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Introduction: The fixed dose combinations used in chronic obstructive pulmonary disease (COPD) patients need their rationale evaluation. If there is no added benefit; then it amounts economic burden on the society, reduced compliance, and unsuccessful therapy. This study evaluated the effectiveness of three regimens of dry powder inhaled preparations including tiotropium 18 µg once a day; tiotropium 18 µg plus formoterol 12 µg once a day, and tiotropium 18 µg once a day plus formoterol 12 µg twice a day in moderate COPD patients. Materials and Methods: A randomized, double-blind, placebo-controlled, active drug controlled parallel design study was conducted in 42 moderate COPD patients without any other comorbidity. Three (R1, R2, and R3) regimens were evaluated in patients to assess the appropriate evidence-based pharmacotherapy regimen. The forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), Borg's scale of dyspnea, and vital signs (blood pressure and pulse rate) were measured on serial time points for 24 h. Results: The trough FEV1 values of R1, R2, and R3 in liters were 1.836 ± 0.51, 1.886 ± 0.47, and 1.805 ± 0.37, respectively and did not show any statistical difference. No statistical significance was observed in FVC (liters), FEV1% predicted, ΔFEV1 (liters), ΔFEV1% predicted, ΔFVC % predicted, and Δ FVC (liters) except in 24 h FVC percentage predicted values where P - value for R3 is in the range between 0.05 and 0.1 over R1. Conclusions: Study shows that tiotropium alone once a day is the evidence based and rationale pharmacotherapy in moderate COPD. There is no advantage or statistical significance of adding long acting β2 agonists (LABA) such as formoterol to tiotropium either for 12 h (once daily) or 24 h (twice daily). [ABSTRACT FROM AUTHOR]

Background: Rapid response team (RRT) has been implemented in developed countries with the aim of early recognition and response to critical care triggers for the better patient outcome. However, the data concerning their efficacy is hardly available until date from Indian subcontinent. Aims: To evaluate the impact of RRT implementation on patient outcome during medical emergencies. Settings and Design: Retrospective observational study of RRT records of in-bed patients of super specialty academic teaching hospital. Materials and Methods: RRT record forms during the first half of the year from January 2012 to June 2012 were included for all inpatients and out-patients irrespective of their age, gender and diseases profile after their inclusion in the system. Outcomes such as patient stayed in the room, patient transfer to intensive care unit (ICU), patient discharge and generation of code blue event, mortality and length of stay in hospital/ICU were measured. Statistical Analysis: Descriptive analysis was performed with the help of statistical software STATA 9.0 and R 2.13.2 (StataCorp LP, Lakeway Drive College Station, Texas, USA). Results: Analysis of 41 RRT calls showed decreased code blue calls by 2.44% and decrease in mortality by 4.88%. Average length of stay in ICU and hospital post RRT assistance for patients was 2.55 and 6.95 days respectively. Conversely percentage of patients requiring a higher level of care was more (75.61%) than those who stayed in their rooms/wards (24.39%). Conclusion: Implementation of RRT in this hospital was associated with reduced code blue events and its attendant mortality outside the ICU settings. However, more number of patient requiring higher levels of care delineates the need for a larger evidence based medicine study. [ABSTRACT FROM AUTHOR]

Purpose: To discuss the pharmacotherapeutic aspects of Mirabegron which is a first-in class novel β3 receptor agonist drug recently approved by the food and drug administration (FDA) for the treatment of overactive bladder (OAB).Materials and Methods: We conducted a computerized search of the MEDLINE/PUBMED databases with the word Mirabegron, β3 receptor agonist and overactive bladder.Results: Effect of Mirabegron on β3 adrenergic receptor purportedly releases nitric oxide(NO) by an increase in intracellular Ca2+ through accumulation of cyclic adenosine monophosphate (cAMP). Along with NO which relaxes the detrusor muscle, it also releases an urothelial-derived inhibiting factor (UDIF) that inhibits contractions. It increases the bladder capacity by causing bladder relaxation during the storage phase.Conclusion: Mirabegron appears to be a promising treatment in OAB patients by shifting its management from reducing detrusor over-activity to inducing relaxation. Also it lacks the troublesome side effects associated with the standard antimuscarinic management. [ABSTRACT FROM AUTHOR]

Methicillin Resistant Staphylococcus aureus (MRSA) is a worldwide increasing problem and difficult to cure because MRSA are resistant against almost all the clinically available antibiotics, Synergistic effects of Ocimum sanctum extract and antibiotics on MRSA isolated clinically from swabs from pus, wound, nasal cavity, burn wound at Swaroop Rani Nehru Hospital, and Nazareth Hospital, Allahabad, were explored. MRSA were screened for resistance against selected antibiotics such as Penicillin, Gentamicin, Cephalexin, Ciprofloxacin and Tetracycline by using disc diffusion method. Synergetic effect of acetone extract of Ocimum sanctum and antibiotics were evaluated Zone of inhibition were increased significantly with all antibiotics. [ABSTRACT FROM AUTHOR]

Dissolution of a simulant UK nuclear waste glass containing Mg, Ca and Zn was investigated over 35 d at 50 °C in ultra-high quality (UHQ) water and simulant groundwater solutions. The dissolution rates were influenced subtly by the groundwater composition, following the trend, from least to most durable: clay > UHQ water > granite ≈ saline. Solutions were rapidly silica saturated but boron dissolution rates continued to increase. This is hypothesised to be due to the formation of secondary Mg-silicate precipitates, preventing the formation of a passivating silica gel layer and allowing glass dissolution to proceed at close to the maximum rate. [ABSTRACT FROM AUTHOR]

This paper examines the role of Generative AI (GenAI) and Large Language Models (LLMs) in penetration testing exploring the benefits, challenges, and risks associated with cyber security applications. Through the use of generative artificial intelligence, penetration testing becomes more creative, test environments are customised, and continuous learning and adaptation is achieved. We examined how GenAI (ChatGPT 3.5) helps penetration testers with options and suggestions during the five stages of penetration testing. The effectiveness of the GenAI tool was tested using a publicly available vulnerable machine from VulnHub. It was amazing how quickly they responded at each stage and provided better pentesting report. In this article, we discuss potential risks, unintended consequences, and uncontrolled AI development associated with pentesting. [ABSTRACT FROM AUTHOR]

Background: COVID 19 resurgence in multiple waves and the highly infectious variant of SARS-CoV-2 (B.1.617) has wreaked havoc across healthcare systems in India. We conducted a study to delineate the clinico-epidemiological profile of COVID-19 patients in this second wave of the pandemic. Methods: This was a retrospective, single centre, observational study at the Emergency Department(ED) of a teaching institute in North India. The ED health records were screened for patient files with the diagnosis of COVID -19, age > 14 years, presenting from 10th April to 30th of May. ED clinical notes, disposition, and mortality data were retrieved and analysed. Results: 1647 files were screened and 253 eligible patients of COVID-19 were included in the study. 60% patients were male, mean age (+ SD) was 54 (+ 14.8 years). Shortness of breath (74.7%), fever (71.9%), cough (57.7%) were the common presenting symptoms. 20% of patients were nil comorbid; Diabetes (44.7%) and Hypertension (41.5%) were the common comorbid illnesses. 73.1% patients had severe COVID illness, 39.9% had oxygen saturation <90% on arrival and 33.2% had <70%. More than 90% patients required respiratory support on arrival. 25% of people presented to hospital after home isolation, of which 81% had severe COVID at presentation. 39 % patients of mild illness had received corticosteroids. Conclusion: The second wave of COVID-19 with rapid upsurge of cases overwhelmed the healthcare system with a higher proportion of severe COVID-19 cases and higher mortality, thus stressing the need for prior planning, preparation and strengthening healthcare systems across tiers. [ABSTRACT FROM AUTHOR]

Two-dimensional (2D) nanoflakes of vanadium pentoxide (V 2 O 5) are directly developed on the titanium (Ti) substrate (VO@Ti) as an innovative electrode for pseudocapacitor. The designed VO@Ti electrode offers impressive capacitance of 1520 Fg-1 at 1.5 Ag-1 and superb long-term reliability with a 99% retention over 12000 cycles at 20 Ag-1 based on the merits of highly exposed active sites and improved electrical conductivity. The designed VO@Ti electrode offers high capacitive type charge storage based on the merits of highly exposed active sites and improved electrical conductivity. [Display omitted] • 2D-morphology based novel V 2 O 5 nanobelts as an electrode material for supercapacitor is developed. • Binder-free VO@Ti electrode exhibits exceptional high charge storage performance 1520 at F g-1 at 1.5 A g-1. • The VO@Ti electrode exhibited high capacitance retention of 99% after 12000 cycles. • The VO@Ti electrode stored highly capacitive type charge at low scan rates. [ABSTRACT FROM AUTHOR]

Background: The global incidence of oral cancer occurs in low-resource settings. Community-based oral screening is a strategic step toward downstaging oral cancer by early diagnosis. The mobile health (mHealth) program is a technology-based platform, steered with the aim to assess the use of mHealth by community health workers (CHWs) in the identification of oral mucosal lesions.Materials and Methods: mHealth is a mobile phone-based oral cancer-screening program in a workplace setting. The participants were screened by two CHWs, followed by an assessment by an oral medicine specialist. A mobile phone-based questionnaire that included the risk assessment was distributed among participants. On specialist recommendation an oral surgeon performed biopsy on participants. The diagnosis by onsite specialist that was confirmed by histopathology was considered as gold standard. All individuals received the standard treatment protocol. A remote oral medicine specialist reviewed the uploaded data in Open Medical Record System. Sensitivity, specificity, positive and negative predictive values were calculated. Inter-rater agreement was analyzed with Cohen's kappa coefficient (κ) test, and the diagnostic ability of CHWs, onsite specialist, and remote specialist was illustrated using receiver operating characteristic curve.Results: CHWs identified oral lesions in 405 (11.8%) individuals; the onsite specialist identified oral lesions in 394 (11.4%) individuals; and the remote specialist diagnosed oral lesions in 444 (13%). The inter-rater agreement between the CHW and the onsite specialist showed almost perfect agreement with the κ score of 0.92, and a substantial agreement between CHW and remote specialist showed a score of 0.62. The sensitivity, specificity, positive and negative predictive values of CHWs in the identification of oral lesion were 84.7, 97.6, 84.8, and 97.7%, respectively.Conclusion: The trained CHWs can aid in identifying oral potentially malignant disorders and they can be utilized in oral cancer-screening program mHealth effectively. [ABSTRACT FROM AUTHOR]

Background: Overprescribing of potentially harmful medication in UK general practice has a complex association with socioeconomic deprivation., Aim: To assess trends in general practice prescribing of five high-risk medications and their relationship with deprivation., Design & Setting: An observational study was conducted using general practice data from three English regions with varied sociodemographic factors: West Yorkshire and Harrogate (WY), Black Country and West Birmingham (BC), and Surrey and East Sussex (SE)., Method: Practice-level prescribing data were obtained from 2016-2021 for five drug classes: opioids, hypnotics, gabapentinoids, non-steroidal anti-inflammatory drugs (NSAIDs), and antibacterials. Prescribing trends were demonstrated using a linear model., Results: Reduction in NSAID, opioid, hypnotic and antibacterial prescriptions, and the increase in gabapentinoid prescriptions, were significant at each financial year time period. Index of Multiple Deprivation (IMD) was positively associated with all drug classes except antibacterials, which showed a positive association when incorporating the interaction term between IMD and age.When adjusting for IMD and population, region was independently associated with prescribing rate. Compared with WY, IMD had a smaller association with prescribing in BC for NSAIDs (coefficient = -0.01578, P = 0.004) and antibacterials (coefficient = -0.02769, P = 0.007), whereas IMD had a greater association with prescribing in SE for NSAIDs (coefficient = 0.02443, P <0.001), opioids (coefficient = 0.08919, P <0.001), hypnotics (coefficient = 0.09038, P <0.001), gabapentinoids (coefficient = 0.1095, P <0.001), and antibacterials (coefficient = 0.01601, P = 0.19)., Conclusion: The association of socioeconomic deprivation with overprescribing of high-risk medication in general practice varies by region and drug type. Geographical location is associated with overprescribing, independent of socioeconomic status., (Copyright © 2024, The Authors.)

Background and objective While smartphones offer various benefits, addiction to them among young people poses a serious problem for parents and educators globally. Several studies have tried to assess the impact of the excessive use of/addiction to smartphones on students' overall academic performance. While a few studies have found a positive impact, most have observed a negative impact, mainly in the form of deterioration of mental and physical health and academic performance of students. In light of this, we conducted this study in three medical colleges in Karnataka, India with the objectives of determining the effect of smartphone addiction on the academic performance of undergraduate medical students and to identify the risk factors associated with it. Material and methods This cross-sectional study, conducted between July 2022 and October 2023, involved undergraduate medical students from Yenepoya Medical College, Subbaiah Institute of Medical Sciences, and Adichunchanagiri Institute of Medical Science. A total of 481 students were enrolled by stratified random sampling. Data were collected with the help of Google Forms by using a pre-tested questionnaire. Mobile phone addiction was assessed by using the smartphone addiction scale-short version (SAS-SV). Results Among 481 students, 211 (43.9%) were found to be mobile phone addicts. An independent t-test showed that academic performance was negatively affected in students who were mobile phone addicts. Multivariate logistic regression analysis revealed several factors significantly associated with mobile phone addiction, including male gender, regular mobile gaming, seeking recognition/popularity through social media, frequent smartphone checking, perceiving smartphone use as more attractive than other activities, limited co-curricular activities, and increased smartphone use during periods of depression or anxiety. Conclusions Based on our findings, smartphone addiction has a negative impact on the academic performance of students. To mitigate this issue, educational institutions should integrate efforts to tackle smartphone addiction into their curricula and prioritize addressing the identified risk factors., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee issued approval 2022/267. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Zeerak et al.)

Introduction  Chronic subdural hematoma (SDH) is one of the most common conditions encountered in the neurosurgical practice. Surgical modalities like twist drill craniostomy, burr hole evacuation, mini-craniotomy, and craniotomy are practiced in the management of chronic SDH. Mini-craniotomy without excision of membranes may help to achieve best results with decreased complication rate. Materials and Methods  Patients with chronic SDH operated from September 2013 to September 2022 were included in the study. Mini-craniotomy (40-60 mm) was done and cruciate incision was given over the dura. Dura was left wide open by reflecting and suturing the cut edges of the dural leaflets to the craniotomy edge allowing to evacuate subdural space under vision during surgery and to allow any residual collection to drain out freely in the postoperative period. A drain was placed between the inner membrane and the bone flap. Preoperative and postoperative clinical and radiological parameters were recorded. Complications, recurrence, and residual collections were noted. Results  Seventy-seven patients were included in the study. Mean age was 57.32 years. Median Glasgow Coma Scale (GCS) at presentation was 13 while median GCS at discharge was 15. Two patients with preexisting comorbidities expired after surgery due to medical causes. No recurrences were noted. Fourteen patients had residual collections which resolved by 6 weeks. Two patients had wound infection. One of these patients later needed a bone flap removal due to osteomyelitis. Conclusion  Mini-craniotomy without membranectomy is a good option for complete evacuation of chronic SDH under vision mainly avoiding the complication of membranectomy. It is not associated with increased complications rate. It needs fewer follow-ups as brain expansion can be established radiologically in a short period., Competing Interests: Conflict of Interest None declared., (Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Aim: The aim of this work was to determine and compare serum and salivary glucose levels in patients with type II diabetes mellitus (DM)., Material and Methods: This study had an overall sample size of 100, which consisted of male and female volunteers aged 30-67 years. Both in-depth interviews and physical tests were conducted. Blood and saliva were collected from the participants while fasting, which were analyzed to determine the levels of salivary alpha-amylase (α-amylase). Both the subjects and the controls were instructed to test their blood glucose levels while fasting and it was suggested that HbA1c values will be used for diagnosing diabetes following the guidelines of the American Diabetes Association, Centers for Disease Control, and World Health Organization., Results: The average age of the control group (Category A) was noted as 47.52±6.28 years, and that of the study group (Category B) was 49.17±7.25 years. In Category A, female (n=23) were 46%, and 54% were male (n=27); and 40% of the people in Category B were female (n=20), and 60% were male (n=30). The majority of patients (54%) in Category B displayed an average level of DM control (n=27), followed by poor control (24%. n=12), well-controlled (20%, n=10), and uncontrolled DM (2%, n=1). Category A had an average salivary α-amylase concentration of 3.1±0.88 U/L, whereas that of Category B was 12.06±2.36 U/L. Thus, the mean salivary α-amylase level of Category B was found to be much higher than that of Category A, and this difference was statistically significant (p<0.001)., Conclusion: The determination of α-amylase levels in the saliva of individuals suspected of having type II DM has been suggested as a potential diagnostic method. Screenings conducted at healthcare institutions and community health fairs, as well as epidemiological studies, might benefit from this method. We believe that normal clinical practice should include the use of saliva in a broad variety of diagnostic tests., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Anjum et al.)

Introduction: Sinus Augmentation has proven to be a predictable and popular approach to overcome bone volume deficiency in the posterior maxilla for patients seeking dental implants. The most common surgical methods utilized for maxillary sinus augmentations are the lateral window approach and crestal osteotome technique, which may cause many complications like sinus membrane tear, bleeding, sinusitis, etc. the purpose of this study is to compare complications rates of different sinus lift techniques in dental implant surgery., Aims and Objective: To assess the intraoperative and postoperative complications between the conventional direct or indirect method with alternative sinus lift techniques using Modified Crestal and Lateral (CAS & LAS KIT) ®method (Osstem/Hiossen)., Materials and Methods: This is a retrospective study where in all the sinus lift cases done during 3year duration in the center data was collected and analyzed a total of 61 sinus lift procedure was done and all the data is tabulated and analyzed., Results: Results show of the total 61 cases 25 (40%) male patients and 36(59%)female patients traditional techniques like summers osteotome and conventional direct or indirect method had 7 cases (33.3%-37.5%) complication rates compared to Modified Lateral osteotome had 2 complications (14.2%) & Modified Crestal osteotome had only 3 case(3.7%) infections, wound dehiscence, membrane tear etc., Conclusion: Modified Crestal & Lateral Osteotome (CAS KIT & LAS KIT) ® technique does reduce the incidence of complications like sinus membrane tear compared to conventional Direct and Indirect techniques, because of stopper system used in hydraulic lift and the special design of drill head of these instruments., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© The Association of Oral and Maxillofacial Surgeons of India 2022.)

Numerous drivers push specialist diagnostic approaches down to primary care ('diagnostic downshift'), intuitively welcomed by clinicians and patients. However, primary care's different population and processes result in under-recognised, unintended consequences. Testing performs poorer in primary care, with indication creep due to earlier, more undifferentiated presentation and reduced accuracy due to spectrum bias and the 'false-positive paradox'. In low-prevalence settings, tests without near-100% specificity have their useful yield eclipsed by greater incidental or false-positive findings. Ensuing cascades and multiplier effects can generate clinician workload, patient anxiety, further low-value tests, referrals, treatments and a potentially nocebic population 'disease' burden of unclear benefit. Increased diagnostics earlier in pathways can burden patients and stretch general practice (GP) workloads, inducing downstream service utilisation and unintended 'market failure' effects. Evidence is tenuous for reducing secondary care referrals, providing patient reassurance or meaningfully improving clinical outcomes. Subsequently, inflated investment in per capita testing, at a lower level in a healthcare system, may deliver diminishing or even negative economic returns. Test cost poorly represents 'value', neglecting under-recognised downstream consequences, which must be balanced against therapeutic yield. With lower positive predictive values, more tests are required per true diagnosis and cost-effectiveness is rarely robust. With fixed secondary care capacity, novel primary care testing is an added cost pressure, rarely reducing hospital activity. GP testing strategies require real-world evaluation, in primary care populations, of all downstream consequences. Test formularies should be scrutinised in view of the setting of care, with interventions to focus rational testing towards those with higher pretest probabilities, while improving interpretation and communication of results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

The coronavirus disease-2019 caused by a novel SARS CoV-2 virus has emerged as a global threat. Still, no drugs are available for its treatment. The main protease is the most conserved structure responsible for the posttranslational processing of non-structural polyproteins of this virus. Therefore, it can be the potential target for drug discovery against SARS CoV-2. Twenty-one thousand two hundred and seven chemical compounds used for sequential virtual screening studies including coronavirus screening compounds (Life Chemical database) and antiviral compounds (Asinex database). The Schrodinger suite 2019 employed for high throughput screening, molecular docking and MM-GBSA through the Glide module. Subsequently, 23 compounds were selected in the phase first selection criteria for re-docking with AutoDock and iDock followed by ADMET prediction. The drug-likeness predicted through Lipinski's rule of five, Veber's rule and Muegge's rule. Finally, three ligands were selected for molecular dynamics simulation studies over 150 ns against the main protease of the SARS CoV-2. They showed promising docking scores on Glide, iDock and AutoDock Vina algorithms (ligand F2679-0163: -10.75, -10.29 and -9.2; ligand F6355-0442: -9.38, -8.61 and -7.6; ligand 8250: -9.795, -7.94 and -7.5), respectively. The RMSD parameter remained stable at 2.5 Å for all the three ligands for 150 ns. The high RMSF fluctuations, RoG of around 22 Å and the binding free energy were favorable in each case. The hydrogen bond interactions of 8250, F6355-0442 and F2679-0163 were six, five and three, respectively. These compounds can be further explored for in vitro experimental validation against SARS-CoV-2. Communicated by Ramaswamy H. Sarma.

Objectives: To assess the adverse effects of propranolol therapy in infantile hemangioma., Methods: An ambispective study was conducted from August 2011 to December 2019. In retrospective arm all children managed for infantile hemangioma with propranolol were included and case records were assessed for adverse reactions. In prospective arm the adverse reactions were identified on the basis of predefined criteria., Results: A total of 514 patients (358 retrospective records) were included. A majority, 378 (73.5%) patients had an excellent response, 75 (14.5%) had partial response and 61 (11.8 %) had no response. A total of 82 (15.9%) patients experienced at least one adverse effect. Diarrhea with weight loss (27, 32.9%) and irritability with decreased sleep (21, 25.6%) were the most common adverse effects. The adverse effects in 22 (4.2%) cases lead to the discontinuation of propranolol. Younger age, low body weight and early onset were risk factors for development of severe adverse reactions., Conclusions: Young children with low body weight were at higher risk for adverse effects of propranolol.

The emergence of the coronavirus disease-2019 pandemic has led to an outbreak in the world. The SARS-CoV-2 is seventh and latest in coronavirus family with unique exonucleases for repairing any mismatches in newly transcribed genetic material. Therefore, drugs with novel additional mechanisms are required to simultaneously target and eliminate the virus. Thus, a newly deciphered N protein is taken as a target that belongs to SARS-CoV-2. They play a vital role in RNA transcription, viral replication and new virion formation. This study used virtual screening, molecular modeling and docking of the 8987 ligands from Asinex and PubChem databases against this novel target protein. Three hotspot sites having DScore ≥1 (Site 1, Site 2 and Site 3) for ligand binding were selected. Subsequently, high throughput screening, standard precision and extra precision docking process and molecular dynamics concluded three best drugs from two libraries. Two antiviral moieties from Asinex databases (5817 and 6799) have docking scores of -10.29 and -10.156; along with their respective free binding energies (Δ G bind) of -51.96 and -64.36 on Site 3. The third drug, Zidovudine, is from PubChem database with docking scores of -9.75 with its binding free energies (Δ G bind) of -59.43 on Site 3. The RMSD and RMSF were calculated for all the three drugs through molecular dynamics simulation studies for 50 ns. Zidovudine shows a very stable interaction with fluctuation starting at 2.4 Å on 2 ns and remained stable at 3 Å from 13 to 50 ns. Thus, paving the way for further biological validation as a potential treatment.Communicated by Ramaswamy H. Sarma.

Objectives: The largest proportion of general practitioner (GP) magnetic resonance imaging (MRI) is musculoskeletal (MSK), with consistent annual growth. With limited supporting evidence and potential harms from early imaging overuse, we evaluated practice to improve pathways and patient safety., Methods: Cohort evaluation of routinely collected diagnostic and general practice data across a UK metropolitan primary care population. We reviewed patient characteristics, results and healthcare utilisation., Results: Of 306 MSK-MRIs requested by 107 clinicians across 29 practices, only 4.9% (95% CI ±2.4%) appeared clearly indicated and only 16.0% (95% CI ±4.1%) received appropriate prior therapy. 37.0% (95% CI ±5.5%) documented patient imaging request. Most had chronic symptoms and half had psychosocial flags. Mental health was addressed in only 11.8% (95% CI ±6.3%) of chronic sufferers with psychiatric illness, suggesting a solely pathoanatomical approach to MSK care. Only 7.8% (95% CI ±3.0%) of all patients were appropriately managed without additional referral. 1.3% (95% CI ±1.3%) of scans revealed diagnoses leading to change in treatment (therapeutic yield). Most imaged patients received pathoanatomical explanations to their symptoms, often based on expected age or activity-related changes. Only 16.7% (95% CI ±4.2%) of results appeared correctly interpreted by GPs, with spurious overperception of surgical targets in 65.4% (95% CI ±5.3%) who suffered 'low-value' (ineffective, harmful or wasteful) post-MRI referral cascades due to misdiagnosis and overdiagnosis. Typically, 20%-30% of GP specialist referrals convert to a procedure, whereas MRI-triggered referrals showed near-zero conversion rate. Imaged patients experienced considerable delay to appropriate care. Cascade costs exceeded direct-MRI costs and GP-MSK-MRI potentially more than doubles expenditure compared with physiotherapist-led assessment services, for little-to-no added therapeutic yield, unjustifiable by cost-consequence or cost-utility analysis., Conclusion: Unfettered GP-MSK-MRI use has reached unaccceptable indication creep and disutility. Considerable avoidable harm occurs through ubiquitous misinterpretation and salient low-value referral cascades for two-thirds of imaged patients, for almost no change in treatment. Any marginally earlier procedural intervention for a tiny fraction of patients is eclipsed by negative consequences for the vast majority. Only 1-2 patients need to be scanned for one to suffer mismanagement. Direct-access imaging is neither clinically, nor cost-effective and deimplementation could be considered in this setting. GP-MSK-MRI fuels unnecessary healthcare utilisation, generating nocebic patient beliefs and expectations, whilst appropriate care is delayed and a high burden of psychosocial barriers to recovery appear neglected., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The basic and regulatory knowledge of prescription writing is essential for every medical student to evolve into a prescribing physician. Prescription becomes the most important clinical pharmacology tool and evidence of the medication access, prescription errors, prescribing errors, negligence and further litigations once released from the hands of the physicians. A questionnaire based cross-sectional survey was done to evaluate knowledge of basic and regulatory aspects of prescription writing in the light of growing violence against physicians in India., Methods: The basic and regulatory knowledge and awareness of 90 practicing physicians was evaluated for arts of prescription writing by a novel questionnaire based on Indian regulatory guidelines. It was assessed for content validity, face validity, readability and reliability. A statistical significant Cronbach's alpha values of greater than 0.9, Flesh Reading Ease score of 37.4 and Flesch-Kincaid Grade level of 11.2 were obtained. A total of 39 questions comprised of 70 statements categorised into three broad sections containing 13 questions in each were asked in 30 min., Results: The knowledge of the prescription writing is very limited in doctors. They are not sure that Over-The-Counter drugs do not need prescription, pharmacist is the decoder of their written prescription, cross-prescribing (prescribing drugs of other system of medicine) is illegal and they should not dictate prescription on phone. Majority of the physicians are unaware that writing prescription serial number, Rx, refill information and dispensing direction of habit forming drugs is not legal requirement in India., Conclusion: Medication access through prescription writing is marred with prescription errors. The physicians have limited regulatory and basic knowledge of prescription writing. Therefore their training of prescription writing through defined global teaching modules is needed. The prescription communications need to be lucid, accessible, comprehensive and straight between doctors and patients following the tenets of country specific regulatory requirements. Graphical abstract Need of standard uniform global basic and regulatory training guidelines for prescription writing.

Aim: To compare the clinical sequelae of the efficacy of PRF vs PRF + collagen plug in soft tissue healing and preservation of the socket width, height, and bone density in patients reporting for extractions of maxillary or mandibular anterior or posterior teeth and patients who desired replacement of teeth with dental implants in future., Materials and Methods: The study included 54 patients who were divided randomly into 3 groups consisting of 18 patients in each group: in group I, no preservation of extraction socket; in group II, PRF was used; and in group III, PRF + collagen plug was used for preservation of extraction socket. Assessment of the soft tissue healing, bone density, bone height, and width was done on 1st, 8th, 12th, and 16th weeks, postoperatively., Result: Both PRF and PRF + Collaplug are comparable to each other in preserving the bone height, bone density, and also similar soft tissue healing; however PRF + Collaplug is better than PRF alone in preserving the bone width 4th month postoperatively, indicating that the resorbable Collaplug® does play an additional role in preserving the socket width., Conclusion: PRF + Collaplug® has better clinical outcome in socket preservation in comparison to PRF alone. However, as results were not statistically significant, subjecting a larger sample size with PRF + Collaplug® for socket preservation may result in statistical critical values to substantiate our observations., Clinical Significance: PRF and Collaplug® can help in ridge preservation after extraction and also avoid additional bone grafting procedures in future implant placement for the patients. How to cite this article: Ahmed N, Gopalakrishna V, Shetty A, et al. Efficacy of PRF vs PRF + Biodegradable Collagen Plug in Post-extraction Preservation of Socket. J Contemp Dent Pract 2019;20(11):1323-1328.

Objectives: The proper assessment orients learning in the desired direction. The structuring of assessment tools helps in minimizing the examination bias. However, the structuring of viva voce (SVV) has not been tried much. Therefore, this study was conducted to comparatively evaluate the structured written theory examination (STE) outcome with structured and unstructured viva voce assessments in third semester MBBS students., Methodology: Twenty uniform viva voce cards each containing eight structured questions with equitable, progressive cognitive levels were prepared. The random permutation (randomization) was done by shuffling the cards before the student picked up one card in a double-blind fashion. Of 135 students, 33-35 students per day were assessed for 4 continuous days through checklist-based evaluation by the same examiner following the STE. Parallel unstructured practical viva voce assessment was done for a major practical exercises held., Results: The intragroup percentage coefficient of variance values progressively increased in order of unstructured practical viva assessment (UPA%, 18.25) < structured written theory examination (STE%, 47.26) < structured theory viva voce (SVV%, 63.91). Thus, SVV% is more discriminatory than UPA%. The students in appropriate categories were 72 (53%) in%vSTE-SVV, 18(13%) in %vSTE-UPA, and 20 (14%) in %vSVV-UPA, respectively. A very high statistically significant correlation ( P = 0.001) is seen between STE% and SVV% and highest erroneous results are seen in %vSVV-UPA (110, 81%)., Conclusion: The SVV provides uniform, equitable, unbiased, and reflective assessment of students. Thus, a comprehensive objective and meaningful assessment can be achieved by structuring of written theory, practical, and viva voce.

Objective: This study was conducted to compare the efficacy of Obwegeser's pterygoid osteotome and Laster shark-fin osteotome by measurement of strain adjacent to the pterygomaxillary suture and the amount of force required for dysjunction., Materials and Methods: Two popular instruments Obwegesser's pterygoid and shark-fin osteotome were tested on dry human skulls. The external force required for separation of the pterygomaxillary suture with these osteotomes was generated by an electronically controlled 'Instron' tester Bi-06-108. Tests were performed with pterygoid osteotome placed on one randomly chosen side and shark-fin osteotome on the other side of the same specimen. The amount of strain developed by each of these instruments was recorded using two strain gauges on the right and left lateral pterygoid plates., Results: [Table: see text]., Conclusion: Based on the distribution of strain, from this study, we conclude that Laster shark-fin osteotome is efficacious over Obwegeser's Pterygoid osteotome, in Le fort I osteotomy., Competing Interests: Compliance with Ethical StandardsThis article does not contain any studies with human participants or animals performed by any of the authors. Ethical committee clearance was taken from the college ethical committee.

A total of 50 Candida isolates were isolated and identified from clinical specimens and these were tested for resistance to various antifungal drugs. It was observed multi-drug resistance in all candida isolates by 84%, 62%, 60%, 76%, 46, 30%, and 22% against fluconazole, clotrimazole, Amphotericin B, itraconazole, ketoconazole, miconazole and nystatin tested respectively. The isolates, which were found to be resistant to antifungal drugs were selected and subjected to antifungal testing against six ethanolic plants, extract namely Azadiracta indica, Allium sativum, Cordia dichotoma Ocimum sanctum, Syzygium cumini and Trigonella foenum grecum. All the plant extracts tested were found to effective against all MDR Candida isolates with inhibition zone ranging from 10- 18mm in diameter. Ethanolic extract of Allium sativum was observed most effective against the isolates among all the plants extracts tested. The minimum inhibitory concentration (MIC) of all ethanolic plant extract was recorded ranging from 1.56-25mg/ml against MDR candida isolates. Phytochemical analysis of the alcoholic plant extracts revealed the presence of alkaloid, flavanoid, glycosoid, phenol; phenol, tannins, saponins in all the plants studied. The present study may be successful in identifying the plants with different antimicrobial activity. These plants containing various phytochemicals may be exploited in the treatment of infectious diseases caused by drug-resistant microorganisms.

Purpose: The present study was done to assess the prevalence of tobacco abuse among school going students of the age group 15 to 18 year old in the rural areas of Almora district, Uttrakhand state, India., Materials and Methods: Schools were grouped into 4 zones north, south and east, west based on their location in district, respectively. Second stage one private and one government school was randomly selected from each zone of rural Almora. All students belonging to age 15 to 18 year were selected from the selected schools. Data was collected by a pretested, closed ended questionnaire., Results: Overall, the prevalence of tobacco consumption among the adolescents was 45.42%. 63% male and 47.1% female adolescents were habituated to it. All female and majority of the male adolescents predominantly consumed a smokeless form of tobacco., Conclusion: The prevalence of tobacco consumption indicates a downward shift in the age for the uptake of tobacco habit by adolescents and a rising prevalence among girls. Our findings suggest that tobacco use prevention and control measures are warranted and should be started very early preferably at primary education level.