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Background: Metaverse, the disruptive digital technology, has demonstrated significant effectiveness in the fields of preventive and cognitive therapy, diagnostics, surgical interventions and rehabilitation. Virtual Reality (VR), a part of Metaverse, integrates imaging data and input from users and deliver a 3D graphical output which can be visualised through a wearable headset. Augmented reality (AR) on the other hand, can control the presence of the user in the real world. Methodology: A review was undertaken of peer-reviewed literature on the emerging evidence on the applications of AR and VR in healthcare. Research studies carried out to identify effectiveness of AR and VR technologies were included. Result: AR & VR have been effective in rehabilitation of patients of Autism Spectrum Disorders and Mild Cognitive Impairment by improving motor skills, social skills and various cognitive indices like task learning and attention. In the surgical field, AR head mounted device (HMD) can provide three-dimensional, patient specific anatomic information during surgery. It minimises surgical complications and improves patient satisfaction. AR is of particular interest in complicated spinal surgeries and orthopaedic manoeuvres which require high level of surgical skill. AR has also been used successfully in different types of robotic surgeries as well. In several countries AR technology have been used in basic medical and advanced surgical training. Major challenges in implementing AR and VR in the field of health care persist in the domains of cyber security, ethical issues and cost effectiveness. Conclusion: VR and AR technology can maximise patient outcomes and rapidly develop satisfactory patient management in fields of cognitive research and surgical interventions. More clinical trials with immersive digital technologies are required. Ethical and cyber security challenges are present but there are ways to overcome them. It is our duty as physicians to participate in the development of these innovations to ensure virtual health reality benefits for our patients in real-world setting.

Envenomation from snakebites (SBs) is a significant public health hazard globally. The venomous SB is associated with moderate-to-severe pain. Weak opioids such as tramadol or acetaminophen are commonly used for pain management but often provide inadequate analgesia. We hereby report our experience of using ultrasound-guided selective superficial peroneal, sural, and saphenous nerve blocks for pain management following SBs in nine patients. The selective peripheral nerve blocks are achieved with a small amount of local anesthesia and without loss of motor functions.

This study is the first study to incorporate a novel approach to single-implant-retained mandibular overdenture with a bar attachment on a single implant in the symphysis region. The use of a single-implant-retained bar overdenture significantly improved patients' chewing efficiency, indicating enhanced overdenture retention and stability. Materials and Methods: Ten maxillary and mandibular completely edentulous patients were enrolled in the study. A complete denture was fabricated for them. On completion, bite force, retention force, and bone change were recorded. Bite force was recorded with the strain gauge, retention force with the force measurement gauge, and bone changes with radiographs. Conclusion: Single-implant-supported bar mandibular overdenture (SISBOD) can be a suitable standard economic option for edentulous mandible and can greatly improve the quality of life of patients.

Background: Despite a huge number of advancements in the medical field, periodontitis still remains one of the most prevalent oral diseases worldwide. Aim: Thus, the primary aim of our study was to evaluate the prevalence of periodontal diseases in patients reporting to the tertiary healthcare setup in Ranchi. Materials and Methods: Based on inclusion criteria, subjects aged 18–60 years were selected and a per forma was filled by the observer. The prevalence of periodontal disease was measured using the community periodontal index, simplified oral hygiene index, and stage of periodontitis. Results: Descriptive variables were assessed using frequency, percentage, mean, and standard deviations, while the categorical analysis was performed using the Chi-square tests. Conclusion: General awareness about periodontal health and regular dental visits should be given utmost importance among the rural populations of every developing country.

Background: Persons with intellectual and developmental disabilities (IDD) suffer from stark, well-documented health and healthcare disparities, despite data indicating that the majority see a healthcare provider at least annually. Multiple surveys have indicated that over 90% of physicians feel they have inadequate knowledge and skill in caring for those with IDD. This has been recognized as a key barrier to health equity. Objective: To evaluate the content of high-impact clinical literature for a potential cause of clinician knowledge deficits. Methods: We performed a bibliometric analysis of publications within major, high-impact general, and specialty clinical journals from 1946 to 2020 to determine the relative frequency of publications regarding IDD and publication rate. Results: We observed a significant decline in articles regarding IDD over the past 20 years within high-impact general medical journals, and a significant decline over the past 15 years within high-impact, specialty society-published journals of Psychiatry, Psychology, and Neurology. Furthermore, we observed that high-impact general medical journals devoted a significantly smaller proportion of publication space to articles regarding IDD than they did for conditions with similar prevalence such as HIV/AIDS, breast cancer, and drug abuse. Conclusion: The declining rate and low frequency of clinical publications regarding IDD within the major, respected clinical literature may be contributing to physicians’ ability to source evidence-based information, thereby impacting perceptions of skill and knowledge deficits, and therefore may be contributing to healthcare disparities in this population. Well-designed clinical studies that engage persons with IDD may lead to an evidence base within the clinical literature that will improve physician confidence and care quality.

Basal cell carcinoma (BCC) is the most common malignant skin tumor, constituting 80% of nonmelanocytic skin tumors. Intermittent exposure to ultraviolet radiation is considered a major risk factor for BCC. This study was done in 2023 at a tertiary care cancer centre in North India. Pigmented BCC is a rare entity, a histopathological and clinical variant of BCC. This entity belongs to the category of nonmelanocytic skin tumors but exhibits increased pigmentation. Increased pigmentation also creates suspicion of melanocytic tumors, seborrheic keratosis, and Discoid Lupus Erythematosus DLE. However, this diagnostic dilemma can be elicited with histopathological analysis and clinical correlation. However, to prevent basal cell carcinoma, the best is to avoid direct sunlight; if it cannot be avoided, use sunscreen.

Introduction: Hemoglobin D Punjab is a common hemoglobin D variant, which is essentially known to cause a mild disease even in homozygous state. Heterozygous state of hemoglobin D Punjab with sickle cell is the only presentation when a severe disease may be expected. We aim to study the spectrum of clinical and haematological profile of all case of haemoglobin D, reported at an apex referral centre of the country. Material and Methods: This is a record based retrospective study of cases of hemoglobin D Punjab from hematology OPD of a apex medical care centre. The clinical and hematological findings of 30 cases with genotype/phenotype of hemoglobin D Punjab were recorded from physical records and electronic data maintained at the institute. The cases were divided into homozygous Hb D Punjab, Double heterozygous hemoglobin S and D, Hemoglobin D-β-thalassemia, and Hemoglobin D trait. Results: The reported 30 cases consisted of 3 cases of homozygous Hb D Punjab, 8 cases of co-mutation of Hb D and beta thalassemia, 6 cases of co-mutation of Hb D with sickle cell and 13 cases of Hb D trait. All three cases of Hb D disease were mild to moderately symptomatic with co-existent splenomegaly. Out of the 8 cases reported of Hb D-β-thalassemia, three cases were found to have moderate anemia and one with severe anemia. The MCV of all participants were reduced, while, MCHC of all cases was within normal range. Among the 6 cases of compound heterozygous Hb D and S Disease two had hemolytic faces and three cases had splenomegaly. Blood transfusion was required by four out of six cases at varied frequency. Conclusion: We find the spectrum of symptoms presented by the cases of hemoglobin D Punjab is varied and few cases may require blood transfusion and medical care with follow up even in absence of heterozygous hemoglobin S inheritance.

Background: Era's one of the utmost scourges is air pollution, owing to not only its impact on climate change but also its impact on public and individual's health due to combined morbidity and mortality. Objectives: The current study was intended to monitor the air quality data from two districts of Chhattisgarh, namely Raipur and Korba, so that policymakers will be able to take corrective measures to control individual's health-related issues associated with polluted air. Methods: All air samples were collected from around Raipur and Korba city of Chhattisgarh and submitted to the Chester LabNet, a laboratory based in 3 Oregon, USA, for analysis. Particulate matter (PM2.5) was determined by using the gravimetry technique and used the X-ray fluorescence 4 technique to detect the presence of heavy metals. Results: PM2.5 levels in all samples in Raipur and Korba ranged from 131.4–653.8 μg/m3 to 150.3–1699.2 μg/m3 which is 2.18–10.88 and 2.5–28.3 times higher than standards prescribed by the Ministry of Environment, Forest and Climate Change (MoEFCC) of 60 μg/m3. Heavy metals such as silica (Si), lead (Pb), nickel (Ni), and manganese (Mn) levels were recorded higher than the standard level reported by the National Ambient Air Quality Standards in locations of Raipur and Korba, Chhattisgarh. Conclusion: Although Chhattisgarh, a state in Central India covered with 45% forest, but it is suffering from low air quality due to developing township and industrial area, which is causing a lot of commotion in the local community. At this time, the government should approach to take immediate action and measures to control air pollution and to reduce the terrible impact on the health of local citizens.

Introduction: Metastatic vertebral fractures (VF) commonly cause severe disabling pain in cancer patients. VFs are common among elderly patients and account for approximately 1.5 million per year in the general population. Objective: Bone metastasis, which is a second major cause of pathologic fracture, may lead to severe intolerable pain, life-threatening hypercalcemia, spinal cord compression, and immobility. The purpose of this study was to evaluate pain relief and improvement in quality of life (QOL) in patients with metastatic VF undergoing percutaneous vertebroplasty (PVP). Methods: Ten cancer patients having metastatic VF underwent PVP from July 2018 to August 2020. All demographic data, procedures, improvement in pain, and analgesic requirements of patients were taken from a computer data system and telephonic follow-up. Results: Majority of patients were suffering from carcinoma lung followed by carcinoma pancreas. The mean ± standard deviation of Visual Analog Scale preoperatively was 8.8 ± 1.35, reduced to 2.14 ± 2.11 at 6 months postoperatively, suggesting significant pain reduction. Eight patients had reduction in analgesic requirements and two did not require any analgesics postoperatively. During the entire follow-up, there was no delayed complication. Conclusion: PVP is an effective, safe, and minimally invasive procedure for treating painful metastatic vertebral compression fracture refractory to conservative treatments. It provides a marked reduction of pain, maintains mechanical stability of the vertebrae, and improves QOL.

Background: Minimally invasive and percutaneous treatments are effective treatment options for idiopathic trigeminal neuralgia (TN).Objectives: Multiple approaches have been described for the treatment of TN. This narrative review has been done to evaluate the current literature on different percutaneous treatment options for TN and to determine whether anyone treatment is better. Methods: The literature through a search of PubMed and Google Scholar was done and the review of the citations of relevant literature, and the authors knowledge of the literature and activity in the field. The literature was reviewed to find the preferred technique of preferred percutaneous treatment by different investigators and the difference in the outcome and/or complications and side effects. Results: Multiple techniques of such as percutaneous retrogasserian glycerol rhizolysis (PRGR), radiofrequency thermal coagulation (RFTC), and percutaneous balloon compression (PBC) for idiopathic TN have been used by different researchers. Effective pain relief and improved quality of life have been reported to be achieved by all the approaches. RFTC has been the most extensively used method, but PBC has been found to be more suitable for corneal preservation in cases of ophthalmic (V1) division pain. The most common imaging method used by large number of researchers is fluoroscope, though few authors have recommended computed tomography scan guidance for placement of cannula in foramen ovale and Meckle's cave, especially in cases with difficult anatomy. Limitations: This review has focused only on percutaneous techniques used by pain physicians. Other techniques such as radiosurgery and gamma knife used by radiologists and neurologists are not included. Conclusions: minimally invasive and percutaneous treatments such as PRGR, RFTC, and PBC are effective methods for the treatment of idiopathic TN. Selection of approach is largely dependent on the pain physician's choice, experience, and equipment available and can be used interchangeably; although for V1 neuralgia, PBC has superiority due to the preservation of corneal reflex.

Atlantoaxial instability (AAI) is surgically a complex entity due to its proximity to vital neurovascular structures. C1-C2 fusion has been an established standard in its treatment for a considerable time now. Here, we have outlined the most common techniques for C2 screw fixation in practice at present such as C2 pedicle, C2 pars, C2 translaminar, C2 subfacetal, C2-C3 transfacetal, and C2 inferior facet screw. We have discussed in detail the technical as well as biomechanical aspects of each technique of C2 screw fixation in AAI and explored the intricacies of each technique.

Aims and Objectives: Haematological malignancy may show varied presentation in different regions of world, however, Uttarakhand lacks any recent data about them. The present study was therefore conducted to study the pattern of haematological malignancies on bone marrow examination in institute of Uttarakhand. Materials and Methods: This study was conducted at All India Institute of Medical Sciences, Rishikesh, Uttarakhand, over a period of 3 years. It included patients of haematological malignancies diagnosed on bone marrow examination. Patient's age, sex, clinical history and bone marrow diagnosis were noted for every case. All the data were entered into the excel sheet and statistically analysed. Results: The study included total 256 cases of haematological malignancies with male:female ratio of 1.13:1 and mean age of 39.3 years. Chronic myeloproliferative neoplasm (CMPN) was the most common haematological malignancy (49%) with chronic myeloid leukaemia (CML) being its most common type (40%). All the haematological malignancies showed male preponderance except for non-Hodgkin's lymphoma. Mean age of CMPN was 45.81 years and of acute myeloid leukaemia was 36.92 years. Bone marrow aspirate (BMA) and trephine biopsy (BMT) together were able to diagnose 81.3% of cases of haematological malignancies. Conclusion: The study concludes that haematological malignancies present at lesser age with male preponderance in Uttarakhand. CML is the most common haematological malignancy followed by acute lymphoblastic leukaemia. BMA and BMT are complimentary to each other for diagnosis of haematological malignancies and should be used together to avoid missing of any case.

Background: Bone marrow metastasis is an uncommon yet significant presentation of many non haematological malignancies. Aims: The present study was conducted with the aim of analysing the clinical, haematological and biochemical parameters of the patients with bone marrow metastases and determines the parameters which could possibly indicate the presence of bone marrow metastases. Patients and Methods: Bone marrow aspirate, imprint and biopsy slides of 22 cases with bone marrow metastases were reviewed and the haematological and biochemical data of all these cases were compared with that of 20 controls without any evidence of metastases. Results: The mean values of mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR) and serum lactate dehydrogenase (LDH) were found to be significantly different (P < 0.001) between the cases and controls. MPV 3.5 and LDH >452 U/L showed a high likelihood ratio in predicting bone marrow metastases. Conclusion: Parameters such as MPV, NLR and LDH can be used as efficient and easily available methods to predict bone marrow metastasis for a rapid diagnosis.

Context: Automated cell counters have revolutionised laboratory medicine and are being used worldwide. They give accurate results, can run large number of samples and generate accurate results within a short span of time. Quality check procedures in this equipment ensure accuracy of results. However, for platelet counts, the pathologist is still dependent on confirming the results by manual methods, especially in situations of low platelet count and flagging by the electronic counter. Different laboratories use different methods for manual estimation of platelet counts. Aims: This study was done to compare the platelet counts assessed on peripheral smear examination by different multiplication factors, and to identify the multiplication factor which derives the most accurate platelet count. Settings and Design: This was an observational study. Methods: Peripheral smears prepared from 100 ethylenediaminetetraacetic acid-anticoagulated blood samples were manually examined under oil immersion field (OIF) for platelets. Platelet count was further calculated by multiplying the number of platelets per OIF using multiplication factors of 10,000, 15,000 and 20,000. This was compared with platelet (PLT)/red blood cell (RBC) method and automated platelet counts. Accuracy of various manual methods was evaluated by calculating the per cent difference of the methods with automated analyser counts. Statistical Analysis Used: Descriptive statistics was used for statistical analysis. Results: Manual platelet count estimation on peripheral smear employing multiplication factor of 15,000 was found to have comparable accuracy to analyser counts, followed by the PLT/RBC ratio method. Conclusions: This study confirms that for manual estimation of platelet counts on peripheral smear, a standard multiplication factor of 15,000 on OIF gives the most accurate result, which is closest to counts obtained by automated analysers.

Purpose This study was conducted to compare the therapeutic effect of 1% carboxymethyl cellulose (CMC) and 0.18% sodium hyaluronate (SH) on ocular surface damage induced by various anti-glaucoma medications. Patients and methods The study included 100 patients who were diagnosed as having primary open-angle glaucoma, normal tension glaucoma, or ocular hypertension and were on anti-glaucoma drugs. The patients were divided in two groups: group A patients received 1% CMC, whereas group B patients received 0.18% SH for 3 months. The severity of ocular surface disease symptoms was assessed by the ocular surface disease index (OSDI) questionnaire. Ocular examination with tear film break-up time, fluorescein staining, Schirmer’s test, and conjunctival impression cytology was performed sequentially on days 0, 30, and 90. Results Both CMC-treated and SH-treated groups showed improvement in the OSDI scores at days 30 and 90. However, the OSDI scoring was statistically significantly better in the SH group at both follow-up intervals (P0.5). Conclusion Both SH and CMC improved the symptoms and signs of ocular surface damage caused by the preservatives used in anti-glaucoma medication. However, SH showed faster efficacy than the CMC-based formulation.

BACKGROUND: Coronavirus disease 2019 (COVID-19) virus usually spreads through aerosol and close contact. Frontline health-care workers handle aerosol-generating procedures like endotracheal intubation. To reduce this risk, COVID-19 barrier box came into the picture. However, the COVID-19 barrier box may compromise easy and successful intubation, and their limitation must be studied. OBJECTIVES: The objective of this study was to assess the time to successful intubation with or without the COVID-19 barrier box using the Macintosh laryngoscope and King Vision video laryngoscope (KVVL). We also assessed the first-pass success rate, ease of intubation, Cormack–Lehane (CL) grade, and requirement of external laryngeal manipulation. METHODS: We conducted this manikin-based randomized crossover study to assess the time to successful intubation by anesthesiologists (22) and emergency physicians (11) having 1 year or more experience with or without COVID-19 barrier box by using the Macintosh laryngoscope and KVVL. Our study randomized the sequence of the four different intubation scenarios. RESULTS: The comparison of mean duration of intubation between KVVL (13.21 ± 4.05 s) and Macintosh laryngoscope (12.89 ± 4.28 s) with COVID-19 barrier box was not statistically significant (95% confidence interval: 1.21–0.97). The ease of intubation, number of attempts, and requirement of external laryngeal manipulation were not statistically significant. Intubations were statistically significant more difficult with barrier box in view of higher CL grade. CONCLUSION: Time to intubation was longer with COVID-19 barrier box using KVVL as compared to Macintosh laryngoscope which was statistically not significant.

Background and Aims: Regional anaesthesia techniques are a part of perioperative medicine that affects both perioperative and long-term outcomes. We have a paucity of the data on the usage and practices of plexus and peripheral nerve blocks (PNBs). To the best of our knowledge, this is the first effort to validate a survey for plexus and PNBs. Subsequently, this questionnaire could be used for the survey to look for the trends and disparities in PNB practices and further to develop a national registry in the future. Methods: Thirty questions were prepared after evidence-based search and reviewed by experts for suggestions. Changes were done and the questionnaire with the grading sheet was sent to 19 experts. The responses were analysed to calculate the content validity index (CVI) item-wise (I-CVI), scale-wise (S-CVI), and modified kappa statistics. The I-CVI of 0.78 and an S-CVI/average of 0.90 was taken as acceptable with more than six experts. Results: Fourteen experts out of 19 assessed and graded the questions as per the provided sheet and submitted suggestions through the mail. Question reframing, option reconsideration, and change from single to multiple choices were incorporated as per the suggestions of the experts. Mean I-CVI for relevance, simplicity, clarity, and ambiguity was 0.99, 0.98, 0.98, and 0.99, respectively. S-CVI/average was 0.98, 0.97, 0.98, and 0.99 for relevance, simplicity, clarity, and ambiguity, respectively. Conclusion: We conclude that this questionnaire has met the content validity criteria and can be used to study plexus and PNBs practices.

Background: Arthrocentesis of the temporomandibular joint (TMJ) is the unadorned form of surgical therapy which comprises of lavage of inflammatory enzymes and mediators and improve joint mobility and eliminate pain by pressure of the lavage solution in the upper compartment of TMJ. Objectives: The current study was conducted to assess and compare the effectiveness of arthrocentesis with normal saline alone and in conjunction with sodium hyaluronate (SH) injection in the treatment of internal derangement of the TMJ. Methodology: Sixty patients with internal derangement of the TMJ were randomly divided into two equal groups; Group 1 was performed with normal saline and Group 2 with normal saline followed by 1 ml of SH. The patients were followed up after 1 week to check for any postoperative complications and 1, 2, and 3 months for subsequent sessions and changes in subjective and objective variables. Results: The increase in mouth opening from preoperative to 3 months' postoperatively was 4.9 mm for Group 1 and 6.43 mm for Group 2. The change in the pain score (visual analogue scale scale) in Group 1 from the preoperative session to 3 months' follow-up was 7.23–4.1 and in Group 2 was 7.36–3.7. The difference in clicking/popping in Group 1 from preoperative session to 3 months' follow-up was 2.43–1 and in Group 2 was 2.4–0.53. Conclusion: Patients refractory to conservative treatment showed promising results with arthrocentesis with SH than arthrocentesis alone in treatment of TMJ internal derangement.

Background: Dental plaque is a complex ecosystem which consists of densely packed microbial colonies, microbial by-products, salivary glycoproteins and desquamated epithelial cells. Clinical studies have proved the relationship between plaque and periodontal disease. Aim: This study compares the anti-plaque efficacy and anti-inflammatory potential of turmeric gel with 0.2% chlorhexidine gel along with scaling and root planing (SRP). Materials and Methods: One hundred and fifty individuals were selected and divided into three groups for the study. Group A was instructed to use 0.2% chlorhexidine gel, whereas Group B used turmeric gel along with SRP. Participants were assessed for plaque and gingivitis on the 14th and 21st days. Subjective and objective criteria were assessed. The clinical data were recorded and used for statistical analysis to obtain results. Results: The percentage reduction of plaque index (PI) between the chlorhexidine and turmeric gel on 21st day were 74.85 and 65.91 respectively. similarly, the percentage reduction of gingival index (GI) between the chlorhexidine and turmeric gel on 21st day were 58.49 and 62.46 respectively. Conclusion: Turmeric gel shows a slightly lower anti-plaque property in comparison to chlorhexidine gel. Their effect on a reduction of gingival inflammation was equal. It was also noted that turmeric gel showed better acceptability and biocompatibility by the participants.

Aims: The aim of this study was to evaluate and compare canal transportation (CT), centering ability (CA), and volumetric changes in the curved canals prepared using Hyflex Electrical Discharge Machining (HEDM), ProTaper Gold (PG), and NeoEndo Flex rotary file systems through cone-beam computed tomography (CBCT). Materials and Method: Sixty mesiobuccal canals of maxillary molars were selected. Pre- and postinstrumentation CBCT scans were taken in the same position. CT and CA were calculated at 1 mm, 4 mm, and 7 mm from the apex; change in volume for the whole canal was measured and analyzed statistically. Results: The results showed that mean CT of HEDM and NeoEndo was less than PG at all levels, with significant differences at 4 mm and 7 mm. Regarding CA, no significant differences were found among the file systems. PG showed maximum volumetric increase with no statistically significant differences between the groups. Conclusion: All the experimental file systems respected the canal anatomy, although in the middle third, PG showed significantly more CT than HEDM and NeoEndo, whereas in the coronal third, PG showed significantly greater CT than NeoEndo. Regarding CA, no significant differences were found among the file systems. PG showed maximum volume of dentin removal.

Aim: This study was aimed to evaluate and compare the pull-out bond strength of fiber post using glass ionomer cement (GIC), resin-modified glass ionomer cements (RMGIC), self-etch adhesive resin cement, and self-adhesive resin cement in endodontically treated teeth. Materials and Methods: Forty single-rooted teeth with single canal were decoronated, endodontically treated, post space were prepared and divided into four groups (n = 10) based on the cement used for luting the fiber post. Group 1: GIC, Group 2: RMGIC, Group 3: Self etch adhesive resin cement, Group 4: Self-adhesive resin cement. Pull-out test was evaluated for the prepared samples. Statistical analysis was performed using analysis of variance and Tukey's test (P = 0.05). Results: The mean pull-out bond strength of Group 4 was statistically higher than Group 1,2 and 3. Group 1 showed the least bond strength among all the groups. Conclusion: Within the limitation of this study, self-adhesive resin cements provide better bond strength of fiber post to root canal compared to self-etch adhesive resin cement and glass ionomer based cements.

Background: Endemic fluorosis is one of the major health problems in India. About 96% of the fluoride found in the body is in bones and teeth. When ingested in adequate quantities, fluoride is beneficial for teeth by reducing the level of dental caries, whereas the ingestion of fluoride in higher concentrations may cause fluorosis. Objectives: The objective of the study was to find the prevalence of dental fluorosis in school-going children of 6–14 years in Greater Noida City, residing there since birth. The severity of fluorosis was determined after estimating the fluoride concentration in drinkable groundwater. The distribution of dental fluorosis was then compared according to various variables. Materials and Methods: A sample of 1516 school-going children, residing in the Greater Noida since childhood and consuming the groundwater, were taken across various schools from all five directions. These children were examined for dental fluorosis according to the Dean's criteria for assessment. Results: The prevalence of dental fluorosis in 6–14-year-old school-going children was 69.9%. A stepwise increase in prevalence was noted with a corresponding rise in the water fluoride content in different zones of the city. Conclusion: The prevalence of dental fluorosis was found to be 69.9% with the groundwater concentration gradient ranging from 1.6 to 2.4 ppm.

Background: Tumor necrosis factor-alpha (TNF-α), a ” major inflammatory cytokine,” not only plays an important role in periodontal destruction but also is extremely toxic to the host. Till date, there are not many studies comparing the levels of TNF-α in serum and its relationship to periodontal disease. Aim: Our study aimed to compare the serum TNF-α among the two study groups, namely, healthy controls and chronic periodontitis patients and establish a correlation between serum TNF-α and various clinical parameters. Hence, an attempt is made to estimate the level of TNF-α in serum, its relationship to periodontal disease and to explore the possibility of using the level of TNF-α in serum as a biochemical ” marker” of periodontal disease. Materials and Methods: Forty individuals participated in the study and were grouped into two subgroups. Group A – 20 systemically and periodontally healthy controls. Group B – twenty patients with generalized chronic periodontitis. The serum samples were assayed for TNF-α levels by enzyme-linked immunosorbent assay method. Results: The mean serum TNF-α cytokines for Group B Generalized chronic periodontitis (GCP) was 2.977 ± 1.011, and Group A (healthy) was 0.867 ± 0.865. The range of serum TNF-α was from (0.867 to 2.977). Serum TNF-α cytokines had highly significant correlation with all clinical parameters (plaque index, probing pocket depth, clinical attachment loss, and gingival index) among all study participants (P = 0.001). Conclusion: These observations suggest a positive association between periodontal disease and increased levels of TNF-α in serum. It can be concluded that there is a prospect of using the estimation of TNF-α in serum as a ” marker” of periodontal disease in future. However, it remains a possibility that the absence or low levels of TNF-α in serum might indicate a stable lesion and elevated levels might indicate an active site but only longitudinal studies taking into account, the disease ” activity” and ” inactivity” could suggest the possibility of using TNF-α in serum as an ” Indicator” of periodontal disease.

A new-onset acute kidney injury (AKI) after arthroplasty impairs rehabilitation and outcome. A prior knowledge of risk factors contributes to a planned preventive management and prognostication. Although many studies have addressed the issue, our objective was to perform a meta-analysis to bring a consensus on the perioperative risk factors promoting AKI postoperatively. We conducted a systematic review and meta-analysis of observational studies reporting risk factors with odds of development of AKI according to the existing criteria after hip or knee replacement surgery. We searched the PubMed and Google Scholar databases for free English articles published until June 2018. Two authors independently screened the articles and extracted data. Discrepancies were resolved by consensus or consulting the third author. Methodological quality of the articles was assessed using the Newcastle-Ottawa Scale. A total of five studies were included in this meta-analysis. The following risk factors were found to contribute to new kidney injury: advanced age; male gender; preoperative liver, cardiac, or kidney diseases; presence of heart failure; American Society of Anesthesiologists grade ≥ 3; requirement of perioperative blood transfusion, revision arthroplasty, and knee arthroplasty; body mass index; and use of angiotensin-converting enzyme inhibitors. Diabetes, hypertension, duration of surgery, type of anesthesia, and preoperative serum creatinine were not found to be associated with renal injury. The key limitation was the availability of small number of studies. More longitudinal observational studies addressing the issue are the need of the hour, and, till then, a preventive strategy aimed at the identified risk factors should help.

Aims and Objectives: Total quality management is an essential component of laboratory to maintain quality and includes pre-analytical, analytical and post-analytical phases. Pre-analytical phase starts from ordering investigation by the clinician till it is analysed in the laboratory. It is essential that a pathologist is aware of the confounding factors that may lead to pre-analytical errors with the knowledge of reducing them to improve the quality of the lab. The present study was conducted to evaluate the pre-analytical errors in the haematology laboratory and steps taken to minimise it. Materials and Methods: The study was conducted in the Haematology Laboratory of Pathology Department, All India Institute of Medical Sciences, Rishikesh, over a period of 4 years and included all the blood samples analysed in the lab. The pre-analytical variables including requisition form, patient preparation, labelling, sample collection, quality and transportation were analysed for the errors along with the corrective actions taken to minimise them. Results: A total of 25,15,583 investigations were received in the haematology laboratory over a period of 4 years. The total errors observed in the haematology lab in pre-analytical phase were 13,031 comprising 0.51% of total haematological investigations during the study period. The most common error observed was due to clotted sample (40.3%), followed by haemolysed samples (15%) and incomplete or wrongly filled requisition forms (10%). Conclusion: Pre-analytical phase forms an integral part of total quality management system and its analysis is essential to minimise the errors in haematology lab. The quality of blood sample with completely filled requisition forms and prompt transportation of sample to the lab are essential components to avoid pre-analytical errors. In addition, continuous training and acknowledgement of non-conformance with root cause analysis is the basic key for reducing errors and improving quality of haematology lab.

BACKGROUND: Menopause in females is a corporeal stage that gives rise to a number of adaptive changes both at systemic and oral levels, prototypically occurring in the late fourth or fifth decade of life. Though physiological aging affects the oral tissue, the hormonal changes due to menopause also act as a major contributing factor in deteriorating the health of oral tissues. Thus, the main aim of our study was to compare the overall periodontal status and alkaline phosphatase levels in the saliva of females in their pre and postmenopausal ages. MATERIAL AND METHODS: This study was conducted on 200 female subjects coming to the Department of Periodontology at Rajendra Institute of Medical Science for oral prophylaxis. The subjects were arbitrarily selected in the age group ranging from 15 to 70 years and were further divided based on the inclusion criteria. Group A included 100 subjects with age ranging from 15 to 45 years, and group B, 100 subjects with age 54 to 70 years. Signs of periodontitis including clinical attachment loss, furcation involvement, and probing depth and salivary alkaline levels were obtained, evaluated, compared, and analyzed. RESULTS: In group A 65% of patients had grade 0 and 28% had grade 1 of clinical attachment level. Similarly in group B, 44% of the total had grade 0 of clinical attachment loss, 38% had grade 1, and 18% were of grade 2. On evaluating grades of furcation involvement, around 45% of the total patients in group A were grade 1 (incipient, pocket formation), while in group B, 51% of the total patients were grade 1. At least 46% in group A and only 20% in group B had no signs of furcation involvement. Salivary alkaline phosphatase levels in pre and postmenopausal patients showed a significant difference between the two groups was obtained. CONCLUSION: The study concluded a major difference in the periodontal health of pre and postmenopausal women with many influencing factors apart from menopause itself.

Background: Student psychological health has been an increasing concern. The COVID-19 pandemic situation has brought this vulnerable population into renewed focus. Objective: Our study aims to conduct a timely assessment of the effects of the COVID-19 pandemic on the mental health of college graduates and postgraduates. Methodology: We conducted online survey with 550 students to understand the effects of the pandemic on their psychology and well-being. The data were analyzed through quantitative and qualitative methods. Results: Of the 550 students, 138 (71%) indicated increased stress and anxiety due to the COVID-19 outbreak. When asked about how the lockdown in COVID-19 situation affecting them, 97% said that it is severely affecting them. When asked about what the problems do you faced during online class, 5% said the Internet, 83.8% said noninteractive, and 11.2% said lack of explanatory mediums. When asked about number of hours spent on the Internet, 100% said more than 10 h. When asked about the activities to keep yourself busy during lockdown in COVID-19 situation, 37% said social media followed by 23% who mentioned cooking. Conclusion: Due to the long-lasting pandemic situation and onerous measures such as lockdown and stay-at-home orders, the COVID-19 pandemic brings negative impacts on education. The findings of our study highlight the urgent need to develop interventions and preventive strategies to address the psychological health of college students.

Background: COVID-19 pandemic resulted in lockdown affecting all businesses globally. Everyone was forced to work from home (WFH) leading to challenges in productivity and motivation. Methodology: One thousand working professionals who worked from home participated in the online survey with semi-structured questionnaire using nonprobability Snowball sampling technique. Descriptive statistics was used to analyze the findings and to collect data method. Results: Participants were asked about their biggest worries during lockdown COVID-19 situation and their biggest worry was infection to COVID-19/death. Professionals were asked whether they were affected or not affected due to “WFH” in COVID situation. The questionnaire items were clubbed into six major categories of job role overload, lifestyle choices, family distraction, occupational discomfort, job performance, and distress, and majority categories were affected. Conclusion: Thus, it is observed that the increase in work commitments leads to distress among employees while distractions from family members disrupt the quality of work. While good job performance contributes to life satisfaction, distress significantly diminished it. This paves the way for more studies to be done on work–life balance under WFH arrangements for as long as the pandemic of COVID-19 is prevalent.

Background: Many academic institutions have been cheering lecturers to execute flipped learning methodologies. The present study determined perceived competency of dental interns toward dental practice among various dental colleges. Materials and Methods: A total of 138 interns of dental college were provided with self-administered questionnaire with close-ended questions. All were instructed to read it and submit it. Results: Out of 138 subjects, there were 78 males and 60 females. The mean value for general patient management was 3.12 and 3.0 in males and females, periodontology and dental public health was 2.54 and 2.65, conservative dentistry was 2.70 and 2.82, oral rehabilitation was 2.32 and 2.30, orthodontics was 2.10 and 2.28, management of children and special needs patients was 2.52 and 2.64, oral and maxillofacial surgery was 2.49 and 2.42, and drug and emergency management was 2.62 and 2.60, respectively. Conclusion: Dental interns were well prepared toward dental practice.

Purpose: A pilot randomized control trial to compare the efficacy and side effects of intralesional and oral propranolol in periorbital and eyelid capillary hemangiomas. Methods: Twenty patients were prospectively randomized to two groups of ten each. Group 1 was initiated on oral propranolol 1 mg/kg/day titrated to final dose of 3 mg/kg/day over 1 week which was continued for 6 months and then tapered over 1 week; Group 2 received 3 doses of direct intralesional propranolol hydrochloride 1 mg/ml; 0.2 ml/cm 4–6 weeks apart. Hemangioma area and corneal astigmatism were measured. Results: Within each group at 6 months there was a significant reduction in area (group 1: 83.48 ± 11.67%,P= 0.0019; group 2: 67.78 ± 21.71%,P= 0.0019) and improvement in astigmatism (pre, post: group 1: 2.98D @ 179.8°, 1.13D @ 179.8°,P= 0.0045; group 2: 1.62D @ 90.16°, 0.75D @ 179.9°,P= 0.0001). There was no difference in area reduction (P = 0.056), change in appearance (P = 0.085), ptosis (P = 0.23) and side effects (lethargy, poor feeding;P= 0.171) between the two groups. Conclusion: Efficacy and side effects with intralesional propranolol are comparable to oral propranolol for periorbital and eyelid lesions.

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

Light chain myeloma (LCM) has a reported worldwide incidence of approximately 15%–20% among all multiple myeloma (MM) patients. Few western studies have shown strong correlation of LCM with anemia, higher International Staging System scores, proclivity to renal failure, elevated lactate dehydrogenase levels, raised serum-free light chain ratio, higher frequency of extramedullary plasmacytomas, and poorer overall survival, attributable probably to lack of differentiation and skeletal destruction. The primary aim of this retrospective observational study was to define the clinical and hematological characteristics as well as prognostic outcome of Indian LCM patients in comparison with the IgG and IgA subtypes. Patients were defined according to the International Myeloma Working Group diagnostic criteria 2016 and staged as per the International Staging System. Out of 104 patients of newly diagnosed MM in which results of serum immunofixation (IFE) were available, 65 were of IgG isotype (62.5%), 15 had IgA (14.4%), and 24 had light chain myelomas (LCMs) (23.1%). It was observed that LCM patients significantly correlated with hypercalcemia and higher serum-free light chain ratios, whereas IgA patients were strongly associated with anemia and lower serum albumin levels. However, no difference was found among the three subgroups in terms of serum lactate dehydrogenase levels, proclivity to renal failure, presence of lytic bone lesions, prognostic scoring, pretransplant chemosensitivity, and progession-free survival (1 year). Thus, it may be concluded that Indian LCM patients have significantly different clinico-hematological profile in comparison with other published studies worldwide. Also, their prognostic outcomes are not worse when compared with patients of other protein isotypes, probably due to standardized treatment regimens applied.

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

Background: FLT3-ITD and NPM1 mutations are considered to be the major determinants of the patient response to therapy and outcome. The primary aim of this study was to establish the correlation between these molecular mutations and the clinico-hematologic parameters as well as the prognostic outcome of the Indian acute myeloid leukemia (AML) patients. Materials and Methods: This prospective study involved newly diagnosed nonpromyelocytic AML patients who had undergone complete diagnostic workup, including immunophenotyping, conventional cytogenetics and molecular analysis for NPM1 and FLT3-ITD mutation by reverse transcriptase polymerase chain reaction at presentation. Results: Overall, the prevalence of NPM1 and FLT3-ITD mutations was found to be 14.4% and 10.8%, respectively. Among patients with normal karyotype, leukocytosis was significantly associated with NPM1+ group than the NPM1− group (P = 0.0019) and more severe degree of anemia was observed in the FLT3-ITD+ patients than the other groups (P = 0.025). No significant correlation was found in terms of age at presentation (P = 0.56), sex ratio (P = 0.467), median platelet count (P = 0.27), and blast percentage between NPM1+ and FLT3-ITD+ groups. Complete remission (CR) rates were better in the NPM1+/FLT3-ITD− group than the other three groups. Unlike most other studies, improved CR rates as well as disease-free survival were observed in the NPM−/FLT3-ITD− group than the FLT3-ITD+ groups although not reaching statistically significant levels. Conclusion: Some differences in the clinical behavior of the Indian AML patients in comparison to that of the West in the presence of NPM1 and FLT3-ITD suggests that comprehensive studies are required to confirm the definitive role of these mutations among AML patients, especially with normal karyotype.

Background: Thirty-one cases of fever with rash were reported among students of a college in Pune, India, from March to May 2014. The clinical profile was similar to that of measles and 7 of them tested positive for measles-specific immunoglobulin M (IgM). An outbreak of measles was declared, and epidemiological investigation was carried out to assess the situation and suggest preventive measures. Methods: An epidemiological case sheet filled for each case to identify the source and likely contacts. Medical and administrative authorities were sensitized about the increase in incidence and clustering of cases. A surveillance system was set up for detection of new cases and follow-up of contacts. Throat swabs and blood samples from 12 cases were tested by ELISA method for commonly occurring viral exanthematous fevers to confirm the diagnosis and 7 were positive for measles-specific IgM antibody. Preventive measures were advised to control the outbreak. Results: A total of 31 cases of fever with rashes were reported among students of a college in Pune, India, during the months of March–May 2014. Most of the students were in the age group of 18–24 years. Samples from 12 cases were sent for testing and 7 tested positive for measles-specific IgM antibodies. Seven cases were epidemiologically linked to a lab-confirmed case. All cases had fever, maculopapular rash, and sore throat and gave a history of vaccination for measles in childhood. Conclusion: An epidemiological investigation was carried out for outbreak of measles in a young adult population of college students from Pune. It is reported that, with increase in overall coverage of vaccination, there is a rise in incidence of measles in vaccinated individuals. The age profile also shifts to higher age groups. Investigation of such outbreaks provides an opportunity to identify high-risk groups, changes in measles epidemiology and weaknesses in the routine immunization programs.

Aims and Objectives: To determine the effectiveness of transcutaneous electrical nerve stimulation (TENS) in stimulating salivary flow in post-radiated oral cancer patients, and to compare the salivary flow rate between unstimulated saliva and saliva stimulated with TENS in post-radiated oral cancer patients. Materials and Methods: In 30 patients who underwent radiotherapy for oral cancer, unstimulated saliva was collected every minute for 5 min in a graduated test tube. The TENS unit was activated and stimulated saliva was collected for 5 min in a separate graduated test tube, and the flow rate was compared with the unstimulated salivary flow rate. Results: A statistically significant improvement was seen in saliva production during stimulation (P < 0.001). In addition, statistically significant increase in TENS stimulated saliva was observed in patients aged ≥50 years compared to that in patients aged

Background: Impact of two methods of dental health education (DHE) on knowledge and practices of primary school children in a rural area regarding oral care was planned to be studied. Materials and Methods: Study population comprised of 199 primary school children aged 10-13 years in rural field practice area of a medical college. After collecting baseline data, students were allocated into two groups by block randomization using variable blocks. DHE with educational pamphlets and demonstrations was given to both groups. In addition, the intervention group was also shown videos showing correct oral health practices. Data were proposed to be collected at 3 and 6 months from baseline for impact evaluation. The results at 3 months postintervention are being presented. Results: The results after 3 months of intervention found significant difference in the impact on: (a) Practices regarding method of cleaning teeth (P < 0.001), (b) knowledge on best method of cleaning teeth (P < 0.001), (c) reason for regular brushing of teeth (P < 0.001), and (d) requirement to clean teeth after eating something sweet (P < 0.001) in favor of group receiving additional intervention. Conclusion: There is a significant difference in the impact of health education using integrated modes of pamphlets distribution, demonstrations, and A-V aids (group A) as compared to demonstrations and pamphlets distribution only (group B).

Background: The maternal health status of Indian women was noted to be lower as compared to other developed countries. Promotion of maternal and child health has been one of the most important components of the Family Welfare Programme of the Government of India. For sustainable growth and development of country, there is a need to improve MCH Care in the country. Safe motherhood by providing good antenatal care (ANC) is very important to reduce maternal mortality ratio and infant mortality rate and to achieve millennium development goals. Objectives: This study aimed to determine the level of knowledge, attitude, and practice on ANC among pregnant women attending the antenatal clinic at a Tertiary Care Hospital in Pune and their association with various sociodemographic factors. Materials and Methods: A cross-sectional study was carried out among 384 pregnant women in their 3 rd trimester attending the antenatal clinic in a Tertiary Care Hospital of Pune, Maharashtra during October 2011 to September 2012. Pretested questionnaire was used for collecting data by interview after obtaining informed consent. Statistical analysis was performed using SPSS version 20 and Epi Info Software. Results: Study reveals that about 58% women had adequate knowledge regarding ANC. It was found that almost all the variables such as age, education, occupation, parity, type of family, and socioeconomic status (SES) had a significant association with awareness about ANC. 100% women were having a positive attitude toward ANC. Around 70%, women were practicing adequately, and variables such as education and SES had a significant association with practices about ANC. Conclusion: These findings can be used to plan a Health Intervention Program aiming to improve the maternal health practices and eventually improve the health status of the women.

Objective: To investigate the clinical performance of International Caries Detection and Assessment System II (ICDAS II) (a ranked visual scale), radiovisiography (RVG) (a digital radiography device), and an alternating current impedance spectroscopy (ACIS) device for the detection and assessment of occlusal caries in primary teeth. Materials and Methods: Twenty-five molars were assessed using all three systems under standardized in vivo conditions. They were then extracted and also assessed by examiners in vitro. Downer′s histological scoring criterion was the validation gold standard. Sensitivity, specificity, positive and negative likelihood ratios, and area under the receiver-operator curves were calculated for enamel caries and dentine caries. Repeatability was analyzed using intraclass correlation coefficient (ICC). The performances of the systems between in vivo and in vitro settings by the same examiner were also compared. Statistical Analysis: SPSS version 17.0 (SPSS Inc., Chicago, IL, USA) was used to analyze the data. Comparison of the performance of all three systems for all caries and dentine caries using receiver operating characteristic curves was calculated using a range of cutoffs. Reliability was assessed using ICC method. Results: ICDAS II system showed the highest validity and repeatability for assessing occlusal caries in the primary molars. RVG was less accurate than the ICDAS II for detecting caries lesions confined to enamel. However, when dentine was involved, RVG was found to be as effective as ICDAS II. Conclusion: Within the limitations of the study, the in vivo results of ICDAS II and RVG were satisfactory and comparable to those obtained in vitro, with ICDAS II performing better. The ACIS device was least accurate among the three systems for caries assessment.