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To the Editor: Cholangiocarcinoma (CCA) is a rare malignancy of the biliary tract, comprising 3% of all gastrointestinal cancers.1 Typically diagnosed in the seventh decade of life, it seldom occurs in the pediatric age group, making cases in pediatric patients notable.2 CCA in children and adolescents is frequently associated with underlying risk factors. In contrast, only 30% of adults exhibit them.3 We report the youngest presentation of a sporadic case of CCA in a 5-year-old boy with an unremarkable medical history. A 5-year-old boy presented with a 15-day history of progressive abdominal distension and vomiting. Notably, there was no weight loss, fever, or jaundice. Clinical examination revealed a distended abdomen with dilated veins and marked hepatosplenomegaly. Laboratory findings included a hemoglobin of 12.5 g/dL (13-18 g/dl), a white blood cell count of 14,810/μL (4000-11500/uL), and a platelet count of 341,000/μL (331000/uL). The biochemical profile revealed a total serum bilirubin level of 0.6 mg/dL (0.2-1.2 mg/dL), serum aspartate aminotransferase of 37 U/L (up to 35 U/L), serum alanine transaminase of 11 U/L (up to 55 U/L), albumin of 3 g/dl (3.5-5.2 g/dL), and an INR of 1.1. Tests for human immunodeficiency virus, hepatitis B surface antigen, and hepatitis C virus were negative. The abdominal and pelvic contrast-enhanced computed tomography revealed an enlarged liver with multiple scattered, well-defined hypodense lesions, the largest in segment VI of 3.3x3.0cm. The spleen was enlarged, without focal lesions. Multiple paraaortic and mesenteric lymph nodes were enlarged, and the abdomen had moderate free fluid. Serum carbohydrate antigen 19-9 (CA 19-9) was l136 U/mL (RR: 0-37 IU/mL), and alpha-fetoprotein was 2.19 IU/mL (RR: 0-8 IU/mL). An ultrasound-guided liver biopsy revealed a neoplasm characterized by tumor cells with eosinophilic cytoplasm, vesicular nuclear chromatin, and prominent nucleoli arranged in a glandular pattern, cords, and nests. Immunohistochemistry (IHC) results were strongly positive for CK7 and CK19 and negative for CK20, SALL4, AFP, Glypican 3, HepPar1, Arginase1, and β-catenin, suggesting CCA (Figure 1). Figure 1Photomicrographs of the liver biopsy. A – Microscopy displaying a neoplasm composed of tumor cells arranged in a glandular pattern, cords, and nests (H&E, 10X); B – positive, diffuse, and strong cytoplasmic reaction for CK19 (10X); C – negative reaction for CK 20 (10X); D – negative reaction for HepPar1(10X).: Fluorodeoxyglucose positron emission tomography (FDG-PET) indicated liver enlargement with FDG avid multiple hypodense lesions but no distant metastasis. Pediatric surgery consultation was sought, but due to the poor general condition of the patient and multifocal lesions in the liver, it was deemed inoperable. The child underwent systemic chemotherapy with gemcitabine and cisplatin. After two cycles, the patient developed massive pleural effusion, ascites, and respiratory failure. Repeat FDG PET indicated progressive disease, and the patient continued on supportive measures but ultimately succumbed to the illness. Parents were counselled to an autopsy to search for any underlying hepatic disease but were not willing to do the same. CCA is an extremely rare malignancy in children, with an incidence of 0.0036/100,000, compared to that of 1.67/100,000 in the adult population.4 It is a bile duct malignancy and is divided into three subtypes depending on their anatomical site of origin: intrahepatic (iCCA), perihilar (pCCA), and distal CCA (dCCA). The most characteristic and common presentation of extrahepatic cholangiocarcinoma (eCCA) is jaundice and is seen only in 10-15% of cases of iCCA. iCCA is located in the liver parenchyma proximal to the second-degree bile ducts and generally presents with nonspecific symptoms like abdominal pain, nausea, weight loss, malaise, and night sweats. Diagnosis is often delayed in such cases. It also has a propensity for liver metastasis. Surgical resection with negative tumor margins is achieved only in 45% of the patients.5 Several risk factors have been linked to CCA like congenital biliary dilatation, choledochal cyst, choledocholithiasis, Caroli disease, primary sclerosing cholangitis (PSC), progressive familial intrahepatic cholestasis (PFIC), viral infections (Hepatitis B virus and hepatitis C virus), Inflammatory bowel disease, and Opisthorchis viverrine and Clonorchis sinensis infection.6-8 Most pediatric and adolescent cases have underlying risk factors for CCA, while only 30% have an underlying risk factor in adults. An extensive search revealed only three cases reported in English literature of pediatric cholangiocarcinoma presenting in the first decade of life. All cases had underlying risk factors; PFIC in 2 and 1 had congenital biliary dilatation. The presenting complaints were fever, pruritis, abdominal pain, and vomiting, and none of them had features of biliary obstruction. Two of them were diagnosed with iCCA and succumbed to their illness within 5 months of diagnosis. One had eCCA who underwent surgical resection and is alive post-year after surgery.6,8 To the best of our knowledge, our case represents the youngest presentation of sporadic CCA (Table 1). Table 1 Summary of patients with pediatric cholangiocarcinoma presenting in the first decade of life described in the literature: Ref. Age (years)/ Sex Comorbidities Presenting symptoms Tumor markers Site Treatment Status/ Follow up Scheimann et al.8 4/F PFIC Fever CA 19-9 132 IU/mL ICCA Chemo Death within 5 months from diagnosis Giant cell hepatitis Biliary cirrhosis AFP-61.5 IU/mL Scheimann et al.8 7/F PFIC Pruritis Not available ICCA None Death within 4 months from diagnosis Giant cell hepatitis Biliary cirrhosis Saikusa et al.6 3/M Congenital biliary dilatation with pancreaticobiliary maljunction Abdominal pain Not available ECCA Resection Alive/ 1 year Index case 5/M No comorbidities Abdominal distension CA 19-9- 136 IU/mL ICCA Chemo Death within 2 months from diagnosis AFP (–) 2.19IU/mL AFP: Alpha-fetoprotein. CA: Carbohydrate antigen; Chemo: chemotherapy; ECCA: Extrahepatic cholangiocarcinoma; ICCA: Intrahepatic cholangiocarcinoma; PFIC: Progressive familial intrahepatic cholestasis. Morphologically, CCA can be tubular/acinar adenocarcinoma with well, moderate, or poor differentiation and show immunopositivity for CK7, CK19, and EMA. Metastatic colorectal adenocarcinoma, upper gastrointestinal tract cancers, and metastatic pancreaticobiliary adenocarcinoma are close differentials and can be differentiated based on CK20 and a comprehensive IHC panel including MUC2, MUC5AC, CA19-9, mCEA, CA125, SMAD4, respectively.9 The prognosis for children and adolescents with CCA is unfavorable. Surgery is a potentially curative option; however, most patients have metastatic or locally advanced disease at presentation, and only 25% are eligible for resection. Robust data supports the use of first-line cisplatin and gemcitabine chemotherapy in adults with advanced disease.10 Survival is related to the extent of disease spread; thus, early diagnosis of CCA is essential for positive outcomes.

In this study, for the very first time developing of n- and p-type 3-D single-channel (SC) FinFET and gate-all-around (GAA) Multi-Bridge-Channel FETs (MBCFET) like nanowire FET (NWFET) and nanosheet FET (NSFET) are benchmarked towards device and circuit levels which are emulated with International Road map for Devices and Systems (IRDS) for sub-5-nm technology nodes. Compared to the FinFET, the MBCFETs exhibits higher ON-current ( $I_{\mathrm {ON}})$ , switching ratio ( $I_{\mathrm {ON}}/I_{\mathrm {OFF}})$ , lower subthreshold-swing (SS) and drain-induced barrier lowering (DIBL). Except for extended parasitic capacitances ( $C_{\mathrm {para}})$ , our benchmarking results show that the NWFET and NSFET achieve the high-performance (HP) and low-power (LP) goals of IRDS. Furthermore, the NSFET delivers superior performance towards DC and analog/RF metrics. The cut-off frequency ( $f_{\mathrm {T}})$ and gain bandwidth product (GBW) are higher (because of high $I_{\mathrm {ON}})$ in the case of NSFET, even though the capacitive effect is significant. Further, the logic circuit applications like CMOS inverter and ring oscillator (RO) circuits are analyzed and compared in detail. The CMOS inverters propagation delays ( $\tau _{\mathrm {p}})$ is reduced to 31% from FinFET to NWFET and 12% from NWFET to NSFETs is noticed. Also, the NWFET and NSFET based ROs offer 39% and 56% high oscillation frequency ( $f_{\mathrm {osc}})$ compared to that of FinFET counterpart. Finally, the single stage current mirror performance and operational transconductance amplifiers (OTA) gain and common mode rejection ratio (CMRR) are carried out towards analog and mixed-mode circuit applications.

Aim: This study aims to evaluate the GP dissolving property of ethanolic extract of sweet lime peel (Citrus limetta), peppermint oil, cedarwood oil, and an emulsion (equal volumes of ethanolic extract of sweet lime peel, peppermint, and cedarwood oils) compared to xylene and chloroform (CHCl3). Methods: Equal weight of GP were divided into 7 groups and immersed for 5 min and 10 min in the test and control groups. Distilled water was used as a negative control. Absolute weight loss (WL) was calculated. Results: Data were analyzed using Kruskal–Wallis test followed by Dunn's pairwise comparison with a significance value of P ≤ 0.05. The median WL of GP in the solvents shows a significant difference at 5 min (P = 0.001) and 10 min (P = 0.000). After 5 min, the order of WL was highest in sweet lime peel extract, CHCl3, and emulsion followed by xylene and peppermint oil. After 10 min, the highest WL was seen in emulsion, CHCl3 followed by sweet lime peel and peppermint oil. Cedarwood oil had no GP solvent effect at both time intervals. Conclusion: Sweet lime peel extract, emulsion, and peppermint oil showed a significant GP dissolving effect at 5 and 10 min and were comparable to CHCl3. Cedarwood oil showed no GP dissolving effect.

Background: A strong correlation exists between infertility, psychological stress, and quality of life (QoL) among women, and hence, emphasis must be made on improving the psychological context and incorporating psychological counseling as a part of infertility evaluation and management. The Perceived Stress Scale (PSS) and Modified FertiQoL tools are used to measure the stress perceived by an individual and to assess the impact of fertility problems on the QoL of women, respectively. Objectives: The objective was to assess the psychological stress and QoL among the infertile women using the Perceived Stress Scale (PSS) and Modified FertiQoL (Core) instruments, respectively, to find the correlation between psychological stress and QoL among the study participants and to find the experiences of women who received prior infertility treatment. Materials and Methods: A mixed methodology study was conducted by the Department of Obstetrics and Gynecology, Radiodiagnosis and Psychiatry on infertile women attending ESIC Medical College, Hyderabad, Telangana, between December 2020 and August 2021. A total of 274 participants who met the inclusion criteria were enrolled for the quantitative study and 10 participants for the qualitative study. Descriptive statistics (frequency, mean, and standard deviation), comparisons (Student's t-test), and correlations (Pearson: r-value) were used for quantitative data analysis and thematic content analysis for the qualitative data. Results: The mean age of the participants was 29.17 years (range 22–39 years) with a mean duration of infertility of 6.17 years. The results showed that the mean Perceived Stress Scale (PSS) score among the participants was higher (21.07 ± 4.350) with the low mean Core FertiQoL scores (49.20 ± 7.232). It was also found that there was a significant negative correlation between PSS and total Core FertiQoL scores. The study showed a significant negative correlation between the PSS scores and total FertiQoL, emotional, and mind–body subscales (P < 0.01 significant). It was found that there was a significant negative correlation between PSS scores and subscales of total FertiQoL, in women aged >30 years and those with a duration of infertility of >5 years. Content analysis of in-depth interviews with the women treated for infertility revealed the difficulties the women faced while seeking treatment. Conclusion: The study showed that infertility-related stress was affecting the QoL of women. Based on the recommendations, a holistic approach to the management of infertile women was made, and counseling sessions, yoga, and meditation were started for infertile women.

Background: Langerhans cell histiocytosis is an uncommon proliferative histiocytic disorder which can affect any organ. It is common in children and can rarely occur in adults. In the central nervous system, the hypothalamic-pituitary axis is most commonly involved. Brain parenchyma is rarely affected. Case summary: We report a case of a 13-year-old male who presented with chief complaints of headache and swelling over the right frontal region. On imageology, a clinical diagnosis of meningioma was considered. The tumor was excised and on histopathological examination diagnosis of Langerhans cell histiocytosis was considered Conclusion: Intracranial Langerhans cell histiocytosis is a rare condition which can mimic primary neoplasms of the central nervous system such as glioma, meningioma and metastatic deposits on imageology. Histopathology is the gold standard for diagnosis.

Aim: Thyme has got good anti-inflammatory, antimicrobial, and antifungal properties and is reported to be very effective against oral microflora. The aim of the present study was to compare the antimicrobial activity of zinc oxide and thyme oil to zinc oxide and eugenol. Methods: Anti-bacterial efficacy of zinc oxide + eugenol and zinc oxide + thyme oil paste was evaluated against mature Enterococcus faecalis (E. faecalis) dentinal biofilm evaluated by the zone of inhibition (ZOI), biofilm disruption evaluated by colony-forming unit (CFU) reduction, and confocal laser scanning microscopy (CLSM). The red and green fluorescence thresholds were manually set according to their respective intensity and kept consistent for each sample. The ratios of live/dead cells were automatically calculated by the software. Results: The results of the present study showed that there was a statistically significant difference in antimicrobial efficacy for thyme oil compared to eugenol as evaluated by ZOI (P = 0.032). Thyme oil was significantly better than eugenol in antimicrobial efficacy according to the percentage of CFU reduction (P = 0.0422) in E. faecalis biofilm. Based on CLSM evaluation, there was no statistically significant difference (P = 0.172) between the two groups. Conclusion: Zinc oxide + Thyme oil paste, used in this study has shown promising antibacterial activity against E. faecalis and hence can be used as an alternative sealer.

Background: COVID-19 pandemic has affected mankind globally. After the three waves since March 2020, the threat continues instilling fear in the minds. Vital parameter monitoring through remote health monitoring system (RHMS) becomes critical for effective disease management and manpower safety and confidence. In a low resource setting like India, a comprehensive, wearable, and remotely operable device that is economical was required to be introduced for COVID-19 care. Present study validated the remote health monitoring device named COVIDBEEP with gold standard equipment. Materials and Methods: Six parameters, namely heart rate, SpO2, respiratory rate, temperature, blood pressure, and ECG were acquired in the supine position using the devices. Result: Analysis was performed using Graph Pad Prism. Intraclass correlation coefficients were used to measure concurrent validity. Bland–Altman graphs were plotted to know the agreement for each vital parameter. Confidence limits were set at 95%. All the parameters recorded from the devices showed a significant correlation with an “r” value between 0.5 and 0.9 with P value between 0.001 and 0.0002. Bland–Altman plots showed a minimum bias of 0.033 for heart rate and maximum of 3.5 for systolic blood pressure and respiratory rate. Conclusion: The association between the parameters recorded by the devices strengthened as the time of collection of data increased. Agreement between the two methods in 95% confidence interval was also proven to be significant for the parameters. Therefore, the indigenously developed COVIDBEEP has shown good validity in comparison to standard monitoring device.

In this article, the performance of 3-D nanosheet FET (NS-FET) in inversion (INV) and junctionless (JL) modes is demonstrated and compared at both device and circuit levels. In JL mode, the ON current ( $I_{\mathrm {ON}}$ ) rises with an increase in temperature compared to the downfall trend in INV mode. In addition, compared to JL mode, the INV mode exhibits a better negative temperature coefficient of threshold voltage ( $\text{d}V_{\mathrm {th}}$ /dT). Further, the mixed mode circuit simulations are carried out using the Cadence Virtuoso platform through the Verilog-A model. From the analysis, it is observed that an increase of 20% gain in INV mode compared to JL mode for a common source (CS) amplifier. The JL mode NS-FETs achieve higher CMOS inverter switching current ( $I_{SC}$ ) and lower energy-delay products (EDP) as temperature rises. A three-stage ring oscillator (RO) is designed, and the oscillation frequencies ( $f_{\mathrm {OSC}}$ ) of 43.39 GHz and 38.8 GHz are obtained with INV and JL modes. Although JL NS-FET offers less intrinsic capacitances, the $f_{\mathrm {OSC}}$ is high for INV mode due to higher $I_{\mathrm {ON}}$ . Furthermore, reducing supply voltage ( $V_{\mathrm {DD}}$ ), the $f_{\mathrm {OSC}}$ falls by 67% with INV and 62.6% with JL modes. These results will give a better understanding of this emerging NS-FET at both device and circuit levels at advanced technology nodes.

Aim: The purpose of this survey is to gain insight into the choice of endodontic posts and failure mode of different types of posts and their management by the dentist. Material and Methods: Dentists have a wide range of options for the use of endodontic posts, so they should know the preferred post, the failure mode for a different type of post, and its management in case of failure, so questionnaire was prepared based on this. Survey was done among general dentists, endodontists and prosthodontists, through Google Sheets, SurveyMonkey, and manually. 230 dentists (156-general; 45-endodontists; 29-Prosthodontists) participated in this survey. Results: FRC post is preferred post in anteriors among general dentists, endodontists and prosthodontists. The most preferred post in posteriors among endodontists is FRC(49%), prosthodontists is cast post, among general dentists it is cast post and metal posts(36% each). Selection criteria among all the groups are requirement for esthetic crown. Managing endodontic failure among 54% of general dentists, 56% of endodontists and 66% of prosthodontists is post retrieval using ultrasonics followed by retreatment. Fracture of teeth is the predominant reason among all the groups for failure of post retained crown. The management of FRC post failure among endodontists and prosthodontists were ultrasonic retrieval. Commonest failure for FRC post among general dentists and endodontists is post dislodgement wheras among prosthodontists is tooth fracture. Conclusion: Prosthetic rehabilitation of root canal-treated teeth is the ultimate goal of endodontics. Correct knowledge ensures the right attitude in selecting the best post for core retention in endodontically treated teeth.

The high incidences of COVID-19 cases are believed to be associated with high transmissibility rates, which emphasizes the need for the discovery of evidence-based antiviral therapies for curing the disease. The rationale of repurposing existing classes of antiviral small molecule therapeutics against SARS-CoV-2 infection has been expected to accelerate the tedious and expensive drug development process. While Remdesivir has been recently approved to be the first treatment option for specific groups of COVID-19 patients, combinatory therapy with potential antiviral drugs may be necessary to enhance the efficacy in different populations. Hence, a comprehensive list of investigational antimicrobial drug compounds such as Favipiravir, Fidaxomicin, Galidesivir, GC376, Ribavirin, Rifabutin, and Umifenovir were computationally evaluated in this study. We performed in silico docking and molecular dynamics simulation on the selected small molecules against RNA-dependent RNA polymerase, which is one of the key target proteins of SARS-CoV-2, using AutoDock and GROMACS. Interestingly, our results revealed that the macrocyclic antibiotic, Fidaxomicin, possesses the highest binding affinity with the lowest energy value of −8.97 kcal/mol binding to the same active sites of RdRp. GC376, Rifabutin, Umifenovir and Remdesivir were identified as the next best compounds. Therefore, the above-mentioned compounds could be considered good leads for further preclinical and clinical experimentations as potentially efficient antiviral inhibitors for combination therapies against SARS-CoV-2.

Abstract Background Repeated attacks of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have been attributed to bacterial infections. However, sputum microbiology for identifying the bacteriological profile is not performed usually and remains controversial. Thus, we performed a prospective, cross-sectional study to assess the clinico-bacteriological profile of the patients with AECOPD and antibiotic resistance pattern of bacteria isolated from sputum samples. The study involved 104 consecutive hospitalized patients, of either gender, aged 40–90 years, and diagnosed with AECOPD. Before initiating an empirical antibiotic therapy, the sputum samples of all the patients were collected and subjected to Gram staining, bacterial culture, and antibiotic sensitivity. Results The most common bacterial isolates were P. aeruginosa (30.7%) followed by K. pneumoniae (20.3%) and S. pneumoniae (8.6%). Both Gram-positive and Gram-negative bacteria were most sensitive to Meropenem (91%) followed by Amoxicillin-clavulanic acid (83%). However, these bacteria were most resistant to Cefoperazone-sulbactam (43%) followed by Levofloxacin (41%). P. aeruginosa and K. pneumoniae were most resistant to Cefoperazone-sulbactam (23%) followed by Fluoroquinolones (23–35%), while S. pneumoniae was most resistant to Ciprofloxacin (44%) followed by Amoxicillin-clavulanic acid (33%). Conclusions Isolation of P. aeruginosa, as the most common agent, further confirms its roles in severe attacks of AECOPD. The regularly used antibiotics were found to be resistant to most isolates, thereby suggesting that severity of AECOPD may be attributed to the prevalence of antibiotic-resistant strains.

Introduction: Among the endocrine disorders, thyroid disorders are the most common. Long term and excessive intake of fluoride plays a significant role in the development of thyroid disorders. Nalgonda is one of the highly drought-prone districts in Southern India and its groundwater has 10 to 15 parts per million (ppm) of fluoride in contrast to a maximum permitted level of just 1.5 ppm. The entire Nalgonda division is under the threat of fluorosis due to high concentration of fluoride in the drinking water. Aim: To assess the prevalence of thyroid disorders in and around areas of Nalgonda district, Telangana, India. Materials and Methods: A cross-sectional study was conducted in Department of Biochemistry, Government Medical College, Nalgonda, Telangana, India, from December 2021 to May 2022. Total 391 subjects attending Outpatient Department (OPD) of General Medicine, Nalgonda were included in the study. Samples were analysed for thyroid function tests (total T3,T4, thyroid stimulating hormone) by chemiluminiscence immuno assay method in an Abbott architect ci4100 automated analyser. Statistical analysis was done by using Microsoft Excel spreadsheets and results were expressed as prevalence percentages, mean±Standard Deviation (SD). Results: In the present study, the mean age was 39.5±20.506 years. Out of the total participants, 273 (69.8%) subjects were found to be euthyroid and 118 (30.2%) had thyroid disorders. Among 30.2% subjects with thyroid disorders, 32 (8.2%) were hypothyroid, 19 (4.9%) were hyperthyroid, 54 (13.8%) were having subclinical hypothyroidism, 13 (3.3%) were having subclinical hyperthyroidism. The prevalence of thyroid disorders was higher in females compared with males, with the ratio of 3:1 and females contributing to major disease burden. Conclusion: According to this study, prevalence of thyroid disorders was 30.2% with more disease burden in females. Subclinical hypothyroidism contributes to the major disease burden.

Abstract Background Heavy menstrual bleeding (HMB) is a common clinical finding in patients with uterine leiomyomas that can negatively impact their quality of life. Recently, a novel oral GnRH-antagonist (elagolix) has emerged as a possible therapeutic agent for this ailment. Herein data was pooled from clinical trials assessing the safety and efficacy of elagolix with and without add-back therapy. Main text PubMed and Cochrane library were systematically searched for RCTs that measured the efficacy and safety of elagolix for the treatment of uterine fibroid-associated HMB. All safety and efficacy endpoints were compared between elagolix-alone, elagolix w/add-back therapy, and placebo. The primary efficacy endpoint was defined as the number of women who achieved menstrual blood loss (MBL) < 80 ml and a reduction in MBL from baseline of > 50% at the end of treatment. Secondary outcomes assessed included change in hemoglobin levels, incidence suppression of bleeding and amenorrhea, and the incidence of adverse events. The random effects model was used to pool data, and heterogeneity was assessed using I2. Our search identified 4 clinical trials meeting our PICO criteria, with a total of 916 patients. Analysis of the primary outcome revealed that elagolix-alone was the most effective treatment compared to both placebo (LOR = 3.47, CI = 3.03–3.91, p = 0.000, I2 = 0.0%) and add-back therapy (LOR = 0.64, CI = 0.12–1.16, p = 0.016, I2 = 43.1%). Furthermore, both elagolix groups (irrespective of add-back therapy) observed a significant improvement in post-treatment hemoglobin levels as compared to the placebo group (elagolix-alone vs PBO: LOR = 1.44, CI = 0.66–2.22, I2 = 66.0%, p = 0.000; elagolix-w/add-back therapy vs PBO: LOR = 1.22, CI = 0.78–1.66, I2 = 0.0%, p = 0.000). Concerning safety, while elagolix without add-back therapy had the highest overall incidence of adverse effects (elagolix-alone vs placebo LOR = 0.84, CI = 0.48–1.20, I2 = 7.8%, p = 0.000; elagolix-alone vs elagolix-w/add-back LOR = 0.68, CI = 0.09–1.26, p = 0.024, I2 = 64.6%), the incidence of serious (life threatening) adverse events between all 3 treatment groups was not statistically different. The inclusion of add-back therapy with elagolix made the treatment noticeably safer (elagolix-w/add-back vs placebo: LOR = 0.19, CI = − 0.10 to 0.48, I2 = 0.0%, p = 0.194) without seriously compromising its efficacy. Conclusion High-quality evidence from 4 trials suggests that elagolix is an effective treatment for leiomyoma-associated HMB, with a marked improvement in all efficacy endpoints. Furthermore, the inclusion of add-back therapy in the treatment regimen should be considered as it mitigates the hypoestrogenic effects of elagolix.

Purpose: The aim of this study was to measure the implantable collamer lens (ICL) vault changes with anterior segment optical coherence tomography (AS-OCT) after the implantation of the Visian posterior chamber phakic ICL with a central hole (V4c) in relation to the pupil size. Methods: This retrospective observational pilot study included 32 eyes of 16 patients, who underwent V4c ICL implantation. ICL vault was measured with AS-OCT in undilated and fully dilate state of the pupil. Primary outcome measure was the change in the vault of V4c ICL at the maximum and minimum pupil size. Results: Median (IQR) undilated and post-dilated vault measurement was 393.00 (335.50–493.50) microns and 421.00 (338.50–503.75) microns, respectively, which was not statistically significant (P = 0.44). Conclusion: No statistically significant difference was observed between the undilated and post-dilated ICL vault measurements. Hence, the postoperative vault can be measured either in resting, undilated state or fully dilated state of the pupil and would be similar irrespective of the pupil size.

Introduction: Ovarian malignancy is the sixth most common cancer in women and the seventh most common cause of cancer death. Intraoperative frozen section evaluation plays a critical role in guiding the type and extent of surgery. The overall accuracy of the intraoperative frozen section diagnosis for ovarian tumours was reported to be ranging from 85% to 95%. Aim: To determine frozen section accuracy in the diagnosis of ovarian neoplasms. Materials and Methods: The present study was a retrospective study taken up in the Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, from January 2011 to December 2018 during which all the ovarian masses which were sent for frozen section and later for regular Histopathological Examination (HPE) were included in the study. All the slides of these cases were reviewed by two senior pathologists in a double blind study. The frozen section and the permanent section reports of each patient were compared. The overall accuracy, sensitivity, specificity, positive and negative predictive values of the frozen section diagnoses were studied for benign, borderline and malignant cases by using 2×2 tables. The final histopathological diagnosis was considered as gold standard. Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) software version 22.0 for windows. Results: The study included 289 cases and the overall accuracy of frozen section was 87.89%. Thirty five cases were incorrectly diagnosed, of which 24 cases were underdiagnosed and 11 were overdiagnosed. With respect to malignant potential, the sensitivity for malignant tumours was 81.4% with specificity of 96.8%. For benign tumours, the sensitivity and specificity were 93% and 91.4%, respectively. Borderline tumours had the lowest sensitivity of 68.7% with specificity of 91.8%. Conclusion: Gross examination is to be done carefully for tumour tissue selection for frozen section diagnosis intraoperatively. The results help to decide the type and extent of surgical management.

Naturally available plant growth-promoting rhizobacteria (PGPR) have 1-aminocyclopropane-1-carboxylic acid (ACC) deaminase enzymes, and are capable of processing the plant-borne ACC by converting it into α-ketobutyrate and ammonia. Thus, the PGPRs help in the depletion of ethylene levels, and enhance abiotic stress tolerance in plants. In the present study, two rhizobacterial strains, i.e., Bacillus cereus and B. haynesii, isolated from Vigna mungo and Phaseolus vulgaris, were used. These strains were taxonomically identified by 16S rDNA sequencing as B. cereus and B. haynesii, with NCBI accession numbers LC514122 and LC 514123, respectively. The phylogeny of these strains has also been worked out based on homology, with data available on NCBI GenBank. The strains were screened for their plant growth-promoting traits, and quantified in the same way. The enzymatic activity and molecular weight of the ACC deaminase obtained from both bacterial strains have also been determined. An in vitro drought tolerance study was done by using PEG 6000. These bacterial strains exhibited higher ACC deaminase activity (~5 to 6 µmol/mL), exopolysaccharide yield (15 to 18 mg/10 mL protein), and indole acetic acid (27–32 µg/mL). These characteristics indicate that the bacterial strains under present study may be helpful in enhancing the drought tolerance of the crops with enhanced yield. Bacillus cereus has been found to be a tolerant strain to As, Ba, and Ni, based on the plate assay method, and so it has the potential to be used as biofertilizer in fields affected by these metals.

Purpose: To compare the visual outcome, safety, safety index, efficacy, efficacy index and corneal transparency between single-step transepithelial photorefractive keratectomy (t-PRK) and conventional photorefractive keratectomy (PRK) with manual debridement of epithelium in eyes with low to high simple myopia and compound myopic astigmatism. Methods: In this retrospective ,case control study, we analysed and compared the postoperative uncorrected visual acuity(UCVA), postoperative best corrected visual acuity (BCVA) , safety, safety index,efficacy,efficacy index and the corneal transparency between t-PRK and PRK with 6th-generation Amaris excimer 500E laser (Schwind eye-tech-solutions) in 115 eyes of 59 patients. Results: Preoperative Mean Refractive Spherical Equivalent (MRSE) was - 3.88 + 0.23 Diopters(D) and -4.73 + 0.23D in PRK and t-PRK group respectively(p=0.09). In both the groups , none of the eyes lost postoperative BCVA at the end of mean follow-up period of 3.5 months . All the eyes achieved post operative UCVA of 20/40 or better in both the groups. Incidence of trace corneal haze was high in t-PRK group at the end of 3.5 months (P = 0.003). Conclusion: Single-step t-PRK and PRK provide similar results at the end of mean follow-up period of 3.5 months postoperatively with regards to post-operative UCVA, post operative BCVA, safety, safety index, efficacy and efficacy index. There was high incidence of trace haze in t- PRK eyes. Both the procedures are predictable, effective, and safe for correction of low to high myopia.

Introduction: High prevalence of chronic kidney disease (CKD) not associated with known risk factors has been reported from coastal districts of Andhra Pradesh. The Study to Test and Operationalize Preventive Approaches for Chronic Kidney Disease of Undetermined Etiology in Andhra Pradesh (STOP CKDu AP) aims to ascertain the burden (prevalence and incidence) of CKD, the risk factor profile, and the community perceptions about the disease in the Uddanam area of Andhra Pradesh. Methods: Study participants will be sampled from the Uddanam area using multistage cluster random sampling. Information will be collected on the demographic profile, occupational history, and presence of conventional as well as nonconventional risk factors. Glomerular filtration rate (GFR) will be estimated using the Chronic Kidney Disease Epidemiology Collaboration equation, and proteinuria will be measured. All abnormal values will be confirmed by repeat testing after 3 months. Cases of CKD not associated with identified etiologies will be identified. Biospecimens will be stored to explore future hypotheses. The entire cohort will be followed up every 6 months to determine the incidence of CKD and to identify risk factors for decline in kidney function. Qualitative studies will be performed to understand the community perceptions and expectations with respect to the interventions. Implications: CKD is an important public health challenge in low- and middle-income countries. This study will establish the prevalence and determine the incidence of CKD not associated with known risk factors in a reported high-burden region, and will provide insights to help design targeted health systems responses. The findings will contribute to the policy development to tackle CKD in the region and will permit international comparisons with other regions with similar high prevalence. Keywords: chronic kidney disease, CKD of uncertain etiology, risk factors

BACKGROUND: Non-motor symptoms (NMSs) were a real burden in Parkinson’s disease (PD) and contributed to severe disability, impaired quality of life (QoL), and shortened life expectancy. AIM: The aim of this study was to investigate the prevalence of NMSs in PD and their correlation of NMS with disease duration, severity, and Unified Parkinson′s Disease Rating Scale (UPDRS) motor score and their impact on patient’s QoL. MATERIALS AND METHODS: This was a prospective cross-sectional study. Sixty-four patients who were diagnosed by United Kingdom Parkinson′s Disease Brain Bank criteria were studied. Non-motor symptom scale (NMSS) analyzed NMS, and motor dysfunction was assessed by the UPDRS II and III during OFF condition and QoL by Parkinson’s Disease Questionnaire-39 (PDQ-39) questionnaire. RESULTS: The prevalence of NMS was 93.75% (n = 60). Most frequent NMS was difficulty in falling asleep (54.7%), urinary urgency (39%), and memory impairment (37.5%). Most disabling symptoms are difficulty in falling asleep (3.34 ± 4.1) and fatigue (2.48 ± 4.2). The total NMSS scores were correlated with Hoehn and Yahr stage, and Movement Disorder Society UPDRS and PDQ-39 scores, but not with duration of disease. Correlation between NMSS and PDQ-39 scores was stronger as compared to the relationship between UPDRS and PDQ-39 scores (r = 0.71 and 0.58, respectively, P = 0.00). CONCLUSION: This study showed the high prevalence of NMSs and value of NMS as predictors of QoL in patients with PD. Therefore, understanding the pathophysiology of these NMSs should be placed at the forefront to develop new therapeutic approaches by improving the QoL of patients with PD.

Calcifying odontogenic cysts (COCs) represent a heterogeneous group of lesions that exhibits a variety of clinical, behavioral, and histological features. COC or Gorlin's cyst is now classified by the World Health Organization as a tumor. Calcifying cystic odontogenic tumor (CCOT) is an uncommon developmental odontogenic lesion that demonstrates histopathologic diversity. Odontogenic tumors such as ameloblastoma have been reported to be associated with CCOT. In this paper, we report a case of ameloblastomatous CCOT in a 16-year-old girl with involvement of mandibular posterior region, which is an extremely rare histologic variant.

Objective: The aim of this study is to evaluate the correlation between dry eye and pterygium. Materials and Methods: A total of 50 patients, aged between 26 and 70 years, were included in this study. Tear film breakup time (TF-BUT) and Schirmer's test (ST) results were compared in pterygium eye and contralateral normal eye of the same patient. TF-BUT and ST results were compared in pterygium eye and contralateral normal eye for different sizes. The paired t-test was used for the analysis. The Pearson correlation was used to assess the correlations of tear BUT and ST with pterygium size. Results: The mean horizontal size of pterygium ± standard deviation (SD) was 2.35 ± 0.54 mm. The mean ± SD of TF-BUT in pterygium eyes was 7.1 ± 2.34 s compared with 9.18 ± 3.21 s in contralateral normal eyes (P < 0.05). The mean ± SDs of ST results in pterygium eyes and the opposite normal eyes were 8.96 ± 2.66 and 10.94 ± 3.88 mm, respectively (P < 0.05). On analysis, the overall difference in the mean TF-BUT between the pterygium eyes, and the contralateral control eyes was significant (P < 0.01). The difference in the ST between the pterygium eyes and the contralateral eyes was not significant for size < 1 (P = 0.17) and 1-2 (P = 0.4) but was highly significant for size

External ophthalmomyiasis is a relatively rare condition caused by infestation of ocular tissue by the larva of Oestrus ovis (sheep botfly) which is a parasite of sheep and goats. We present a case of ophthalmomyiasis caused by O. ovis, from Western India. The patient presented with left eye acute conjunctivitis associated with conjunctival chemosis and watering. The larvae of O. ovis were seen in the bulbar and palpebral conjunctiva. Prompt removal of the larvae was done from the conjunctiva which helped in relieving the symptoms. It is important for ophthalmologists to be aware of ophthalmomyiasis, as this is often misdiagnosed as acute conjunctivitis.

Aim: The aim of this study was to analyze the endothelial cell count and morphology of the endothelial cell of donor corneas using Eye Bank Specular Microscope (EBSM). Materials and Methods: Eye bank data of 100 donor corneas procured and processed between January 2016 and December 2017, at an eye bank associated with a medical college hospital were retrospectively analyzed. Endothelial cell density (ECD), coefficient of variance (CV), and percentage age of hexagonality (6A) of donor cornea were compared across different age groups, gender, and phakic status of the donor tissue. Results: The mean age of the donors was 63.53 ± 19.92 (range 15–92 years). The mean ECD of the donor cornea was 2708.93 ± 271.52 cells/mm2; the average CV was 28.37 ± 6.3; and the average percentages of hexagonal cells were 63.85%. The cell count was significantly greater in the age group of

Aim: The aim of the study is to compare silk sutures and n-butyl-2-cyanoacrylate tissue adhesive in intraoral wound closure and contrast the effects through the assessment of time taken to close the wound, time taken for securing hemostasis, postoperative pain, swelling, bleeding, incidence of postoperative wound infection, and wound dehiscence. Materials and Methods: This study included a total of 20 patients of both genders who required alveoloplasty either bilateral in the same arch or in the upper and lower arches. In the selected patients, the surgical sites were randomly divided into two treatment groups. In group I, surgical wounds closed with n-butyl-2-cyanoacrylate tissue adhesive and silk sutures were used for group II wound closure and the parameters were assessed. Results: Clinically and statistically, there was significant improvement in cyanoacrylate-treated wounds. The time taken for wound closure with n-butyl-2-cyanoacrylate was lesser. Early hemostasis was achieved with n-butyl-2-cyanoacrylate. The postoperative pain, swelling, and bleeding were less with n-butyl-2-cyanoacrylate. Higher incidence of wound infection and wound dehiscence were observed in wounds treated with silk sutures. Conclusion: Cyanoacrylate causes less tissue reaction and achieves immediate hemostasis. The procedure is relatively painless and quicker. There are benefits of protection from wound infection and wound dehiscence. So it may be concluded that n-butyl-2-cyanoacrylate can be used for intraoral wound closure effectively.

Background: Formalin has long been the standard fixative and xylene has been the clearing agent for routine histopathology and immunohistochemistry worldwide. In recent years, as a result of increasing concerns about the potential carcinogenicity of formaldehyde and xylene, attempts have been made to find safer alternatives. In the present study, we considered honey as better alternative for formalin and olive oil as safer substitute for xylene. Aims: The aim of this study was to know whether honey could be a possible substitute for formalin and olive oil could be a possible substitute for xylene. Materials and Methods: Thirty routine biopsy tissues of 1–2 cm were taken. The study group was divided into Group A and Group B. Group A were subjected to normal processing. Group B were fixed into honey for 24 h after which it was taken through routine processing, and then immersed in olive oil instead of xylene. All the sections will be stained with routine hematoxylin and eosin staining. Compare the sections of both the methods. Results and Conclusion: The preservation of tissue by honey giving superior result when compared to that of formalin. Olive oil was found to be effective clearing agent compared to xylene.

Endothelial cell loss after penetrating keratoplasty leads to graft failure. The critical limit of the endothelial cell count for corneal decompensation is thought to be 700 cells/mm2. Clinical specular microscopy indicates that inspite of low endothelial cell density, the corneal graft can be maintained in a relatively dehydrated state. This study reports 4 cases of clear corneal graft having low endothelial cell count. The low endothelial cell count was associated with polymegathism and pleomorphism; inspite of this, the clarity of the graft was maintained.

Aim: To carry out a prospective study to analyze the incidence and risk factors for secondary glaucoma after penetrating keratoplasty (PK). Materials and Methods: Three hundred and eleven consecutive penetrating keratoplasties that were performed between January 1, 2006, and December 31, 2008, with a follow-up of 12 months were prospectively analyzed to determine the factors associated with postoperative glaucoma. Results: Of 311 eyes, secondary glaucoma developed in 57 cases. This yields an incidence of 18.3%. In conditions, such as aphakic bullous keratopathy, the incidence of post-PK glaucoma was 3.0%; in pseudophakic bullous keratopathy 14.0%, and in cases of failed graft 16.0%, while in cases of corneal ulcer and corneal opacity it was 49.0% and 18.0%, respectively. Conclusion: We conclude in our study that the incidence of glaucoma developing post-PK was highest in phakic eyes, which may be due to the formation of posterior synechiae and development of intumescent cataract. Higher incidence of glaucoma developing in infective cases could be due to recipient hot eye and the high incidence in cases of large graft could be attributed to the formation of peripheral anterior synechiae.

Background: The role played by cytology in primary diagnosis is undeniable. With improved management protocols and targeted therapy, the need for accurate diagnosis has become mandatory. Immunochemistry and molecular techniques are increasingly being used on limited tissue samples. Aims: This study was conducted to find out the impact of immunocytochemistry (ICC) on cytology material in cytology practice. Materials and Methods: Immunochemistry was done on alcohol-fixed smears and cell-block preparations. It was done with i6000 BioGenex autostainer using BioGenex reagents. Results: A total of 148 cases occurring over a period of 3 years (September 2010-June 2013) were analyzed. Staining was done on cytology smears in 77 cases and on cell-block sections in 71 cases. ICC helped in diagnosis in 8 cases, confirmed the diagnosis in 26 cases, helped in subtyping in 60 cases, and helped in prognostication in 6 cases. ICC has altered the diagnosis in two cases. It was noncontributory in 43 cases, and the material was inadequate in three cases. Conclusion: In 102 cases (69%), ICC proved to be a useful adjunct in the diagnosis and prognostication; hence, its use is recommended in practice to aid in cytology services.

Aim: We aimed to analyze the early predictors to differentiate primary from secondary dengue infection and the severity of liver involvement with reference to mortality. Materials and Methods: This prospective study was conducted on 200 children having acute febrile illness between 3 months to 15 years age group. One hundred and five serologically confirmed dengue patients were included in the study and classified into primary and secondary dengue infection. Liver function tests (LFTs) and electrolytes were analyzed, and the hepatic dysfunction was correlated to the severity of the disease. Results: Of the 105 serologically confirmed dengue, 62 (59%) were primary and 43 (41%) were secondary dengue infection. Primary dengue infection was more common in

Context: Emergency contraception (EC) is use of drug or device to prevent pregnancy after unprotected sexual intercourse. Unlike other regular methods of contraception which are taken prior to the sexual act, EC is used after the unprotected sex. Aim: To assess the knowledge and attitude toward use of emergency contraceptives among medical students. Setting and Design: A cross-sectional questionnaire based study was conducted among all the medical students in the Government Medical College in North-West India. Subjects and Methods: A questionnaire seeking information on knowledge and attitude of undergraduate medical students was administered over a period of 4 weeks in the month of February and March 2014. Statistical Analysis: The data were entered in MS excel and expressed using percentages. Chi-square test was used as a test of statistical significance. Results: About 61.6% (247/401) of the participants were aware about the timing of use of EC. Audio visual media (76.6%; 307/401) was the most common source of information for of these medical students. Conclusions: The lack of appropriate in-depth knowledge of EC among future health care professional should alarm the medical teaching system as EC is the only method that can be used to prevent pregnancy after unprotected sex or contraceptive accident.

Objectives: To evaluate the effect of concentration and influence of reservoirs on the gingival mucosa of patients submitted to at-home bleaching with 10% and 35% carbamide peroxide (cp). Materials and Methods: A total of 20 patients were submitted to home bleaching with a 10% cp gel for 2 h/day for 3 weeks and 35% cp gel for 30 min/day for 3 weeks (n = 10). The custom-made mouth trays were made with a reservoir on only the left side and cut anatomically 1 mm beyond the gingival margin. Smears of the gingival mucosa were obtained by the exfoliation cytology in liquid media technique before (control), immediately after, and 30 and 45 days after the treatment. The samples were processed in the laboratory and evaluated for inflammation. Statistical analysis was carried out by McNemar test, two proportions test, independent paired t-test, and Wilcoxon test with a level of significance of 1%. Results: The presence of a reservoir in the custom tray resulted in an increase of inflammation immediately after the bleaching procedure. No significant differences were found in the degree of inflammation between the two groups at different period of observations. (P > 0.01). Conclusion: Ten percent and 35% cp bleaching gel caused gingival inflammation immediately after the procedure and persisted until 45 days after the bleaching treatment. The use of a reservoir in the custom tray for home bleaching resulted in higher rates and higher intensity of gingival inflammation.

Aim : The aim of this study was to evaluate & compare the shear bond strength of different restorative composite resins and glass ionomer cement over white mineral trioxide aggregate. Method: Forty specimens of White MTA were condensed into cavities prepared in acrylic blocks and divided into four groups (ten each). In group one, Adper single bond (two-step ′total- etch adhesive′) bonding agent and Z250 composite, in group two Xeno V one component self-etching adhesive bonding agent and CeramX Mono composite, in group three Vertise Flow flowable composite and in group four Glass ionomer cement were placed over White MTA. The shear bond strength was measured in the universal testing machine and the results were analyzed by one-way analysis of variance test. Results: Adper single bond 2 and Z250 composite had statistically significant (p

Trichomoniasis is the most common non-viral sexually transmitted disease (STD) globally and yet is not a reportable disease. Trichomonas vaginalis is an important source of reproductive morbidity and may increase risk of acquisition and transmission of human immunodeficiency viruses (HIV). The World Health Organization (WHO) and the Control Disease Center (CDC) recommend various regimens of nitroimidazole s for treatment. The common nitroimidazoles used for trichomoniasis are metronidazole and tinidazole, which vary in their cost, efficacy, and side effect profile. It is relevant to study these factors for better management of the patients. This study aimed to compare and study the efficacy, compliance of various treatment regimens, their outcomes, and side-effects for trichomoniasis, among STI clinic attendees in Trinidad. A clinical trial study was designed, and after obtaining the informed consent, a routine clinical examination was conducted and the swabs for trichomoniasis tests were collected for diagnosis from the 692 participants. Out of 692 participants, 82 patients with positive diagnosis of Trichomonas infection were treated according to the patient’s choice, using different drug regimens. Compliance to treatment, side effects, and outcome were evaluated. The prevalence of trichomoniasis in the population attending our STI clinic is 11.9% and prevalence of HIV is 9%. Of the total 82 participants for the treatment, 80% were females; nearly 90% of the patients belonged to age group 15−45 years, and over 60% were below 30 years. Among those diagnosed for Trichomonas vaginalis, 14.6% had coexistent HIV infection. The compliance with respect to single dose treatment was significantly better than the long-duration oral regimen and has a significant relation with side effects of the treatment. The outcome is generally better and comparable and shows no significant difference between different treatment regimens used in the study. Metronidazole and tinidazole are commonly used drugs in various regimens. Compliance is better with those treated with tinidazole and metronidazole single dose than with other groups. Outcome is comparable between these regimens, especially when combined with other important factors like abstinence and treatment of the partners. The treatment regimens mainly differed in the compliance side effects profile and duration of therapy, which suggests that to improve the compliance of the drugs with fewer side effects, short course regimen would be a preferred choice.

Introduction: Febrile convulsions are defined as seizures in children between 6 months to 5 years of age, accompanied with fever, but without evidence of underlying CNS infection. The incidence is about 2-5% in the population. The exact pathogenesis is unknown involving various factors. Febrile seizures may be caused due to significant oxidative stress, and along with oxidant status changes. This results in cell damage subsequent to febrile seizures.The high rate of oxidative metabolism, coupled with the low antioxidant defense, makes the brain highly vulnerable to free radical damage. Aim: This study was done to evaluate the oxidative stress and antioxidant status in healthy children and children with febrile seizures. Materials and Methods: The children were divided into two groups – 1. Children without febrile seizures 2. Children with febrile seizures. Malondialdehyde and vitamin C levels were assessed in both groups (30 in each group). Result: Malondialdehyde was significantly increased (p < 0.01) in children with febrile seizures compared to the other group and Vitamin C was significantly decreased (p < 0.001) in febrile seizures children compared to the other children group. Conclusion: The antioxidants have the ability to reduce the febrile seizure manifestations and thus the accompanying biochemical changes like the markers of oxidative stress. This makes the antioxidants (vitamin C) role possible in controlling febrile seizure.

Mucoepidermoid Carcinoma (MEC) is one of the most commonly occurring malignant salivary gland neoplasm, and contributes 2.8%– 15% of all salivary gland tumours. More than half of these cases involve the major salivary glands, primarily the parotid glands and minor salivary glands. Sublingual salivary glands neoplasms are very rare and constitute 0.5% and 1% of all epithelial salivary tumours and approximately 1.5% of the major salivary glands carcinomas. Here we describe a case report of low grade mucoepidermoid carcinoma in the floor of the mouth in a 70-year-old female patient that was mimicking like a ranula clinically.

Aim: The aim of the study is to evaluate effectiveness of various sensory input methods in dental health education among blind children. Oral hygiene status was assessed through visible plaque index and oral hygiene knowledge was assessed through questionnaire before and after oral health education. Materials and Methods: The study involved of 200 blind children with the age range of 8 to 14 years of both genders from two blind schools similar in standard of teaching. The total study population (n=200) was randomized and divided into five Groups, comprising of 40 children in each Group. The first four were the experimental Groups who received dental health education through different modes, while the fifth Group served as control. Oral health related knowledge and plaque scores were assessed in all the study Groups before and after dental health education. Results: After intervention, the mean knowledge scores and plaque scores were statistically significant in all the study Groups when compared to the baseline scores. Conclusion: The present study proved that blind children can maintain an acceptable level of oral hygiene when taught with special customized methods like multisensory approach with creative use of other senses which was found to be effective than unisensory method.

Background: Langerhans cells (LCs) are immunocompetent cells resident within oral mucosa which, together with intraepithelial lymphocytes, play a role in mucosal defence. LCs play a role in the pathogenesis of Oral lichen planus (OLP), a chronic mucocutaneous disorder thought to result from cell-mediated immune damage. In oral squamous cell carcinoma (OSCC), LCs are thought to present tumour antigens to the lymphocytes. Aim: To assess and compare LCs immuno-histochemically in normal mucosa, oral lichen planus and oral squamous cell carcinoma using anti S100 antibody and to know whether LCs play any role in local immune response to these diseases. Materials and Methods: The study was carried out in 65 cases (study group), 30 oral lichen planus and 35 oral squamous cell carcinoma (15 well differentiated, 14 moderately differentiated and 6 poorly differentiated), that were randomly selected from the archives of department of oral pathology and along with control group consisting of 30 normal healthy mucosa. The tissue sections were stained immunohisto-chemically by using anti S100 antibody in each group for detection of LCs. Results: There was significant change in mean value of number of LCs in the study groups i.e. OLP and OSCC when compared to that of control group. The results of our study also revealed that there was decrease in the mean value of langerhans cells as the tumour progressed from well differentiated squamous cell carcinoma to poorly differentiated LCs carcinoma. Conclusion: A better understanding and clarity of LCs is pivotal for designing novel or improved therapeutic approaches that will allow proper functioning of LC’s in patients with OLP and OSCC, thus significantly reducing the morbidity of OLP and OSCC patients.

Test anxiety is a typical experience in classrooms, changing the performance of students from school for college, as a whole being adults who must take job-related exams. Test anxiety can also move termed as anticipatory anxiety, examination anxiety that occurs in a situation like facing the exam. Indeed, there is a stirred upstate in physiological level causing over-arousal, tension and somatic symptoms and psychological level causing poor attention, deterioration in perception and thought fluency this can lead to worry, dread, fear of failure, and catastrophic experiences before or during test situations among the students. In this context, the research attempted to study the present problem, i.e., Text Anxiety about Academic Achievement of Kasturba Gandhi Balika Vidyalaya (KGBV) students. For the study, the researcher identified 100 students studying (8th and 9th standard) in KGBV schools of Kuppam and Gudipalle Mondal of Chittor district of Andhra Pradesh.