Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411211EnglishN2020June3HealthcarePatient Preferences for Dental Clinical Attire, Hairdo and Infection Control Measures: A Cross Sectional Survey English0110Jaya PandeyEnglish Harneet KaurEnglish Arisha IzharEnglish Panchali BatraEnglishAim: The objective of this cross-sectional descriptive study was to survey patients’ preferences to the factors which contribute to the overall looks of the dentist like dental clinical attire, hairdo, makeup, jewelry, presence of beard, preference for name badges, commonly used cross-infection control measures and attributes to be present in clinician. Method: The sample size included 150 patients in the age group of 20-35 years reporting to the out-patient department. A 12 points questionnaire was developed to gather the data accompanied by photographs. Result: Majority of patients in the study considered dental clinical attire was important (68%). Scrubs (46%) followed by white coats (45.3%) were the clinical attires of choice. The white coat was ranked highest in attributes of cleanliness, authority, trustworthiness, approachability and professionalism. 50.7% reported it did not matter what attire was worn under the white coat. Pony or braided hair (39.3%) was rated highest, make up (57.3%) and jewelry (54%) was felt as not important. Males preferred their dentist to be clean shave (53.3%) whereas female subjects said it does not matter (53.3%).90.7% preferred name badges. Majority expected their dentist to wear a face mask and head cap. Amongst the attributes that should be present in clinician, knowledge of the clinician was rated highest (70.7%) followed by trustworthiness, approachability, cleanliness and authority. Conclusion: The results of this study have relevance for clinicians, policy makers and students and will further help in strengthening the bond with the patients who continue to prefer a professionally dressed clinician. EnglishDental attire, Hairdo, Infection control Measures, Clinical attire, White coatINTRODUCTION: Professionalism is an image to encourage a successful doctor-patient relationship thereby empowering the base of effective patient care1. The patient forms an initial impression of the clinician at the first meeting and a fundamental connection is established2. Substantial research regarding the professional image of doctors has been done,3-7 but it is more specifically relating to the medical professionals, little literature has been produced specifically to dental profession.8-10 No such study has been conducted in North India, and only a few studies have been conducted in South India to find out the preferences of Indians toward various professional outfits.11-13 Traditionally, the white coat has been worn by the medical personnel, but nowadays, scrubs are also worn in many parts of the world. The concept of white coat and aseptic surgery was introduced by Lister in the late 19th century as a shield to prevent contamination.8 Nowadays, professionals and students have become more casual about selecting their clinical professional appearances. Although professional appearance is the first impression that may in?uence patients’ expectations of the professional’s care and competence, it has also been linked to dental anxiety, confidence, authority, friendliness, compliance and trust.14,15 While we are aware that the attire and the attitude of a healthcare professional are very important, there are other factors also affecting the appearance, like hairdo, makeup, jewelry and accessories worn as part of the infection control measures. To the best of our knowledge, no study has considered all these factors as they together make an impact on the dentists’ appearance. This study is an effort to find out the patients’ preferences to the factors which contribute to the overall looks of the dentist. The results of this study would help us in striking a balance as to what should be an essential part of the appearance and on which factors the dentist can take some liberty following patient opinion. It will also help us in reinforcing these facts to the dental students. METHODS: The present cross-sectional descriptive study was conducted using survey methodology on new patients attending the out-patient department of the Institute (Faculty of Dentistry, Jamia Millia Islamia). A self-completion bilingual (Hindi and English) questionnaire was developed to know the patients' views on dental clinical attire, appearance, hairdo, and several cross-infection control procedures (Annexure 1). A pilot run for the study was done on 30 patients to validate the questionnaire. The sample included 150 new patients (80 males and 70 females) between the age group of 20-35years and having a minimum graduation level of education. The questionnaires were distributed to the patients by nonclinical reception staff in the waiting area before an initial consultation appointment and written informed consent was taken. The survey was conducted for over four weeks.  The questionnaire included the patients’ demographic information (age, sex, and education) and the questions (along with relevant photographs attached to the back of the question) framed to gain information on patients' preferences in the following areas: Attire (question 1-4, Annexure 1), appearance (question 5-9, Annexure 1), cross-infection measures, (question 10-11, Annexure 1) and attributes to be present in clinician.(Question 12, Annexure 1) In the attire group the first question (Question 1) was asked to rate how important they felt dental clinical attire was by using a modi?ed Likert scale (1 = very important, 2 = important, 3 = quite important, 4 = unimportant). The second question (Question 2) was related to patients' preference for different clinical attire (Fig.1), the photographs displayed male and female models wearing white coats, formals, casuals, and dental scrubs. The background, hairdo, models were the same in all the attires and only the clinical attire was different to remove bias. The next question (Question 3) was regarding the attribute that was most linked to each clinical attire. The fourth question (Question 4) was related to their preferences for different outfits worn under the white coats. The photographs portrayed a female dressed in 3 most commonly worn attires (Fig 2) in India: saree, suit, and western outfits in trousers. The fifth question (Question 5) was framed to find out the patients' preference for different hairstyles. The photograph (Figure 3) displayed 3 hairstyles viz: loose hair, braided pony, and bun. The sixth question was framed to anticipate the patient's preference for makeup worn by the dentist. The accompanying photo showed commonly used makeup items like lipstick, nail paint, foundation and bindi (forehead dot wore by Indian females) The next question (Question 7) related to the appearance of the male dentist in which the patients were asked for their preference for a clean-shaven or dentist with the beard. The eighth and ninth questions asked about the patients' preference for name badges and jewelry (necklace, bangles, rings, and earrings) worn by the dentist respectively. The tenth and eleventh questions asked about their preference to cross-infection measures like facemask and head cap (Fig.4). The last question (question 12) was framed to find the hierarchy of importance, in the patients' perspective, for the followings attributes: cleanliness, authority, trustworthiness, approachability, and Knowledge. After the completion of the questionnaires, they were collected and checked for their completeness and sent for statistical analysis. STATISTICAL ANALYSIS The data were analyzed by SPSS (21.0 version). A chi-square test was used for frequency analysis. The level of statistical significance was set at a p-value of less than 0.05. A p-value 0.05). (Table 1) When asked about which clinical attire amongst white coat, casuals, formals, or scrubs, (Figure 1, question 2) was appropriate for a dentist to wear in clinics, significant differences were seen as ptrustworthiness>approachability followed by authority and professionalism which were rated similarly. Significant differences were seen in the response rate among males and females for an outfit that best portrays for professionalism, where the majority of the males (50.7%) linked it with scrubs whereas females 50.7% said its best portrayed by white coats.20.7% linked formals to professionalism whereas this attire was ranked low in other attributes. Casuals were ranked least for all the attributes amongst all the attires. Scrubs were rated the second-highest in the attires amongst all the attributes. Scrubs conveyed the attributes in the following sequence: professionalism > trustworthiness > approachability > cleanliness >authority. When patients were asked about the outfit of choice for a female dentist from amongst saree, suit, and western formals (trousers and shirt), 50.7% reported it does not matter, followed by 36% who responded for Indian suit. No difference was seen in the distribution rates among males and females as p>0.05. (Table 4) When patients were asked about the choice of hairstyle for a female dentist, pony, or braided hair (39.3%) was rated highest, followed by hair bun (34.7%). No significant difference was seen in the response rate of males and females, though males opted the highest for braided hair and females opted the bun as the highest preference (Table 5). When study subjects were asked whether female dentists should wear makeup or not, the majority of them responded it does not matter (57.3%) and no significant difference was observed in the males’ and females’ responses (Table 6). Significant differences were seen in the response when subjects were asked about which style (clean-shaven or bearded) do you prefer for your male dentist as pEnglishhttp://ijcrr.com/abstract.php?article_id=2682http://ijcrr.com/article_html.php?did=2682 Brosky ME, Keefer OA, Hodges JS, Pesun IJ, Cook G. Patient perceptions of professionalism in dentistry. J Dent Educ. 2003 Aug;67(8):909-15. Short D. First impressions. Br J Hosp Med 1993; 50: 270-271. Petrilli CM, Saint S, Jennings JJ, Caruso A, Kuhn L, Snyder A, Chopra V. Understanding patient preference for physician attire: a cross-sectional observational study of 10 academic medical centers in the USA. BMJ Open. 2018 May 29;8(5):e021239. Jennings JD, Ciaravino SG, Ramsey FV, Haydel C. Physicians' Attire Influences Patients' Perceptions in the Urban Outpatient Orthopaedic Surgery Setting. Clin Orthop Relat Res. 2016 Sep;474(9):1908-18. Zahrina AZ, Haymond P, Rosanna P, Ho R, Rajini AR, Low BT, Lee PY. Does the attire of a primary care physician affect patients' perceptions and their levels of trust in the doctor? Malays Fam Physician. 2018 Dec 31;13(3):3-11. Clark M, Shuja A, Thomas A, Steinberg S, Geffen J, Malespin M, de Melo SW Jr. Patients' perceptions of gastroenterologists' attire in the clinic and endoscopy suite. Ann Gastroenterol. 2018 Mar-Apr;31(2):237-240. Aldrees T, Alsuhaibani R, Alqaryan S, Alzahrani H, Alharethy S, Alghunaim A, Alohali S, Bawazeer M. Physicians' attire. Parents preferences in a tertiary hospital. Saudi Med J. 2017 Apr;38(4):435-439. McKenna G, Lillywhite GR, Maini N. Patient preferences for dental clinical attire: a cross-sectional survey in a dental hospital.Br Dent J. 2007 Dec 22; 203(12):681-5. Tong HJ, Khong J, Ong C, Ng A, Lin Y, Ng JJ, Hong CH. Children's and parents attitudes towards dentists' appearance, child dental experience and their relationship with dental anxiety. Eur Arch Paediatr Dent. 2014 Dec;15(6):377-84. Souza-Constantino AM, Cláudia de Castro Ferreira Conti A, Capelloza Filho L,Marta SN, Rodrigues de Almeida-Pedrin R. Patients' preferences regarding age, sex, and attire of orthodontists. Am J Orthod Dentofacial Orthop. 2018 Dec;154(6):829-834. Kamavaram Ellore VP, Mohammed M, Taranath M, Ramagoni NK, Kumar V, Gunjalli G. Children and Parent's Attitude and Preferences of Dentist's Attire in Pediatric Dental Practice. Int J Clin Pediatr Dent. 2015 May-Aug;8(2):102-7 Nirmala SV, Veluru S, Nuvvula S, Chilamakuri S. Preferences of Dentist's Attire by Anxious and Nonanxious Indian Children. J Dent Child (Chic). 2015 May-Aug;82(2):97-101. Asokan A, Kambalimath HV, Patil RU, Maran S, Bharath KP. A survey of the dentist attire and gender preferences in dentally anxious children. J Indian Soc Pedod Prev Dent. 2016 Jan-Mar;34(1):30-5. Rehman S U, Nietert P J, Cope D W, Kilpatrick A O. What to wear today? Effect of doctor’s attire on the trust and confidence of patients. Am J Med 2005; 118: 1279-1286. Brase G L, Richmond J. The white-coat effect: physician attire and perceived authority, friendliness and attractiveness. J Appl Soc Psychol 2004; 34: 2469-2481. Taylor P G. Does the way house staff physicians dress influence the way patients initially perceive their competence? Paediatric Notes 1985; 9: 1. Gjerdingen D K, Simpson D E, Titus S L. Patients’ and physicians’ attitudes regarding the physician’s professional appearance. Arch Intern Med 1987; 147: 1209-1212.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411211EnglishN2020June3HealthcareDistinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain English1117Muhammet Lutfi SELCUKEnglish Fatma COLAKOGLUEnglishObjective: The aim of this study was to investigate the abilities of some staining methods used in histology to detect neuroglia, cell groups and moieties such as axons and dendrites in the brain, and the ability of detecting the white matter limit. Materials and Methods: Brain tissue from a 14-month-old New Zealand Rabbit was used in the study. The brain was sliced transversally to make it suitable for histological procedures. For this, the brains were placed on the millimeter paper and sliced into three equal parts. The obtained samples were cut 10μm thickness from same side and cranial to caudal and, slides were stained with six staining methods. Each of these slides was photographed as jpeg format by means of a microscope. The sectional images obtained were transferred to Image J programme to estimate their areas. The Likert scale was used to investigate the adequacy of staining methods to determine the border of gray and white matter and cell groups in the brain. As a result of these procedures, statistical results of obtained data were presented in tables and figures. Results: As a result of the Likert scale, CT was the highest score whereas MGG was the lowest average score. Considering all structures in the brain, KB, MGG, MMGG and CT stainings for neuroglia cells; KB, MGG and MMGG staining methods for axon, dendrite and Nissl bodies; furthermore for ependymal cells, pia mater and choroid plexus KB, MGG, MMGG, CT, AgNORs and HE staining methods were found to have the highest score. In the distinction of gray and white matter, KB, MG, MMGG and CT staining methods had the highest score, also. Conclusions: With this study, it is thought that it would help the researchers to determine the boundaries of the anatomical structures of interest in the brain and the selection of histological stains that should be used in the staining of the desired cell groups. EnglishBrain, Histological Staining Methods, New Zealand RabbitINTRODUCTION All living organisms are capable of responding to physical and chemical stimuli from their internal and external worlds. This can be achieved by a well-organized nervous system. The nervous system is anatomically divided into two parts as central nervous system (CNS) and peripheral nervous system (PNS). The CNS is composed only of cells. These are categorized into two types: neurons, which receive and transmit impulses, and neuroglia, which support and facilitate the proper functioning of the neurons. In a cross-section of the brain, two different parts appear. They are dark gray matter and light colored white matter. Gray matter is composed of neuron cell bodies, clusters of which within the CNS are known as nuclei, whereas white matter is recognized by the presence of myelinated axons (Seiferle, 2004; Patestas and Gartner, 2016). Most diseases of the brain are associated with synaptic loss and gradual deterioration or death of the neural cells (brain atrophy) (Coelho et al., 2018). Volume changing in the brain have been proposed as aids in the diagnosis of Alzheimer disease, autism, hyperactivity disorder, schizophrenia and other types of dementia.  Regional brain volume changes or atrophy rates have also been proposed as surrogate markers of disease progression for use in clinical examination (Selcuk and Bahar, 2014; Heggland et al.,2015; Aljondi et al., 2019). In the studies, different methods are used to differentiate gray and white matter in the brain or to calculate volume and volume ratios. MRI images is widely used in the diagnosis of brain diseases. However, the same devices can detect different brain volume ratios and cortical thickness, and even different brain volumes between two scanners of the exact same type with identical imaging protocols (Biberacher et al., 2016; Amiri et al., 2019). In addition, although it attempts to define a specific interruption in the rate of pathological complete brain volume loss in the detection of disease in large tissues, the generally accepted thresholds of regional and global pathological brain atrophy have not yet been established (De Stefano et al., 2016; Uher et al., 2019). However, it is important to note that the structure or organ to be examined is clearly differentiated from other structures (Bahar et al., 2013). Models designed in animals, especially considering the rabbits used for modeling because their perinatal development resembles humans, the need for specially developed and expensive computer aided systems and trained technical personnel to carry out these calculations brings additional financial burden to the studies (Basoglu et al., 2007; Kalkan et al., 2007). This is a value factor that increases the costs when considering the number of the test subjects to be used in the study. In these systems, to quantify specific amounts of regional volume, the tissues concerned must be repeatedly exposed to ionizing radiation, causing damage to the tissue as well as ethical dilemmas. Therefore, in experimental studies, researchers frequently use histological and micro-anatomical methods to differentiate between gray and white matter or to calculate volume and volume ratios, to distinguish cell types found in the brain and to determinate atrophy (Bahar et al., 2013; Chuang et al., 2011; Sivapalan and Aitchison, 2014; Bolat, 2018). Many researchers who do not know the histological and micro-anatomical methods have difficulty in deciding the histological dye method to be used because the methods used in the literature searches are not clearly explained. In this study, it was aimed to investigate the ability of some of the dyes used in morphology to detect the cell groups and parts such as neurons, neuroglia, axons and dendrites in the brain and to investigate the adequacy of detecting the border of gray and white matter. MATERIALS AND METHODS Ethical Clearance The ethical approval for investigation was obtained by Karamanoglu Mehmetbey University Faculty of Health Sciences Ethics Committee (protocol number: 2017/07). Preparation of Cadavers In this study, these healthy male New Zealand Rabbits aged 14 months were used. During the fixation, abdominal aorta and vena cava caudalis were dissected and plastic catheters were placed and by this way, normal saline solution was given into vena cava caudalis and blood was removed from the vessels. Then, 10% neutral formalin solution was perfused via the vena cava caudalis. The rabbit head was kept in a container containing 10% formaldehyde solution for 20 days to complete the fixation (Bahar and Dayan, 2014). Histological Process and Tissue Sampling The brain was sliced transversally to accommodate the histological procedure. For this purpose, these brains were placed on millimeter paper and sliced into six equal parts. Then, these brain samples were dehydrated, cleared, and embedded into the paraffin. Prepared paraffin blocks were cut with a rotary microtome at a thickness of 10µm and six sections were obtained from each block. These sections were stained according to Silver Staining Nucleolus Organiser Regions (AgNOR) (Table 1), hematoxylin eosin (H&E) (Table 2), Kluver Barrera (KB) (Table 3), May Grunwald Giemsa (MGG) (Table 4), Modified May Grunwald Giemsa (MMGG) (Bolat et al., 2012), Crosman's Triple Staining (CT) staining procedures (Selcuk and T?p?rdamaz, 2019). The stained sections were imaged with a stereomicroscope (Olympus SZX16) and recorded in jpeg. These brain sections stained with the used. These staining methods were given in Figure 1, neurons in Figure 2 and choroid plexus in Figure 3, respectively. Evaluation of the Stained Tissue Samples  Obtained sections were evaluated by blind users who were selected randomly from the senior students of the Faculty of Health Sciences. The survey group was composed of 20 healthy and non-colorblind students. First, they were asked to evaluate the distinction between gray and white matter on images, macroscopically. After, with a light microscope, it was microscopically asked to evaluate the borders of gray and white matter, the abilities to get dyes into neurons, neuroglia, ependymal cells, endothelium, axons, and dendrites according to a Likert scale (1: worst, 5: best). The point counting method has often used to assess morphological parameters such as area and volume. Using this method, numerical comparison of possible variables in cross-sections can be made (Bas et al., 2009). For this purpose, the grid function of Image J program was used to calculate the surface area of the sections (Figure 4). The distance between the two points was chosen as 1mm on the point area measuring scale used. A different marker was selected for each area of interest and the points falling into the areas were separately counted. The effect of staining procedures on the areas of these sections was statistically analyzed. Figure 4: Measurement of the area of brain sections using ImageJ (Area of a point = 1mm2, Bar: 1mm) Statistical Analysis Statistical analysis was conducted with SPSS software version 21. Kolmogorov-Simirnov/Shapiro-Wilk’s test was applied to the data and found that the data showed normal distribution. One-way ANOVA was used to compare data obtained from the study. Levene test was used to assess the homogeneity of the variances. Data are expressed as means±standard error (SE). RESULTS In this study, the gray matter, white matter and brain areas of these histological sections applied different staining methods and obtained from New Zealand Rabbit were given in Table 5. As a result of field measurements on these sections, no statistical difference was found among gray matter, white matter, and brain areas (P>0.05). Table 5: Mean gray matter, white matter, and brain areas obtained from transverse sections (Mean±SE) In order to determine the adequacy of these dyes applied on brain sections of New Zealand Rabbits to distinguish the boundary of gray and white matter the mean, standard error, median, minimum and maximum scores of the Likert scale were given in Table 6. As a result of the Likert scale, CT was the highest score whereas MGG was the lowest average score. In one-way analysis of variance, the adequacy of the six types of dyes used to determine the boundary of gray and white matter alba was statistically significant (P0.05). Microscopic evaluation using the Likert scale was given in Table 7. As a result of the stainings, apart from the distinction of gray and white matter, structures in these brain layers were also observed. Neuron bodies, neuroglia cells, dendrites, axon extensions and Nissl bodies were seen in the gray matter layer of the brain; Myelinated axon extensions and neuroglia cells were detected in the white matter. In addition, the presence of choroid plexus, ependymal cells and pia mater was found in the sections. Considering all these structures, KB, MGG, MMGG and CT stainings for neuroglia cells; KB, MGG and MMGG staining methods for axon, dendrite and Nissl bodies; furthermore for ependymal cells, piamater and choroid plexus KB, MGG, MMGG, CT, AgNORs and HE staining methods were found to have the highest score. In the distinction of gray and white matter, KB, MG, MMGG and CT staining methods had the highest score, also. DISCUSSION Nerve tissue contains different structures such as neurons and neuroglia cells. Correct characterization of complex arrangements in healthy tissue can help in understanding neurological diseases. Animal models play an important role in the development of neuroscience and, many models have been established to investigate neurocognitive diseases (Eixarch et al., 2012, Ferraris et al., 2018). Although rodent neurocognitive models are well established, translation values are limited especially considering prenatal myelinations, lysencephalic brain structures and low white matter ratio. Alternatively, rabbits may provide a link between small and large animals since their brains develop during the perinatal period and the timing of white matter maturation is comparable to that of humans. Despite these complex brain structures, their cost is low compared to large animals, their suitability to laboratory conditions increases the use of rabbits (Coelho et al., 2018). Nervous system autism, hyperactivity disorder, schizophrenia, multiple sclerosis, epilepsy, preterm birth, fragile X syndrome, tourette syndrome and many other diseases such as Alzheimer's disease in advanced age in the follow-up and treatment of the disease changes in the volume and surface area are important (Shen et al., 2013). Changes in the surface area of the brain may also be important in some neurological diseases such as epilepsy, schizophrenia, Williams syndrome and cortical developmental malformations (Ronan ve ark 2006; Heegland et al., 2015). Volume and surface area are used as important data in the study of brain functions (Selcuk and Bahar, 2014). Therefore, determination of the brain's gray and white matter volume and volume ratios is very important to understand the relationship between tissue atrophy and clinical status. In the diagnosis of diseases affecting the central nervous system, it is very important to know the volume and anatomical structure of the affected anatomical structure (Raznahan et al., 2013; Shen et al., 2013). In this study, it is aimed to investigate the abilities of some of the dyes used in morphohistology to detect the cell groups and parts such as neurons, neuroglia, axons and dendrites in the brain and the adequacy of detecting the border of gray and white matter. First, the brain tissues were removed from the cavum cranii and, the fixation was performed. After this procedure, the brain tissues were sliced in order to make it suitable for histological procedures and, cross sections were taken by performing routine histological follow-ups and, staining procedures were performed using six histological staining methods. The preparations were evaluated with a Likert scale after being photographed with a microscope. When the statistical results of the data obtained from the Likert scale were macroscopically compared, it was concluded that CT and KB staining methods were more effective according to the other staining methods in terms of its ability to determine the boundary of gray and white matter. In the distinction of gray and white matter examined with a microscope, although KB, MG, MMGG and CT staining methods had the highest scores, there was no difference among them. As a result of microscopic evaluation, KB, MGG, MMGG and CT staining methods for neuroglia cells; KB, MGG and MMGG staining methods for axon, dendrite and Nissl bodies; for ependymal cells, piamater and choroid plexus KB, MGG, MMGG, CT, AgNOR and H&E staining methods were the best staining methods. CONCLUSIONS Many researchers who do not know the histological and micro-anatomical methods have difficulty in deciding the histological staining methods to be used because these methods used in the literature searches are not clearly explained. With this study, it is thought that it will help the researchers to determine the boundaries of the anatomical structures of interest in the brain and to select the histological staining methods that should be used in the staining of the desired cell groups. Therefore, it is thought that the results of this researches would contribute greatly to the literature. ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/ editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.      SOURCE OF FUNDING No funding. CONFLICT OF INTEREST The authors declare that there is no conflict of interests. Figure 1: Stained brain sections (A: AgNOR, B: H&E, C: KB, D: MGG, E: MMGG, F: CT, Bar: 1mm). AgNOR: Silver Staining Nucleolus Organiser Regions,  H&E: Hematoxylin-Eosin, KB: Kluver Barrera, MGG: May Grunwald Giemsa, MMGG: Modified May Grunwald Giemsa, CT: Crosman's Triple Staining. Figure 2: Appearance of neurons according to different staining methods (A: AgNOR, B: H&E, C: KB, D: MGG, E: MMGG, F: CT, Bar: 20µm). AgNOR: Silver Staining Nucleolus Organiser Regions,  H&E: Hematoxylin-Eosin, KB: Kluver Barrera, MGG: May Grunwald Giemsa, MMGG: Modified May Grunwald Giemsa, CT: Crosman's Triple Staining. Figure 3: Appearance of choroid plexus according to different staining methods (A: AgNOR, B: H&E, C: KB, D: MGG, E: MMGG, F: CT, Bar: 20 µm). 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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411211EnglishN2020June3HealthcareCoagulation Profile in Liver Disease English1820Chetali RupelaEnglish Bhavika VaghelaEnglish Hansa GoswamiEnglishBackground: The liver is the cornerstone of the coagulation system. The physiology of blood coagulation is closely linked to liver function as the liver synthesizes most of the factors of the coagulation cascade and fibrinolytic proteins. Aims And Objectives: The objective of this study was to evaluate coagulation abnormalities associated with chronic liver diseases and determine the coagulation abnormalities using various coagulation studies PT (Prothrombin time), APTT (activated partial thromboplastin time). Material and Methods: This study included 50 patients clinically diagnosed with liver disease and who were divided into three categories – cirrhosis, hepatitis, and other liver diseases. Results: Out of 45 patients with liver disease, 39 were having altered coagulation profile and 28 were having altered biochemical parameters. Conclusion: We concluded that various abnormalities of coagulation tests vary greatly with different liver disorders, duration of the disorders, and their severity. Prolongation of prothrombin time (PT) and activated partial thromboplastin time (APTT) in advancing liver cirrhosis indicates damage to the liver parenchyma resulting in decreased production of coagulation proteins with increased risk of bleeding tendencies, which can be detected before these ensue. EnglishPT, APTT, Liver Disease INTRODUCTION The physiology of blood coagulation is closely linked to liver function as the liver synthesizes most of the factors of the coagulation cascade and fibrinolytic proteins. In addition, the liver is also involved in facilitating the clearance of activated clotting and fibrinolytic factors.(1,2) Patients with liver disease are at a substantially increased risk of thrombosis and hemorrhage. Owing to the substantial overlap in the hemostatic abnormalities observed in the patients with acute infectious or toxic hepatitis, chronic hepatitis, and cirrhosis, the severity of hepatocellular dysfunction is typically more informative than the etiology. Prothrombin time (PT) correlates well with the severity of hepatocellular damage as well as with the occurrence of abnormal bleeding and the overall prognosis. Studies have shown that significant prolongation of prothrombin time and activated partial thromboplastin time (APTT) in the absence of significant hypofibrinogenemia suggests their importance as a reliable marker coagulopathies in chronic liver disease patients.(3,4) MATERIALS AND METHODS: This study included 3 months data from may 2019 to july 2019 ( 45 patients) clinically diagnosed with liver disease attending medicine clinics in civil hospital, Asarwa in Ahmedabad. Inclusion Criteria: Primary criterion of inclusion was presence of liver disease including cirrhosis, hepatitis, pseudocyst, liver abscess, and all other liver diseases. All patients of both sexes, age ranging from 20 to 70 years and irrespective of socioeconomic status, were included. Exclusion Criteria: Patients with previous history of coagulation disorders or who took any of the following drugs in the previous week were excluded: aspirin or nonsteroidal anti-inflammatory drugs, antihistaminics, penicillin, thiazides, sulfonamides, beta blockers, and anticoagulants. Sample Collection and Procedure Blood sample was withdrawn by specially trained phlebotomists from antecubital vein in the forearm by means of vacuttee containing 3.2% sodium citrate as anticoagulant. While taking the sample, tourniquet was not tied, as it can change the hemoconcentration and results may vary. The ratio of volume of blood to anticoagulant was 9:1. Plasma was obtained following centrifugation of the anticoagulated blood at 3000 rpm for 20 minutes.     Coagulation tests for prothrombin time, activated partial thromboplastin time (APTT), International normalized ratio (INR)   were done using fully automated coagulometer. Biochemical parameters for liver disease were done using Fully auto analyzer. Both tests were done maintaining ultimate quality control. RESULTS: The findings for age and sex distribution are compatible with previous studies. The patient’s age ranged from 20 to 70 years. The maximum patients were in the age group ranging from 40 to 50 years. Thus, all the patients were above 20years.        The patients presented with complaints, such as jaundice, fever, anorexia, fatigue, weight loss, edema of limbs, abdominal pain, and ascites. Among 45 cirrhotic patients, the most common presenting complaints PRESENT STUDY DATA: DISCUSSION: The Prothrombin Time is the test widely accepted means to monitor patients having disorders of specific coagulation factors in the extrinsic and common pathway of coagulation. In the present study, 86.6% (39/45) patients had prolonged Prothrombin Time in liver disease. INR (International normalized ratio) was raised in 86.6% (39/45) patients with liver disease. The Activated Partial Thromboplastin Time is the test for intrinsic coagulation pathway. It is especially sensitive for factors XII, IX, XI, XIII, and platelet factor 3 adequacies. There were 82.2% (37/45) patients of liver diseases having prolonged Activated Partial Prothrombin Time. Biochemical parameters for liver disease were raised in 28 patients out of 45 (62.2%). The present study correlates with Sohail Ahmed Siddiqui study in which there was 87.7 % alteration in PT and 71.3 % alteration in APTT in patient with liver disease. Also it correlates with Sylvester Chuks Nwokediuko study in which there was 36.6 % alteration in PT and 22.6 % alteration in APTT in patient with liver disease. CONCLUSIONS: In this study, we conclude that patients with liver disease have prolonged prothrombin time (PT), activated partial thromboplastin time (APTT) and international normalized ratio (INR). There was significant prolongation of Prothrombin Time in 39 patients out of 45 (86.6%) and Activated Partial Thromboplastin time in 37 patients out of 45 (82.2%) with liver disease. Study of coagulation profile can help in assessing hepatic cell function and detecting cellular injury. Prolongation of Prothrombin Time and Activated Partial Thromboplastin Time in advancing liver cirrhosis indicates a damage of liver parenchyma resulting in decreased production of coagulation proteins with increased risk of bleeding tendencies, which can be detected before these ensue, by the determination of Prothrombin Time and Activated Partial Thromboplastin Time levels.Thus, preventing patients from landing in life- threatening bleeding complications.  ACKNOWLEDGEMENT: I would like to thank below mentioned references for their useful suggestions during publication making. Lastly, I would like to thank patients of B.J medical college, Ahmedabad  for support and cooperation. Financial Support: None Conflict of interest: None Englishhttp://ijcrr.com/abstract.php?article_id=2684http://ijcrr.com/article_html.php?did=2684 Kaul V, Munoz JS., Coagulopathy of liver disease. Curr Treat Options G Astroenterol 2000 Dec; 3 (6): 433-437. Shah SN, Jansari T., Coagulation profile in liver disease—study of  100 cases. Gujarat Med J 2014; 69 (1): 37-40. Devrajani BR, Ali Talpur MA, Atta-ur-Rahman A, Ali Shah SZ, Das T, Devrajani T. ,  Coagulopathies in patients with liver cirrhosis. World Appl Sci J 2012; 17 (1): 01-04. Ahmad Hameed NS, Irfan Khursheed AS, Hamid A, Naveed IA An assessment of coagulation parameters in liver cirrhosis. Biomedica 2006 Jan-Jun; 22: 74-77. Siddiqui SA, Ahmed M, Ghani MH, Memon MA, Mustafa G, Ghori MA: Coagulation abnormalities in patients with chronic liver disease in Pakistan, J Pak Med Assoc, Vol. 61,No. 4,April 2011;363-367. Nwokediuko SC, Ibegbulam OG: Platelet Function and Other Indices of Hemostasis in Chronic Liver Disease, Gastroenterology Research,2010;3(4):167-170 Van Nieuwenhuizen RC, Peters M, Lubbers LJ, Trip MD, TijssenJGP , MulderBJM . Abnormalities  in liver function and coagulation profile following the Fontan procedure. Heart 1999;82:40-46.                                8. Devrajani BR, Ali Talpur MA, Atta-ur-Rahman A, Ali Shah SZ, Das T,  Devrajani                                    T. Coagulopathies in Patients with Liver  Cirrhosis, World Applied Sciences                                             Journal, 2012; 17 (1):01-04.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411211EnglishN2020June3HealthcareChronicles of Cytopathology-A Review English2127Preethi SharmaEnglish Minal ChaudharyEnglish Rajul RankaEnglish Madhuri GawandeEnglish Prajakta ZadeEnglishAlka HandeEnglishThe review gives brief information on the olden days of cytology beginning from its origin to recent modern advancements. It also gives an outline regarding the basics of cytology. The field of cytology has achieved a marvelous drive all across the world owing to its rapidity, accurateness, and cost-efficacy. The literature was searched using MEDLINE/PubMed to identify relevant articles published in English from the date of inception to date. A brief history of cytology, newer cytological methods, modifications in the sampling tools and the sensitivity and specificity of collecting devices are presented in the article. The review will benefit all the dental practitioners facing challenges during performing exfoliative cytology. EnglishCytology, Collecting devices, Cytomorphometry, CancerINTRODUCTION The field of cytology has attained a great amount of drive throughout the nation with respect to its rapidity, reliability, and inexpensiveness. The branch of cytology was identified and practiced in the 18th and 19th centuries.1 The advancement of this branch was not standardized untill the 20th century. In 1989, the first American Board of examination in the field of cytopathology has commenced.2 The field of cytopathology is well established with two main branches exfoliative cytology and fine-needle aspiration biopsy.2 The study of exfoliated cells from pre-malignant and malignant lesions of cervical mucosa by Papanicolaou and Traut has strongly swayed the way for Oral cytology.1 The worth of using a microscope in the 19th century was recognized by Pathologists Italian Morgagni, the British Baillie, and the French Bichat.1 In the sputum of oropharyngeal carcinoma, the architecture of abnormal cells was first identified in the 19th century. Exfoliative cytology in the oral cavity was first identified by Montgomery and Von Ham.3 The purpose of performing Cytology is to reach at an accurate diagnosis, screening and follow up. The Advantages are a simple, safe and quick method of collection. It is cost-effective and gives accurate results.4 Cytopathological Features of malignancy include cellular pleomorphism, nuclear pleomorphism, altered Nuclear/Cellular ratio, hyperchromatism, enlarged nucleoli, increased and abnormal mitotic activity.4 There were many contributions and publications in the field of Cytology (Table 1). With many breaks and deviations after an arduous 150 years, cytology has become a subspecialty of pathology in the last 25 years. In an attempt to improve the quality of smears and staining of cells, various new tools for sampling with modifications were introduced. The sensitivity and specificity of the tools were identified. (Table 2 & Table 3).   Englishhttp://ijcrr.com/abstract.php?article_id=2685http://ijcrr.com/article_html.php?did=2685

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411211EnglishN2020May18Life Sciences A Study on Intervention of Multiple Intelligence Theory in Modern Teaching Approach among the Primary and Upper Primary Teachers of ICSE and SSC Schools of Hyderabad District of Telangana State English2834Paripally ShankarEnglish Introduction: Education is a complex social, cultural and ethical process designed in a social or cultural context. It is related with social structures, cultural environments, values and ideals of people, society and the government. All these factors are dynamic. By all these the definition of teaching has been changing depending on time, place and society. Good teaching may be designed to affect maximum learning. The distribution of intelligence is follows Individual differences in all human beings. By understanding the various factors of intelligence a teacher can understand how to empower the intelligence of the students. Aim/Objectives: The purpose of this study is to understand the intervention of multiple intelligence theory in the modern teaching approach among the primary and upper primary teachers of ICSE schools and SSC schools of Hyderabad. Main focus of this study was to identify the components of multiple intelligence theory embedded in the teaching of content. Method: The tool was designed with utmost care to elicit responses from teachers in order to validate the degree to which they are using due components of multiple intelligence in their daily class room teaching. Sample: The samples on which the study was administered are a total of 80 teachers, 40 from primary and 40 from upper primary both from ICSE and SSC school in and around Hyderabad. Conclusion: The study revealed that there is no significant difference in the intervention of multiple intelligence theory among the primary and upper primary teachers of ICSE and SSC Schools. EnglishMultiple Intelligence Theory, Intervention, Teaching, Modern Approach, Educationhttp://ijcrr.com/abstract.php?article_id=4771http://ijcrr.com/article_html.php?did=4771 1. Bruce Jerry A, Kordinak Thomas S, Harmanj M. “Current trends in assessment.” J. Educ. Psychol. 2008; 2(3):09-13. 2. Thomas B. “Intelligence and creativity in education”, Jaipur, India, Aavishar Publishers. 2004 3. Usha R. “Advanced Educational Psychology” Hyderabad, Himalaya publishing house. 2018; 339-418. 4. Nagarani G, Nagaraju MTV. “An evaluative study on interpersonal skills among B.Ed students.” Indian Journal of research in Education and extension. 2007; 1:61-72. 1. Bruce Jerry A, Kordinak Thomas S, Harmanj M. “Current trends in assessment.” J. Educ. Psychol. 2008; 2(3):09-13. 2. Thomas B. “Intelligence and creativity in education”, Jaipur, India, Aavishar Publishers. 2004 3. Usha R. “Advanced Educational Psychology” Hyderabad, Himalaya publishing house. 2018; 339-418. 4. Nagarani G, Nagaraju MTV. “An evaluative study on interpersonal skills among B.Ed students.” Indian Journal of research in Education and extension. 2007; 1:61-72.