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The scaffolds used in regenerative endodontic therapy (RET) provide structural support for cells so that they can adhere to the scaffolds and also are crucial for cellular proliferation and differentiation. The objective of this network meta-analysis was to compare effects of different intracanal scaffolds on success outcomes of RET.PubMed/Medline, EMBASE, Cochrane, CINAHL, Scopus, and Web of Science databases were searched. Studies evaluating and/or comparing clinical and/or radiographic success of RET using different scaffolds with a minimum of 12 months follow-up were included. The Cochrane Collaboration risk of bias (ROB) tool and appropriate tools from Joanna Brigg's Institute were used for the assessment of ROB. A network meta-analysis was performed to compare the primary outcome (clinical success) and other success outcomes (root maturation, and pulpal sensibility) using different scaffolds.Twenty-seven studies fulfilled the desired inclusion criteria of which 25 had a low ROB whereas two had a moderate ROB. Clinical success of RET using platelet-rich plasma (PRP), blood clot (BC), and platelet-rich fibrin (PRF) scaffolds ranged between 91.66%-100%, 84.61-100%, and 77-100% respectively. The different scaffolds did not show any statistically significant difference in clinical success (PRF versus BC [p=1.000], PRP versus BC [p=1.000], and PRF versus PRP [p=0.999]), apical root closure (PRF versus BC [p=1.000], PRP versus BC [p=0.835], PRF versus PRP[p=0.956]), and pulp sensibility (PRF versus BC[p=0.980], PRP versus BC [p=0.520], and PRF versus PRP, p=0.990]).The intracanal scaffolds used during RET did not result in significant differences in regard to clinical success, root maturation, and pulpal sensibility.

Schools have a powerful influence on children's development and well-being, and school teachers are considered role models to transmit life values and instill health-related behaviors. The effectiveness of a training program for school teachers in understanding the role of sugars and their impact on oral and overall health has not been previously reported.The present study aimed to assess the effectiveness of a training program for school teachers on the role of sugars in oral and general health.An interventional study was carried out on 308 Kendriya Vidyalaya Sangathan school teachers to evaluate the effectiveness of a training program in improving school teachers' knowledge of the role of sugars in oral and overall health. The training program was carried out using a training module, and a validated questionnaire was utilized to assess school teachers' knowledge before and after the training program.The overall evaluation of mean knowledge change scores revealed significantly higher scores after the training program (8.12 ±1.58) when compared with the pre-training scores (6.84±1.66) Conclusion: A training program on the role of sugars in oral and general health effectively improved school teachers' knowledge.

Spinal anesthesia is an attractive choice for ambulatory surgery of the lower abdomen and lower limbs but it requires a local anesthetic agent of short duration with minimal side effects. We compare the effect of intrathecal chloroprocaine with fentanyl to bupivacaine with fentanyl in ambulatory urology surgery. Hundred patients aged 18 – 60 years undergoing ambulatory urology surgery randomly divided into two groups of 50 each. Group A received 40 mg of 1% chloroprocaine with 20mcg fentanyl and group B received 7.5 mg of 0.5% bupivacaine and 20mcg fentanyl. Sensory and motor block characteristics, time to ambulation, void and time for ready to discharge from hospital were recorded. There was no difference in terms of demographic data and duration of surgery. Peak sensory block level was T5 in group A and T4 in group B. The mean time to reach the peak block level was similar in both groups (P=0.228). Time to two-segment regression and regression to the S2 segment were shorter in group A (PChloroprocaine and fentanyl is a better choice for ambulatory urology surgery in comparison to low dose bupivacaine and fentanyl.

Anticoagulant therapy is commonly indicated during pregnancy to prevent thrombosis and prevention of prosthetic heart valve-associated thromboembolic events. Warfarin is a synthetic anticoagulant with low molecular weight and can cross the placenta resulting in congenital abnormalities termed fetal warfarin syndrome. This paper highlights the case of an 8-year-old boy with warfarin embryopathy. It highlights the extraoral and intraoral findings of the case along with the cephalometric analysis and provides insight into the phenotypic variations among the different cases reported in the literature.

Vitamin D–resistant rickets shows the resistance to vitamin D (Vit-D) therapy, which traditionally works well in cases with deficiency rickets. The signs start appearing as early as in the first month of life and are characterised by the defective mineralisation at the ends of cartilage and bones despite having normal Vit-D levels in the serum. This case report highlights the dental and maxillofacial manifestations in a 3-year-old girl diagnosed with pseudo-Vit-D deficiency rickets. The report also highlights the variations in the dental manifestations of the condition reported in the literature.

Background and objectives: Induction of anesthesia is a critical part of anesthesia practice. Sudden hypotension, arrhythmias, and cardiovascular collapse are threatening complications following injection of induction agent in hemodynamically unstable patients. It is desirable to use a safe agent with fewer adverse effects for this purpose. Present prospective randomized study is designed to compare propofol and etomidate for their effect on hemodynamics and various adverse effects on patients in general anesthesia. Methods: Hundred ASA I and II patients of age group 18–60 years scheduled for elective surgical procedure under general anesthesia were randomly divided into two groups of 50 each receiving propofol (2 mg/kg) and etomidate (0.3 mg/kg) as an induction agent. Vital parameters at induction, laryngoscopy and thereafter recorded for comparison. Adverse effect viz. pain on injection, apnea and myoclonus were carefully watched. Results: Demographic variables were comparable in both the groups. Patients in etomidate group showed little change in mean arterial pressure (MAP) and heart rate (HR) compared to propofol (p > 0.05) from baseline value. Pain on injection was more in propofol group while myoclonus activity was higher in etomidate group. Conclusions: This study concludes that etomidate is a better agent for induction than propofol in view of hemodynamic stability and less pain on injection. Resumo: Justificativa e objetivos: A indução da anestesia é uma parte crítica da prática de anestesia. Hipotensão súbita, arritmias e colapso cardiovascular são complicações ameaçadoras após a injeção de agente de indução em pacientes hemodinamicamente instáveis. É aconselhável o uso de um agente seguro com menos efeitos adversos para esse propósito. O presente estudo prospectivo, randômico teve como objetivo comparar propofol e etomidato quanto a seus efeitos sobre a hemodinâmica e aos vários efeitos adversos em pacientes sob anestesia geral. Métodos: Cem pacientes ASA I e II, idades entre 18-60 anos, programados para procedimento cirúrgico eletivo sob anestesia geral foram divididos aleatoriamente em dois grupos de 50 cada para receber propofol (2 mg/kg) e etomidato (0,3 mg/kg) como um agente de indução. Os parâmetros vitais na indução, laringoscopia e posteriormente foram registrados para comparação. Efeitos adversos como dor à injeção, apneia e mioclonia foram cuidadosamente monitorados. Resultados: As variáveis demográficas foram comparáveis em ambos os grupos. Os pacientes do grupo etomidato apresentaram pouca alteração da pressão arterial média (PAM) e da frequência cardíaca (FC) em comparação com o grupo propofol (p < 0,05) a partir do valor basal. Houve mais dor à injeção no grupo propofol, enquanto houve mais atividade mioclônica no grupo etomidato. Conclusões: Este estudo conclui que etomidato é um agente melhor para a indução que propofol em relação à estabilidade hemodinâmica e menos dor à injeção. Keywords: Propofol, Induction of anesthesia, Myoclonus, Hemodynamic stability, Mean arterial pressure, Palavras-chave: Propofol, Indução da anestesia, Mioclonia, Estabilidade hemodinâmica, Pressão arterial média

BACKGROUND AND OBJECTIVES: Induction of anesthesia is a critical part of anesthesia practice. Sudden hypotension, arrhythmias, and cardiovascular collapse are threatening complications following injection of induction agent in hemodynamically unstable patients. It is desirable to use a safe agent with fewer adverse effects for this purpose. Present prospective randomized study is designed to compare propofol and etomidate for their effect on hemodynamics and various adverse effects on patients in general anesthesia. METHODS: Hundred ASA I and II patients of age group 18-60 years scheduled for elective surgical procedure under general anesthesia were randomly divided into two groups of 50 each receiving propofol (2 mg/kg) and etomidate (0.3 mg/kg) as an induction agent. Vital parameters at induction, laryngoscopy and thereafter recorded for comparison. Adverse effect viz. pain on injection, apnea and myoclonus were carefully watched. RESULTS: Demographic variables were comparable in both the groups. Patients in etomidate group showed little change in mean arterial pressure (MAP) and heart rate (HR) compared to propofol (p > 0.05) from baseline value. Pain on injection was more in propofol group while myoclonus activity was higher in etomidate group. CONCLUSIONS: This study concludes that etomidate is a better agent for induction than propofol in view of hemodynamic stability and less pain on injection. RESUMO JUSTIFICATIVA E OBJETIVOS: A indução é uma parte crítica da prática de anestesia. Hipotensão súbita, arritmias e colapso cardiovascular são complicações ameaçadoras após a injeção de agente de indução em pacientes hemodinamicamente instáveis. É aconselhável o uso de um agente seguro com menos efeitos adversos para esse propósito. O presente estudo prospectivo, randômico, teve como objetivo comparar propofol e etomidato quanto a seus efeitos sobre a hemodinâmica e aos vários efeitos adversos em pacientes sob anestesia geral. MÉTODOS: Cem pacientes ASA I e II, entre 18-60 anos, programados para procedimento cirúrgico eletivo sob anestesia geral, foram divididos aleatoriamente em dois grupos de 50 cada para receber propofol (2 mg/kg) e etomidato (0,3 mg/kg) como um agente de indução. Os parâmetros vitais na indução, laringoscopia e posteriormente foram registrados para comparação. Efeitos adversos como dor à injeção, apneia e mioclonia foram cuidadosamente monitorados. RESULTADOS: As variáveis demográficas foram comparáveis em ambos os grupos. Os pacientes do grupo etomidato apresentaram pouca alteração da pressão arterial média (PAM) e da frequência cardíaca (FC) em comparação com o grupo propofol (p < 0,05) a partir do valor basal. Houve mais dor à injeção no grupo propofol, enquanto houve mais atividade mioclônica no grupo etomidato. CONCLUSÕES: Este estudo conclui que etomidato é um agente melhor para a indução do que o propofol em relação à estabilidade hemodinâmica e menos dor à injeção.

Background and objectives: Foot drop in postoperative period is very rare after spinal anesthesia. Early clinical assessment and diagnostic interventions is of prime importance to establish the etiology and to start appropriate management. Close follow-up is warranted in early postoperative period in cases when patient complain paresthesia or pain during needle insertion or drug injection. Case report: A 22-year-old male was undergone lower limb orthopedic surgery in spinal anesthesia. During shifting from postoperative ward footdrop was suspected during routine assessment of regression of spinal level. Immediately the patient was referred to a neurologist and magnetic resonance imaging was done, which was inconclusive. Conservative management was started and nerve conduction study was done on the 4th postoperative day that confirmed pure motor neuropathy of right peroneal nerve. Patient was discharged with ankle splint and physiotherapy after slight improvement in motor power (2/5). Conclusions: Foot drop is very rare after spinal anesthesia. Any suspected patient must undergo emergent neurological consultation and magnetic resonance imaging to exclude major finding and need for early surgical intervention. Resumo: Justificativa e objetivos: Pé caído no período pós-operatório é muito raro após a anestesia espinhal. Avaliação clínica e intervenções diagnósticas precoces são de primordial importância para estabelecer a etiologia e iniciar o tratamento adequado. Um acompanhamento atento é justificado no pós-operatório imediato nos casos em que o paciente se queixa de parestesia ou dor durante a inserção da agulha ou da injeção de fármacos. Relato de caso: Paciente do sexo masculino, 22 anos de idade, submetido à cirurgia ortopédica de membros inferiores sob anestesia espinhal. Durante a transferência para a sala de recuperação pós-operatória, houve suspeita de pé caído durante a avaliação rotineira da regressão do nível espinhal. O paciente foi imediatamente encaminhado ao neurologista e uma ressonância magnética foi feita, mas não foi conclusiva. O manejo conservador foi iniciado e o estudo de condução nervosa foi realizado no 4° dia de pós-operatório, o que confirmou a neuropatia motora pura do nervo fibular direito. O paciente foi dispensado com imobilizador de tornozelo e fisioterapia após ligeira melhora da força motora (2/5). Conclusões: Pé caído é muito raro após a anestesia espinhal. Qualquer paciente suspeito deve ser submetido à consulta neurológica de emergência e ressonância magnética para excluir o principal achado e a necessidade de intervenção cirúrgica precoce. Keywords: Spinal anesthesia, Paresthesia, Magnetic resonance imaging, Physiotherapy, Palavras-chave: Anestesia espinhal, Parestesia, Imagem de ressonância magnética, Fisioterapia

BACKGROUND AND OBJECTIVE: Spinal Anaesthesia is the most commonly used as it is very economical, easy to administer and safe. Dexmedetomidine, an alpha-adrenoreceptor agonist, is being used as a neuraxial adjuvant as it provides stable hemodynamic conditions, good quality of intra-operative and prolongs post-operative analgesia with minimal side effects. This study is aimed to assess the effect of intrathecal administration of different doses of dexmedetomidine with hyperbaric bupivacaine on the duration of sensory and motor block, side effects produced by spinal anaesthesia in lower limb orthopaedic surgeries. METHODS AND MATERIALS: A randomized double blind study is planned in 90 patients divided in 3 groups. Group A, B and C patients received inj. Bupivacaine (12.5mg) with normal saline, with dexmedetomidine (5μg) and with dexmedetomidine (10 μg) respectively. Hemodynamic data were recorded after every 5 min for 30 minutes than after every 15 min. Degree of motor block (Bromage 1), sensory block, time of regression of sensory block, side effects were assessed. RESULT: Dexmedetomidine (10 μg) prolonged time for two segment regression. Effect was greater in group C (Dex 10 μg) than group B (Dex 5 μg) as well as higher sedation scores achieved intraoperatively. Hemodynamic stability was maintained in all the three groups. CONCLUSION: Dexmedetomidine in different doses prolongs the anaesthetic effect of intrathecal hyperbaric bupivacaine. A 10 μg dose may be of benefit for prolonged duration of surgery.

Background: Neuromuscular blockers (NMB) are very important for generalanesthesia, Rocuronium and Vecuronium are used as non-depolarizing muscle relaxants. In a randomized study we had compared both drugs as regard theonset of action, intubating condition and hemodynamic changes. Method:-Sixty patients ( 20 to 60 year), scheduled to undergo elective general surgery, were included in thisrandomized, double-blind controlledstudy.After induction of anaesthesia, patientswere divided randomly into two groups according to the muscle relaxant used. Group I received Inj. rocuronium while GroupII received Inj.vecuronium.Haemodynamic parameters comprising of heart rate, mean arterial pressure were measuredpreoperatively, pre induction, post induction, post relaxant, post intubation (1 min) and after 3, 5,7,10,15 and 30 min after intubation. Results:-Rocuronium has maintained excellent cardiovascular stability for the dose used in present study. There was an increase inheart rate following rocuronium administration but the average maximum increase of 5 beats/min was clinically insignificant.Rocuronium is 3-6 times less potent than vecuronium as a neuromuscular blocker but is slightly more potent in blocking theresponses to either vagal or preganglionic sympathetic stimulation.

To assess the oral health and related practices of a group of illicit drug users in Delhi, India; to compare with that of non-drug users; and to assess the impact of illicit drug use on oral health.Cross-sectional study. Comparison was made with non-drug users to investigate any differences in oral health between illicit drug users and general population.Illicit drug users attending a drug dependence treatment clinic in Delhi (n=126). Equal number of non-drug users attending other outpatient departments in the same setting.Oral health practices assessed using structured questionnaire; dental caries, periodontal status and oral mucosa assessed using World Health Organization 2004 criteria; oral hygiene assessed using OHI-S.Mean DMFT and OHI-S scores amongst the drug users were 3.48 and 3.80, respectively. Bleeding, shallow pockets and deep pockets were found as the highest CPI finding in 42%, 44% and 12% of drug users respectively. Premalignant states of leukoplakia and OSMF were diagnosed in 13% and 4% of drug users respectively. Significant differences were found between drug users and non-drug users with respect to oral hygiene practices; DMFT, OHI-S, CPI scores; and leukoplakia. In multivariate analysis, illicit drug use was significantly associated with CPI highest score (OR = 2.21, 95% CI 1.08-4.52).The illicit drug users had significantly poorer oral hygiene practices, oral hygiene and periodontal health; higher caries experience; and higher prevalence of leukoplakia as compared to non-drug users. The findings of the study suggest that illicit drug use is independently associated with poor periodontal health.

Biodegradable implants of ciprofloxacin hydrochloride for post operative site delivery were prepared using glyceryl monostearate and different concentrations of polyethylene glycol (PEG 6000) glycerol and Tween 80 as erosion enhancers by compression and molding technique. Formulations were subjected to in vitro drug release by the USP dissolution method, while promising formulations were subjected to in vitro drug release by the agar gel method and also to stability studies. It was observed that glyceryl monostearate formed hydrophobic matrix and delayed the drug delivery. Antibiotic release profile was controlled by using different combinations of erosion enhancers. The formulation prepared by compression method showed more delayed release as compared to formulations prepared by molding method., Biorazgradljivi implantati ciprofloksacin hidroklorida za postoperativnu primjenu pripravljeni su pomoću gliceril monostearata (GMS) i različitih koncentracija polietilen glikola (PEG 6000), glicerola i Tween 80 kao promotora erozije metodom kompresije i lijevanja. Oslobađanje ljekovite tvari iz pripravaka praćeno je in vitro prema USP metodi. Pripravci koji su dali dobre rezultate ispitani su i in vitro metodom s agarom te su podvrgnuti testovima stabilnosti. Primijećeno je da gliceril monostearat tvori hidrofobni matriks i usporava oslobađanje lijeka. Koristeći različite kombinacije promotora erozije postignuto je kontrolirano oslobađanje antibiotika. Oslobađanje iz implantata dobivenih metodom kompresije sporije je od implantata dobivenih metodom lijevanja.

Measuring academic achievements is never an easy task. This is particularly so when individuals are assessed for promotions in several fields with differing job descriptions. Assessment by peers is time-consuming and may be prone to bias; thus, objective criteria are required to minimize these concerns. The Medical Council of India (MCI) has laid down guidelines for appointments and promotions of teachers in medical institutions in India. Among the criteria used for promotions, publication of research is an essential requirement. Though the need for this requirement has been debated, it is believed that the quality of teaching improves when medical teachers are involved in research. Many countries have made it mandatory for their medical faculty to do research; some other countries incentivize the conduct and publication of research. Reports have also lamented that the physician–scientist might become an endangered species [1], [2]. Thus, linking publications with promotions might benefit both the individual and society. The flipside is that the time spent on research might take teachers away from teaching or clinical duties, particularly in under-staffed specialty departments. Further, the quality of research is likely to be poor when the resources and training in research are lacking [3]. Poor quality may even discredit research as a professional activity. Insistence on a certain amount of published research to maintain teaching credentials may lead to the phenomenon of ‘publish or perish’ [4]. Finally, it is important to consider that biomedical research may, at times, be relevant to non-biomedical journals and criteria for awarding credit to such publications should also be devised. The MCI requires that the medical faculty engages in research. One measure to achieve this goal is the mandatory ‘thesis’ for postgraduate (masters; MD/MS/DNB) and post-doctoral (DM/MCh/DNB) courses. Each student, regardless of specialty, is required to undertake a research study with a faculty member as the guide and often one-to-a-few faculty members from the same or related subjects as co-guides. Apart from providing training in doing research, the thesis is expected to inculcate an appreciation for research methodology and critical analysis. This experience is relevant to students who will become full-time researchers, and is also beneficial to medical practitioners who may never conduct further research but should be able to discern the merits of newer management options for their patients. The MCI's initial guidelines for promotion to the position of Associate Professor and Professor required publication of at least two research papers by the candidates [5]. In September 2015, the MCI issued a ‘clarification’ on what constitutes ‘research publications’ for promotion of teaching faculty of medical colleges/institutions in India (Box 1) [6]. This ‘clarification’ raises the following issues. Box 1 Guidelines for counting research publications for promotion of teaching faculty of medical colleges/institutions in India as laid down in an order by Medical Council of India in September 2015 a Index agencies: Scopus, PubMed, Medline, Embase/Excerpta Medica, Index Medicus and Index Copernicus b Types of articles to be considered: Original research articles and original research papers. c Criteria for National/International journal: Published by a National/International – specialty journal/journal of a national/international society provided it included in one of the indexes mentioned above. d Authorship: First author, second author e E-journals: E-journals not included The above would also be applicable for ‘accepted for publication’ papers/articles.

Background Early childhood caries (ECC) in preschool children debilitate their quality of life affecting oral function, appearance and social well-being. A tool for measuring oral health-related quality of life for preschoolers may help in making clinical decisions and assist policy makers in planning and management of health programs in the country. Objective To translate oral health-related early childhood quality of life (OH-ECQoL) tool into Nepali language and test its validity and reliability. Method OH-ECQoL was translated into Nepali language by two Nepalese professional translators which was back translated by professional English translator. This was sent to three independent advisors to see the appropriateness of translation. Pilot testing was done in 20 parents and questionnaire was finalized after needed corrections. Final version was introduced to the 118 parents of children aged 24- 71 months. Caries status was recorded for all children participating in the study. Concurrent, construct, discriminant validity and internal consistency reliability, test -retest reliability were evaluated. Result OH-ECQoL scores and perception of parents for general and oral health of their children was significant (at 0.01 level). There was significant difference in OH-ECQoL scores between no ECC and severe ECC groups and moderate and severe ECC groups (at 0.05 level). There was also a significant correlation between child impact section and family impact section (at 0.01 level). Cronbach’s alpha was 0.891 demonstrating good internal consistency. Intra class coefficient was 0.963 suggesting excellent test-retest reliability. Ninety-one (77.1%) children had severe ECC and 40(33.9%) parents were from upper middle class. Conclusion The Nepali version of OH-ECQoL is a valid and reliable tool for assessing the oral health-related early childhood quality of life in children of Nepal.

The present pilot study was conducted on five primary mandibular second molars requiring endodontic treatment to evaluate the clinical and radiographic success of root canal filling material which was a mixture of calcium hydroxide paste (1 cm), Zinc oxide powder (15 gms) and distilled water using hand operated lentulo spirals. All the five cases on clinical evaluation after 2,4,6,9, and 12 months were found to be asymptomatic with no history of pain, tenderness or abnormal mobility. Immediate post-operative radiographic evaluation revealed adequate root canal filling in all cases. The obturated material remained upto the apex of root canals till the beginning of physiologic root resorption. The roots of the primary teeth as well as the filling material mentioned above were seen to resorb at the same rate in one case.