in the BMP program. Results: Mean (SD) age of the participants was 31.9 (8.4) years and a majority had 6–9 years of education (65%), were single (63%), and unemployed (72%). Presence of mood disorder (b = 111.3; 62.3–160.3), good program attendance score (b = 33.2; 21.0–45.4), and higher total number of previous hospital admissions (b = 6.4; 3.1–9.6) were associated with a longer length of abstinence in the BMP program. Conclusion: A number of factors as described above can be utilized to modify the BMP and target different groups of patients who are less likely to stay abstinent for a longer duration, ensuring greater effectiveness of the BMP.

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Background: Healthcare workers at field level constitute a major pillar in the large public health infrastructure of India. At this juncture, it becomes necessary to understand their role in achieving MDGs, issues, and challenges on the field and how 'prepared' they are to embark upon the new responsibilities in the coming 15 years to achieve the SDGs. This will form a springboard for the next generation of healthcare providers to successfully achieve the SDGs. Materials and Methods: This qualitative research study was conducted in the rural part of Thane district from September 2016- March 2017. Four Focus Group Discussions (FGDs) were done to assess the role, activities, reasons for successes and shortcomings of MDG indicators for healthcare providers and thereby assess preparedness for achieving health-related SDGs at the grass-root level. Results: Major challenges faced in the field were cultural barriers, poverty, illiteracy, fear, disregard for the health workers. There were challenges in human resource management such as workload, unpaid work, dissatisfaction, grievance redressal, leaves, etc., Suggested technical and health-centric interventions were skill development, supportive supervision, incentives and better implementation of new policies. Training in soft skills is needed. Conclusions: The health workers seem to be unaware of the term MDGs/SDGs but, showed a deep sense of commitment towards improving the health of people and meeting their work targets despite the challenges faced in the field. Their justified concerns need to be addressed to have better retention and improved performance.

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Background: The analysis of salivary enzymes contributes to the clarification of pathogenesis and improvement in the diagnosis of periodontal disease. The present study aimed to examine the prospective association between smoking and periodontal disease progression and the effects of smoking on the following salivary biomarkers related to periodontitis: Alkaline phosphatase (ALP), acid phosphatase (ACP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), creatinine (CRE), blood urea nitrogen (BUN), urea (UA), free-hemoglobin (f-Hb), and neopterin. Materials and Methods: A total of 64 male patients aged 21–60 years were recruited and grouped as Group 1: 16 healthy nonsmokers, who had never smoked. Group 2: 16 smokers with gingivitis. Group 3: 16 smokers with moderate periodontitis. Group 4: 16 smokers with severe periodontitis. Stimulated saliva was collected for at least 5 min and clinical measurements; salivary biomarkers were assessed in automated analyzer. Results: Data showed significant correlation among salivary ACP, AST, LDH, CRE, BUN, UA, and f-Hb and neopterin levels showed higher in group 4 compared with other groups. Conclusion: This study indicated that smoking has several detrimental effects on periodontal tissues. A higher level of salivary biomarkers was seen in smokers with severe periodontitis. Hence, these biomarkers are helpful in future for the earlier detection of periodontal diseases progression and can also be used as potential salivary biomarkers for assessing smoking status and severity in chronic periodontitis.

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Background: Tobacco dependence is a major public health problem that results in significant morbidity and mortality. Approximately, 5 million people are killed annually by tobacco use. Aim: To assess the oral health status among adult tobacco and non-tobacco users attending outreach activities in Ghaziabad District, Uttar Pradesh. Methods: A cross-sectional study was conducted on 800 subjects from all the 4 blocks of Ghaziabad district visiting the outreach activities. A pre-tested questionnaire was used to assess the demographic variables and oral hygiene practices. Oral health status was assessed using WHO (World Health Organization) 2013 Oral Health Assessment Form and the Smith and Knight Tooth wear index was used to assess the degree of tooth wear. Statistical analysis was done by the Statistical Package for Social Sciences (SPSS) version 20.0. Result: The mean age of the tobacco users in the study was 40.94 (13.83) years. The prevalence of dental caries and tooth wear was 88.0% and 89.2%, respectively. Majority of tobacco users consumed a smokeless form of tobacco 67.5%, followed by smoke 21.5% and followed by both form 11.0%. Conclusion: The present study concluded that adult population of Ghaziabad lack the knowledge and awareness regarding consumption of areca nut, gutka, and tobacco smoking. Hence, there is an urgent need to take effective steps, especially on launching community awareness programs for the adult population and public to educate them about the consequences of tobacco use, and on assessing their effectiveness in curbing the problem.

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Background and Aims: Hands are the first way of which many infectious diseases are transmitted. Hand hygiene is a means of infection control in schools. Close consideration of handwashing in educational units is important to control and prevent infection transmission. The present study aimed to determine the effect of handwashing education on awareness, attitude and handwashing skills of third-grade elementary school students in Tehran. Methods: In this study, 76 third grade students of elementary schools located at district 1 of Tehran with the mean age of 9 years were randomly divided into intervention and control groups using pre-test and post-test. Data collection for intervention and control groups was done using a researcher-made awareness- and attitude-gauging questionnaire, along with a checklist of handwashing performance which was completed in cooperation with the health instructor. Results: The results of this study showed that there was a significant difference between the awareness of 3^rd-grade students in intervention (69.79 ± 1.61) and control (49.03 ± 1.18) groups (P < 0.05). Moreover, students' attitude toward handwashing improved as a result of education, and the intervention group (62.37 ± 0.65) had a more positive attitude toward hygiene and handwashing compared to the control group (48.45 ± 0.73) (P < 0.05). In the case of handwashing performance, the intervention group (56.76 ± 1.33) had better health performance compared to the control group (40.08 ± 0.67) (P < 0.05). Conclusion: Practical training, preparation of educational posters and videos can enhance awareness, attitude and handwashing performance.

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Objective: This study aimed to assess the meniscus and cruciate ligament lesions of the knee using magnetic resonance imaging (MRI) and to investigate the correlation between clinical and MRI diagnoses. Patients and Methods: Herein, we reviewed the electronic medical records of 240 patients who underwent knee MRI. The images were evaluated and then the clinical and MRI diagnoses were compared. Results: Of the 240 patients, 66% were male and the mean age was 40.6 ± 15.5 years (range, 2-79 years). Knee pain alone was the most common presenting symptom (50.64%) followed by pain after trauma (47.92%). Majority of the knee lesions were medial meniscus (MM) lesions (63%) followed by osteoarthritis (48%) and ACL lesions (35%). The majority of the MM and ACL lesions were tears (54.6% and 69.41%, respectively) followed by degeneration (33.55% and 17.65%, respectively). However, the MM lesions were predominantly observed in the posterior horn (Odds ratio [OR], 152; 95% confidence interval (CI), 21.550–1072.113; P < 0.001). The ACL lesions were significantly more common in men than in women (OR, 0.355; 95% CI, 0.191-0.661; P = 0.001), and altered signal intensity on T2- and proton density–weighted images was the most common sign (P < 0.001). A strong compatibility was observed between the clinical and MRI diagnoses (Kappa = 0.141; P < 0.001). Conclusion: MM and ACL lesions are the most common injuries of the knee, which can be diagnosed by physical examination in most cases. Further confirmation by MRI should be reserved for doubtful cases only.

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Introduction: Tuberculosis (TB) is the leading killer and the commonest opportunistic infection (OI) in human immunodeficiency virus (HIV) infected individuals with 0.3 million deaths in 2017. When HIV and TB co-infection occurs, they form a deadly combination with each accelerating the progression of the other, resulting in increased morbidity and mortality. Aim and Objectives: To study the demographic pattern, clinical presentation, opportunistic infections, radiological and laboratory profile, management, and outcome of HIV-TB coinfected individuals. Materials and Methods: A prospective cross-sectional study was carried out on confirmed HIV cases already diagnosed with TB and those newly detected with TB after admission, where diagnosis was carried out following standard operative procedures. Results: In our study of 58 HIV-TB co-infected individuals, 40–50 years was the most common age group affected. Males were affected more with majority being married. The most common presentation was fever (67%) followed by gastrointestinal symptoms. Majority of TB cases were newly diagnosed (65.5%), with predominance of pulmonary tuberculosis (PTB) (n = 35) followed by those having only extrapulmonary tuberculosis (EPTB) (n = 12) and both (n = 11). TB was diagnosed by microscopy in 32.7%, while radiologically, chest X-ray was most common (36.2%). Also, 50% were infected with other OIs where oral candidiasis was the most common (37.93%). The overall mean CD4 count was 220 cells/μL and those with EPTB had lesser CD4 counts than those with PTB. All were on DOTS regimen and majority showed improvement. Conclusion: In a country like India where both these diseases are rampant, we recommend better information, education, understanding and awareness for prevention, care, early diagnosis, and treatment of these two notorious infectious diseases with prevention of relapse and default of TB cases in HIV-TB co-infected individuals a priority.

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Background: This study was conducted to determine the effects of iron overload on growth and correlation of serum ferritin and growth disorders in children with thalassemia. Methodology: It was a crosssectional study conducted from January to June 2019 on 70 children age up to 18 years with transfusiondependent thalassemia. Detailed history, demographics, anthropometric parameters, clinical and laboratory details were evaluated. Data was analyzed by statistical package of social sciences (SPSS) software. Logistic regression model was used to determine the correlation between serum ferritin with short stature. Results: It included 46 male and 24 female, of which 65.71% had short stature and 77% were underweight. The mean serum ferritin level was 1,560.9 μg/L, 45.71% have serum ferritin level > 2,500 μg/L, and 65.71% had hemoglobin levels of 5–8 g/dL before transfusion. The receiver operating curve value of serum ferritin was 1,107 μg/L with respect to the incidence of short stature and there was significant correlation between serum ferritin level and the incidences of short stature (P = 0.001). Conclusion: There was a significant correlation between serum ferritin level and growth disorders.

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Background: The quest for an ideal restorative material has led to the discovery of biological restoration that is, the use of natural tooth as a restorative material. Thus, the aim of the present study is to evaluate the knowledge about biological restorations and efficacy of health education. Materials and Methods: It was a questionnaire-based pre- and post-educational interventional study. Around 386 parents reported to the department and willing to participate were included in the study. Data were collected through a self-administered questionnaire. The study was carried out in three phases where the second being the health education by individual approach. The data were further subjected to statistical analysis. Result: Our study comprised of 117 (30.3%) fathers and 269 (69.7%) mothers. When enquired about the awareness of biological restoration and tooth banks 96.6% and 95.3% of the parents were unaware of it respectively. About the acceptance of biological restoration treatment before the intervention, only 26% of parents accepted the treatment. However, after the educational intervention, the acceptance increased to 93%. Conclusion: A lacuna exists as per the knowledge and awareness of biological restorations was concerned. Health education can be considered as a pioneering approach in the creation of awareness and there is an increased need to conduct such educational interventions to improve parents' attitudes.

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Introduction: Gingivitis is codified as the most familiar oral disease in children and teenagers. Several studies reported that most of the children and adolescents have negative impact on quality of life (QoL) due to gingivitis or destructive periodontal disease or poor oral health status. Existing literature in this context on Indian population is sparse. Hence, this study has been shouldered to find out possible coalition between gingivitis and COHRQoL. Objective: This study desires to evaluate the confederation of gingivitis and child oral health-related quality of life (COHRQoL) among school children of Lucknow. Methods: A cross-sectional survey was conducted in school going children with the age group of 11–14 years, with a representative sample of 400 students in Lucknow city. For data on oral health-related quality of life (OHRQoL), a predesigned questionnaire (CPQ11-14) was used for demographic information and questions on oral symptoms, functional limitations, emotional, and social well-being. Gingival status was evaluated by Gingival index (Loe and Silness 1963). Results: QoL was found to be moderately affected in children with severe gingivitis as compared with children with no gingivitis, mild, and moderate gingivitis, but this difference was found to be statistically nonsignificant (P = 0.896). Conclusion: The present findings indicated that the existence of substantial levels of gingivitis might be fatalistically related with how children perceive their oral health and daily life.

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Purpose: To compare the effect of topical 1% prednisolone acetate and 0.09% bromfenac versus topical 1% prednisolone acetate alone on macular thickness following Nd: YAG laser capsulotomy. Materials and Methods: About 150 eyes with posterior capsule opacification following were included. All patients were treated with Nd: YAG laser posterior capsulotomy. Patients were randomly divided into two groups of 75. Group 1-Patients received: Topical 1% prednisolone acetate and Topical 0.09% bromfenac. Group 2-Patients received: Topical 1% prednisolone acetate alone. Outcome measures by an independent observer were BCVA by Snellen chart, IOP by NCT, and Central Macular Thickness (CMT) by Macular OCT. All patients were examined before the procedure, 1 h after the procedure, at 1 week, and at 6 weeks. Statistics: 1. Quantitative variables: Mann-Whitney Test and Wilcoxon ranked sum test. 2. Qualitative variables: Chi-square test. A P value of < 0.05 was considered statistically significant. Results: Mean IOP increase in both groups is statistically significant at 1 h and later decreases back to nonsignificant levels at 1 week and 6 weeks. No significant change in mean CMT was seen in the duration of 6 weeks neither in Group 1 nor Group 2. Conclusion: Prophylactic antiglaucoma medications are not recommended in patients undergoing Nd: YAG laser capsulotomy. No evidence of cystoid macular edema was recorded till the end of 6 weeks follow-up.

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Background and Objective: Attention-deficit hyperactivity disorder (ADHD) is known as the most common neurological disorder in childhood. Failure to timely diagnose ADHD can lead to harmful effects for the individual and the family. The relationship between this disorder and the addiction to video games has been reported in children. Therefore, this study aimed to investigate the degree of addiction to video games in Iranian children with ADHD, compared with normal children. Materials and Methods: In this applied research, 99 children with ADHD referring to Imam Hossein Hospital and 99 normal children in elementary schools of Tehran (control group) were recruited. Data were collected using Conner's Scale and Young's Internet Addiction Test (video games). The data were analyzed using SPSS (version 22). Results: In this study, 11% of the children with ADHD and 4% of the normal children had addiction to video games. This difference was significant between the two groups (P < 0.05). Moreover, 58% of the children with ADHD and 27% of the normal children were exposed to video games. This difference was also significant between the two groups (P < 0.05). Conclusion: The results showed that the frequency and prevalence of addiction to video games were higher in children with ADHD than in normal children. Therefore, it can be concluded that timely diagnosis of this disorder leads to better treatment.

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Introduction: Anemia is a major public health problem amongst elderly population in India. Anemia in old age further worsens the age-related decline in functional ability, mobility, fatigue, bone density, and skeletal muscle mass. There is lack of evidence on the prevalence and risk factors of anemia among elderly population. Hence, this study was undertaken. Methodology: A community-based cross-sectional study was conducted during the year 2015–2016 in District Nainital, Uttarakhand state, India. A total of 958 subjects were selected from 30 clusters (villages) identified using population proportional to size methodology. Information on sociodemographic profile, nutritional status, body mass index, and dietary intake was obtained. Blood sample was collected from each subject on the filter paper for estimation of hemoglobin (Hb) level using cyanmethemoglobin method. Results: We found that 92.1% of the elderly subjects were anemic. Moderate and severe anemia was found to be significantly higher among female subjects, unemployed, illiterates, subjects using smoke-producing fuel, subjects belonging to lower socioeconomic status, malnourished and underweight subjects, subjects with self-reported hyperacidity, and subjects who had not utilized health facility and had lower iron and vitamin C intake when compared with subjects with mild anemia and normal hemoglobin levels. Conclusion: High prevalence of anemia exists amongst elderly subjects living at high-altitude region of rural Uttarakhand State, India. There is a need to educate the elderly population about the importance of adequate intake of foods rich in iron and vitamin C to reduce the prevalence of anemia among them.

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Aim/Objectives: This study was aimed to detect extended-spectrum beta-lactamase (ESBL) producing Pseudomonas species isolated from various clinical samples by phenotypic methods with their susceptibility testing. Materials and Methods: Hundred Pseudomonas isolates were taken from various clinical samples of patients attending outpatient department (OPD) and inpatient department (IPD). Antimicrobial susceptibility test and ESBL detection were assessed using CLSI guidelines on Mueller Hinton agar. Results: Out of 100 Pseudomonas isolates, 46 isolates were from female and 54 were from male patients. More cases of pseudomonal infection were in the age group between 46 and 60 years (34%), and 59% of Pseudomonas species were isolated from patients belongs to urban areas and the rest 41% were from rural. The isolates collected from OPD were 61% and rest 39% from IPD. Pseudomonas species showed maximum resistance to cephalosporin group of antibiotics and showed least resistance to imipenem, and showed 100% susceptibility to colistin. ESBL production was detected in 42% of total isolates. Conclusion: The present study highlights that the Pseudomonas species remains an important cause of nosocomial infections. ESBL producing Pseudomonas species continue to be an important organism causing life-threatening infections. Multidrug resistance was seen in most of the strains. Resistance is developing even to combination of ceftazidime clavulanic acid. Resistance is developing to last resort of antibiotic, i.e. imipenem also. This gives the alarming signal for the future, making the therapeutic options more difficult. Strict infection control measures are to be taken to contain this so-called water and soil organisms as Pseudomonas.

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Background: Outbreaks of dengue fever cause widespread mortality. There is a paucity of studies on predictors of morbidity and mortality in dengue. This observational study was performed to study the factors predicting adverse outcomes caused due to dengue fever thereby optimally manage the patient's to reduce mortality. Methods: The study included a 1-year retrospective and 1-year prospective period were clinical, laboratory and outcome data of patients between 18–30 years of age, having serology proven (NS1/dengue IgM) dengue fever were recorded and analysed. Results: Out of 418 patients, 404 (96.64%) recovered and 14 (3.35%) expired, resulting in a 3.35% mortality rate. Platelet count did not determine the outcome in dengue patients. The shock factor was present in 45 (11.1%) patients who recovered and 10 out of 14 patients who expired (71.4%), P value was statistically significant. Mean value of SGOT and SGPT in dengue patients who expired were 2865.43 and 1510.07 IU/L, respectively, which were significantly higher than the mean values of SGOT and SGPT in those who survived. Bleeding was present in 39 (9.7%) patients who recovered. Out of the 14 expired patients, bleeding was present in 5 (35.7%) which is statistically significant. Hence, on multivariate logistics analysis, bleeding, a higher SGOT and SGPT value and shock were found to be significant risk factors for mortality in dengue fever patients. Conclusion: Bleeding, shock and raised SGOT and SGPT levels were identified as predictors of adverse outcomes and mortality in dengue fever. Timely identification of these risk factors and active management is important to reduce dengue-related mortality.

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Background: The knowledge about Internet search trends helps to know the information-seeking behavior of the Internet users and this would help in formulating Information Education and Communication strategy. Aim: The aim of this study was to explore the global Internet search trends about vaccine-related information in English. Materials and Methods: First, we conducted a pilot interview with 15 participants (convenience sample from a tertiary care hospital) to make a list of five common query keywords (viz., When, Where, Cost, Side effect, Schedule) for vaccine-related search. Then, we obtained the search trends from “Google trends” for 5 years with the five query keywords prefixed with vaccine (e.g. vaccine when). In the second phase, individual vaccine search was conducted with a particular vaccine name and query keyword (e.g. measles vaccine side effect). Results: Five-year search trend showed that the highest volume of search was for “schedule” (36.79%), followed by “when” (26.57%), “cost” (21.97%), and “where” (11.99%). The “side effect” showed the lowest volume of search (2.68%) (χ² = 10595, P < 0.0001). The search volume was increased over the years. The highest volume of the “when” and “where” were searched from the USA. The “cost” was searched in the highest volume from Australia. “Side effect” and “schedule” of the vaccine were searched with the highest volume from Philippines and Nepal, respectively. Conclusion: This study provides a glimpse of global vaccine-related search trends over a period of 5 years. Information on the “schedule” and “when” to get the vaccine should be strengthened for wider dissemination of knowledge.

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Objective: Despite the increase in contraceptive usage over the years, there still exists a gap in the knowledge, attitude, and practices regarding contraception. The study has been designed to assess the knowledge, attitude, practice, and preferences on contraceptive methods among the nursing staff, to determine the association between knowledge and attitude on contraceptive methods with the variables. Materials and Methods: A cross-sectional descriptive study of 173 nursing staff using a structured questionnaire on knowledge, attitude scale, and practice and preference were done at AIIMS, Jodhpur during June 2018 to August 2019. Results: It was observed that 82.6% were of 21–30 years of age, 86.7% were Hindus, 67% were from the nuclear family, 41% were married between 19 and 25 years, 86.7% were nulliparous, 75.7% had access to various contraceptives through health workers, 79.8% got information through media. 73.4% were willing to use postpartum contraception. In our study, a major reason for 80.9% to use family planning was to prevent unintended pregnancies. Majority 71% had the favorable attitude and 14.4% had an unfavorable attitude toward contraceptive methods. In this study, 64.1% preferred male condom as Rank 1, intrauterine device 57.8% as Rank 2, and Lactational Amenorrhea Method 58.3% as Rank 3 for postpartum contraception. There was an association between the practice of family planning and marital status, age, and family size. Conclusions: The study showed that the majority of the females nursing staff had moderate knowledge and favorable attitude toward contraception use.

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Introduction: The results of previous studies show that breast augmentation surgery is effective in improving women's satisfaction and the quality of life. The type of surgical survey tool can be effective in validating the results. The BREAST-Q is a strong and valid questionnaire that has not been performed nationwide as a breast augmentation's survey tool on the quality of life indicators. Therefore, in this study, the effect of breast augmentation surgery on quality of life, satisfaction, and marital life was assessed in married women using BREAST-Q as a validation tool. Materials and Methods: This prospective study was performed on 60 married women who underwent breast augmentation surgery from April 2014 to April 2015. Participants were asked to complete the BREAST-Q questionnaires before and 6 weeks after surgery. Statistical analysis was performed using t-test. The level of significance was considered 0.05. Results: The results of patients filling out the BREAST-Q questionnaires showed that breast augmentation surgery improved the three variables of satisfaction with breasts, psychosocial well-being, and sexual well-being significantly (P < 0.001). The mean values of the significance of change index also show that a significant improvement is achieved in all three variables up to 100%. Conclusion: The results of this study show that in addition to the direct relationship between breast augmentation surgery and quality of life improvement, satisfaction, and marital relationships, using the BREAST-Q questionnaire can be a tool for physicians to assess the psychometric effects of the breast surgery.

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Background: Ageing is an inescapable reality of human existence. The elderly population of India is steadily increasing with growing mental health needs which pose many challenges for the health care system. The aim of this study is to assess anxiety, depression, and cognitive disorders among urban and rural elderly and to explore the availability of social support mechanisms and a responsive health system for elderly. Methods: This study is a mixed-method approach. For a quantitative study, a community-based cross-sectional survey is conducted in Jodhpur, Rajasthan. A total of 330 elderly persons aged 60 years and above are randomly screened for depression (GDS), anxiety (GAD), and cognitive impairment (HMSE). Further for a qualitative study, in-depth interviews are conducted with 7 key informants including policy and program managers, service providers, and facilitators from the state. For quantitative data analysis, Excel and SPSS are used and for Qualitative data analysis, Thematic Framework Approach is used. Results: The mean age of the respondents is 67.9 ± 7.8. The prevalence of severe depression is 17%, severe anxiety is 10.3%, and cognitive impairment is 51.2%. The prevalence of all the three is more in rural elderly as compared to urban elderly as well as more in female individuals as compared to males. Qualitative analysis revealed that there are challenges in early identification of mental disorders at both the levels: service providers and elderly. Psychological and financial issues are also seen in elderly who are not supported by their children. There are cases of fear for elder abuse and influence of western culture in the society. Conclusion: There is a sizeable prevalence of psychological issues in elderly population. Therefore, there is a need to adopt holistic and integrated psychogeriatric services for the improvement of quality of life in elderly.

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Introduction: Oral mucosal disorder (OMD) has the potential disorder than any other oral disorder. It is found in the all over would. In our country India, is also more prone area of oral mucosal disorder. People more affected in male, low educated, low socioeconomic. Areca nut consumption is more so oral mucosal disorder is more reported, this survey was undertaken in darbhanga and is surrounding to determine the demographic data of oral mucosal disorder and to identify their association with various factors. Materials and Methods: A total of 5620 patients of Oral mucosal disorder attending the dental outpatient clinic of the Department of Oral Medicine and Radiology in dental college and department of dentistry in darbhanga medical college over a period of 36 months were selected for the study. A detailed case history and clinical examination was done in visible light. Study was done on the basis of age group, gender, socioeconomic habit duration, frequency of habit, and type of habit. Statistical Analysis Used: Simple t- test analysis was performed. Results: Of the 5620 cases of OMD studied, 75.01% cases were male. 49.09% were low socioeconomic people, 36.12% graduate educated, 47.29% smokeless habit and frequency of habit more than two time 57.12%. Oral mucosal disorder. Conclusion: Younger populations have relatively a higher percentage of oral mucosal lesions than would older populations. Habits, like smoking and smokeless, which further increase with age, can also increase the incidence of oral mucosal disorder Prevalence of habits was more in males than females.

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Introduction: Increasing age, long-term deleterious habits, and increased bone resorption leading to the gingival recession have become a significant reason for poor geriatric oral health among which root caries are the most prevalent ones among the Indian population. Methodology: A cross-sectional study was conducted among the geriatric population above 60 years of age and those who gave voluntary consent for participating in the study were included in the study and were briefed about the questionnaire. The self-administered questionnaire was given and complete oral examination was done. Results were analyzed using the SPSS 22 version using descriptive analysis and Chi-square test. Result: Percentage of deleterious habits amongst males was higher than that of females i.e. 56%. Thus, males were reported with root caries more than females. The percentage of married people suffering from root caries was 85%. The most prevalent occupation among the geriatric population was found to be the farmers with 37%. Religion with maximum percentage and frequency was found to be Hinduism with 84%. Educational statuses with 6^th to 12^th standards were reported with maximum root caries, i.e. 55%. Conclusion: The study showed that criteria including income, gender, marital status, occupation, religion, and educational status were significant in assessing the prevalence of root caries. Whereas the risk factors such as habits, methods of cleaning, and brushing techniques influenced the root caries among the geriatric population.

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Noise is pervasive in everyday life and can cause both auditory and nonauditory health effects. Noise-induced hearing loss remains highly prevalent in occupational settings. Nonauditory effects of noise can cause tinnitus, headache, auricular plenitude, dizziness, and gastric, visual, sleep, and mood disorders, endocrine imbalance, and cardiovascular disorders. A cross-sectional study among resident above the age of 18 years of the selected urban slum near railway track of Raipur City with a sample size of 400 was conducted. 23.0% of the study subjects responded of facing auditory fatigue, followed by 11.5% of the study subjects reported of hearing loss, 6% of the study participants perceived that the surrounding noise led to an increase in their blood pressure. Loss of sleep/insomnia was reported by 6% of resident in our study. Health effects of environmental noise are manifold, serious and, because of the widespread exposure, very prevalent. These factors stress the need to regulate and reduce environmental noise exposure.

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Background: According to the GBD report published in 2016, the burden of cancer in Kerala is 135.3/100,000 population in contrast to the national average of 100/100,000 population. Cancer is a complex disease that requires broad engagement of various departments and organizations to implement a community based health promotion strategy. Objective: To estimate the prevalence of diagnosed cancers, warning signs and selected risk factors of cancer in Niranam Panchayath of Pathanamthitta district, Kerala. Methodology: A total of 13,736 population was covered by door to door survey using a structured questionnaire. The questionnaire collected information on the sociodemographic variables of the residents, source of water supply, warning signs of cancer and details of diagnosed cancer cases. Results: The mean age of the population was 39.7 ± 21 years. The prevalence of diagnosed cases of cancer in our study was 652/100,000 population. Most common type of cancer identified was Breast cancer (37.3%). The prevalence of any warning sign among the study population was 400/100,000 population. Breast lump was the common warning sign identified. Increasing age, female gender and occupational status were the factors found to be significantly associated with cancer. Recommendations: Community based health education to increase awareness, screening for cancers and breast self-examination in the community could help in early diagnosis and prevention at primary level. Scientific study to assess the risk factors of cancers using case control design could be done in this population along with soil and water sample testing for carcinogens.

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Background: The overall success of osteointegrated dental implants depends on various factors. The deleterious effects of smoking on wound healing after the tooth extraction and its association with poor quality of bone are well documented. Similar effects of tobacco use on the success of dental implants are expected. Cigarette smoke mainly contains nicotine that delays the bone healing and increases the rate of infections at the implant insertion site. Aim: The purpose of the present study was to evaluate and compare the marginal bone loss around dental implants in smokers and nonsmokers. Materials and Methods: The study was conducted on 500 individuals who received dental implants in maxillary or mandibular edentulous regions from 2010 to 2017. The sample was divided into two groups: Group I (smokers, n = 280) and Group II (nonsmokers, n = 220). Marginal bone loss was measured on mesial, distal, buccal, and lingual side of each implant using periapical radiographs 3 months after loading, 6 months after loading, and 12 months after loading. Results: The crestal bone loss around dental implants was significantly greater in smokers (Group I) as compared to nonsmokers (Group II) irrespective of the duration of loading (P < 0.001). Marginal bone loss did vary significantly by location in either groups. Conclusion: Smoking overall lowers the success rate of dental implants. Increased duration and frequency of smoking leads to a greater degree of marginal bone loss around dental implants.

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Background: At present, different designs of tooth brushes are available, each one is being claimed to be the best by their manufacturers. There is a need to compare the plaque removal efficacy of the most popular designs. Aim: The aim of the present study was to compare the degree ofplaque removal obtained with the use of two commercially available tooth brushes with round ended and thinner tip bristles. Materials and Methods: The study involved 60 subjects within age range 18–40 years, randomly distributed into 2 groups, 30 in each: Group A- round ended bristle, Group B– thinner tip bristle. Turesky, Gilmore, Glickman Modification of Quigley-Hein Plaque Index, (1970), (PI) was assessed at baseline, 2 weeks, 4 weeks, and 6 weeks; and Muhlemann and Son, (1971), Sulcus bleeding index (SBI) at baseline and 2 weeks were assessed in each subject. Scaling was done at 2^nd week, 4^th week, and 6^th week after assessment of parameter. At 4^th week the subjects were switched over to another type of brush for crossover evaluation. Results: Over 2 weeks, both the groups showed significant (P < 0.05) reduction in plaque score, better reduction in Group A with mean differences of 0.48 than 0.41 in Group B, though it was insignificant on intergroup comparison (P = 0.09). There was reduction in SBI in both groups with mean difference of 0.50 in Group A and 0.11 in Group B and this was statically insignificant. But on comparison, between the two groups at 2 weeks, statically significant reduction was there in Group A. Brushing with specified brush, after scaling, at 4^th week Group A had significantly better plaque control (P < 0.01). Upon crossover analysis, better efficiency of round ended bristles was observed but it did not reach the significance level (P = 0.126). Conclusion: Within the limitations of the study, the data derived from the study show that both the toothbrushes had shown decrease in plaque scores. Round ended bristles were more efficient.

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Background: Diagnosis of urinary tract infection (UTI) can be challenging as symptoms are nonspecific. The gold standard for the diagnosis of urine culture is not easily available in resource constrained settings. Hence, the need for affordable point of care diagnostic test could be an inexpensive alternative for urine culture or microscopy. The objective of the study was to validate the urine dipstick test to detect UTI in a resource constrained primary care setting. Methods: A diagnostic accuracy study was conducted in a health center in an urban slum by Bangalore Baptist Hospital. We included 136 patients suspected to have UTI. Patients were asked to give urine samples for urine dipstick analysis, urine microscopy, and urine culture and validity of the dipstick was analyzed. Results: A total of 136 patients fulfilling the inclusion criteria were recruited. Nitrite had higher specificity than leukocyte esterase (95% vs. 73%). Positive predictive value for nitrite and leukocyte was 84% and 51%, respectively. A combination of fever, dysuria along with lower abdominal pain had higher specificity (92%). Most common organism that was isolated was E. coli (56%) followed by S. aureus (13%). E. coli was susceptible to nitrofurontoin. Conclusion: Urine dipstick could be used as a simple diagnostic test in a limited resource setting for a rapid diagnosis and initiation of empirical antibiotic therapy. Urine dipstick for nitrite has a good specificity.

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Aim: This study aims at comparing the effect of Yoga, Zumba dance, and Aerobic exercises in controlling blood pressure among the Indian population without using hypertensive drugs. Objective: This study is designed to analyze the effect of Yoga, Zumba, and Aerobics in controlling blood pressure among the Indian population and to determine which of the three is better to treat hypertension without using hypertensive drugs. Background: Hypertension is a disease which is nowadays most commonly seen among children and adolescents and has been found that regular exercise tends to reduce the levels of high blood pressure in a very effective way among which the effects of aerobics exercise on reducing high blood pressure in hypertensive patients had been more convincing that regular aerobics exercise reduces the blood pressure by > 1.5 mmHg.

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Burnout syndrome (BS) is a relatively common occupational problem. It is a psychological and behavioral syndrome described by three dimensions: emotional exhaustion (EE); depersonalization (DP); and low personal accomplishment (PA). Objectives: This study aims to calculate the prevalence of BS and its related risk factors among physicians of primary health care centers (PHCCs) of the Ministry of Health (MOH, Al Ahsa, Saudi Arabia. Materials and Method: A cross-sectional study was conducted in which 280 physicians working in PHCCs were selected as a comprehensive sample, the response rate was 80.7%. We excluded the trainee of residency programs, interns, and hospital physicians providing partial service in PHCCs. The data was collected by using two-part self-administered questionnaire including sociodemographic data, working conditions, and Maslach Burnout Inventory™-Human Services Survey for Medical Personnel—MBI-HSS (MP). This data was analyzed using Statistical Package for Social Sciences (SPSS) program. Results: The mean score for EE was 24.99 ± 11.54 SD. The mean score for DP was 9.19 ± 6.13 SD. For PA, it was 29.41 ± 9.9 SD. The percentage of participants who scored high in EE was 47.3%. About one-half of the participants scored high DP and 59.7% had diminished PA. About one-quarter of the participants (24.3%) scored high burnout in all three dimensions. High EE was present in ages from 35 to 45 years, Saudi participants, rotating or covering physicians, and participants who were satisfied with their job. High DP was seen in Saudi physicians, family physicians, rotating or covering physicians, those who were not satisfied with their job, and physicians who work in rural areas. Low PA was seen in physicians who were not satisfied with their job, rotating or covering physicians, participants who do not have tasks other than clinical work, and physicians who work in Omran sector. Conclusion: There is a significant level of burnout among physicians working in PHCCs in Al Ahsa. High burnout was associated with some risk factors. Further research is needed to study this problem in depth.

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Background: Non-orthodontics specialist should have the responsibility of taking care of the smiles of the patients. This also has the implications on the oral health of the patient. The present study was done to determine awareness, perception, and practice regarding orthodontic practice and principles among non-orthodontic specialists. Materials and Methods: The present study is a cross-sectional descriptive questionnaire study conducted among non-orthodontic specialists working in private clinics. The survey was conducted in among 212 non-orthodontic specialists. In the present study a close ended interview schedule was prepared to perception and practice of Dental specialists. After entry of data in Microsoft excel 2007. SPSS version 19.0 is used to analyze the data. Results: Dental specialists have moderate awareness, positive perception and poor practice regarding Orthodontic practice and principles. Awareness regarding, Orthodontic was significantly (P = 0.02*) associated with practice while Perception was significantly associated (P = 0.00*) with Awareness. Age group was significantly (P = 0.01**) associated with awareness of study participants. Specialty and year of practice of dental professional was significantly (P = 0.05*), (P = 0.00***) associated with perception regarding Orthodontic practice and principles. Number of Orthodontic patients treating per months was significantly associated (P = 0.00***) with Practice of study participants of Orthodontic practice and principles. Conclusion: From above it has been concluded that dental specialists has moderate awareness, positive perception and poor practice regarding Orthodontic practice and principles. Age group, type of Specialty, Year of practice and number of Orthodontic cases treated per month significantly associated with awareness, perception, and practice of dental professionals regarding Orthodontic practice and principles.

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Introduction: Acute lymphoblastic leukemia (ALL) is the most common malignancy in children. Anthracyclines are among the most common and effective drugs for the treatment of children ALL. However, long-term consumption and higher doses of these drugs may lead to toxic effects on the heart of children. For this purpose, in the present study, the baseline and posttreatment echocardiography status was evaluated in children with ALL during 7 years. Materials and Methods: This retrospective cross-sectional study was performed on 53 children with ALL who were under the age of 18 years. Different factors including risk groups, age, gender, white blood cells, dosage, and duration of treatment, as well as baseline and posttreatment echocardiography findings including EF, E/E^/, E^//A^/, MVE/A were evaluated in all patients. Results: All enrolled patients had not any abnormalities in the baseline echocardiography preventing the beginning of chemotherapy. The results of this study did not show a significant difference in mean baseline echocardiography parameters after treatment including EF̨E/E/̨E//A/̨, MVE/A. In addition, there was no significant difference in mean EF, E^//A^/̨, MVE/A, and ̨E/E^/before and after treatment among SR, IR, and HR groups. Although there was no significant difference in the mean EF, E^//A^/, and MVE/A before and after treatment between male and female sex, the mean E/E^/after chemotherapy in girls (8.5 ± 0.7) was significantly higher than the mean before treatment (6.85 ± 1.5) (P < 0.001). It was also higher than the mean in boys (7.04 ± 0.99) (P = 0.019). Although there was no significant relationship between the duration of chemotherapy and the mean of EF̨E/E^/̨E^//A^/̨, MVE/A after treatment, high dose of the drug was found to be significantly associated with a gradual decrease of EF or systolic function of the heart (P < 0.001). There was no significant relationship between drug dose and other parameters of echocardiography including E^/A^/, MVE/A, and E/E^/after treatment. Conclusion: It appears that chemotherapy should not be delayed by echocardiography. Based on the findings presented herein, increasing the dose of anthracycline can be considered as an effective factor in reducing the systolic function of the heart (EF reduction). On the other hand, chemotherapy in the period of 1 to 5.3 years does not seem to have a significant effect on the mean parameters of EF, E/E^/, E^//, and MVE/A although another study with higher sample size and follow-up is needed to confirm these results.

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Context: Modern thyroid surgery has undergone a paradigm shift from subtotal thyroidectomy to an extended total thyroidectomy (TT) even for benign disorders. This entails removal of all embryological remnants even in benign disorders. Aims: To study the prevalence of various embryological remnants of the thyroid and surgical utility and implications in preventing complications. Settings and Design: Retrospective study of total thyroidectomies done by a single endocrine surgeon by standardized technique. Methods and Material: A detailed search of all embryological rests including Pyramidal tract (PT), Tubercle of Zuckerkandl (TZ), and Thyro-thymic thyroid rests (TTR) were done in 1118 patients undergoing TT over 6 years. The cases with and without TTR were divided as Group A and B, respectively. Their prevalence and impact on parathyroid preservation and other clinical parameters were analysed. Statistical Analysis Used: Descriptive analyses. Results: Out of the 1118 TT cases, TTR was seen in 230 (20.57%) cases, TZ in 598 (53.48%), cases and PT in 641 (57.33%) cases. Among group-A (n = 230), 213 had unilateral and 17 had bilateral TTR with 51 (22.17%) having retrosternal extension. Compressive symptoms, presence of TZ and PT were also significantly higher in group A. On follow up the incidence of temporary hypoparathyroidism was significantly higher in group-A, where as permanent hypoparathyroidism, temporary and permanent vocal cord palsy were comparable between the two study groups. Conclusions: Embryological remnants related to thyroid are not uncommonly encountered during total thyroidectomy. A thorough search and complete removal is crucial for the successful outcome of the procedure.

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Introduction: The surgical removal of impacted third molars is considered one of the most frequent procedures in oral and maxillofacial surgery. The utilization of drain is suggested for the reduction of postoperative complications, because it permits the drainage of the fluids located in the tissue spaces. Material and Methods: A prospective randomized clinical study was conducted with 30 patients each in two groups undergoing surgical extraction of mandibular third molars with and without drain. For the group with drain, a small no. 8 size rubber drain was used. Patients were evaluated for postoperative pain, swelling, and trismus. Result: The trismus was greater (highly significant with P < 0.001) on the first, third, and seventh postoperative days in the control group. When swelling was being evaluated, highly significant statistical difference was observed between the two groups on the first and third postoperative days (P < 0.001), but on the seventh postoperative day, there was no statistically significance (P > 0.05). On comparison of postoperative pain, there was no statistically significant difference between any follow up days. Conclusion: Use of tube drain is effective in reducing the postoperative discomfort in terms of pain, swelling and trismus after surgical removal of impacted mandibular third molar.

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Context: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are major public health issues as they may progress into chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC). Aims: to identify the prevalence and risk factors of HBV and HCV among diabetic patients in Duhok province. Patients and Methods: It is a prospective study conducted in Shilan private hospital from June 2016 until December 2018. The serum of all diabetic patients was investigated by Enzyme-linked Immunosorbent Assay (ELISA) to detect HBsAg and anti-HCV. Diabetes mellitus (DM) was diagnosed according to American Diabetes Association (ADA). The results were analyzed by entering the data in Statistical Package for the Social Sciences (SPSS). Results: Three hundred seventy five DM patients were included in this study. The mean age of the patients was 54.38 ± 9.23, and the majority was female patients (65.87%). Out of 375 patients, 8 cases (2.13%) were HBV and 2 cases (0.53%) were HCV. Considering risk factors associated with HBV and HCV infections among diabetic patients, alcoholism was associated with both infections. Hemodialysis was a risk factor for HCV infection among diabetic patients but it was not associated with HBV. Conclusions: Although prevalence of HBV and HCV is higher among diabetic patients, its prevalence is low in comparison to other studies. It is recommended to screen HBsAg and anti-HCV in all alcoholic diabetic patients. Hemodialysis remains a significant risk factor for HCV transmission among diabetic patients with end stage renal disease (ESRD).

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Introduction: The study was conducted to assess the impact of oral health status on the oral health-related quality of life (OHRQOL) of children between 12 and 15 years with type-1 diabetes mellitus (IDDM) in Saudi Arabia and compare these findings to age and gender matched medically fit children. Materials and Method: A total of 40 children aged between 12 and 15 years with (IDDM) group presenting to the pediatric endocrinology clinic of the KSMC, Riyadh were age and gender matched to a control group of children reporting for a routine dental checkup at the dental clinics of the REU. The oral health of all children was recorded using WHO examination criteria. Parental perception of the OHRQoL was recorded using the validated Arabic version of the short-form child oral health impact profile—short-form COHIP-19. The independent samples t-test was used to compare the DMFT, Gingival index, and COHIP19 domains of the two groups. Results: Individuals with IDDM had higher Gingival Index and DMFT scores; however, the differences were not statistically significant. The IDDM group showed higher COHIP scores across all domains. However, the differences were only statistically significant for the oral health domain (P = 0.003). Conclusion: Children with IDDM had better oral health both in terms of dental caries and gingival status when compared to their age-matched controls. However, they had significantly higher oral health domains that suggest a poorer overall OHRQoL in children with IDDM.

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Background: Although the psychosocial impact of type-1 diabetes mellitus (T1DM) patients is well recognized, data about its prevalence in India is scant. Hence, this study was undertaken to determine the prevalence and spectrum of psychosocial morbidities among pediatric T1DM patients and factors associated with psychosocial distress. Methods: Among 39 pediatric T1DM patients, a cross-sectional questionnaire-based study was carried out. Psychological distress was measured by applying a childhood psychopathological measurement schedule (CPMS) questionnaire. Psychosocial distress was analyzed across various sociodemographic factors and disease-specific variables by applying the Chi-square test using the statistical package for social sciences (SPSS) version 16. Results: The mean age of the study sample was 11.59 + 2.65 years (range: 6–16 years). Out of a total 39 patients, 21 (53.85%) were found to be psychologically distressed. The mean CPMS score was 12.74 + 9.54. Mean scores among psychologically distressed and nondistressed patient groups were 19.19 + 8.5 and 5.22 + 2.74, respectively. Anxiety, conduct disorder, and depression were the most common problems identified. Psychosocial distress was more prevalent among those who were postpubertal, males, Muslims, residing in rural areas, living in a nuclear family, having no sibling, and from the upper-lower socioeconomic background. Psychosocial distress was significantly associated with an increased number of insulin injections per day (P = 0.041) and dietary and drug regimen noncompliance (P = 0.001). Conclusion: The present study revealed a very high prevalence (53.85%) of psychosocial morbidity among T1DM patients. Psychosocial distress was significantly more among patients taking an increased number of insulin injections per day and patients who were noncompliant with the dietary and drug regimen.

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Background and Aims: Breast and cervical cancers are two of the most common cancer diagnosed and are leading cause of death among females. Mortality and complication rates are higher in countries with lower awareness regarding breast and cervical cancer. The aim of this study is to assess the community inquisitive insight regarding breast and cervical carcinoma after sensitising them with health education. Setting and Design: This is a qualitative research done on adolescent school going girls. The analysis is done using the verbal and written queries during group interaction sessions after the health education regarding breast and cervical cancer was imparted. Results and Conclusion: A community specific health education material regarding breast and cervical cancers should include information regarding normal physiological process like menstruation, available preventive, and screening and management modalities of common cancers, the explanations for myths and redressal of stigma prevailing in the specific community.

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Background: The transfusions in patients with thalassemia are a double-edged sword as the patients develop complications due to inadequate transfusions and due to multiple transfusions. These complications vary from metabolic complications such as diabetes mellitus and clinical complications such as growth retardation, transfusion-transmitted infections (TTI), and iron overload. We selected Balasore district in Odisha which is a satellite center of AIIMS Bhubaneshwar and has a huge population of hemoglobinopathy patients especially thalassemia and this district in Odisha lags in terms of healthcare and health awareness. Materials and Method: In all, 123 patients with thalassemia major were included in this study for the evaluation of metabolic and clinical complications. Anthropometric measurements such as height and weight with age and gender were used for evaluation of growth parameters as per World Health Organization (WHO) reference data. Children were termed wasted and stunted if the values were below 2 standard deviation of the reference WHO median. Blood samples were collected for TTI status and fasting blood sugar levels. Result: A total of 118 (95.9%) were detected to have under nutrition, 73 (59.3%) of the patients were HCV-positive, and 54 (48.6%) had high fasting blood sugar levels. Based on the HCV status, they were classified as HCV-positive and HCV-negative to compare the anthropometric and growth status in these patients. About 98.6% of the HCV-positive cases were undernutrition and 83.6% were stunted. Conclusion: There is an increasing trend of associated metabolic derangements in patients with thalassemia. The district-level health services have an urgent need for improvement in chelation regimes and screening technologies.

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Background: Malalignment in the pelvic and spinal column disturbs the balance and decreases the postural control ability. Malalignment is known as one of the main causes of back pain particularly the nonspecific chronic low back pain (NSCLBP). The aim of the study is to compare the effect of muscle energy technique (MET), craniosacral therapy (CST), and sensorimotor training (SMT) on postural control in patients with NSCLBP. Materials and Methods: In this randomized clinical trial study, 45 NSCLBP patients were accidentally allocated in three groups including CST (n = 15), MET (n = 15), and SMT (n = 15). Clinical interventions including CST, MET, and SMT were performed in 10 sessions in 5 weeks (2 sessions per week). The parameters of center of pressure (COP) were assessed in 8 positions such as standing position on double or single leg with open or closed eyes or half squat position on double or single leg with open or closed eyes. Results: The results of this study showed that all three methods of CST, MET, and SMT are effective in postural control in patients with NSCLBP, although it seems that CST is effective on more balance factors. CST has a greater effect on balance in standing position on a single leg with closed eye. It was also found that the effect of CST was continuous after follow-up. Conclusion: Moreover, MET and SMT methods were effective in balance control in NSCLBP patients and postural control was more affected by CST.

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Background: “Early Childhood Caries”(ECC) is a serious global oral health problem affecting children of 71 months of age or younger. ECC has a multifactorial model of causation and diet imparts an intricately specific effect. Aim: The study aims to determine the protective and harmful role of different dietary consumption in the causation of ECC in South Indian children, assessed by the Healthy Eating Index-2005 (HEI-2005). Settings and Design: A pilot study of cross-sectional analytical study design was conducted in a dental college and hospitals in India. Materials and Methods: Hundred healthy South Indian children of 3–6 years age were screened for dental caries by the ICDAS II criteria, dmf/dmfs and pufa index. Participants were divided into three groups according to their caries status such as [Group 1:caries-free, group 2:ECC, group 3:severe ECC (S-ECC)]. Questionnaires were collected with demographic details, 24 h previous dietary record, and a subsequent 3-day chart of dietary consumption. Accordingly, the HEI-2005 score was calculated for each participant. Descriptive statistics was used for analysis of sociodemographic data, Kruskal–Wallis test for multivariate analysis, and for interpreting the total effect of HEI on study groups, logistic regression analysis was used. Results: Caries experience in South Indian children demonstrated a significant association with age. Caries-free children showed significantly higher association with darkgreen/orange vegetables/legumes, milk, and calories from SoFAAS (solid fat, alcohol, and added sugars) than the other groups. Conclusions: The study findings illustrated a prominent protective role played by specific components of the HEI-2005, as healthy dietary intake against dental caries in South Indian children.

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Introduction: Esophageal varices develop as a consequence of portal hypertension (PHT) in patients with chronic liver disease. Hence, screening of all cirrhotic patients with upper gastrointestinal endoscopy to detect the presence of significant esophageal varices implies a number of unnecessary endoscopies and has its limitation where such facilities are not available, especially in the rural part of country. Method: Patients with either sex, aged between 18 and 60 years with diagnosis of cirrhosis were studied. Detailed history, physical examination along with relevant investigations were recorded and upper gastrointestinal endoscopy was done within 2–3 days of investigation. Esophageal varices were graded as I-IV, using the Paquet grading system and patients were classified dichotomously either as having large esophageal varices (LEV) group A (Grade III-IV) and no varices group B (grade I-II). Result: A total of 50 patients with cirrhosis of liver were recruited in the study. Among hematological markers, only low platelet count was significantly associated with the presence of LEV (P value <0.05). None of the biochemical markers were found to be significantly associated with LEV. All the ultrasonographic parameters, i.e. spleen size, splenic vein size, portal vein size, and the presence of portosystemic collaterals were found to be significantly associated with the presence of LEV (P value <0.05). Conclusion: Though upper gastrointestinal endoscopy remains the gold standard for the diagnosis of esophageal varices in cirrhotic patients,those patients at high risk of having LEV can be screened by using clinical, hematological, biochemical, and radiological markers.

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Background: Easy fatigability is a common presenting complaint in Indian women who visited primary care hospitals. Many medical conditions like cancer, chronic bronchial asthma, prolonged use of glucocorticosteroid, renal disorder, and hypothyroidism have been associated with low levels of vitamin D. Correction of vitamin D level improves the symptom of fatigue. Whether low vitamin D causes fatigue in otherwise healthy women is the subject of research. Aim: This prospective nonrandomized and therapeutic study observed the prevalence of hypovitaminosis D in women with fatigue and the effect of correction of vitamin D level in fatigue-like symptoms. Material and Methods: One thousand two hundred adult women, who presented in our primary care hospital with complaints of easy fatigue, otherwise no associated medical illness were included. They completed the fatigue assessment questionnaire (FAQ). Patients with hypovitaminosis D received cholecalciferol (60000 IU) therapy for 5 weeks. Scores of pre- and post-treatment FAQs were noted and compared. Results: The prevalence of low vitamin D was noted in 84.8% women who presented with main complaints of fatigue. After the correction of vitamin D level, fatigue symptom scores improved significantly (P < 0.001) in 82.6% of the women in all five-subscale categories of the FAQ. Conclusion: We observed a high prevalence of low serum vitamin D level in women who presents with fatigue with no medical illness. A significant improvement was noted in the severity of their fatigue symptoms after the correction of vitamin D levels with cholecalciferol therapy.

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Introduction: Colorectal carcinoma is the most evident carcinoma in the elderly. Despite its high incidence and mortality rate, there is insufficient research about the best treatment options for colorectal carcinoma. Objective: This study was designed to assess the best treatment modality for colorectal carcinoma in elderly Saudi patients. Methods: We conducted a retrospective analysis of medical records at the Princess Norah Oncology Center (PNOC), King Abdulaziz Medical City, Jeddah, Saudi Arabia. We included patients treated at PNOC between 2010 and 2015. Only patients aged above 70 years with advanced colon were included in the study. Results: The cohort included 57 patients with an average age of 76.51 with 27 alive patients and 30 dead patients. Nonmucinous adenocarcinoma had significant higher mortality (n = 20). Most patients received surgical treatment which was associated with less risk for mortality; however, it was nonsignificant. Surgery was followed by first-line treatment which had a mortality rate of 50%. The least treatment associated with mortality was local liver treatment (n = 0). Survival analysis found that only treatment with significant higher survival was shift to next line of treatment (at least once) [HR = 0.06, 95% CI (0.00, 0.79), P value = 0.03]. Other treatments were not associated with significant mortality reduction. First-line treatment was associated with higher mortality risk; nevertheless, it was nonsignificant. Conclusion: Local radiotherapy and local liver ablation had the least mortality rate. However, in multivariate Cox regression analysis, we found that shift to next line of treatment was associated with the significant high survival rate.

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Background: In the normal physiology of the bladder wall, it has sufficient elasticity so that it can maintain normal pressure during filling phase of bladder. Bladder functional pathology can cause many problems for patients. Method: This evaluation is a cross-sectional study conducted on patients suspected of neurogenic bladder. In this study, patient refered for urodynamic testing at first, urodynamic test performed by urologist and then Shear wave elastography was performed by radiologist. Data such as age, sex, height, and weight, and other demographic data were also evaluated. Patients were informed before and after the urodynamic and Shear wave sonography tests. Finally, the data were entered into SPSS software and were statistically analyzed. Results: We observed that the mean and standard deviation of the age was 15.7 ± 6.2 years. Also found that in gender 19 (63.3%) patients were males and 11 (36.7%) were female. On the other hand, in terms of BMI, most patients were normal in this regard (50%), as well as in other cases, including weight loss in 3 (10%) patients, overweight in 8 (26.6%) patients, and obese were in 4 patients (13.3%). in our assessment about the efficacy of the ultrasound elastography approach to the anterior wall, which showed that the specificity of the test in the diagnosis of neurogenic bladder was 83% and this is statistically significant in patients (P < 0.05). We also observed in the posterior wall posture that the specificity of this test was 85% in the diagnosis of neurogenic bladder, which indicates a high diagnostic capability of this test, and this is statistically significant in patients (P < 0.05). Conclusion: Based on the results observed in this evaluation, ultrasound elastography has a high specificity for neurogenic bladder detection in comparison with urodynamic study. Accordingly, due to the less invasive nature of this method than urodynamic study, this method can be used to identify patients with neurogenic bladder.

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Context: Cardiovascular diseases (CVD) are one of the leading causes of premature deaths among noncommunicable disease. Hypertension increases the risk of cardiovascular events. In addition to well-known risk factors for hypertension like obesity, lack of physical activity, studies have shown independent association between tooth loss and increased blood pressure and stroke. However, the relevant literature is not conclusive. Aims: Aim of our study was to investigate the association between tooth loss and increased blood pressure among adult patients. Methods and Material: A cross-sectional study among 270 adults aged 20–59 years was conducted. The dependent variables were systolic blood pressure (SBP) and diastolic blood pressure (DBP). The main exploratory variable was the number of self-reported natural teeth for each dental arch. They were recorded as 10 or more natural teeth, less than 10 natural teeth, and no natural teeth. Data were analyzed using descriptive statistics, independent t-test, ANOVA, and multiple linear regression analysis. Results: Mean SBP was 125.3 mmHg and DBP was 78.9 mmHg. Moreover, 29.3% of participants had hypertension, 8.9% were edentulous, 22.8% had lost more than 10 teeth, and 68.3% had lost less than 10 teeth. Increased SBP was seen with increased tooth loss among participants. After adjusting for all covariates, no significant association between tooth loss and SBP and DBP was seen. Conclusions: The mean SBP was higher among the participants who were edentulous than partially edentulous. However, there was no significant association between tooth loss and SBP and DBP after adjusting for confounding factors.

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Introduction: Liver biopsy is considered as the gold standard for diagnosis of chronic liver disease, yet liver biopsy is an invasive method that may be associated with complications. Therefore, non-invasive methods are needed to diagnose fibrosis. This study was conducted to compare liver stiffness measured by Shear-wave Elastography (SWE) to fibrosis in liver biopsy. Method and Materials: In this prospective study, 176 adult patients with chronic liver disease of different etiologies were included. All patients were evaluated using SWE and a liver biopsy. The diagnostic accuracy of SWE was evaluated using receiver operating characteristics (ROC) plots based on the degree of fibrosis (METAVIR score). SPSS software version 19 was used for statistical analysis and P < 0.05 considered significant. Results: There was a significant correlation between liver stiffness and fibrosis stage (ρ=0.939; P < 0.0001). The ROC curve AUC were 0.871, 0.895 and 0.937 for fibrosis stages F2, F3 and F4 respectively. The cutoff values were 8.6 kPa for F2, 10.7 kPa for F3, and 13.8 kPa for F4, with sensitivity and specificity of 81.76% and 77.01%, 90.20% and 78.40%, 89.53% and 94.38% respectively. Conclusion: The results of this study showed that liver SWE is an effective non-invasive method for assessing liver fibrosis in patients with chronic liver disease of different etiologies.

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Background: Muscle fatigue affects the precision of the subjects' performance and limits the range of physical and sports activities. There is limited scientific evidence to support the use of soft tissue manipulation for enhancing muscle performance and its recovery. The aim of this study is to compare the effects of soft tissue manipulation and rest on the knee extensor muscle fatigue after maximal isokinetic contractions. Methods: Fifteen healthy females 20–30 years of age were selected for this research. This study implemented a semi-experimental test–retest measurement method. The subjects then either rested or received soft tissue manipulation on the knee extensors for a duration of 15 min. After intervention (soft tissue manipulation or rest), the parameters were evaluated for the third time. Results: The stability of the average of peak torque (APT), average power (AP), and visual analog scale (VAS) before performing fatigue protocol was 85%, 83%, and 31.9%, respectively. The stability after fatigue was 43%, 50%, and 93%, respectively. After maximal fatigue and a decrease in torque output to below 50% maximal torque, 15 min of soft tissue manipulation could change the APT after fatigue from a mean of 58.3 (nm) to 91.5 (nm), the AP from 39.4 to 63.6 (nm/s), and the VAS, from 90.0 to 12 (mm). But 15 min of rest could change the APT from 52.5 to 68.1 (nm), the AP from 37.6 to 48 (nm/s), and the VAS from 90.0 to 27.3 (mm). Conclusion: The study showed that soft tissue manipulation was more effective than rest as a strategy to return muscles to a normal state and caused more relief in perceived fatigue.

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Introduction: Hysterectomy as kind of surgery in which the uterus is removed, is carried out in a very high number around the world. Uterus is important because of its impact on feminism and fertility, so the exit of this important organ can lead to many physical and mental disorders. These mental disorders can affect the quality of life of patients and ultimately lead to a reduction in the hope of their lives. Materials and Methods: This study was cross sectional on 50 women under hysterectomy referred to the Semnan Amir-Al-Momenin hospital in 2017, in which patients were evaluated in terms of effective subsets of life expectancy that were determined from the angle of view of miller questionnaire, and finally the data were analyzed by SPSS v. 19. Results: The results showed that there is no significant difference between hope to life before and after hysterectomy in those who underwent hysterectomy. The results of our study showed that age, occupation, and education factors in patients who participated in this study did not have any meaningful relation with life expectancy after hysterectomy surgery and there was also a statistically significant correlation between the scores of hope for life before hysterectomy with the rate of education in individuals. Conclusion: Hysterectomy does not affect the patients' quality of live and don't reduce the hope of living in people who underwent surgery.

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Background: India being major consumer of tobacco faces various problems involved for its cessation. Over the time enormous methods have been evolved which may aid in tobacco cessation. Materials and Methods: The present study was conducted among 100 adult tobacco users attending tobacco cessation clinic. The individuals where randomized into 2 counselling groups: Group A - Basic health education (BHE) and Group B Cognitive Behavioral Therapy (CBT). Baseline evaluation of demographic parameters, smoking/smokeless behavior was recorded and Fagerstrom's test for Nicotine Dependence (FTND) was utilized to assess subjects' nicotine addiction levels. Follow up was done at intervals of 2 weeks and 4 weeks to assess the reduction in the mean FTND score. Appropriate statistical test was utilized to evaluate the results. Results: The majority of individuals in the study were male in age group of 41-60 years. The reduction in mean FTND score was found in both Group A and B on follow-up. But when both groups were compared, reductions in mean Fagerstrom scores were found to be more in CBT group than in BHE group at all time intervals. Conclusion: Individuals in both the group have quit the tobacco use by both the interventions followed by proper schematic follow up.

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Introduction: Hyponatremia, defined as a serum sodium concentration ([Na+]) <135 mEq/L. It is not a disease but rather a pathophysiologic process indicating disturbed water homeostasis. Hyponatremia should be further classified to provide directions for diagnosis and treatment. It is a heterogeneous disorder. The classifications of hyponatremia are commonly based on tonicity and volume status. The initial differentiation in hypotonic and non-hypotonic hyponatremia is important because management is different. Several studies have been conducted previously to measure the incidence of hyponatremia in medically ill patients. Several studies have demonstrated an increased prevalence of hyponatremia in the presence of co-morbid conditions. We conducted this study to bring out various causes of hyponatremia; their relation with sex, age and outcome and hyponatremia's classification and incidence in our hospitalised population. Materials and Methods: This study was conducted to find out etiology, classification, prevalence and outcome and its relation with age and sex in patients of hyponatremia admitted in our institution. A total number of 106 patients were studied. Results: Hospital-based incidence of hyponatremia was found to be 1.17%. Mean age of patients in study was 62.25 ± 17.7 years. Male to female ratio was 1.25:1. Altered sensorium was the most common neurological symptom. Ninety-five (90%) patients were hypo-osmolar. Out of ninety four patients, 38 (40%) were euvolemic. Chronic obstructive pulmonary disorder (COPD) with cor pulmonale with right-sided heart failure (n = 9, 31%) was the most common cause in hyper-volemic hyponatremia. Acute gastroenteritis (n = 13, 48%) was the most common cause in hypo-volemic hyponatremia. Syndrome of inappropriate anti-diuretic hormone secretion (SIADH) was the most common cause (n = 20, 53%) of euvolemic hyponatremia. Out of 106 patients, 11 (10.38%) patients expired. Conclusion: Hyponatremia acts as a poor prognostic marker of the primary disease. It is important to recognise it early because of the potential morbidity and mortality, economic impact on the patients and health care associated with it. Early management of hyponatremia, which includes determination of the rate of correction, the appropriate interventions and the presence of other underlying disorders, may help in improving the outcome and shortening the hospital stay of the patients.

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Aim: The present study was conducted to assess the presence of anemia in patients with advanced heart failure (HF) and compared the clinical characteristics of patients with anemia and without anemia. Methodology: The present study was conducted on 102 patients (60 males, 42 females) with advanced HF admitted in hospital. In all, general physical and clinical examinations were performed. All were subjected to complete blood count (CBC), hematocrit, and assessment of urea, creatinine, sodium, potassium, and brain natriuretic peptide (BNP). The levels of serum iron, ferritin, iron saturation, and iron-binding capacity were also evaluated. The causes of HF were assessed. Results: Mean age was 48.2 ± 5.7 and 42.2 ± 6.2 years in males and females patients, respectively. Left ventricular ejection fraction (LVEF) was 0.26 ± 0.8 in males and 0.24 ± 0.5 in females. 71.5% males and 76.3% females were on inotropic support. The etiology of HF was ischemia in 29% males and 27% females, high blood pressure in 15% males and 12% females, obesity in 18% males and 19% females, valvular heart disease in 7% males and 5% females, diabetes in 11% males and 6% females, and idiopathy in 20% males and 31% females. There was a significant difference in mean age, initial HB, final HB, hypertension, creatinine, BNP, and initial hematocrit level in patients with anemia and without anemia (P < 0.05). Deaths in hospital were also significant (P < 0.05). Conclusion: Anemia was seen in one-third of the patients with HF. Anemia was an independent marker with poor prognosis. Anemic patients were older than non-anemic patients.

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Background: Dietary preferences and childhood eating behavior has marked influence on nutritional status of children. The objective of the study was to find out eating behavior of primary school children in a rural area of West Bengal using Child Eating Behavior Questionnaire and to determine association of body mass index (BMI) with eating behavior. Methodology: It was an institution-based observational study with cross-sectional design done from May to August, 2018. The study was done among 142 children studying at four primary schools at Singur, in the rural field practice area of our institute. The four schools were selected randomly using list of primary schools in the area. Eating behavior of children was assessed using Child Eating Behavior Questionnaire (CEBQ). BMI of the children was assessed using WHO Z scores tables for children. Data analysis was done using SPSS Version 16 and binary logistic regression was done to find out association of BMI with eating behavior of study participants. Results: The proportion of under-nutrition and overnutrition was 22.0% and 16.0%, respectively. Food fussiness was significantly associated with thinness [BMI below (−2SD)]. Enjoyment of food, satiety response was significantly associated with overnutrition [BMI above (+1 SD)]. Food avoidance subscale was significantly associated with thinness [OR: 2.5, CI: 1.11, 5.63] and this subscale was protective for overweight [OR: 0.22, CI: 0.07, 0.69]. Conclusion: This study showed association of BMI with child eating behavior. Therefore, awareness among parents should be created to change problematic eating of their children which would further help them to achieve normal BMI.

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Background: Hepatic encephalopathy (HE) is an established clinical manifestation in chronic liver disease (CLD). It is associated with various factors including gastrointestinal bleed, constipation, and dyselectrolemia. Recently 25-hydroxyvitamin D (25-OHD) deficiency has been identified as one of the factors associated with the development of HE. The current study was aimed to assess the level of 25-OHD in patients with CLD and hepatic encephalopathy and the relationship between 25-OHD deficiency and hepatic encephalopathy. Materials and Methods: This cross-sectional study included 100 subjects of either sex between 18 and 60 years of age, diagnosed as CLD on the basis of ultrasonography with hepatic encephalopathy and 50 age, sex-matched CLD subjects without encephalopathy. Hemogram, hepatic and renal functions, serum electrolytes, coagulation profile, and serum 25-hydroxyvitamin D levels were recorded. Results: The baseline variables were matched for age, sex, hepatic and kidney function, and coagulation profiles. The hemoglobin (P = 0.002) and platelet count (P = 0.0003) were significantly lower in subjects with HE. The mean level of 25-OHD was significantly lower in subjects with HE as compared to the control group (25.62 ± 21.94 nmol/L vs 37.44 ± 18.61 nmol/L, P < 0.001). The mean 25-OHD level was 30.64 ± 21.64 nmol/L in grade 1 HE, 12.03 ± 11.05 nmol/L in grade 3 with P < 0.0001, and 18.8 ± 16.88 nmol/L in grade 4 with P < 0.0001 when compared to grade 1. Moderate and severe deficiency of 25-OHD level was significantly associated with higher grades of HE, i.e. grades 3 and 4 (P < 0.0001). There was a significant negative correlation between 25-OHD levels and worsening grades of hepatic encephalopathy (person's correlation coefficient r = -0.354; P = 0.0003). Conclusion: In this cohort of North Indian population, serum 25-OHD level was significantly lower in patients with CLD and HE. The levels of 25-OHD showed a significant negative correlation with hepatic encephalopathy.

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Aim: The present study was conducted to determine the podoplanin expression in odontogenic tumors and cysts. Materials and Methods: It consisted of 12 cases of the keratocystic odontogenic tumor (KCOT), 10 cases of ameloblastoma, 8 cases of dentigerous cysts (DC), 8 cases of radicular cysts (RC) and 8 dental follicles (DF) as controls which were immunohistochemically evaluated using an antibody against podoplanin. Results: Immunostaining intensity, % of PPC and total score of ameloblastoma was higher than DC and DF but less than KCOT (t- 1.48). When DC was compared with KCOT and RC, the podoplanin expression was significantly higher with DC (P < 0.05). The podoplanin expression was comparatively higher with KCOT as compared to RC and DC. OT (t-4.40) revealed higher podoplanin expression as compared to OC and DF (t-5.54). Conclusion: There was significantly higher expression of podoplanin in cases of ameloblastoma and KCOT as compared to the RC, DC and DF. Podoplanin may be considered as a useful marker to delineate the aggressiveness of ameloblastoma and KCOT.

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Background: With the increasing focus on setting up emergency care centers in railway stations across India by the government, there are no baseline data in India, or the world, about the profile of patients presenting with emergencies on the trains and at the railway stations. Materials and Methods: This retrospective study included all people who presented with any medical emergency to the Emergency Care Center (ECC), Katpadi Railway Station in South India, between January 2017 and December 2017. Details were obtained from the register maintained by the emergency nurses stationed at the ECC. Results: Among 1076 patients who presented to the ECC during the study period, the mean age was 37 years (standard deviation: 19.01) with two-thirds (66.1%) being males. A quarter (23.4%) were trauma-related and 76.6% were medical emergencies. Sharp force injuries [58.8% (151/252)] was the predominant mode of trauma, while laceration [57.1%] (144/252) was the predominant type of injury sustained. Common nontrauma presenting complaints included fever (27.5%), headache (17.9%), nausea/vomiting (17.9%), and abdominal pain (15%). The maximum number of cases was in the summer months of May–June with heat-related symptoms, while the maximum number of fever cases was recorded during the monsoon season. The majority (905/1076; 84.1%) were able to continue their journey further, and 13.9% required referral to a nearby hospital. During the 1-year study period, 2 patients with trauma and 18 with various medical conditions died at the railway station or at a hospital after resuscitation at the ECC. Conclusions: Trauma, fever, headache, and vomiting are the most common emergencies among patients traveling by rail and at the railway stations. Establishing well-equipped ECCs across the country to handle trauma and other medical emergencies during travel is part of primary care provided and is the need of the hour.

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Background: Early initiation of insulin therapy and thereby the better control of blood sugar levels has shown reduction in complications. Although insulin therapy has been demonstrated to be efficacious, its initiation is often delayed due to multiple factors including the refusal of insulin therapy by the patients. This study aims to explore the reasons for the refusal of insulin therapy in a resource-constrained primary care setting in an urban slum in India. Materials and Methods: We included 148 patients who required insulin therapy but refused. A semi-structured questionnaire was administered by a primary care physician. Chi-square test was done to test the association between demographic factors and the reasons for refusal. P < 0.05 was considered as significant. Results: The mean age of the patients was 49.53 (SD+/-9.8) years. Majority (40.5%) of the patients had diabetes for 6-10 years, and most of them were living with their families (89.9%) and 77% of them were dependent on their family for their financial and physical needs. Financial constraint was the most common reason for reason (74.3%) followed by afraid of pain (68.9%) and fear of dependency (57.4). Gender, occupation, and duration of diabetes and witnessing insulin administration were significantly associated with stigma related to insulin therapy. Conclusion: Financial constraint is one of the key factors as patients have to buy insulin out of pocket and are not covered by insurance. Government initiatives to reduce and monitor the cost of the insulin would be of great benefit to the patients in this setting.

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Background: The specialty of obstetrics and gynecology is showing a widening gap between the vacant positions and the number of applicants as reported by the Saudi Commission for Health Specialties (SCFHS). This study was conducted to explore the medical students' views on obstetrics and gynecology as a future career and identify factors influencing these views. Methods: An observational survey was conducted on 148 medical students in years 5 and 6 at Jazan University between June 2019 and July 2019. Participants completed a self-report online questionnaire covering their sociodemographic details, interest in obstetrics and gynecology, and views on the specialty. Results: Overall, obstetrics and gynecology was selected as the first specialty choice by 8.8% and second choice by 17.6%. Intention to take a career in obstetrics and gynecology was associated with female sex (P = 0.01). While over half of the participants emphasized the merits of obstetrics and gynecology as exciting, interesting, and challenging, over 40% viewed the specialty as stressful, over one-third described it as demanding, and over one-quarter appreciated its riskiness. Conclusion: This study showed that 8.8% of the respondents chose obstetrics and gynecology as their first career choice. Sex was the only factor influencing the views of medical students on the specialty, with more females favoring the specialty than males. To improve its appeal, students should be supplied with more information about the specialty and its training opportunities, as well as exposure to areas of special interest.

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Objectives: The aim of this study (1) To evaluate the Saudi public's knowledge and attitude on dental stem cells (DSC) for therapeutic/banking purposes, (2) To evaluate the perception of Saudi dentists towards DSC and their attitude towards banking of DSC. Methodology: This was a cross-sectional study based on an electronic survey distributed through the social media nationwide among the Saudi public, and through paper-based surveys among dentists in Riyadh. By convenience, eligible study participants were Saudi adults from the community and dentists from 17 dental centers in different regions of Riyadh. Using SPSS v. 25, descriptive statistics (n,%; PMS ± SD) and bivariate analyses (Pearson's Chi square, Mann Whitney) were conducted to determine factors associated with the study outcomes, with a P value statistically significant at <0.05. Results: For the Saudi public, 1494 participants completed the survey. The PMS ± SD of public knowledge was 25.5 ± 25.9, while their attitude was 80.2 ± 27.0. Factors associated with higher knowledge scores were younger age groups, while female participants, older age groups, university educated and employed participants had higher attitude. For Saudi dentists, 246/262 (94%) dentists responded to the questionnaire. Their PMS ± SD of perception towards DSC research for regenerative purposes was 74.5 ± 15.6. Factors associated with higher perception scores were those with more experience. Dentists who had higher perception scores towards DSCs were significantly more willing to save teeth for regenerative dental treatment. Conclusion: The Saudi public community had poor knowledge about the therapeutic and research benefits of DSC, yet high degree of attitude to enroll in a future Saudi DSC bank. Saudi dentists had moderately high levels of perception towards DSC research.

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Background: Revitalizing the primary health care (PHC) centers has been at the top of the priority list of the Lagos State Government. Achieving this goal should restore the confidence of the people in and increase their utilization of PHC centers in their communities. At the forefront of the provision of comprehensive, continuous and coordinated care for individuals within the context of the family and community are family physicians (FPs), who are equally saddled with the task of clinical governance by virtue of their strategic position in the health system. It became expedient to expand human resource capacity building as a primary care quality improvement initiative of the state through the introduction of a post-graduate training program in family medicine at its biggest multi-specialist secondary health care facility. Objectives: To identify the strengths and weaknesses of the primary care system at the new training center and also, to compare the strengths and the weaknesses of the primary care system between the new training facility and the tertiary facility. Methods: Cross-sectional study design was employed to survey the perspective of the FPs and FPs -in-training at the new training facility and tertiary health facility about the primary care system in their facilities through self-administration of the Primary Care Assessment Tool-primary care practitioner (provider) survey. Results: A total of 33 FPs and FPs-in-training participated in the survey. They were on full-time employment and had spent an average of 51 and 66 months in service at the new family medicine training facility and the tertiary facility, respectively. They perceived that patients' waiting time at their facilities doubled (1 h 47 min at the new training center) and tripled (2 h 23 min) their expectations of a reasonable time to wait respectively. The weakest primary care quality dimensions were the same in both centers and the scores were closely comparable between the new and the old as follows: Coordination (43.8%; 52.9%), community orientation (44.1%; 63.2%), ongoing care (61.9%; 61.3%), and access (63.1%; 65.1%). However, the tertiary center had higher scores in all dimensions except ongoing care and the differences in scores between the new and the old were statistically significant in three dimensions namely: Comprehensiveness (P = 0.038), community orientation (P = 0.049), and cultural competence (P = 0.035). Conclusion: The new training facility may leverage the experience of the old in the dimensions where the latter has demonstrated statistically significant differences in strengths (cultural competence, comprehensiveness, and community orientation). Health administrators/policymakers should consider doctors' feedback as a necessity for planning and implementing changes to continuously improve the quality of the primary care system at these training facilities.

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Background and Aims: Little is known about the prevalence of osteoporotic fracture, its sociodemographic correlates, and its comorbid conditions among the adult population of the Kingdome of Saudi Arabia (KSA). Hence, the present work aimed to assess the prevalence of adults at high risk of osteoporotic fracture in the presence of its known risk factors. As well, to determine the most commonly associated comorbidities of osteoporosis in Saudi Arabia. Methods: A cross-sectional study was performed among 518 Saudi adults aged over 45 years in Al-Ahsaa city, KSA. The Arabic version of the fracture risk assessment FRAX without bone mineral density (BMD) was presented in an online questionnaire. Results: The 10-year risk for major osteoporotic fracture was found in 50.81% of the participants; 23.48% of them were at high risk and 25.71% at moderate risk. Also, 26.27% of the respondents were at high risk of hip fracture. Significant correlates of osteoporotic fractures included female gender (P = 0.003), old age (P = 0.000), age at menopause (P = 0.000), low body mass index (BMI; P = 0.000), previous fracture (P = 0.000), alcohol consumption (P = 0.000), positive family history (P = 0.000), corticosteroids (P = 0.000), rheumatoid arthritis (P = 0.000), thyroid hyperactivity (P = 0.000), gonadal insufficiency (P = 0.000), chronic liver disease (P = 0.000), nutritional, or gestational disease (P = 0.000). Conclusion: More than a third of the surveyed population had osteoporosis, which was associated with many sociodemographic and clinical characteristics. Therefore, early interventions for osteoporosis and the prevention of other comorbidities may improve the outcome of osteoporosis.

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Introduction: Anaemia is a major health problem in India especially among pregnant women and nutritional anaemia, primarily iron deficiency, is the most common type of anaemia caused primarily due to iron deficiency. About 58% of pregnant women in India are anaemic and it is estimated that anaemia is the underlying cause of 20–40% of cases of maternal deaths. Therefore, the present study was planned to study the prevalence of anaemia among pregnant women and to explore the relationship between anaemia during pregnancy and different dietary factors. Aim and Objective: To study the prevalence of anaemia and dietary habits among pregnant women in an urban slum of Haryana. Materials and Methods: A cross-sectional study was carried out among pregnant women in the urban field practise area of Pt. B.D. Sharma PGIMS, Rohtak. All Pregnant women registered in 2018 were interviewed using a semi-structured pretested questionnaire. Observations were interpreted as per the WHO criteria. The data were analysed by SPSS statistical software version 20. Results: Out of 408 study participants, 348 (85.3%) were anaemic with mild, moderate and severe anaemia in 80 (19.6%), 244 (59.8%) and 24 (5.9%), respectively. More than half (50.5%), of the anaemic mothers, were found in the first trimester, respectively. The association of vegetarian diet and tea consumption was statistically significant with the severity of anaemia. (P < 0.05). Conclusion: The present findings showed a high prevalence of anaemia and unhealthy dietary habits significantly associated with it among pregnant women. Efforts to identify anaemia that may be responsive to modifiable factors such as diet to improve health outcomes are needed.

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Background and Aims: Water Sanitation and Hygiene (WASH) within the context of Sustainable Development Goal (SDG) is well debated; however, WASH in health care sector is still in nascent phase, especially for maternity units. Although there are studies on WASH in maternity units, least are focused towards the microbiological safety. The objective of present study is to compare the visual assessment with microbiological assessment of selected maternity units of Gujarat (India) and to document microbiological contamination and drug resistance. Methods: A cross-sectional study was carried out in 10 selected maternity units of Sabarkantha and Gandhinagar district of Gujarat, India, during Feb-March 2018. Two steps of Tool Box Plus were used for documentation: visual and microbiological assessment. Antimicrobial Resistance (AMR) patterns amongst positive microorganisms were also documented. Results: Although the majority of the studied maternity units were visually clean, the microbiological findings contraindicated the same. The overall visual score across all facilities was close to 50% indicating good visual cleanliness. Out of 195 samples collected, 18% (35) samples were positive for pathogenic organisms and the majority were identified from mops and labour table. 1/3^rd of organisms were resistant to > 5 antibiotics. Pathogenic organism identified includes Acitenobacter, Klebsilla, MR CONS, E coli, Psudomonas Aeruginosa and Pseudomonas species. Conclusions: Visual assessment alone which is currently used for assessment of hygiene is not a proxy for safety. It should be validated by the microbiological method. Microbiology surveillance should be explored to get valuable insights on the effectiveness of cleaning practices of the maternity units.

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Intimate partner violence (IPV) is a sensitive, growing, and preventable health issue that affects many people around the world with significant physical and psychological impacts. Factors associated with an increased risk of perpetrating violence include low education, child maltreatment and exposure to violence in the family, attitudes accepting of violence, and gender inequality. However, encounters between victims exposed to IPV and healthcare providers are often not satisfactory, and therefore, several barriers preventing healthcare providers from responding to IPV have been documented. More efforts are needed at different levels to implement preventive measures and to improve the detection and management of IPV victims, especially at front-line health settings like family practices and emergency care services. Several interventions have been suggested to improve the healthcare responses to IPV, including developing protocols, training of health professionals to raise the awareness of providers, transferring know-how, and convincing them to respond to IPV.

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The partial-thickness rotator cuff tears (PTRCTs) are known as a prevalent pathology, which cause inability mostly in athletes. So far, a number of treatments have been suggested depending on patient characteristics and size and location of the tears. Surgical repair in rotator cuff tears that include 50% or more of the tendon thickness is the accepted practice in the following failure of nonoperative treatment. In the surgical procedure, acromioplasty is known as a long-established component and used to modify the detrimental acromion morphology, which accounts for rotator cuff tearing. A range of trials has been reported that compare the results of surgical procedure with and without acromioplasty in patients undergoing rotator cuff repairs. According to the findings of 15 studies including ~1,500 patients, with mean age 60 years (range 5–80 years) and mean follow-up of 22 months (range 13–26 months) found by searching on Cochrane Register of Controlled Trials databases, Excerpta Medica/Embase, and Medline/PubMed, we revealed that acromioplasty cannot present an impressive effect on patient outcome scores at intermediate and short-term follow-ups. In fact, despite the theoretic advantages of acromioplasty in the setting of PTRCTs, it has reported little or no efficacy on outcomes of postoperative patients.

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Nikolsky's sign has been a very useful diagnostic tool in cases of skin disorders like pemphigus, toxic epidermal necrolysis, etc., The sign is demonstrated when lateral pressure is applied on the border of an intact blister, which results in the dislodgment of the normal epidermis and extension of the blister.

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Hepatitis caused by Hepatitis C virus (HCV) is a major cause of chronic liver disease. HCV is transmitted by injection drug use, blood transfusion, hemodialysis, organ transplantation and less frequently sexual intercourse. It has been recognized as a global health problem because of the progression to cirrhosis and hepatocellular carcinoma. Globally, about 170 million people are infected with HCV. Since the discovery of this virus in 1989, the clinical management of chronic hepatitis C infection has undergone a paradigm shift from alpha interferon to direct-acting antiviral (DAA) therapy. However, resistance to many of these antiviral agents has been reported increasingly from all over the globe. This review article focuses on the emerging HCV resistance to DAAs and the relevance of in vitro DAA resistance testing in clinical practice.

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