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<xml><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Development of Analysis Model using Artificial Intelligence Algorithms for Post-Traumatic Stress Disorder Data: A Letter to the Editor&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>01</FirstPage><LastPage>02</LastPage><AuthorList><Author>Harish Kumar Banga</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract/><AbstractLanguage>English</AbstractLanguage><Keywords/><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3895</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3895</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Is Phone Radiation Harmful to Health?&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>03</FirstPage><LastPage>03</LastPage><AuthorList><Author>Anumol Thomas</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract/><AbstractLanguage>English</AbstractLanguage><Keywords/><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3896</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3896</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Dual Energy Computed Tomography in Gout: Our Experience&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>04</FirstPage><LastPage>07</LastPage><AuthorList><Author>Sagdeo A.</Author><AuthorLanguage>English</AuthorLanguage><Author> Askari A.</Author><AuthorLanguage>English</AuthorLanguage><Author> Singh J.</Author><AuthorLanguage>English</AuthorLanguage><Author> Tins B.</Author><AuthorLanguage>English</AuthorLanguage><Author> Ball P.A.</Author><AuthorLanguage>English</AuthorLanguage><Author> Morrissey H.</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Gout is a common medical problem, affecting at least 1% of men in Western countries, with a male: female ratio ranging from 7:1 to 9:1. For many patients, traditional investigations can be inconclusive. Dual Energy Computed Tomography (DECT) is emerging as a valuable tool for non-invasive confirmation of urate deposits in painful joints. Aim: To establish the effectiveness of the DECT in the identification of gout in patients with complex presentations where the diagnosis is not clear. Method: DECT at 140 kV and 80kV was used to image patients where the clinical diagnosis was unclear Results: Seven case studies are presented where an unclear clinical presentation was successfully diagnosed with the use of DECT. Conclusion: In a specialist tertiary referral centre, treating many patients whose presentation is atypical, DECT has become a valuable tool in confirming the presence or absence of gouty arthritis, in difficult cases with a diagnostic dilemma.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Imaging, Dual Energy, X-Ray, Computed Tomography, Gout, Gouty Arthritis, Hyperuricaemia, Rheumatology</Keywords><Fulltext>Introduction: &#xD;
&#xD;
In Western countries, Gout is a common condition reported to affect around 1% of men with a reported male to female ratio between 7 and 9:1.1&#xA0; The typical presentation is with intermittent, recurrent of mono- or oligoarticular inflammation characterised by very severe pain, however, a much less specific presentation with polyarticular chronic joint pain may occur, complicating the differential diagnosis.1&#xD;
&#xD;
Dual Energy Computed Tomography (DECT) can identify specific elements and molecules such as iodine, calcium and uric acid, providing valuable new diagnostic information.2 Imaging and identification of urate deposits provides a novel, rapid, non-invasive and reliable method for the confirmation of gout.3&#xD;
&#xD;
In patients with or without a history of gout and a recent suspicion for gouty arthritis, DECT has a marked diagnostic impact when hyperdense soft-tissue deposits are present.4A definitive diagnosis requires the direct identification of urate crystals in the joint and the exclusion of infection. Serum urate levels are frequently normal during attacks of acute gout, so reliance on urate level during acute attacks of gouty arthritis is not useful.5 The classic plain radiographical signs such as well defined, punched out, periarticular erosions with overhanging edges, may not be seen until six or even more years after initial attacks. MRI can be very useful, but is expensive and, like conventional computed tomography, lacks specificity.6&#xD;
&#xD;
Ultrasonography can be useful if the classic features of gout are present, being low cost, no radiation exposure, easy availability, and the ability to combine it with aspiration. However, it requires an experienced sonographer and high-resolution equipment.7 Since none of these imaging modalities can specifically identify the chemical composition of uric acid, a specific display algorithm based on the chemical composition of uric acid by dual-energy CT (DECT) scans is useful as an accurate imaging tool for gout.8&#xD;
&#xD;
The colour-coded information of the urate deposits in DECT scans allows for a computer-automated procedure to measure the volume of each clinical or subclinical tophus, which can then be summed to produce a total volume of urate deposition in peripheral joints of a given patient. Thus, DECT scans also carry several potential advantages as a follow-up imaging tool over MRI, which was recently evaluated to quantify tophus size. These advantages include a lower cost (&#x223C;1/6), a shorter scan time (&#x223C;15 min for all peripheral joints), simultaneous scanning of multiple joints, obvious colour-differential display of crystals and minimal influence of positioning. Furthermore, the MRI volume measurement of tophus size involves the manual tracing of consecutive MR images.6&#xD;
&#xD;
The potential applications of DECT also include establishing the extent of gout by identifying subclinical intra- and extra-articular tophi, evaluation of nodular lesions, diagnosing the concurrent presence of gout in patients with other arthropathies, identifying urate deposits in challenging and atypical anatomical sites of gout, understanding the anatomical distribution of the disease and monitoring the response to treatment through measurement of individual tophus volume and total tophus burden. Of note, OMERACT has proposed tophus regression as a core domain for outcome measures in chronic gout.9&#xD;
&#xD;
The obvious colour display and three-dimensional volume-rendered imaging of the disease allow information to be easily and communicated to clinicians and patients.&#xD;
&#xD;
The radiation exposure of DECT for peripheral joint imaging is minimal. It is estimated that the DECT radiation dose is 0.5 mSv of dose per scanned region and the total amount for all peripheral joints per patient ranges from 2 to 3 mSv, which is similar to the annual global per caput average dose due to natural radiation sources (2.4 mSv).10&#xD;
&#xD;
Furthermore, the target image areas for gout are radio-insensitive peripheral joints, and the vast majority of patients with gout are predominately middle-aged or elderly men, which supports a minimal risk of radiation associated with this potential modality for gout at a practical level.10&#xD;
&#xD;
DECT scans are possible in patients with severely impaired renal function. Usually, the two scan-energies are set to 140kV and 80 kV. Based on these two imaging series, different crystals with different absorption characteristics can be distinguished using several commercially available software modalities. These software tools allow for colour coded discrimination of urate crystal deposits as well as several other crystal types. DECT can serve as a problem-solving tool in the presence of challenging clinical presentations.11&#xD;
&#xD;
Aim: &#xD;
&#xD;
To establish the effectiveness of the Dual Energy Computed Tomography in the identification of gout in patients with complex presentations where the diagnosis is not clear.&#xD;
&#xD;
Method: &#xD;
&#xD;
This is a gout diagnosis quality improvement audit. This report is based on the review of seven patients records where DECT at 140 kV and 80kV was used to image patients where the clinical diagnosis was unclear. All possible patient identifiers were removed, with only gender and age was used. Patients verbal approvals were taken to use their pictures in this report.&#xD;
&#xD;
Result and Discussion&#xD;
&#xD;
Case report-1: A 74-year-old male, known case of chronic gout on Allopurinol. His co-morbidities were atrial fibrillation, hypertension and osteoarthritis. This patient presented with increasing pain/swelling in hands particularly the PIPs of both middle fingers that were slightly tender with nodular swellings over PIP and DIP. Uric acid was normal. The patient was anxious regarding his management and the presence of these nodular swellings. He thought that a change of management or increase in the Allopurinol dose is required. It was felt that his pain was due to a degenerative process rather than gout. CT dual-energy confirmed the complete absence of any urate crystals in the hands. We concluded that his chronic pain is caused mainly by the degenerative process. Management focused on physical therapy and the continuation of the same medications.&#xD;
&#xD;
Case Report 2: A 54-year-old female was referred by her general practitioner with a history of Left foot pain on/off with swelling and redness. Her father and brother both have gout and she was very anxious that her symptoms are due to gout. On investigations her autoimmune screen including anti-CCP and ACE is negative, uric acid was normal. X-rays were unremarkable. DECT showed no evidence of any crystal deposition providing reassurance to the patient. She was advised physical therapy and occasional NSAID. &#xD;
&#xD;
Case report 3: A 47-year-old female, known case of Fibromyalgia, irritable bowel syndrome and gall stones. She was referred for painful toes in addition to fatigue due to fibromyalgia by her doctor. Examination revealed second toe classic dactylitis with tenderness but no other features of Spondylo-arthropathy. Her blood showed, ESR: 25 mm/Hr, CRP: 2mg/L, Uric Acid 512&#xB5;mol/L. DECT revealed urate crystals in the second MTPJ. No crystals seen around 1st MTPJ and no erosive changes. She was advised to lose weight and pharmacological therapy was considered. &#xD;
&#xD;
Case report 4: A64-year-old male, known case of psoriatic arthritis and osteoarthritis, complained of severe hand and knee pains interfering with his job for the past 6 months. Clinically, he had mild to moderate tenderness in relevant joints, and could not make a full fist. X-ray showed prominent degenerative in knees and hands but no erosions. Ultrasound (US) showed MCPJ synovitis but no clear underlying aetiology. DECT confirmed the presence of uric acid crystals within flexor hand and proximal tendons corresponding clinically with areas of tenderness. Pharmacological treatment was commenced, and he achieved considerable relief.&#xD;
&#xD;
Case report 5: A 50-year-old male, drinking 35 units of alcohol weekly, was admitted to Hospital for left ankle pain and swelling. No crystals or infection in the synovial fluid. Uric acid level was 474&#xB5;molL-1 and autoimmune tests were negative. Examination revealed second MTPJ swelling but no findings in the ankle or big toes. &#xD;
&#xD;
DECT confirmed urate crystals in the second toe, Achilles tendon insertion; peroneal tendons and tibiofibular syndesmosis established the diagnosis of gout (Figure 1).&#xD;
&#xD;
&#xD;
&#xD;
Case report 6: A 72-year-old female patient presented with sudden swelling of MCPJs and proximal phalanges in all digits except the thumbs. Examination revealed, mild redness, no other signs of inflammation. The patient was extremely concerned, as she had a probable previous diagnosis of gout. Her uric acid level was highly elevated at 586&#xB5;molL-1, autoimmune screen was negative. US reported fatty tissue with an unusual pattern of deposition. DECT confirmed the unusual fatty deposition and distribution, ruled out tophi, tumours or nodules. Patient was reassured that the swellings were not gout related and the latter should be treated independently. &#xD;
&#xD;
Case report 7: A 74-year-old male, known case of gout on Allopurinol 300 mg, continued drinking alcohol around 60 units weekly. He presented with moderate feet pain in both feet for &gt;12 months. On examination he has bilateral MTPJ swelling and tenderness. His ESR was 8mm/Hr, CRP was 26mg/L, autoimmune screen including Anti-CCP is negative and uric acid is normal at 218&#xB5;mol/L. Intermittent oral steroids helped his symptoms. DECT showed the presence of urate crystals around the MTPJs, mid and hindfoot and ankle tendons confirming the diagnosis of gout (Figure 2).&#xA0; &#xD;
&#xD;
&#xD;
&#xD;
Conclusion&#xD;
&#xD;
In straightforward cases where there is a typical clinical picture of acute arthritis where septic arthritis is the main differential diagnosis against crystal arthropathy, joint aspiration showing the presence of negatively birefringent monosodium urate crystals, gout would be straightforward to confirm and manage. However, in difficult situations like excessive swelling of peripheral soft tissue and the absence of accessible fluid or tophus, there is a need for a specific and sensitive imaging tool. All our cases posed a diagnostic dilemma that needed confirmation, DECT was very useful to confirm or refute gouty arthritis. In our small case series, DECT, helped us to exclude the diagnosis of gout in cases 1,2 and 6, whereas in the remaining cases, gout was confirmed.&#xD;
&#xD;
When the clinical presentation is unclear, DECT is a non-invasive, valuable, underutilised investigation that can establish the diagnosis of gout particularly when other arthritic conditions are present moreover it may rule out gout as a cause of the inflammatory process.&#xD;
&#xD;
Acknowledgement&#xD;
&#xD;
The authors acknowledge the help received from the scholars whose articles are cited and included in references to 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&#xD;
&#xD;
Conflict of interest: No conflict of interest known&#xD;
&#xD;
Funding: No external funding&#xD;
&#xD;
Authors&#x2019; contributions: &#xD;
&#xD;
Sagdeo A, Askari A, Singh J, Tins B. conducted data collation and clinical interpretation and Ball PA. Morrissey H. reviewed the report and drafted the manuscript and author 6 completed the submission.&#xA0;&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3897</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3897</Fulltext></URLs><References>&#xD;
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	Luk AJ, Simkin PA. Epidemiology of hyperuricemia and gout. Am J Manag Care 2005;11(15 Suppl): S435-68. &#xD;
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	Courtney CA, Nelson RC, Boll DT, Paulson EK, Ho LM, Neville AM, et al.&#xA0; Dual-Energy Multidetector CT: How Does It Work, What Can It Tell Us, and When Can We Use It in Abdominopelvic Imaging? Radiogra. 2010:3(4):1037-52.&#xD;
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	Bongartz T, Glazebrook KN, Kavros SJ, Murthy NS, Merry SP, Franz WB, et al. Dual-energy CT for the diagnosis of gout: an accuracy and diagnostic yield study. Ann Rheum Dis. 2015;74:1072&#x2013;7.&#xD;
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	Finkenstaedt T, Manoliou A, Toniolo M, Higashigaito K, Andreisek G, Guggengerger R, et al. Gouty arthritis: the diagnostic and therapeutic impact of dual-energy CT. Eur Radiol. 2016;26(11):3989-39.&#xD;
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	Terkeltaub RA, Gout. New Engl J Med Boston. 2003;349(17):1647-55.&#xD;
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	Schumacher HR Jr, Becker MA, Edwards NL, Palmer, WE, MacDonald PA, Palo W, et al. Magnetic resonance imaging in the quantitative assessment of gouty tophi. Int J Clin Pract. 2006; 60:408-414.&#xD;
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	Thiele RG, Schlesinger N. Diagnosis of gout by ultrasound. Rheumatic. 2007; 46:1116-21.&#xD;
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	Johnson TR, Weckbach S, Kellner H, Reiser MF, Becker CR Clinical image: dual-energy computed tomographic molecular imaging of gout. Arthritis Rheum. 2007;56:2809.&#xD;
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	Schumacher HR Jr, Edwards LN, Perez-Ruiz F, Becker M, Chen LX, Furst DE, et al. Outcome measures for acute and chronic gout. J Rheumatol 2005; 32:2452&#x2013;5.&#xD;
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	Choi HK, Al-Arfaj AM, Eftekhari A, Munk PL, Shojania K, Reid G et al. Dual-Energy Computed Tomography in Tophaceous Gout, Ann Rheum Dis. 2009;68(10):1609-12.&#xD;
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	Nicolaou S, Yong-Hing CJ, Galea-Soler S, Hou DJ, Luck L, Munk P. Dual-energy CT as a potential new diagnostic tool in the management of gout in the acute setting. Am J Roentgenol. 2010;194:1072-8.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Screening the Effect of Environmental Hazards on Pulmonary Function and Health Risk Biomarkers in Cotton Industry Workers&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>08</FirstPage><LastPage>14</LastPage><AuthorList><Author>Amer NM</Author><AuthorLanguage>English</AuthorLanguage><Author> Ibrahim YH</Author><AuthorLanguage>English</AuthorLanguage><Author> Awad AH</Author><AuthorLanguage>English</AuthorLanguage><Author> Hafez SF</Author><AuthorLanguage>English</AuthorLanguage><Author> Saeed Y</Author><AuthorLanguage>English</AuthorLanguage><Author> Saleh MS</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Cotton industry workers, Stress, Particulate Matter, Noise, Pulmonary Function Tests</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The textile industry is one of the main industries that&#xA0;support the Egyptian economy as it shares with about 10 per cent of the country&#x2019;s exports.1Workers in the textile industry are occupationally exposed to many health hazards that invite serious interference.2Air pollution with cotton dust &#x2013;produced while handling cotton- can induce lung diseases, byssinosis, pulmonary fibrosis, and chronic obstructive pulmonary disease.3 Other respiratory problems due to exposure of workers to particulate matter (PM) include altered pulmonary functions and symptoms of chest tightness.4Small particulates can also penetrate the lungs reaching blood-stream carrying toxins to all parts of the body affecting both respiratory and cardiovascular systems.5,6&#xD;
&#xD;
As reported, risks of cardiovascular diseases due to the exposure to fine particles include heart and stroke attacks with the stimulation of inflammatory responses that may interrupt heartbeats and increase the coagulation leading to premature death.7Hypertension is also found to be associated with chronic exposure to PM.8 Besides, particulate matter is suspected to cause endocrine disruption leading to the development of metabolic diseases like obesity and diabetes mellitus that interns increase the risk of cardiovascular disease.9&#xD;
&#xD;
Inflammatory responses induced by chronic exposure to PM could explain some of the biological mechanisms underlying their toxic effects. Recent research reveals an increase in circulating levels of interleukin-6 (IL-6), Granulocyte-Macrophage Colony-Stimulating Factor, C-reactive protein, ?brinogen, Tumor Necrosis Factor-&#x3B1; and other inflammatory and pro-inflammatory mediators in response to environmental exposure to PM.10According to literature, three hypotheses are proposed to explain pathogenesis induced by PM that involves inflammatory responses.11. One suggestion states that activate in?ammatory responses directly in the lung followed by spill-over effect leading to systemicin?ammation. Others suggest the activation of sensory receptors in the lung through inhalation of a PM that affects the autonomic nervous system and stimulates the sympathetic pathways with subsequent disturbances on the cardiovascular system.A third assumption suggests that ultrafine particles interact directly with target tissues, yet it is still controversial.&#xD;
&#xD;
Excessive noise in the working environment of textile industry represents another occupational exposure with the threat of loss of hearing.12Besides,noise could induce stress with negative health effects including catabolism and intestinal problems, immune suppression, cardiovascular diseases and insulin resistance due to the longer-lasting activation of the hypothalamic-pituitary-adrenal (HPA) axis.13&#xD;
&#xD;
Shift work has also been regarded as one of the most hazardous risk factors in the work environment.14 It disrupts circadian rhythm affecting health and wellbeing and predisposing to heart problems and other chronic diseases.15 Moreover, evidence states that stress levels among workers are increased by work pattern and some researchers attribute it to disruption in social and family relationships in consequence to shift work.16Cortisol and &#x3B1;-amylase are among the most popular biomarkers of stress. The HPA-axis is dedicated to mediate body responses towards physical and mental stress and regulates the release of cortisol,17 while&#x3B1;-amylase increases in blood after pharmacological activation of the adrenergic pathways triggering the sympathetic receptors as a response to physical stress.&#xD;
&#xD;
Developing countries are greatly in shortage of good knowledge of such kinds of hazards.18A serious attention to the health situation of cotton textile workers and underlying environmental hazards are a factual urgency. This could help to identify aspects of health needs as they provide a guide upon setting workplace health programs, identifying key issues impacting the health of working staff, planning workplace health initiatives, and helping to emphasize workers commitment and level of engagement.19&#xD;
&#xD;
Hence, the present work is a screening study for assessment of environmental hazards (particulate matter, fibres, shift work and noise) and health risk predictors including clinical (pulmonary function and blood pressure) and biochemical (cortisol, &#x3B1;-amylase and, IL-6)factors among cotton-weaving and spinning workers. &#xD;
&#xD;
METHODS&#xD;
&#xD;
Participants&#xD;
&#xD;
The study was carried on workers in the weaving and spinning section (open-end spinning process) at the cotton textile factory at Giza governorate. Fifty-two participants&#x2013;representing the full capacity of the morning shift- were subjected to all of the investigations, and were included in the study. Participants were interviewed where their age, working years (exposure duration) and health complaints (headache, hearing problems, respiratory and cardiac complaints) were recorded. Work is on three shifts per day (8 hr each) where each worker works on the same shift for one week and transfer to the other shift time on the following week on a rotatory basis. Body mass index (BMI) was calculated after weight and height measured for all participants as kilograms per square meter. Both clinical examination and blood sampling for assessment of relevant biomarkers were performed in accordance with ethical considerations and after receiving approval (with number 16/401) from the ethical committee of the National Research Centre (NRC) and consent from all participants. &#xD;
&#xD;
Blood sampling and Biochemical assessments&#xD;
&#xD;
Blood samples (5 ml) were obtained from participants using sterile plastic syringes on sterile test tubes and left for 30 min at room temperature to coagulate, then centrifuged at 3000 rpm for 10 minutes. The separated serum was divided into several aliquots and kept frozen at-80&#xB0;C to be used for biochemical analysis. &#xD;
&#xD;
Biochemical markers assessed for cotton industry workers at the open end area included cortisol, estimated by ELISA method, kit supplied from Perfect Ease Biotech (Beijing) Co., Ltd. and IL-6, estimated by ELISA method, using the kit supplied from lab science, USA. Serum &#x3B1;-amylase was determined using the colourimetric kit (Biodiagnostic, Egypt)&#xD;
&#xD;
Clinical examination&#xD;
&#xD;
&#xD;
	&#xD;
	Blood pressure measurement:&#xD;
	&#xD;
&#xD;
&#xD;
Systolic and diastolic blood pressures(SBP and DBP, respectively) were measured twice using a standard mercury sphygmomanometer for all participants while sitting, then average readings were calculated. &#xD;
&#xD;
&#xD;
	&#xD;
	Pulmonary function tests:&#xD;
	&#xD;
&#xD;
&#xD;
Determination of Pulmonary Ventilatory Function was done using a portable spirometer Model Smart pft USB. Serial number, name, date of birth, height and weight were recorded as personal data. Upon examination, each individual was asked to breathe normally from 5 to 7 times, then take a deep breath slowly and expire till the end very slowly. Participants were then asked to breathe at a normal rate again 5 to 7 times. Concerning the forced expiratory function, subjects were instructed to breathe normally 5 to 7 times, then to inspire deeply as maximum as possible, then expire forcibly till the end of expiration. They were asked to breathe normally again 5 to 7 times.&#xA0; The test was repeated three times as a minimum for accuracy.&#xD;
&#xD;
Environmental assessments&#xD;
&#xD;
&#xD;
	&#xD;
	Measurements of particulate matter:&#xD;
	&#xD;
&#xD;
&#xD;
Total suspended particulates (TSP) and respirable particulates (PM10) were measured by using HAZ-DUST (American instrument) with continuous monitoring for the morning shift work at four different sites; the opening of cotton bales (site 1), weaving sections (open end) (sites 2&amp;3) and humidification room (site 4). The standard limits for TSP and PM10 are 10 mg/m3 and 3 mg/m3, respectively according to Egyptian environmental law 4/1994. &#xD;
&#xD;
&#xD;
	&#xD;
	Assessment of the presence of fibres:&#xD;
	&#xD;
&#xD;
&#xD;
According to NIOSH method No 7400,20 for a period varying between 60-120min. at a flow rate of 5 L/min., air samples were collected on membrane fibres (0.45-micrometer pore size, 25-millimetre diameter) mounted on an open face fibre holder. Samples were then stored after collection in sealed boxes in the upward position and sent for analysis in the air pollution laboratory at NRC. The membrane filters were made transparent by mounting in immersion oil.&#xD;
&#xD;
The analysis was done for the presence of fibres at a magnification of 400Xusing phase-contrast microscopy (Olympus, Tokyo, Japan). Fibres were considered for counting using Walton Beckett reticule in the eyepiece if they had the dimensions of &gt;5 &#xB5;m in length and </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3898</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3898</Fulltext></URLs><References>&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Emotional State Due to the Covid &#x2013; 19 Pandemic in People Residing in a Vulnerable Area in North Lima&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>15</FirstPage><LastPage>20</LastPage><AuthorList><Author>Rosa PS</Author><AuthorLanguage>English</AuthorLanguage><Author> Hernan MS</Author><AuthorLanguage>English</AuthorLanguage><Author> Eduardo MS</Author><AuthorLanguage>English</AuthorLanguage><Author> Anika RA</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: The COVID-19 pandemic has generated a negative impact on the emotional state of people and makes them more susceptible to presenting different symptoms that compromise their mental health. Objective: The objective is to determine the emotional state due to the COVID-19 pandemic in people who reside in a vulnerable area in North Lima. It is a quantitative, descriptive, non-experimental cross-sectional study, with a total population of 306 participants from the Carabayllo district who responded to a questionnaire on sociodemographic data and the depression, anxiety, and stress scale (DASS-21). Results: In the results, we observe the emotional state, where 186 (60.8%) of the participants present a low emotional state, 92 (30.1%) have a high emotional state and 28 (9.1%) have a medium emotional state. Conclusions: It is concluded, virtual medical care should be carried out for the mental health care of vulnerable people.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Depression, Anxiety, Stress, Pandemic, Coronavirus</Keywords><Fulltext>Introduction &#xD;
&#xD;
From a global perspective, the coronavirus pandemic (COVID - 19) has triggered unprecedented alterations,1 where a latent threat has been found in the population in their emotional state that generates a negative impact that compromises both their health and how to prevent it.2&#xD;
&#xD;
The health crisis that exists worldwide due to the COVID-19 pandemic has triggered multiple factors that compromise the emotional state of the general population,3 where high rates of depressive symptoms, anxiety and stress pictures are evident due to the confinement and self-quarantine of the population.4,5&#xD;
&#xD;
Although, not only have these factors been seen in the population,6 but they are also prone to experiencing loneliness, anguish, sadness and worry generated by quarantine and isolation in their homes since sometimes some people tend to live alone in their homes and experience these factors mainly.7&#xD;
&#xD;
All these factors have not only been caused by the COVID-19 outbreak in the population, but are also due to the preventive measures that were taken by the government,8, COVID - 19 will play a fundamental role in the implications that not only affect people&amp;#39;s physical well-being, but also their psychological well-being.9&#xD;
&#xD;
Therefore, the impact of the COVID-19 pandemic is one of the causes that generate a very high emotional burden, where the person does not tolerate certain prevention measures, isolation and quarantine makes their mental health more vulnerable.10&#xD;
&#xD;
In a study in Spain, with 3480 participants aged 18 years old and over, its results showed that in females 18.7% presented depression, 21.6% anxiety and 15.8% present post-traumatic stress, concluding the female sex with health problems, presenting symptoms related to COVID - 19 and having a close relative infected, make her more vulnerable to presenting these factors compromising her mental health.11&#xD;
&#xD;
In a study conducted in Australia,12 with 3770 study participants, they stated that 21.6% of the participants had moderate to highly severe depression, 28.6% moderate to highly severe anxiety and 28% moderate to highly severe stress, although between 22% and 29% of the participants of both sexes presented symptoms of depression, anxiety and stress, although the majority were seen more in sex feminine than masculine.&#xD;
&#xD;
In a study carried out in Turkey, with 2076 participants who are health workers, their results stated that 86.9% of health workers were afraid of infecting their relatives with COVID - 19 and due to this, they manifested a high index of depression, anxiety and stress, they infect the members in their homes.13&#xD;
&#xD;
Therefore, the objective of the research is to determine the emotional state due to the COVID-19 pandemic in people who reside in a vulnerable area in North Lima.&#xD;
&#xD;
Therefore, its hypothesis in the research work is that the emotional state is presented negatively due to the isolation and quarantine of the population caused by the COVID-19 pandemic.&#xD;
&#xD;
Methodology&#xD;
&#xD;
Type of Research&#xD;
&#xD;
In the present research work, due to its properties and the way of collecting data according to the present variables, it is a quantitative approach, with a descriptive, non-experimental and cross-sectional methodological design14.&#xD;
&#xD;
Population&#xD;
&#xD;
The study covered 306 study participants from the ages of 17 to 85 who live in a Human Settlement in the Carabayllo district. Also, the Sociodemographic data o the population is shown in Table I.&#xD;
&#xD;
Inclusion criteria&#xD;
&#xD;
&#xD;
	&#xD;
	People ranging in age from 17 to 85 years old.&#xD;
	&#xD;
	&#xD;
	People who are voluntarily present in the research work.&#xD;
	&#xD;
	&#xD;
	People residing in the Carabayllo district.&#xD;
	&#xD;
	&#xD;
	People who signed the consent informed ACTAN&#xB0;050-2020-CE/UMA UNIVERSIDAD MARIA AUXILIADORA&#xD;
	&#xD;
&#xD;
&#xD;
Technique and instrument&#xD;
&#xD;
The technique for the study was carried out using the DASS-21 questionnaire or data collection instrument, which aims to measure the emotional state of the COVID-19 pandemic in people residing in a vulnerable area of ??North Lima.&#xD;
&#xD;
The depression, anxiety, and stress scale (DASS-21), each of the three DASS scales contain 14 items, divided into subscales of 2 to 5 items with similar content. The depression scale assesses dysphoria, hopelessness, devaluation of life, self-loathing, lack of interest or participation, anhedonia, and inertia. The anxiety scale assesses autonomic arousal, skeletal muscle effects, situational anxiety, and the subjective experience of anxious affect. The stress scale is sensitive to levels of non-specific chronic arousal. It evaluates the difficulty to relax, the nervous excitement and the discomfort, agitation, or irritation, over-reactivity and impatience. It consists of 4 answer alternatives, 0 "not at all", 1 "sometimes", 2 "many of the time" and 3 "most of the time" to rate the degree to which they have experienced each state during the past week. To obtain the final score of the DASS-21, the total score obtained must be multiplied by two (data x2).14,15&#xD;
&#xD;
The validity of the instrument to measure emotional state was determined based on the exploratory factor analysis technique. The Kaiser-Mayer-Olkin sample adequacy measure obtained a coefficient of 0.962 (KMO&gt; 0.5), while the Bartlett sphericity test obtained significant results (X2 approx. = 7050.468; gl = 210; p = 0.000). &#xD;
&#xD;
The reliability of the instrument was determined with the Cronbach&amp;#39;s Alpha statistical test, in which a coefficient of 0.977 (&#x3B1;&gt; 0.8) was obtained for the items (i = 21).&#xD;
&#xD;
In this research work, the depression, anxiety, and stress scale (DASS-21) will be used as a data collection instrument. The data collection processing was through the questionnaire in people residing in a vulnerable area of ??North Lima, in which the matrix for the database was carried out in the SPSS Statistics Base 26.0 program, in which the data analysis and processing to make tables and figures to later be described and interpreted in results and discussions, respectively.&#xD;
&#xD;
Place and application of the instrument&#xD;
&#xD;
The questionnaire was carried out to measure the emotional state due to the COVID-19 pandemic in people residing in a vulnerable area of ??North Lima, in which it was carried out in the district of Carabayllo, in the Las Malvinas de Carabayllo Human Settlement&#xD;
&#xD;
Coordination was made first with the directive members for the permits to carry out the research, then the corresponding permission for each head of household explaining about the study, also knowing what is going to be carried out.&#xD;
&#xD;
The questionnaire only took approximately 15 minutes to fill out, and at the time of collecting the surveys, we concluded that people supported us in the study, generating an atmosphere of trust and satisfaction in the study.&#xD;
&#xD;
Results&#xD;
&#xD;
In Figure 1 and Table 1, we observe the emotional state, where 186 (60.8%) of the participants have a low emotional state, 92 (30.1%) have a high emotional state and 28 (9.1%) have a medium emotional state.&#xD;
&#xD;
In Figure 2, we can see that the female sex presents a low emotional state 103 (55.4%) than the male sex 83 (44.6%), at the medium level the female sex 15 (53.6%) and the male sex 13 (46.4%) and a high level 53 (57.6%) female and 39 (42.4%) male.&#xD;
&#xD;
In Figure 3, the emotional state is observed about its dimensions, where we can see that in the depression dimension, 94 (30.7%) of the population have extremely severe depression, followed by 88 (28.8%) with normal depression, 59 (19.3%) with moderate depression, 38 (12.4%) with mild depression and 27 (8.8%) with severe depression, in terms of their anxiety dimension, we observe that 134 (43. 8%) of the population presents extremely severe anxiety, 60 (19.6%) with normal depression, 46 (15%) with moderate depression, 38 (12.4%) with mild depression and 28 (9.2%) with severe depression and in its stress dimension, we observed that 142 (46.4%) of the population presented normal stress, 64 (20.6%) severe stress, 44 (14.4%) extremely severe stress, 28 (9.2%) moderate stress and 29 (9.5%) mild stress.&#xD;
&#xD;
In Table 2, we observe the relationship between the emotional state and the level of education in people residing in a vulnerable area of ??North Lima, which was determined with Pearson&amp;#39;s chi-square test (X2). The level of significance of the test obtained a value of 0.73 (p&gt; 0.05) (X2 = 40.627; d.f = 12). Therefore, an association hypothesis is not rejected, for which there is statistical data that verify the relationship between the emotional state and the level of education. In which, we can interpret that people with university education complete 68 (73.9%) have a low emotional state, followed by secondary education complete 45 (58.4%), university education incomplete 28 (66.7%), secondary education incomplete 24 (55.8%) and people with primary education complete have a high emotional state 14 (48.3%).&#xD;
&#xD;
Discussions&#xD;
&#xD;
The research work has emphasized the emotional state from a focus on mental health in the general population, which seeks to carry out preventive strategies that allow the population to maintain or improve at a psycho-emotional level that allows them to cope with the situation in which are undergoing quarantine and isolation because of the COVID-19 pandemic.&#xD;
&#xD;
The results reflected that the emotional state of the population is low, this is because many of the population have not been able to cope with the COVID-19 pandemic since last year, where the risk of being infected has impacted at the level of mind them, where factors such as depression, anxiety and stress that are the main ones in affecting their emotional state, since being in quarantine and isolation make people unable to face this situation in the most appropriate way. They argue that depression, anxiety and stress are factors that compromise people&amp;#39;s mental health, where it makes them vulnerable to any situation that they cannot confront, and due to this, they are prone to have negative ideas in themselves and can hurt themselves by not knowing how to deal with it7.&#xD;
&#xD;
Regarding sex, it is observed that the female sex presents a lower emotional state than in the male sex, this is because the psycho-emotional burden in the female sex is highly compromised not only because the COVID-19 pandemic affects their daily routines and puts their well-being at risk, but also affects due to factors such as infected or deceased family members, the alarming increase in positive cases, makes the symptoms of anxiety and stress mainly become more noticeable. They argue that women are more susceptible to their emotional state is altered, where factors such as apathy, sadness, despair, pessimism and low self-esteem, are indications that the person presents high depressive symptoms since when more depression is serious, anxiety and stress begin to rise, complicating their physical and mental well-being11.&#xD;
&#xD;
Regarding its dimensions, it can be observed that depression and anxiety are highly compromised, this is because as a result of the health crisis caused by the COVID-19 pandemic, since, during confinement at home, people have problems such as Insomnia, changes in appetite and physical activity, feelings of frustration, guilt, loneliness and helplessness and lack of courage, all of which have caused anxious depressive symptoms in the population and this can be considered aggravated causing obsessive and hypochondriacal behaviours. They argue that quarantine and isolation have generated difficulties in people, factors such as inactivity, sedentary lifestyle, inadequate food intake, insomnia, fatigue and worry, since all this manifests itself because depressive symptoms are present and because of this these factors are becoming more noticeable12.&#xD;
&#xD;
Conclusions&#xD;
&#xD;
It is concluded that virtual medical care should be carried out for the mental health care of vulnerable people.&#xD;
&#xD;
It is concluded to carry out strategies to promote mental health, such as relaxation activity, healthy diet, adequate water intake, daily breaks and maintaining sociable contacts, since they are important to reduce anxiety, depression, and stress in people.&#xD;
&#xD;
It is concluded that it is necessary to intervene in public and mental health to improve the perceptions of the person of risk to COVID-19, the concern for loneliness and improve the state of mind so that they improve the person in a positive way&#xD;
&#xD;
The limitation in the research work is the few studies that have been carried out in our country since in these times mental health is what is being prioritized more because over time it can generate conflicts and consequences in people due to the consequences by COVID - 19.&#xD;
&#xD;
This study will be beneficial because there have been no studies where the research was raised and the instrument details important points to know how the population is at a mental level due to COVID - 19.&#xD;
&#xD;
Conflict of Interest&#xD;
&#xD;
The authors declare no conflict of interest.&#xD;
&#xD;
Funding Source&#xD;
&#xD;
This research work does not have Funding Sources&#xD;
&#xD;
Acknowledgement&#xD;
&#xD;
The 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.&#xD;
&#xD;
Author&#x2019;s Contributions&#xD;
&#xD;
Rosa PS: Conceived and designed the analysis, wrote the paper and translation.&#xD;
&#xD;
Hernan MS: Collected the data, Performed the analysis. &#xD;
&#xD;
Eduardo MS: Contact the people for the survey-taking.&#xD;
&#xD;
Anika RA: Contributed data and analysis tools.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
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5. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Koksal E, Dost B, Terzi &#xD6;, Ustun Y, &#xD6;zdin S, Bilgin S. Evaluation of Depression and Anxiety Levels and Related Factors Among Operating Theater Workers During the Novel Coronavirus (COVID-19) Pandemic. J Perianesthesia Nurs. 2020;35(5):472&#x2013;477. &#xD;
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6. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Craig A, Hughes B, Swamy G. Coronavirus disease 2019 vaccines in pregnancy. Am J Obstet Gynecol 2021;3(2):100295. &#xD;
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7. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Ren X, Huang W, Pan H, Huang T, Wang X, Ma Y. Mental Health During the Covid-19 Outbreak in China: a Meta-Analysis. Psychiatr Q. 2020;91(4):1033&#x2013;1045. &#xD;
&#xD;
8. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Lahav Y. Psychological distress related to COVID-19 &#x2013; The contribution of continuous traumatic stress. J Affect Disord. 2020;277:129&#x2013;137. &#xD;
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9. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Hasan A, Sadia M, Hossain S, Hasan M. The impact of COVID-19 pandemic on mental health &amp; wellbeing among home-quarantined Bangladeshi students: A cross-sectional pilot study. J Affect Disord. 2020;277:121&#x2013;128. &#xD;
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10. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Werner E, Aloisio C, Butler A, Antonio K, Kenny J, Mitchell A, et al. Addressing mental health inpatients and providers during the COVID-19 pandemic. Semin Perinatol. 2020;44:151279. &#xD;
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11. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Gonz&#xE1;lez C, Aus&#xED;n B, &#xC1;ngel M, Saiz J. Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain. Brain Behav Immun. 2020;87:172&#x2013;176. &#xD;
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12. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Hammond N, Crowe L, Abbenbroek B, Elliott R, Tian D, Donaldson L, et al. Impact of the coronavirus disease 2019 pandemic on critical care healthcare workers&#x2019; depression, anxiety, and stress levels. Aust Crit Care. 2020;19(7):1&#x2013;9. &#xD;
&#xD;
13. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Tengilimo?lu D, Zekio?lu A, Tosun N, I??k O, Tengilimo?lu O. Impacts of COVID-19 pandemic period on depression, anxiety and stress levels of the healthcare employees in Turkey. Leg Med. 2021;48:101811. &#xD;
&#xD;
14. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Hern&#xE1;ndez R, Fern&#xE1;ndez C, Baptista P. Metologia de la Investigaci&#xF3;n. 2017. p. 1&#x2013;634. &#xD;
&#xD;
15. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Lovibond A. Depression Anxiety Stress Scale (DASS-21). J Psychiatr&#xA0; Res.1995;19(3): 67-71.&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Evaluation of Relation between Extraoral Facial Measurement and Mesiodistal Width of the Anterior Teeth&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>21</FirstPage><LastPage>27</LastPage><AuthorList><Author>Jeewan Bachan Dhinsa</Author><AuthorLanguage>English</AuthorLanguage><Author> Sanjeev Mittal</Author><AuthorLanguage>English</AuthorLanguage><Author> Urvashi Sukhija</Author><AuthorLanguage>English</AuthorLanguage><Author> Rishabh Ranjan</Author><AuthorLanguage>English</AuthorLanguage><Author>  Manasvi Jamwal</Author><AuthorLanguage>English</AuthorLanguage><Author> Manini Monica</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The selection of anterior teeth is essential for establishing a correct proportion for facial rhythm and pleasant looks. In the absence of a pre-extraction record, a various extraoral facial landmark can be used to determine the width of maxillary anterior teeth. Using facial measurements to determine the size of the anterior teeth no suitable universal reliable method is present. Objective: This study was done to find the correlation between various extraoral landmarks and the width of six anterior maxillary teeth. Methods: A total of 100 dentate subjects (64 females, 34 male) were included in this in vivo study. The various extra oral-facial landmarks such as the interpupillary distance (IPD), intercanthal distance (ICD), bizygomatic distance (BZW), internal distance (IAD), philtral width (PW) were measured with a digital vernier calliper. The combined mesiodistal width of six anterior teeth (CW) was recorded with a flexible scale. The collected data were analysed using Statistical Package for Social Sciences (SPSS) version 21, software (IBM Inc, USA). Results: Extra oral-facial measurements and CW were higher in the males as compared to the females. Among all the extraoral facial measurement, only Bizygomatic width show significant correlation with the combined width of maxillary anterior teeth. Conclusion: The regression equation 31.291 + 0.040 &#xD7; BZW can be applied to determine the width of the anterior teeth.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Interpupillary Distance, Intercanthal Distance, Bizygomatic Width, Interalar Distance, Regression Analysis</Keywords><Fulltext>Introduction &#xD;
&#xD;
In this competitive world full of economically, professionally and socially sound population that is steadily cutting across the limitations and confinements, an attractive and pleasant look is becoming a sheer necessity. As we all know the human face plays a major role in highlighting human appearance in the forms of identity, personality, social identity and the individuals&#x2019; self-confidence. 1 &#xD;
&#xD;
&#xA0;loss of the natural teeth takes a generalised effect on the individual especially the facial appearance which in result leads to creating a psychological trauma to a person leading to poor self-esteem.2 Denture esthetics is defined as &#x2018;the cosmetic effect produced by a dental prosthesis which affects the desirable beauty attractiveness, character and dignity of the individual&#x2019;.3 It becomes the goal of a prosthodontist to recreate what the ailing individual has lost with simultaneously maintaining the harmony of the facial appearance and the surrounding dento-labial relations of the anterior maxillary teeth. The selection of appropriate sized artificial anterior teeth requires both scientific knowledge and skill. &#xD;
&#xD;
In the early work before the 19th-century tooth size was determined by the &#x201C;temperamental theory&#x201D;, in which the dentist or practitioner determined the tooth forms based on the patients&#x2019; health and appearance. This hypothesis was replaced further on by using a system in which facial form was used to determine the tooth form; it was although later on discredited. &#x201C;Frush and Fischer&#x201D; then introduced the Dentogenic Theory in which they used the &#x201C;sex, personality, age (SPA) factor&#x201D; for selecting the denture teeth.4 hence the early and late 19th century, methods mostly involved the &#x201C;Trial and Errors&#x201D; until the patient and dentist established a satisfaction for a particular size of a tooth. &#xD;
&#xD;
As dentistry is evolving now a day there a numerous parameter for anterior teeth selection which involves parameters such as pre-extraction records which mainly include the photographs, extracted teeth, radiographs and stone models. In the absence of such records, it becomes a major hassle and hurdle in replacing and designing the aesthetics for a completely edentulous patient. Therefore, in such cases, we use various extra oral-facial landmarks as guides for the determination of the mesiodistal width of artificial maxillary anterior teeth.4&#xD;
&#xD;
The facial proportion was defined as the comparative relation of facial elements in a profile.5 The size, form, and colour of the teeth must be in harmony with the surrounding oral and facial structures, the width of the teeth is considered by some to be more critical than the length.5 several authors have attempted to identify normal tooth dimensions. When no pre-extraction records are available, selecting the proper anterior teeth size for edentulous patients can be difficult. Several efforts have been made to precisely quantify the selection of the anterior teeth.&#xA0;&#xA0;The golden proportion has been well known for hundreds, per&#xAD;haps thousands, of years, but Ricketts has been the first orthodontist to apply it to the composi&#xAD;tion of facial hard and soft tissues. He also used the term &#x2018;&#x2018;golden sectioning.&#x2019;&#x2019; Applying a divider, the di&#xAD;vine proportion is the length of the longer side in 2 linear measurements, at 1.618, and the short side is 1.6,7&#xD;
&#xD;
According to Young &#x2018;&#x2018;it is apparent that beauty, harmony, naturalness, and individuality are major qualities&#x2019;&#x2019; of esthetics.7 Esthetics is one of the primary considerations for patients seeking prosthetic treatment. The size and form of the maxillary anterior teeth are important not only to dental esthetics but also to facial esthetics. The goal is to restore the maxillary anterior teeth in harmony with the facial appearance. However, there is little scientific data in the dental literature to use as a guide for defining the proper size and shape of anterior teeth or determining normal relationships for them.8&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xD;
&#xD;
We all know that facial surface anthropometry is a term used to describe the measurements for the facial features and the method of recording the positions of these facial features. The various facial measurements are substantially based on the spatial correspondence between the definable points present on the face. There have been a total of 20 landmarks and parameters which are of interest for the various medical and dental professionals. In the current era, there are three methods present to conduct the facial measurements they are&#x2013; Manual anthropometry, 2D photography and 3D stereo-photogrammetry. The method 3D stereo-photogrammetry uses the various laser scanners and records the images as a 3D virtual object which can be further evaluated and viewed from the various aspects.9 This tool has been proved as an excellent guide hut with only a current drawback the cost of the equipment involved. &#xD;
&#xD;
2D photography has been found as an alternative way to measure the landmarks as an alternative to manual anthropometry. In this method, the photographs are taken of the subject or individual with their head positioned in orientation with their Frankfurt plane horizontal to the ground. In this 2D method measurements are taken from the photograph instead of from the patient directly, but in this method locating the bony structures under the skin requires palpation. &#xA0;Whereas the manual anthropometry method makes the records and the measurements using sliding and spreading calliper or by using a flexible measuring tape. This technique is easily accessible and of less cost. &#xD;
&#xD;
However, the studies have shown a lot of variations in their results and also made it clear that no single variable is accurate enough&#xA0;for clinical application. Extraoral landmarks of an individual have been used as a guide for anterior teeth selection. 10,11 Correlating the anterior teeth size and the extra-oral landmarks can help in achieving an aesthetically pleasing appearance.&#xD;
&#xD;
In the prosthodontics literature, we mostly come across studies of populations outside of India, along with the apparent lack of information about the reliability of determining the width of the maxillary anterior teeth with the various extra oral-facial landmarks. There are no universally accepted parameters for the selection of the width artificial maxillary anterior teeth for the Indian population. Hence the purpose of this in vivo study was to evaluate the reliability of the various extra oral-facial landmarks such as the interpupillary distance (IPD), inner canthal distance (ICD), bizygomatic width (BZW), inter alar distance (IAD), and the philtral width (PW) with the combined mesiodistal width of the 6 anterior maxillary teeth (CW) for the selection of the width of artificial maxillary anterior teeth in the population.&#xD;
&#xD;
MATERIALS AND METHODS&#xA0; &#xD;
&#xD;
The current descriptive cross-sectional in vivo study was done in the department of prosthodontics crown and bridge, Maharishi Markendeshwar College of Dental Sciences and Research, Mullana, Ambala, Haryana, India. The subjects selected were under and postgraduate students. Approval for the study was obtained from the institutional ethical committee (IEC). Written consent was obtained from the subjects and they were explained in detail about the procedure. A total of 100 dentate subjects (male and females) were selected according to the following inclusion and exclusion criteria. &#xD;
&#xD;
Inclusion criteria &#xD;
&#xD;
&#xD;
	&#xD;
	Dentulous subjects having permanent maxillary teeth with good alignment.&#xD;
	&#xD;
	&#xD;
	No history of orthodontic treatment or extraction of anterior teeth.&#xD;
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	Patients having attained the age of 18, complete facial growth.&#xD;
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	No gross facial asymmetry. &#xD;
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	No restoration or caries in anterior teeth.&#xD;
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Exclusion criteria &#xD;
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	Artificial crowns on upper front teeth.&#xD;
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	Gingival inflammation or hypertrophy of maxillary anterior teeth.&#xD;
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	Congenital or surgical facial asymmetry defects.&#xD;
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	&#xD;
	Loss of tooth structure due to caries, restorations &#xD;
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	&#xD;
	History or evidence of any dental irregularities, microdontia or macrodontia and malformed teeth. &#xD;
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	&#xD;
	No abnormal pupillary response and vision inability or defect. &#xD;
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&#xD;
Recording of the combined width of the maxillary anterior (CW)&#xD;
&#xD;
Subjects were seated upright in a dental chair, having their heads supported, so they can look forward towards the horizon and the head is parallel to the floor.&#xA0; &#xA0;The maxillary impression was made using the irreversible hydrocolloid (Coltoprint-ncr, Coltene). The impressions were thoroughly washed under water and disinfected by spraying 1% sodium hypochlorite solution and poured with type ? dental (Kalabhai Ultrarock).&#xA0; The combined mesiodistal width of the 6 anterior maxillary teeth (CW) was measured on the dental cast with the help of a flexible millimetre scale, which was kept on the distal most of one canine to the distal-most part of other canine following the curvature of the arch on a dental model&#xD;
&#xD;
Recording of the extra oral-facial measurements&#xD;
&#xD;
&#xD;
	&#xD;
	Inter pupillary width(IPD)&#xD;
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	&#xD;
	Inter canthal distance (ICD)&#xD;
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	Bizygomatic width (BZW)&#xD;
	&#xD;
	&#xD;
	Inter Alar distance (IAD) &#xD;
	&#xD;
	&#xD;
	Philtrum Width (PW)&#xD;
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&#xD;
&#xD;
The landmarks were measured using a digital vernier calliper (Yuri) having the following specifications-&#xD;
&#xD;
&#xD;
	&#xD;
	Measuring field as model: 150m/6in, 200mm/8in, 300mm/12in &#xD;
	&#xD;
	&#xD;
	Resolution: .01mm/.0005in&#xD;
	&#xD;
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	Accuracy (DIN862): max deviation-0.02mm over 100mm, 0.03mm above*&#xD;
	&#xD;
	&#xD;
	Measuring system: Capactive &#xD;
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	&#xD;
	Display: LCD (11mm)&#xD;
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	&#xD;
	Max. Measuring Speed: 3m/s&#xD;
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	&#xD;
	Power Supply: 1&#xD7;AG13 or SR44 Battery, 1.5v&#xD;
	&#xD;
&#xD;
&#xD;
The IPD was measured from the centre of one pupil to the centre of the other pupil. A steel metal scale was used to mark and depict the centre of the pupil. The ICD was measured as a distance between the medial angles of the palpebral fissures of the eye.&#xA0; The BZW was measured between the two most prominent point on the zygomatic bone with the help of a facia face bow. The IAD was measured as the distance between the widest points on the outer surface of the alae of the nose on either side. The PW was recorded between the two most prominent parts at the base of the philtrum. &#xD;
&#xD;
All the measurements were recorded in millimetres. Each reading of extra oral-facial measurement and CW were made 3 times and the mean was obtained.&#xD;
&#xD;
The collected data were analysed using Statistical Package for Social Sciences (SPSS) version 21, software (IBM Inc, USA). The data so obtained were compiled, tabulated, evaluated and statistically analysed with Tukey Hsd Post Hoc and the Pearson Correlation test. &#xD;
&#xD;
RESULTS &#xD;
&#xD;
The Table 1 depicted the mean and standard deviations for the extra oral-facial measurements (in millimetres) for the total population subjects (N-100). The mean and SD for IPD, ICD, BZW, IAD and PW &#xA0;&#xA0;were 52.6626 +5.85833, 27.5151+ &#xA0;2.92275, 125.0746 + 12.08289, 34.1742 + 9.54873, 14.1366 + 14.72079 respectively.&#xD;
&#xD;
&#xA0;The mean of the facial measurements (IPD, ICD, BZW, IAD and PW) for males (N-64) were found to be higher as compared with the female (N-36). When male and female facial measurements were compared with the Tukey Hsd Post Hoc test, the males reported significantly higher IPD (p = 0.012*), ICD (p = 0.036*), BZW (p = 0.017*) as compared to the female population. Although males reported higher IAD (p = 0.222) and PW (p = 0.635) it failed to reach the level of significance Table 2. &#xA0;&#xA0;&#xD;
&#xD;
&#xA0;The mean and SD of combined mesiodistal width of the 6 maxillary anterior teeth (CW) for the total population, females and males were shown in Table 3. &#xA0;The males (39.5269) reported significantly higher CW (p = 0.041*) as compared to female (38.7052) population.&#xD;
&#xD;
&#xA0;Table 4 showed the regression equation with different facial measurement.&#xA0; Pearson&#x2019;s correlation coefficient was calculated to measure the strength of a linear relationship between facial measurements and, it was not found to be significant except for BZW which was found to be significant (p=0.0042*), showing a weak positive (0.208) correlation between the variables. &#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
The selection of anterior teeth is done to satisfy the esthetics of an individual seeking rehabilitation or a complete denture fabrication. To select artificial teeth, the dentist or clinician requires scientific knowledge as well as artistic skill. The prosthodontist has to very carefully blend the art and science with the arrangement as well as the selection of the anterior teeth.2 &#xA0;&#xD;
&#xD;
When a completely edentulous patient seeks treatment for rehabilitation with no pre-extraction record available, it becomes great difficult for the dentist to select the proper anterior teeth for the individual 12 To overcome this problem a systematic approach is needed, several anatomical facial landmarks such as IPD, ICD, BZW, IAD and PW have been suggested and said to aid in the estimation and selection of the width of the maxillary anterior teeth.13&#xD;
&#xD;
Various instruments can be used for recording facial measurements. Different authors used a vernier calliper, Willis Gauge, Boley Gauge in our present study we had used the digital vernier calliper to record the facial measurements and the Facebook to measure the bizygomatic width as done by Rawat et al.2,4,14&#xD;
&#xD;
A wide variety of instruments had been used to record the intraoral measurements like a piece of string or dental floss,2 digital3 and non-digital vernier calliper, flexible scale. For the measurements of the CW different researchers measured the distance from the curve present between the distal aspects of the two maxillary canines at the contact points. Whereas the other researchers used the cusp tips of the canines.15 The use of the flexible scale had been used in the study conducted by Gomes et al.16 Measuring the combined width of anterior teeth had also been done by recording the individual value of each tooth.14 The type IV gypsum product used to make the dental casts due to its high strength.17&#xD;
&#xD;
The mean for the inner canthal width in various populations was compared and reported by similar studies by Gomes et al. Lucas et al. and Ellkhawa et al. While the El-sheikh, and Kassab reported lower ICD widths compared to the present study.5,18-21 In a study conducted by Park et al. recording of the bizygomatic width was done by using the widest dimension of the face.22 In a study conducted by Bonakchandarchain the Inter alar value was found to be 36.37mm similar to our study but greater inter alar width were found in the study by Dharap AS et al. 39.8 mm and smaller values reported by Hoffman et al. (34.28 mm) and Al-El-Sheikh (33.27 mm).23,24, 25 In a study reported by Cesario et al.15 The IPD was found to be 59.16mm greater than our study whereas a study by Mishra et al. reported a similar value of IPD as of our study.26 Variation found in the mean values reported can likely be due to racial variations and difference in measuring technique.&#xA0; &#xD;
&#xD;
In our study extra oral-facial measurement, CW was more in male as compared to female. &#xA0;Higher values in males may be due to various factors such as hereditary, robust built, hormones. These findings were also supported by Tripathi et al. Vajro &amp; Nogueira, Smith. and Cesario &amp; Latta.15,27,28&#xD;
&#xD;
Higher mean inner canthal widths in male compared to females was also found by Gomes et al.and Wazzan et al.5,12 However, a study done in the Brazilian population by Gomes et al. reported statistically insignificant difference for the mean of the ICD between the males and females.5&#xD;
&#xD;
In this study the use of regression analyses was carried out among the entire facial dimension only BZW showed a significant correlation with CW. The regression method was also used by Isa et al,29 Tripathi et al. Scandrett et al. and Neda et al. in their studies.1,30,31 The estimated combined width of the anterior teeth was found to be less than one-third of the BZW in a study by Tripathi et al.1 which concluded that the BZW is an important landmark for the selection of the anterior teeth.&#xA0; In our study the combined width of maxillary anterior teeth may be estimated from the equation CWBZW&#xA0;= 31.291 + 0.040 &#xD7; BZM).&#xA0; Therefore the use of the regression formulas in the current study may aid in the selection of the anterior teeth for edentulous individuals, for an inexperienced dentist.&#xD;
&#xD;
Scandrett et al. evaluated various facial parameters such as the bizygomatic distance, the inter-alar width, the inter-commissural width, the sagittal cranial diameter, the inter-buccal frenulum distance, the philtrum width, and the age as predictors for the width of the maxillary anterior teeth and the maxillary central incisors.30 The investigators concluded that no single predictor is accurate enough to be used 100% for the clinical application. Therefore, more than one variable is needed for the prediction of maxillary anterior teeth width. &#xD;
&#xD;
Similar to our study Authors Patel et al. and Sinavarat et al. also found no significant correlation between the IAD and the CW.32,33 In the study done by Mishra et al,26 the Pearson&#x2019;s correlation coeffi&#xAD;cient for the CW and the IAD was found to be weak, negative (except in Aryans), whereas it was found to be highly significant. Also, a significant correlation of value 0.05 level (two-tailed) was found for the Mongoloids. Ellakwa et al. reported a weak and insignificant correlation between IAD and CW. Latta et al. found a non-significant correlation for the BZW and IAD.19,34&#xD;
&#xD;
&#xA0;In our study magnitude of the correlation between facial and tooth variable was small, as if the correlation between the variables reach 1, the use for the biometric ratio can justify the prediction, by which the error will be significantly small.26 The investigators concluded that no single predictor is accurate enough to be used 100% for the clinical application. Therefore, more than one variable is needed for the prediction of maxillary anterior teeth width.&#xD;
&#xD;
The limitations of this study were that this study was conducted in a smaller population. There is a need for further investigations to be done in a larger population as well as in different races. The use of the digital vernier calliper for measurement presents with an inability of the thinner beaks of the calliper to be inserted into tight teeth contacts, as well it had been seen that many individuals do not cooperate with the placement of the calliper to record the facial landmark. The measurements were recorded on the soft tissue landmarks and intra operator reading variations were found in the same individual due to the inconsistent pressure applied during the recording of the measurement. Such difficulties can lead to errors in the measurements.&#xD;
&#xD;
Clinical implication:&#xA0; Extra oral-facial landmarks found to remain stable with time, can be used as initial guides to select the width of the anterior maxillary teeth for better aesthetic results when no pre-extraction records are available. More than one facial measurement can be used as a predictor for the selection of the anterior maxillary teeth. The BZW may serve as a reference for establishing the width of maxillary anterior teeth.&#xD;
&#xD;
CONCLUSION &#xD;
&#xD;
Based on the findings of the study, it can be concluded that:&#xD;
&#xD;
1. The extra oral-facial measurements were higher in the males as compared to the females. &#xD;
&#xD;
2. The combined width of the anterior maxillary teeth was significantly more in males than in females.&#xA0; &#xD;
&#xD;
3. Only bizygomatic width showed a significant correlation with the combined width of anterior teeth. 4. The regression equation 31.291 + 0.040 &#xD7; BZW can be applied to determine the width of the anterior teeth.&#xD;
&#xD;
Conflict of interest: nil&#xD;
&#xD;
Source of funding: self&#xD;
&#xD;
Authors contribution&#xD;
&#xD;
&#xA0;1.Dr. Jeewan Bachan Dhinsa-Data analysis&#xD;
&#xD;
2.Dr. Sanjeev Mittal&#xA0; -Investigation&#xD;
&#xD;
3.Dr. Urvashi Sukhija&#xA0; -Manuscript preparation&#xD;
&#xD;
4.Dr. Rishabh Ranjan-Statistical analysis&#xD;
&#xD;
5.Dr. Manasvi Jamwal&#xA0;&#xA0;&#xA0;&#xA0; -Evaluation&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
6.Dr. Manini Monica&#xA0; -Editing&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3900</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3900</Fulltext></URLs><References>&#xD;
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	Prabha JL, Jain RA. Realiability of intercommissural width in the determination of the width of maxillary anterior teeth in Indian and Malaysian population, Drug Invent Today. 2018;10:506-510.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Comparative Study of Two Manual Technique on Triceps Surae Muscle Flexibility in Working Females Wearing High Heels&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>28</FirstPage><LastPage>34</LastPage><AuthorList><Author>Ahmed H</Author><AuthorLanguage>English</AuthorLanguage><Author> Alqhtani R</Author><AuthorLanguage>English</AuthorLanguage><Author> Alshahrani A</Author><AuthorLanguage>English</AuthorLanguage><Author> Mughal M Y</Author><AuthorLanguage>English</AuthorLanguage><Author> Khan A R</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Objective: This study aimed to observe the influence of two manual techniques in improving the flexibility of the triceps surae muscle in working females wearing high heels. Methods: This study is based on a pretest-posttest experimental control group design, which included forty-five working females wearing high heels. All the participants were assigned randomly into three groups A, B and C. Group A received a hot pack treatment for 20 minutes followed by a Muscle Energy Technique (MET) which was repeated four times (10-second contraction, 5-second relaxation). Group B received a hot pack intervention for 20 minutes followed by static stretching which was repeated five times (30-second hold, 15-second rest between each repetition). Group C received only a hot pack intervention for 20 minutes. Active ankle dorsiflexion range of motion (ADFROM) on day 1 pre-intervention (baseline) and post-intervention on Day 1, 3, 5 and 8 was taken as an outcome measure. Results: For the variable ADFROM, the data analysis showed insignificant differences (p0.05) against control group C, though an insignificant difference (p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Flexibility, Muscle Energy Technique, Static stretching, Triceps surae muscle. Footwear, Manual therapy</Keywords><Fulltext>INTRODUCTION &#xD;
&#xD;
Nowadays, wearing high heels is a fashion followed by around 40 to 70% of women in the world.1An average height of a high-heeled shoe is approximately 10cm while the height of a low-heeled or flat-soled shoe range between 0-4cms. Moreover, a high-heeled shoe has a narrow toe holder and a stiff heel cap that projects anteriorly2 with an excessive plantar curvature.3&#xD;
&#xD;
Most women acknowledge that wearing high-heeled shoes provides a sense of self-esteem and intellectual well-being, which makes this type of footwear popular. However, some researchers have reported that the use of these shoes has subsequently had an adverse effect on different body structures. 4,5,6&#xD;
&#xD;
Studies suggested that the use of high heels can contribute to the incidence and progression of knee pain,7,8 an increased predisposition toward degenerative knee osteoarthritis 8,9, low back pain due to increased spinal curvature 10,11&#xAD; and changes in gait pattern, such as walking speed and mobility.12-15&#xD;
&#xD;
Studies established that the practice of wearing high-heeled shoes for an extended period increases plantar flexion and leads to decreased triceps surae muscle extensibility and decreased ankle joint range of motion. this can lead to Achilles tendinitis, gastrocnemius strain, and plantar fasciitis.4,5&#xD;
&#xD;
As a result, calf muscle stretches are commonly prescribed in an attempt to increase ankle joint dorsiflexion and to reduce the symptoms of such disorders.16-21 Physical therapists are using a wider approach of interventions to maintain and increase flexibility, reduce joint stiffness, avoid dysfunction and deformities resulting from muscle contractures. This includes moist heat packs, ultrasonic therapy, constant passive motion, stretching, MET, or a combination of these methods.22,23,24&#xD;
&#xD;
The stretching technique used and widely accepted proved to be beneficial in increasing flexibility22. Similarly, athletes used the stretching to elongate the muscle-tendon unit (MTU) at the end range of motion and holding that stretch for up to one minute before relaxing, and then repeated this stretch several times.25-29&#xD;
&#xD;
Apart from static stretching, MET is also used to improve muscle flexibility.&#xA0; It is a manual technique that has been described as a gentle form of manipulative therapy effective for restoring movement deficits of both the spine and extremities. It is considered to be effective in elongation of shortened/contractured muscle, strengthening of muscles, draining of fluids, and improving the ROM of a restricted joint. While osteopaths and other manual therapists use MET extensively, there is insufficient research aiding and validating its theories and use to explain the effects of MET.24, 30 Furthermore, many studies have reported on the effectiveness of MET and the contract-relax technique in increasing flexibility of the hamstring muscle.31-34&#xD;
&#xD;
The results of the above-mentioned studies are more or less conflicting, so this study aims to establish the effectiveness of MET and static stretching in increasing the muscle flexibility of the triceps surae and also to investigate which technique is more effective. &#xD;
&#xD;
MATERIAL AND METHODS &#xD;
&#xD;
Participants&#xD;
&#xD;
A different subject pretest-posttest experimental control group design was selected for testing the hypothesis and data was collected. An active ADFROM was taken as the outcome measure to establish the effect of the two manual techniques. Forty-five working females wearing high heels were recruited for this study. The study was approved by the institutional review board of the integral institute of allied health sciences and research at integral university (RRC-2016-04). All the participants were recruited from the Outpatient Physiotherapy Department IIMSR, Lucknow. The criteria for inclusion were working females wearing high heels, age 20-30 years having triceps surae muscle tightness with active dorsiflexion ROM &lt; 20o. Subjects were excluded if they had hypermobility of the ankle joint, skin diseases, wounds, neurological problems, circulatory problems and metal implants in the leg or foot. &#xD;
&#xD;
Procedures&#xD;
&#xD;
All the participants were selected based on the above criteria. Before participation, the whole procedure was explained to the subjects and informed consent was given and signed by them. Then, all the participants were randomly assigned into three equal groups A, B and C. The experimental group&amp;#39;s A and B received a hot pack intervention plus MET and a hot pack intervention plus static stretching, respectively. Control group C received the hot pack intervention only. Data collected at baseline (pre-intervention Day 1), and post-intervention Days 1, 3, 5 and 8.&#xD;
&#xD;
Assessment of ankle ROM&#xD;
&#xD;
For goniometric measurements of ankle dorsiflexion ROM, a standard tape measure was used to ensure that the participants were positioned prone on the testing table with their lateral malleolus nine inches beyond the table&#x2019;s edge. Then, the researchers marked the 5th metatarsal head, the base of the 5th metatarsal, fibular head, and lateral malleolus with a permanent marker. The moving arm of the goniometer was placed at the lateral border of the foot, while the fixed part of the goniometer was placed along the long axis of the fibula to lie at the centre of the axis of rotation at the lateral malleolus. To establish the reliability of ROM measurements, readings were taken thrice, and their mean used for analysis.&#xD;
&#xD;
Interventions&#xD;
&#xD;
Hot pack&#xD;
&#xD;
The patient was comfortably positioned in prone lying on a plinth and a hot pack was placed over the triceps surae muscle for 20 minutes. This was carried out on both experimental and control groups for five consecutive days.&#xD;
&#xD;
Static stretching&#xD;
&#xD;
In order to stretch the calf muscle, the participant was asked to place their forearms against the wall with their forehead resting on their hands. Participant stood barefoot between two to three feet away from a solid wall, placed the testing foot perpendicular to and facing the wall, the opposite leg placed on the ground with the knee bent and the foot in front of the body. The testing limb was placed straight out behind the body, keeping the knee straight and the heel flat on the ground. Once the subject became comfortable, they were instructed to lean forward at the hips until they felt a stretching sensation in their calf muscle. Each stretch was held for a duration of 30 seconds35, 36. This was repeated five times in a single session for five consecutive days.&#xD;
&#xD;
Muscle energy technique&#xD;
&#xD;
The participant lay in a supine position with feet extending over the edge of the plinth while the knees were kept straight. For the right leg MET, the therapist held the tested Achilles tendon with the right hand just above the heel to keep the heel in the palm of their right hand. The therapist&#x2019;s left hand was placed so that the fingers rested on the dorsum of the foot. Then, the barrier was assessed and the muscle was kept in a comfortable position, in the mid-range away from the restriction barrier. The participant was instructed to exert an effort (approx. 20% of maximal contraction) of available strength towards the plantar flexion, against unyielding resistance, with appropriate breathing i.e. inhale as they built up the isometric contraction, holding the breath for 10 seconds during the contraction, and then exhaling as they slowly loosened the contraction. This was followed by a rest period of five seconds to ensure complete relaxation before re-commencing the stretch. Then the tissue was held for 10 sec. in the slight stretch to enable a slow lengthening of the tissue. This was repeated four times in a single session for five consecutive days.&#xD;
&#xD;
Statistical methods&#xD;
&#xD;
A computer software package SPSS.inc was used for the statistical analysis of the data. Baseline demographic data of subjects, including age and sex, were descriptively summarized and statistically analysed. The ADFROM, as a dependent variable measured on Day 1 (pretest data is represented as PREROM1, posttest data is represented as POSTROM1), on Day 3 (Pretest data is represented as PreROM3, posttest data is represented as POSTROM3), on Day 5 (Pretest data is represented as PREROM5, posttest data is represented as POSTROM5), and after two days follow-up on Day 8 (represented as follow-up).&#xD;
&#xD;
Analysis was conducted using one-way ANOVA and post-hoc (Bonferroni&#x2019;s test) analysis with the level of significance, &#x3B1;, set at 0.05. The paired t-test was used for the analysis within the groups, set ting the confidence interval and the level of significance, &#x3B1; at 95% and 0.05, respectively.&#xD;
&#xD;
RESULTS &#xD;
&#xD;
This study was designed to check the comparative effects of MET and static stretching on improving the flexibility of triceps surae among working females wearing high heels. 45 working females who wear high heels were evaluated for the study and their age, weight, height and BMI were recorded. Demographic details with their means and standard deviations are presented in Table 1.&#xD;
&#xD;
Between-group analysis&#xD;
&#xD;
The mean and standard deviation details of between-group analyses showed in table 2.&#xA0; The pretest reading i.e. PREROM1 for all the three groups was statistically insignificant (p=.136). On comparing Group A and Group B, the PREROM1 is insignificant (p=.710). Similarly, PREROM1 values for Group A and Group C were insignificant statistically (p=.144) and again when Group B was compared with Group C for PREROM1, the values were insignificant (p=1.00) as shown in table 3.&#xD;
&#xD;
The posttest reading on Day 1 i.e. POSTROM1 for all the three groups was also statistically insignificant (p&gt;0.05). Further post-hoc analysis revealed insignificant differences (p&gt;0.05) between Groups A and B (p=1.00), Groups A and C (p=.063), and Groups B and C (p=.359).&#xD;
&#xD;
On Day 3, i.e. at POSTROM3, a significant difference was found (p= .005) between Groups A, B and C (Figure 1). However, post-hoc analysis revealed an insignificant difference between Groups A and B (p= .596) and Groups B and C (p=.120), but there was a significant difference between Groups A and C (p=.004) as shown in table 3.&#xD;
&#xD;
On day 5, i.e. POSTROM5, a significant difference (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3901</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3901</Fulltext></URLs><References>&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Ayurvedic Management of Myopia in Children: A Case Series&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>35</FirstPage><LastPage>40</LastPage><AuthorList><Author>Sreekanth Nelliakkattu Parameswaran</Author><AuthorLanguage>English</AuthorLanguage><Author> Ratna Prava Mishra</Author><AuthorLanguage>English</AuthorLanguage><Author>  Jaya Sankar Mund</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Myopia is one of the leading causes of visual impairment in schoolchildren. The most common management option, prescription of corrective spectacles, neither correct nor prevent progression of the error. The cardinal symptom of myopia, the inability to see distant objects, may be compared with Timira (blurring of vision) in Ayurveda. Case Series: The cases of three children who presented to Sreedhareeyam Ayurvedic Eye Hospital with the blurring of vision and who were diagnosed with myopia are presented here. Intervention: The children underwent specially tailored Ayurvedic treatment protocols, which included oral medicines, Netra Kriyakalpa (ocular therapeutics), and treatments for the head. Results: Improvement in visual acuity and refraction was observed at the end of the treatments. Multiple follow-ups demonstrated either improvement or maintenance of visual acuity. Conclusion: The main challenge for the patients was maintaining and improving vision. The results of the series indicate the potential of Ayurvedic treatments to both manage myopia and to maintain, and improve in some cases, vision in children.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Ayurveda, Case report, Timira, Kriyakalpa, Complementary and alternative medicine, Refractive error</Keywords><Fulltext>Introduction&#xD;
&#xD;
Vision 2020: The Right to Sight contends that uncorrected refractive errors are among the top causes of visual impairment and blindness.1 Myopia is the leading cause of visual impairment in children among the three types of refractive error, with a rapid increase in prevalence.2 Myopia presents a significant impact on an individual&#x2019;s quality of life as well as the economy.3 Research on causal factors, possible treatments, and efforts at prevention have been spurred in light of the increasing incidence and prevalence of myopia.4 The aetiology of myopia is multifactorial as per the Consortium for Refractive Error and Myopia (CREAM) study, which demonstrated 24 genomes with a 10-fold increase in myopia.5 Conventional management options for myopia have either short-term benefits or significant side effects.6 Although significant strides have been made in the field of surgical correction, they might not always be effective in the tender and delicate eyes of children. In light of the above, treatment options in contemporary and alternative medicine (CAM), including Ayurveda, may be sought.&#xD;
&#xD;
Methodology&#xD;
&#xD;
The cases of three children diagnosed with myopia and who underwent Ayurvedic eye treatments are presented in this series. Points regarding their history were given by their legal guardians. The CARE guidelines were adhered to for ensuring transparency and effectiveness in reporting.7 Written informed consent was obtained from the parents. Institutional ethics committee clearance was not required to prepare this series.&#xD;
&#xD;
Case 1&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; A 9-year-old male patient presented with a complaint of defective distant vision for 7 months. His parents reported watching TV very closely and his inability to read small letters on the chalkboard from a distance. He was diagnosed with myopia by an ophthalmologist and was prescribed corrective spectacles, which he never used. In September 2017, he started Ayurvedic medication from Sreedhareeyam Hospital, which provided better clarity in vision. Hence, he came for further management. His history was negative for significant illnesses. His mother had a full-term normal delivery and he achieved all cardinal milestones on time. His immediate family members do not present with similar complaints, and his history readings were normal. A review of systems showed normal cardiovascular, gastrointestinal and neurological functions, and vital signs were all normal.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Unaided distant visual acuity (DVA) was LogMAR 0.602 in his right eye (OD &#x2013; oculus dexter) and LogMAR 1 in his left eye (OS &#x2013; oculus sinister), and near visual acuity (NVA) was N6 in both eyes (OU &#x2013; oculus uterque). Pinhole acuity was not determined. Manual refraction showed that a -0.50 diopter (D) lens with -3.00D cylinder and 10&#xB0; axis corrected the DVA OD to LogMAR 0.176, and a -1.50D lens with -3.00D cylinder and 160&#xB0; axis corrected the DVA OS to LogMAR 0.477. Anterior segment examination OU showed normal lids and sclera, normal cornea, deep anterior chamber, and a normal lens. Direct and consensual pupillary reflexes were normal OU. Posterior segment examination OU showed normal media, optic disc, background, and blood vessels. Corneal topography OU demonstrated with-the-rule astigmatism. The patient was admitted for a 15-day course of inpatient Ayurvedic treatment.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Unaided DVA at discharge showed improvement to LogMAR 0.778 OS, while DVA OD was maintained. Manual refraction demonstrated the same readings as found on admission.&#xD;
&#xD;
Case 2&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; A 6-year-old male presented with a complaint of diminished distance vision for 8 months. His parents noticed difficulty in seeing distant objects and inability to read the letters off the chalkboard. He was diagnosed with myopia and was prescribed corrective spectacles, which he still uses but does not provide enough relief. Hence, he came here for better options. His history was negative for any significant illnesses. His mother had given birth to him after thirteen years of marriage, for which she had taken treatment for infertility. He was delivered by lower-segment Caesarean section, and he achieved all his milestones on time. His immediate family members do not complain of similar illnesses. His history readings are normal. A review of systems showed normal cardiovascular, gastrointestinal, and neurological functions, and vital signs were all normal.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Unaided DVA showed LogMAR 0.477 OD and LogMAR 0.176 OS, and NVA was N6 OU. Pinhole acuity and refraction were not attempted. Anterior segment examination OU showed normal lids and sclera, normal cornea, deep anterior chamber, and a normal lens. Direct and consensual pupillary reflexes were normal OU. Posterior segment examination OU showed normal media, optic disc, background, and blood vessels. The patient was admitted for a 19-day course of treatment.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Unaided DVA has maintained OU at discharge.&#xD;
&#xD;
Case 3&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; A 9-year-old male complained of difficulty in the distant vision for 6 years. He noticed difficulty in reading the chalkboard from the back of the classroom. He was diagnosed with myopia and was prescribed corrective spectacles. He came to Sreedhareeyam seeking further options. His history is negative for any significant illnesses. His mother had a full-term normal delivery without postpartum complications. He attained all his milestones on time. His history readings are all normal. . Review of systems showed normal cardiovascular, gastrointestinal, and neurological functions, and vital signs were all normal.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Unaided DVA was LogMAR 0.301 OU, aided DVA was LogMAR 0 OU, and NVA was N6 OU. Anterior segment examination OU showed normal lids and sclera, normal cornea, deep anterior chamber, and a normal lens. Direct and consensual pupillary reflexes were normal OU. Posterior segment examination OU showed normal media, optic disc, background, and blood vessels. The patient was admitted for a 10-day course of treatment. All diagnostic readings were maintained at discharge.&#xD;
&#xD;
Additional Information&#xD;
&#xD;
Vulnerability assessment is done before treatment categorized the patients into the pediatric group with visual deficits. No history of disorientation, trauma, motility deficit and impaired judgment were elicited. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0; The patients&#x2019; treatment protocols involved the administration of oral medicines (Table 1) and external ocular and head therapies (Table 2). Pancakarma (bio-purification) was not administered because the patients were under 10 years old.&#xD;
&#xD;
All medicines, except Netra Prabha eye drops, were manufactured by Sreedhareeyam Farmherbs India, Pvt. Ltd., the hospital&#x2019;s GMP-certified drug manufacturing unit. Netra Prabha eye drops were manufactured by Jiwadaya Netraprabha Pharmaceuticals, Pvt., Ltd., based in Mumbai, Maharashtra, India.&#xD;
&#xD;
Discussion&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0; The patients&#x2019; symptoms were compared with Dvitiya Patalagata Dosha (affliction of the second layer of the eye by humors) as per the Ayurvedic classics. Acharya Vagbhata describes this condition as Timira. The feature of Timira that matches the symptoms of the patients is &#x201C;DurantikasthamRupam ca (patient is unable to perceive distant objects)&#x201D;.8 Invasion of the third Patala is described as Timiraby AcharyaSusruta and Kacaby AcharyaVagbhata.2&#xD;
&#xD;
Ayurveda contends that the same medicines and treatments prescribed for adults may be prescribed to children in a lower dosage and intensity. Mrdu (mild), Laghu (light), Madhura(sweet), Surabhi (pleasant odour), Samsamana (pacifying), and HetuViparita (antagonistic to the cause) are the qualities of the medicines generally favoured for children as these should not greatly affect Dhatus and be both palatable and easy to assimilate. Pancakarma, usually advocated in the management of DrishtigataRogas (diseases of vision) including Timira, is contraindicated in children, especially those under the age of 10. Also, the medicines employed should not be too Tikshna (sharp). These are due to the Saukumaryata (tender and delicate body structure), Alpakayata (under-developed organs), Vividha Anna Anupasevana (unfit GIT to receive all types of food), Aparipakva Dhatu (tissues under progression of transformation), AkleshaSahatva (stress intolerance), and AsampurnaBala (poor immunity). 5-8&#xA0; &#xD;
&#xD;
The oral medicines were Cakshushya (good for eyes), Brmhana (nourishing), and Vata Hara (pacify Vata). In addition, Mustarishtaand Khadirarishtaare Agni Dipanaand were prescribed to maintain normal digestion in the children. &#xD;
&#xD;
Netraraksha Kvatha, prepared from ingredients such as Cyperus rotundusLinn., Symplocosracemosus Roxb., Gmelina Arborea Linn., Aquilaria agallochaRoxb., and Emblica Officinalis Gaertn., is indicated in Netra Roga. MedhyaRasayanaisprepared from ingredients such as Tinospora cordifolia Miers., Centella Asiatica Linn., and Glycyrrhyza glabra Linn., and acts as a nerve tonic. Hrasva capsule, prepared from ingredients such as Vitis vinifera Linn., Symplocosracemosus Roxb., Hemidesmus indicus Linn., and Zingiber officinale Rosc., is indicated for all varieties of refractive error. SaptamrtaGhrta is prepared from Bacopa monnieriLinn., Hemidesmus indicus Linn., and HolarrhenaantidysentricaWall., is indicated in all eye diseases. VainateyaGhrta prepared from Glycyrrhyza glabra Linn., and Tinospora cordifolia Miers., is also indicated in all eye diseases. JatavedhaGhrta is prepared from Terminalia chebulaRetz., Terminalia bellericaLinn, Emblica Officinalis Gaertn., and HolostemmaadakodienR.Br., and is used for Tarpana in Drishti Rogas.Ananta Ghrta is prepared from Cedrus deodara Linn., and HoloostemmaadakodienR.Br., and is also used for Tarpana in Drishti Rogas. Sunetra Junior is prepared from Nelumbo nucifera Gaertn., Ocimum sanctum Linn., Cinnamomum camphora(L.) Presl., and is indicated in eye conditions of patients under 16 years of age. Netra Prabha is prepared from Emblica Officinalis Gaertn., Argemone mexicana Linn., and Cinnamomum Tamala(Buch-Ham) T. Nees., and is indicated in most inflammatory conditions of the eye.3,4,5&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0; Anjana was done in the manner of classical Ascyotana9at Sreedhareeyam in light of hygienic parameters. Drishti Prasadanaand Tarpana was done to strengthen the nerves and to promote vision. The Sneha used for both procedures were Vata Hara. Anna Lepa was done for further pacification of Vata.8,9&#xD;
&#xD;
Conclusion&#xD;
&#xD;
The main challenge in the patients was the improvement of vision; however, improvement was observed due to healthy Dhatus being formed by the treatments and the bodies of the children acclimatizing to the medicines and treatments. Usage of medicines that were Brmhana, Samana, Mrdu, and Madhura, facilitated the formation of a healthy physique as well as strengthening the nerves. The results of this series may be validated with large-scale sample trials and studies.&#xD;
&#xD;
Acknowledgment:&#xD;
&#xD;
The authors thank Sreedhareeyam Ayurvedic Research And Development Institute, Sreedhareeyam Ayurvedic Eye Hospital and Research Center, and SreedhareeyamFarmherbs India Pvt. Ltd., for their help in preparing this case report. The 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 the authors/editors/publishers of all those articles, journals, and books from where the literature for this article has been reviewed and discussed. &#xD;
&#xD;
Conflicts of Interest: None declared&#xD;
&#xD;
Sources of Funding: None declared&#xD;
&#xD;
Authors&#x2019; Contribution&#xD;
&#xD;
&#xD;
	&#xD;
	Sreekanth P. Namboothiri conceptualized, wrote, and edited the article.&#xD;
	&#xD;
	&#xD;
	Ratna Prava Misra and Jaya Sankar Mund reviewed and edited the article, and offered constructive feedback on the same. &#xD;
	&#xD;
&#xD;
&#xD;
Abbreviations:&#xD;
&#xD;
DVA: distant visual acuity&#xD;
&#xD;
NVA: near visual acuity&#xD;
&#xD;
OD: oculus dexter&#xD;
&#xD;
OS: oculus sinister&#xD;
&#xD;
OU: oculus uterqueA&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3902</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3902</Fulltext></URLs><References>&#xD;
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	The International Agency for the Prevention of Blindness, Global Vision Impairment Facts, 2020, https://www.iapb.org/vision-2020/who-facts/&#xD;
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	Fricke TR, Jong M, Naidoo KS. The global prevalence of vision impairment associated with myopic macular degeneration and temporal trends from 2000-2050: systematic review, meta-analysis, and modelling, Bri J Med Sci, 2018;102(7): 855-862 pg.&#xD;
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	Wong HB, Machin D, Tan SB, Wong TY, Saw SM. Visual impairment and its impact on health-related quality of life in adolescents, Asi J Organ, 2009;147(3);505-511 pg.&#xD;
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	Mehta N, Wen A, Myopia: A Global Epidemic: An Overview of the Problem and Efforts to Address It. Retin.2019; 52-55 pg.&#xD;
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	Smith TS, Frick KD, Holden BA, Fricke TR, Naidoo KS. Potential lost productivity resulting from the global burden of uncorrected refractive error, Bull World Health Organi. 2009;87(6):431-437.&#xD;
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	Gwiazda J, Treatment options for myopia, OptomVis Sci, 2009; 89(6): 624-628 pgs&#xD;
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	Gagnier J, Kienle G, Altman DG, Moher D, Sox H, Riley DS, CARE group, The CARE guidelines: Consensus-based clinical case-reporting guideline development, Glob Adv Health Me. 2013:2(5):38-43 pgs.&#xD;
	&#xD;
	&#xD;
	Murthy KR. Ashtangahrdaya of Vagbhata: Text, English Translation, Notes, Appendices, and Index, Vol. III: Uttara Sthana, Krishnadas Academy, Varanasi, 2000, 121pg&#xD;
	&#xD;
	&#xD;
	Murthy KR. &#xA0;Ashtanga Hrdaya: Text, English Translation, Notes, Appendices, and Index, Vol. 1: Sutra &amp;SariraSthana, Krishnadas Academy, Varanasi, 2000:100. &#xD;
	&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Clinical Profile and Prognosis of Community-Acquired Pneum&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>41</FirstPage><LastPage>46</LastPage><AuthorList><Author>Ranjith Kumar GK</Author><AuthorLanguage>English</AuthorLanguage><Author> Eshwarappa P</Author><AuthorLanguage>English</AuthorLanguage><Author> Rashmi GK</Author><AuthorLanguage>English</AuthorLanguage><Author> Nagabhushana S</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>CAP, Sputum, Cough, Pneumonia, Smoking, Gram-negative organism</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Pneumonia is a disease known to the Human race from antiquity. Pneumonia defines as &#x201C;This is an acute inflammatory reaction of the pulmonary parenchyma that can be caused by various infective and noninfective origin.1&#xD;
&#xD;
Even with the availability of a wide variety of antibiotics,2 community-acquired pneumonia (CAP) remains a very common and lethal illness with quite a significant morbidity and mortality, in all the continents of the world. Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality in persons aged over 60 years,3 with incidence and mortality rates increasing with growing age.4 Hospital admission is the greatest burden from pneumonia in terms of severity and health-care costs.&#xA0; Community-Acquired Pneumonia (CAP) is a common disease with an incidence of about 20- 30% in developing countries to an incidence of 3-4% in developed countries.5&#xD;
&#xD;
Even though definite data is lacking, pneumonia remains a leading cause of death in our country.6 The mortality rate of the pneumonia patient, who is being treated as an outpatient (mild disease) is low, in the range of 1-5%, but among patient who requires admission to ICU is approaches 25%.7-10 With the beginning of the antibiotic era, the mortality rate decreased and remained in a constant state. Despite the progress made in the diagnosis of pneumonia, it takes a few days that to in tertiary care centres, to identify the causative micro-organism in the blood or sputum samples and the aetiology of many patients with CAP remains uncertain.2 To make correct therapeutic decisions, physicians need reliable data on the prevalence of different etiological agents in the patients &#x201C;locality,&#x201D; in addition to the clinical, laboratory, and radiological finding.7&#xD;
&#xD;
Because the relative frequency of etiological agents differs in different geographical areas. There are many studies conducted to explain its clinical,&#xD;
&#xD;
Microbiological agents and radiographic features in different population groups, whether these studies can be applied to our population is a real issue to be answered. Because of this, we needed a study on community-acquired pneumonia in our locality, and by doing this study we can help in the early detection of disease, and clinical, bacteriological, and radiological profile of CAP admitted in our geographical area can be known.&#xD;
&#xD;
MATERIALS AND METHODS &#xD;
&#xD;
The study is conducted on 100 consecutive patients admitted in various medical wards of the Mc Gann Hospital attached to Shimoga institute of medical sciences, Shimoga. From June 1st, 2019 to January 30th 2020. &#xD;
&#xD;
INCLUSION CRITERIA: &#xD;
&#xD;
Adult patient aged between 15 to 90 years in diagnosed as having Community-acquired pneumonia (CAP). &#xD;
&#xD;
New or progressive chest infiltrates on chest X-ray with at least one of the following features:&#xD;
&#xD;
1. Fever (temperature &gt;37.7&#xB0;C)&#xD;
&#xD;
2. Purulent sputum&#xD;
&#xD;
3. Cough (H/O 11,000/cumm).&#xD;
&#xD;
EXCLUSION CRITERIA: &#xD;
&#xD;
&#xD;
	&#xD;
	Age less than 15 years, &#xD;
	&#xD;
	&#xD;
	Hospital-acquired pneumonia&#xD;
	&#xD;
	&#xD;
	Aspiration pneumonia&#xD;
	&#xD;
	&#xD;
	H/O pulmonary infarction, pulmonary tuberculosis, immune-compromised.&#xD;
	&#xD;
&#xD;
&#xD;
METHODS: &#xD;
&#xD;
One hundred patients admitted in Mc Gann district Hospital attached to Shimoga institute of medical sciences, Shimoga having Community-acquired pneumonia (CAP) fulfilling the above criteria were taken into the study after taking consent from all the patients. Every patient&amp;#39;s detailed clinical history and examination was done and routine investigations were done for all patients. Chest X-ray PA view is taken. Sputum microscopy and culture are done. Other tests like 2D-Echocardiography, Ultrasound abdomen were done where ever required. Every patient is evaluated in detail to arrive at a possible etiological diagnosis.&#xD;
&#xD;
Statistical Analysis&#xD;
&#xD;
Statistical analysis was done using the Chi-square test. the p-value of &lt; 0.05 was considered statistically significant.&#xD;
&#xD;
The statistical software SPSS 11.0 was used for the analysis of the data.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Demographic Data: The study group consisted of 100 patients, among whom&#xD;
&#xD;
67 were males and 33 were females. They were studied from June 1st, 2019 to January 30th 2020. The male to female ratio is 2:1.&#xD;
&#xD;
The age of patients ranges from 15 to 85, with the mean age 54.4 &#xB1; 14.57 years. Most patient 68 (68%) of CAP were elderly belong to &gt;50 years age group ( Fig 1). &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
Incidence of symptoms&#xD;
&#xD;
Cough was the most common symptom present in (99%) patients, followed by fever (90%), dyspnea (52%), expectoration (87%), fatigue (45%) and chest pain (15%). Other less common findings are haemoptysis (7%), cyanosis (5%). Chest pain was more common in younger than elderly age group patients.&#xD;
&#xD;
In the study, chronic obstructive airway disease was the most common (33%), predisposing conditions. Other were cardiovascular disorders (14%), diabetes mellitus (DM) (14%), Cerebrovascular accident (5%), and chronic liver disease (3%). Among habits, smoking was the most commonly noted in (45%) patient, followed by alcoholism in (12%) patients. Maximum smokers and drinkers were elderly belong to &gt; 50 years age group.&#xD;
&#xD;
Bacteriological incidence in percentage.&#xD;
&#xD;
Streptococcus pneumonia(40%), Klebsiella pneumonia(30%), Staphylococcus aureus(15%), Gram-negative bacilli(11%), Haemophilus influenza(6%).&#xD;
&#xD;
The etiological diagnosis was made possible only in 55 (45.8%) cases.&#xA0; The isolation of organisms done by sputum culture in 44 (36.7%), and by blood culture in 11 (9.1%). The commonest causative organism isolated was Pneumoccocus 20 (36.4%) followed by Klebsiella pneumonia 16 (29%), Staphylococcus aureus 11 (20%), Haemophilus influenzae and Gram-negative bacilli 8 (14.5%).&#xD;
&#xD;
Types of pneumonia according to Chest X?ray findings in patients with CAP &#xD;
&#xD;
Lobar pneumonia seen in 66%, Bronchopneumonia seen in 28%,&#xA0; Interstitial pneumonia in 5%,&#xA0; Pleural effusion seen in 10% of patients ( Fig. 2).&#xD;
&#xD;
&#xD;
&#xD;
(UL-Upper Lobe, ML-Middle Lobe, LL-Lower Lobe)&#xD;
&#xD;
The right lower lobe of the lung is most commonly involved in CAP (P &lt; 0.0001). &#xD;
&#xD;
Bilateral lung involvement is seen in&#xA0; 19.8% of chest X-ray. Multiple lobes involvement is seen in 29 (29%).&#xD;
&#xD;
There is no relation between the area of lung involvement and causative organism.&#xD;
&#xD;
Prognostic factors and Mortality&#xD;
&#xD;
Duration of stay varied from 3 days to 23 days (10&#xB1;7). Sepsis is seen in 17%. Lung abscess 4%, Pneumothorax 3%, Pleural effusion 30%, Respiratory support 45% (in the form of oxygen received by 33% patients, NIV in 7%, invasive ventilation in 5%). The death occurred in 7 patients. Sepsis and respiratory failure is the cause in 6, one had a myocardial infarction.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
Age/Sex Incidence&#xD;
&#xD;
In the study, 100 patients were observed, and the majority of patients 67 (67%) were males in comparison to the female population which were 33 (33%). The male to female ratio is 2:1. The mean age of patients was 54.4 &#xB1; 14.57 years. 68 (68%) belong to &gt; 50 years of age group. It is well-documented that pneumonia incidence rises sharply with extremes of age ( Table 1).11,12&#xD;
&#xD;
&#xD;
&#xD;
The most common symptom is Fever. Most of the symptoms presentations correlate with other studies.&#xD;
&#xD;
Fever in 90 (90%), cough in 99 (99%) and expectoration in 87 (87%) patients. Other symptoms were shortness of breath in 52 (52%), pleuritic chest pain in 15 (15%), hemoptysis in 7 (7%), altered sensorium in 3, nausea, vomiting and lose motions in 2 and abdominal pain in 3 patients. This fact supported by some Indian and Western studies ( Table 2).7,16,17&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
This is the well-established fact that the majority of predisposing risk factors like cigarette smoking, alcoholism, chronic obstructive pulmonary disease, (COPD), coronary artery disease, etc., similar in all most studies. It is more common in middle-aged and elderly predominantly in males. This is by the earlier studies like Jain et al.,18 Fang et al.,7 S A Skull et al.13&#xD;
&#xD;
The most common identified risk factor was smoking (45%), COPD (33%), cardiovascular diseases (14%), followed by DM (14%) and alcoholism (12%), &#xA0;there are many mechanisms which change regional and systemic respiratory antimicrobial immune function which causes respiratory infection. that is proved beyond doubt. These factors are not different in our locality, India or around the world.4,16,17,19.&#xD;
&#xD;
&#xD;
&#xD;
The radiological data in our study showed a predominance of lobar pneumonia in 66 (66%) patients followed by bronchopneumonia in 28 (28%) and interstitial pneumonia in 5 (5%) patients. Radiological information from our study emphasized by similar studies done by O Sow et al.20 Bansal et al.21 Chest X-ray showing infiltrates is necessary to establish the diagnosis of pneumonia. However, it cannot differentiate between bacterial and nonbacterial pneumonia (Table 3).&#xD;
&#xD;
Chest X-ray pattern of patients with CAP&#xD;
&#xD;
In our study shows a significant correlation with Jain et al study. Right lower lobe involvement is commonly similar to Jain et al.18 studies. Maybe because this lobe has straight communication with the trachea. Organisms in more number get lodged in this lobe ( Table 4).&#xD;
&#xD;
&#xD;
&#xD;
In a study, the microbial diagnosis of CAP was confirmed only in 40% of patients. This could be due to the limited use of laboratory tests, error in sample collection. Results of our study showed close resemblance to the study by Ruiz et al.22 In our study, we only used sputum and blood culture as diagnostic tools to identify the culprit organism that causes pneumonia. 32 (32%) isolated by sputum, and 8 (8%) by blood culture. But the fact is that even with the use of extensive laboratory testing and various invasive procedures, etiological confirmation could be achieved only in 45-70% of patients.2,23&#xA0; The most common isolated pathogen was S. pneumonia accounting for 40%. Next common was K. pneumonia which accounts for 30% this followed by S. aureus, and other Gram-negative bacilli 15%, 11%, respectively (Gram-negative bacilli includes H. influenzae, Pseudomonas, Acinetobacter, Escherichia coli, Enterobacter, Citrobacter accounting 6%, 1%, 1%, 1%, 1%, 1% respectively). In the previous 3 decades many studies done in our nation showed the predominance of gram-negative organisms in culture-positive samples .24-27 there is more number of culture-positive Gram-negative bacteria in this study compared to&#xA0; studies were done in other nations ( Table 5).28&#xD;
&#xD;
&#xD;
&#xD;
 &#xD;
&#xD;
The prognosis outcome of CAP in our study is 7% mortality and 93% recovery rate. Joint ICS/NCCP (I) guidelines published in the year 2012 mentioned that mortality rates across India vary from 3.3% to 11%32. Duration of stay is almost similar to most of the studies with 3 to 4 days for mild cases, 10-15 days for severe diseases requiring ICU admission. Complication like lung abscess, pleural effusion, pneumothorax and sepsis varies with other studies, this can be explained by different organisms affecting, their antibiogram and use of different antibiotics and also patient immunity status. Most of the mortality is seen in diabetics, old age, anaemic and malnourished people. &#xD;
&#xD;
CONCLUSIONS &#xD;
&#xD;
The study is conducted on 100 consecutive patients admitted in various medical wards of the Mc Gann Hospital, Department of Medicine attached to Shimoga institute of medical sciences, Shimoga. From June 1st, 2019 to January 30th 2020. to know the incidence and prevalence of etiological organisms in CAP in our area, clinical features, and to know the relation between the involvement of a particular lung area with the causative etiological organism. &#xD;
&#xD;
And the study concluded that Pneumococcus is the most common causative micro-organism in CAP, but there is an increase in the incidence of Gram-negative bacterial infection particularly by&#xA0; Klebsiella pneumonia is seen in our malnad area. Typical symptoms (cough, sputum,&#xD;
&#xD;
breathlessness)&#xA0; were common in both young and elder age group patients, Ageing predisposes to a higher risk of respiratory tract infection in individuals with smoking-related lung diseases and debilitating non-respiratory diseases. Our observations will also be useful to monitor the trends of CAP in the population of the region and will help the physicians to start rational empirical treatment for patients with CAP.&#xD;
&#xD;
ACKNOWLEDGEMENTS&#xD;
&#xD;
This study is supported by many in data collection: Nursing staff, Interns, staff of the department of medicine, SIMS Shimoga. We thank each and everybody.&#xD;
&#xD;
Conflict of interest: nil. Source of funding: nil&#xD;
&#xD;
Authors contribution&#xD;
&#xD;
Dr Ranjith kumar G K. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Dr Rashmi Gk, Dr Eshwarappa, Dr Nagabhushana S contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3903</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3903</Fulltext></URLs><References>&#xD;
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	&#xA0;Seaton A, Seaton D, Leich AG. Crofton &amp; Douglas&#x2019;s. Respiratory Diseases. 5th ed., Vol. 1. Ch. 13. New Delhi: Wiley; 2008. p. 356-429. &#xD;
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	&#xA0;Ishida T, Hashimoto T, Arita M, Ito I, Osawa M. Etiology of community-acquired pneumonia in hospitalized patients: A-3-year prospective study in Japan. Chest 1998; 114 : 1588-93.&#xD;
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	&#xA0;Niederman MS, Ahmed QAA. Community-acquired pneumonia in elderly patients. Clinics in Geriatric Medicine 2003; 19: 101&#x2013;120. 2. Loeb M. Pneumonia in older persons. Clin Infect Dis. 2003; 37: 1335&#x2013;1339.&#xD;
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	Garibaldi RA. Epidemiology of community-acquired respiratory tract infections in adults. Incidence, aetiology, and impact. Am J Med. 1985;78:32-7.&#xD;
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	Diwakar T N, Ravish KS, Hussain ZG. Comparative study of pneumonia severity index and curb65 in assessing the severity of community-acquired pneumonia. J Evol Med Dental Sci. 2013; 2(8):836-850.&#xD;
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	Kulpati DDS, Khastgir T. Reappraisal of cases of pneumonia. J Assoc Physicians Ind. 1988; 36: 660-64.&#xD;
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	Fang GD, Fine M, Orloff J, Arisumi D, Yu VL, Kapoor W, et al. New and emerging etiologies for community-acquired pneumonia with implications for therapy. A prospective multicentre study of 359 cases. Med (Baltimore).1990;69:307-16.&#xD;
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	Marrie TJ, Durant H, Yates L. Community-acquired pneumonia requiring hospitalization: a 5-year prospective study. Rev Infect Dis. 1989;11:586-99. &#xD;
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	Torres A, Serra-Batlles J, Ferrer A, Jim&#xE9;nez P, Celis R, Cobo E, et al. Severe community-acquired pneumonia. Epidemiology and prognostic factors. Am Rev Respir Dis. 1991;144:312-8. &#xD;
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	Pachon J, Prados MD, Capote F, Cuello JA, Garnacho J, Verano A. Severe community-acquired pneumonia: aetiology, prognosis, and treatment. Am Rev Respir Dis. 1990;142:369-73. &#xD;
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	Vilar J, Domingo ML, Soto C, Cogollos J. Radiology of bacterial pneumonia. Eur J Radiol. 2004;51:102-13. &#xD;
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	&#xA0;Siegel RE, Halpern NA, Almenoff PL, Lee A, Cashin R, Greene JG. A prospective randomized study of inpatient IV. Antibiotics for community-acquired pneumonia. The optimal duration of therapy. Chest. 1996;110:965-71.&#xD;
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	Skull SA, Andrews RM, Byrnes GB, Campbell DA, Kelly HA, Brown GV et al. Hospitalized community-acquired pneumonia in the elderly: an Australian case-cohort study. Epidemiol. Infect. 2009; 137, 194&#x2013;202.&#xD;
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	Dey AB, Nagarkar KM, Kumar V. Clinical presentation and predictors of outcome in adult patients with community-acquired pneumonia. Nat Med J Ind. 1997; 10(4):169-172.&#xD;
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	Mishra AB, Behera GB. Community-Acquired Pneumonia, Detection and Prevention&#x2013; A Hospital-Based Descriptive Study. Int J Contemporary Med Res. 2016; 3(4), April:1127-1129.&#xD;
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	Shah BA, Singh G, Naik MA, Dhobi GN. Bacteriological and clinical profile of Community-acquired pneumonia in hospitalized patients. Lung Ind. 2010;27:54-7. &#xD;
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	Jain SK, Jain S, Trikha S. Study of Clinical, Radiological, and Bacteriological Profile of Community-Acquired Pneumonia in Hospitalized Patients of Gajra Raja Medical College, Gwalior, Central India. Int J Sci.2014; 2( 6):96-100.&#xD;
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	Arbo MD, Snydman DR. Influence of blood culture results on antibiotic choice in the treatment of bacteremia. Arch Intern Med. 1994;154:2641-5. &#xD;
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	Bansal S, Kashyap S, Pal LS, Goel A. Clinical and Bacteriological Profile of Community-Acquired Pneumonia in Shimla, Himachal Pradesh. Indian J Chest Dis Allied Sci. 2004; 46: 17-22.&#xD;
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	Ruiz, Ewig, Marcos, Martinez, Arancibia, Mensa et al. Etiology of Community-Acquired Pneumonia: Impact of Age, Comorbidity, and Severity. Am J Respir Crit Care Med. 1999;160:397&#x2013;405.&#xD;
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	Lieberman D, Schlaeffer F, Boldur I, Lieberman D, Horowitz S, Friedman MG, et al. Multiple pathogens in adult patients admitted with community-acquired pneumonia: A one-year prospective study of 346 consecutive patients. Thorax. 1996;51:179-84.&#xD;
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	Ailani RK, Agastya G, Ailani RK, Mukunda BN, Shekar R. Doxycycline is a cost-effective therapy for hospitalized patients with community-acquired pneumonia. Arch Intern Med. 1999;159:266-70. &#xD;
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	Almirall J, Morat&#xF3; I, Riera F, Verdaguer A, Priu R, Coll P, et al. Incidence of community-acquired pneumonia and Chlamydia pneumonia infection: A prospective multicentre study. Eur Respir J. 1993;6:14-8. &#xD;
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	Amsden GW. Pneumococcal macrolide resistance &#x2013; Myth or reality? J Antimicrob Chemother. 1999;44:1-6. &#xD;
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	Berntsson E, Lagerg&#xE5;rd T, Stranneg&#xE5;rd O, Trollfors B. Etiology of community-acquired pneumonia in out-patients. Eur J Clin Microbiol. 1986;5:446-7. &#xD;
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	Basi SK, Marrie TJ, Huang JQ, Majumdar SR. Patients admitted to hospital with suspected pneumonia and normal chest radiographs: Epidemiology, microbiology, and outcomes. Am J Med. 2004;117:305-11. &#xD;
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	Mbata GC, Chukwuka CJ, Onyedum CC, Onwubere BJC, Aguwa EN.: Role of complications of CAP on the outcome of the illness. Ann Med Health Sci Rese. 2013;3( 3):365-369.&#xD;
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	Peyrani P, Forest W. Arnold, Bordon J, Furmanek S, Carlos M et al. Incidence and Mortality of Adults Hospitalized With Community-Acquired Pneumonia According to Clinical Course. Chest. January 2020; 157(1):34-41.&#xD;
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	Lamb A, Patil AH. Management and outcome of community-acquired pneumonia: hospital-based study, Int J Res Med Sci. 2018 Jul;6(7):2271-2274.&#xD;
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	Gupta D, Agarwal R, Aggarwal AN, Singh N, Mishra N, Khilnani GC, et al. Guidelines for diagnosis and management of community-and hospital-acquired pneumonia in adults: Joint ICS/NCCP(I) recommendations. Lung Ind. 2012;29: S2:27-62.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Formulation and Evaluation of Nanoemulsion for Bioavailability Enhancement of Metaxalone&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>47</FirstPage><LastPage>53</LastPage><AuthorList><Author>Sunny Antil</Author><AuthorLanguage>English</AuthorLanguage><Author> Chitra Gupta</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Nanoemulsion, Metaxalone, Zeta potential, High shear homogenization, Ternary phase diagram</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Dental fear is the most common issue which is present in patients. Therefore managing anxiety has become a task to achieve successful treatment. Therefore, dental anxiety is linked with an undesirable effect on oral health.1,2 Here are the numerous treatment options that have come across for the treatment of dental anxiety. There is two treatment option which includes pharmacological and non-pharmacological methods. The use of Pharmacological methods although is effective but it also has its side effects. Due to which there is high demand for non-pharmacological techniques.1&#xA0;One of the recent technique for the management of anxiety disorders is the use of acupuncture and acupressure.&#xD;
&#xD;
In the dental field, a study on adult populations reported a reduction in anxiety after acupuncture; another study proved this procedure to be as in effect as intranasal midazolam in decreasing anxiety in dental patients.2, 3&#xA0;The constant need to incorporate alternative techniques into clinical dental practice led to the introduction of acupuncture, which is apart of ancient Chinese medicine. The technique is created upon the conception of Qi (whose pronunciation is &#x201C;chee&#x201D; meaning &#x201C;life force, energy flow&#x201D;), which states that most of the physical and emotional issues begin at a level of functions that is subtler than the chemistry of the brain and organ function. The specific locations where this Qi gathers are termed acupoints, into which needles are put in to achieve numerous effects.4 This procedure has proven its effectiveness in the management of insomnia, asthma, general anxiety, and anxiety disorders.5-9&#xD;
&#xD;
Acupuncture done by the traditional method using needles can be traumatic for the patients. So by using microcurrent electrical stimulation, acupressure and acupuncture&#xA0; works by stimulating (tonify or sedate) specific reflex points which are present along the lines of energy that run through the body, called Meridians.10,11,12&#xD;
&#xD;
This original research study aims to &#x201C;Evaluate the effect of microcurrent electrical stimulation on two Acupoints that is yintang and shenmen points to control the level of anxiety amongst the patients&#x201D;. In this original research study, a novel technique was used to control anxiety levels in patients receiving Prosthodontic treatment.&#xD;
&#xD;
METHODOLOGY&#xD;
&#xD;
Ethical clearance was obtained from the Ethics Committee of the university and performed at the Department of Prosthodontics And Crown &amp; Bridge Sawangi Meghe Wardha.(DMIMS(DU)/IEC/2018-19/7633) A total of 30 patients were selected from the age group (18-45years). They were planned for Prosthodontic treatment were performed. Patients were enrolled only after they gave written informed consent.&#xD;
&#xD;
The inclusion and exclusion criteria were as follows:&#xD;
&#xD;
&#xD;
	&#xD;
	Exclusion criteria included dental emergencies, &#x2018;those who have experienced acupuncture, &#x2018;language difficulties&#x2019;, &#x2018;history of drug abuse, &#x2018;chronic pain therapy&#x2019;, &#x2018;neurological or psychiatric disorders, &#x2018;malignomas&#x2019;, &#x2018;lesions at the external ear&#x2019;, &#x2018;immunosuppression&#x2019;, &#x2018;pregnancy&#x2019;, &#x2018;asthma and &#x2018;coagulation disorders&#x2019;.&#xD;
	&#xD;
	&#xD;
	Inclusion criteria were patients who fall under 10 to 25 score of modified dental anxiety scale, Patients who will give informed consent for the therapy, patients coming for prosthodontic treatment procedures, patients above the age of 18 years.&#xD;
	&#xD;
&#xD;
&#xD;
The patient was randomly divided into three groups 1, 2 and 3.Ten patients were present in each group. In all three groups, prosthodontics treatment procedures were done. Before and after which Patient was selected based on anxiety measuring scale and using a pulse oximeter, pulse rate, as well as oxygen saturation level, were evaluated before the patient underwent the therapy which was evaluated again after the therapy was done.&#xD;
&#xD;
Modified Dental Anxiety Scale (MDAS) was used to assess the anxiety levels. It has a score of 0-25(not anxious to extremely anxious). In which Patient&#x2019;s under fairly anxious to extremely anxious that is from score (10 to 25) anxiety scale were selected for the study. &#xD;
&#xD;
Group 1 received electrical pulses at yintang anxiolytic point as shown in figure 1 (located midway between the medial ends of the two eyebrows) using a laser acupuncture pen. This pen automatically searches the site, no piercing of the skin is done, it is safe and effective with no side effects. It has 9 intensity levels so a mild range level that is up to 3 intensity level was used in the patients.&#xD;
&#xD;
After this using Pulse oximeter, pulse rate and oxygen saturation levels were checked pre-treatment and post-treatment. Levels of pulse rate and oxygen saturation helped to evaluate whether there is a reduction in anxiety level amongst the patients.&#xD;
&#xD;
Group 2received microcurrent electrical pulses to stimulate anxiolytic points the auricular Shen Men point as shown in figure 2(located at lateral third of the triangular fossa, in the bifurcating point between superior and inferior crura of antihelix)&#xD;
&#xD;
Group 3 was the placebo group, received microcurrent electrical pulses on point not documented to reduce anxiety (located on the forehead above the eyebrows 3 cuns aways from yintang point). The placebo point was selected different from yintang point and Shenzen points to check the efficacy of microcurrent stimulation using a laser acupuncture pen on a point that is different from an acupuncture point which does not have any anti-anxiety effect.&#xD;
&#xD;
For all the patients in treatment groups, a self-report measure of anxiety (MDAS) was recorded 40 minutes before starting the treatment.1&#xD;
&#xD;
Those receiving microcurrent electrical stimulation at the selected acupoints were held passively every 3 minutes for approximately 10 minutes.1&#xD;
&#xD;
After completion of the intended treatment, Modified Dental Anxiety Scale (MDAS) scores were recorded again.&#xD;
&#xD;
All the variations in the pulse rate, beginning with 40 minutes before starting the treatment to 15 minutes post-treatment, were recorded.1&#xD;
&#xD;
With the help of an anxiety measuring scale before and after values were compared. Based on which it was concluded that microcurrent electrical stimulation is effective in reducing Anxiety.&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0;&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Statistical analysis was done by using descriptive and inferential statistics using one way ANOVA and Multiple comparisons: Tukey test and software used in the analysis was SPSS 22.0 version and p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3904</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3904</Fulltext></URLs><References>&#xD;
	&#xD;
	Avisa P, Kamatham R, Vanjari K, Nuvvula S. Effectiveness of acupressure on dental anxiety in children. Pediatric Dent. 2018 May 15;40(3):177-83.&#xD;
	&#xD;
	&#xD;
	Gondivkar SM, Bhowate RR, Gadbail AR, Gondivkar RS, Sarode SC, Sarode GS, Patil S. Impact of oral submucous fibrosis on oral health?related quality of life: A condition?specific OHRQ oL?OSF instrument analysis. Oral Dis. 2018 Nov;24(8):1442-8.&#xD;
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	&#xD;
	Karst M, Winterhalter M, M&#xFC;nte S, Francki B, Hondronikos A, Eckardt A, Hoy L, Buhck H, Bernateck M, Fink M. Auricular acupuncture for dental anxiety: a randomized controlled trial. Anesth Analg. 2007 Feb 1;104(2):295-300.&#xD;
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	Rosted P, Bundgaard M, Gordon S, Pedersen AM. Acupuncture in the management of anxiety related to dental treatment: a case series. Acupunc&#xA0; Med. 2010 Mar;28(1):3-5.&#xD;
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	Ramey D, Buell PD. A true history of acupuncture: Focus on Alternative and Complementary Therapies. Acupunc&#xA0; Med. 2004 Dec;9(4):269-73.&#xD;
	&#xD;
	&#xD;
	Spence DW, Kayumov L, Chen A, Lowe A, Jain U, Katzman MA, Shen J, Perelman B, Shapiro CM. Acupuncture increases nocturnal melatonin secretion and reduces insomnia and anxiety: a preliminary report.&#xA0; J Neuropsy Clin Neurosci. 2004 Feb;16(1):19-28.&#xD;
	&#xD;
	&#xD;
	Liu CF, Chien LW. Efficacy of acupuncture in children with asthma: a systematic review. Ital J Ped. 2015 Dec 1;41(1):48.&#xD;
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	&#xD;
	Pilkington K, Kirkwood G, Rampes H, Cummings M, Richardson J. Acupuncture for anxiety and anxiety disorders&#x2013;a systematic literature review. Acup Med.. 2007 Jun;25(1-2):1-0.&#xD;
	&#xD;
	&#xD;
	Wang SM, Kain ZN. Auricular acupuncture: a potential treatment for anxiety. Anesth Analg. 2001 Feb 1;92(2):548-53.&#xD;
	&#xD;
	&#xD;
	Bussell J. Acupuncture and anxiety 2013: the year in (literature) review. OA Altern Med. 2014;2(1):3.&#xD;
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	&#xD;
	Errington?Evans N. Acupuncture for anxiety. CNS Neurosci Therap. 2012 Apr;18(4):277-84.&#xD;
	&#xD;
	&#xD;
	Raghavan R, Sathish S. Acupuncture in prosthodontics: Review. J Guid. 2016 Feb 1;9(3).&#xD;
	&#xD;
	&#xD;
	Carvalho F, Weires K, Ebling M, de Souza Rabbo Padilha M, Ferr&#xE3;o YA, Vercelino R. Effects of acupuncture on the symptoms of anxiety and depression caused by the premenstrual dysphoric disorder. Acup Med. 2013 Dec;31(4):358-63.&#xD;
	&#xD;
	&#xD;
	Singla D, Anand A, Dharma P, Sharma A.Evaluation Of Pulse Rate And Arterial Oxygen Saturation (Sa02) Levels In Children During Routine Dental Procedures. J Den Spe. 2013 Sept;1(2):27-34&#xD;
	&#xD;
	&#xD;
	Khanam N, Wagh V, Gaidhane AM, Quazi SZ. Assessment of work-related musculoskeletal morbidity, perceived causes and preventive activities practised reducing morbidity among brickfield workers. Ind J Comm Health. 2019 Apr 1;31(2).&#xD;
	&#xD;
	&#xD;
	Khandelwal V, Gupta N, Nayak UA, Kulshreshtha N, Baliga S. Knowledge of hepatitis B virus infection and its control practices among dental students in an Indian city. Int J Adolesc Med Hea. 2017 Aug 18;30(5).&#xD;
	&#xD;
	&#xD;
	Tripathi A, Avasthi A, Grover S, Sharma E, Lakdawala B.M, Thirunavukarasu M, Dan A. Gender Differences in Obsessive-Compulsive Disorder: Findings from a Multicentric Study from Northern India. Asi J Psych.2018:37:3&#x2013;9. &#xD;
	&#xD;
&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Nutritional Management of Osteoporosis: It&#x2019;s More Than Calcium&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>54</FirstPage><LastPage>61</LastPage><AuthorList><Author>Pallavi Singh</Author><AuthorLanguage>English</AuthorLanguage><Author> Virginia Paul</Author><AuthorLanguage>English</AuthorLanguage><Author> Aditya Kumar Singh Pundir</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Osteoporosis is a bone disorder that comes under the highly preventable disorder as, among all the risk factors of this bone disorder, most of them are modifiable and dependent on a person&#x2019;s behaviour. Objective: To review facts and findings related to the management of osteoporosis with the help of nutrients and behavioural modifications. Approach: Facilitating proper nutrition is a crucial part of a successful rehabilitation program for patients having osteoporotic fractures and studies have constantly shown that recommended intake of calcium, vitamin D and other nutrients like protein, vitamin C, vitamin K, sodium and phosphorus leads to reduce the loss of bone mass and fracture risks. Among all the macro and micronutrients, calcium has been a major focus of nutritional prevention of osteoporosis as Calcium has a profitable effect on BMD at every site for all ages. Conclusion: There is a scarcity of available knowledge and awareness regarding the role of different nutrients in the prevention and management of osteoporosis is generally calcium and vitamin D has been a major concern. Simultaneously collected evidence suggested that other factors like lifestyle, genetic factors and age-related factors may be a matter of concern in the management of osteoporosis.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Osteoporosis, Bone Mineral Density, Micronutrient, Calcium, Vitamin D, Nutritional management</Keywords><Fulltext>Introduction-&#xD;
&#xD;
Osteoporosis is the most prevalent skeletal disorder affecting both sexes, but most importantly impacts women who experience a faster bone mineral density loss in the early years after menopause.1Osteoporosis is a bone disease with reduced density of bone, decreased bone strength, and absence of bone tissue relative to the biological bone quantity. People may not usually be conscious of their illness as osteoporosis is a "silent disorder" until they experience fragility fracture owing to weakening bones following a sudden strain on bones, bumps or falls.2 Osteoporosis is an extremely preventable disease as most of them are modifiable and dependent on a person&amp;#39;s conduct among all the risk variables of this bone disorder. Facilitating proper nutrition for patients with osteoporotic fractures is a crucial factor for the success of the rehabilitation program and studies have consistently shown that adequate intake of calcium, vitamin D and other nutrients like protein, ascorbic acid, vitamin K, sodium and phosphorus leads to a reduction in the loss of density of the bones and risk of osteoporotic fractures.3&#xD;
&#xD;
Among all the macro and micronutrients, calcium has been a major focus of nutritional prevention of osteoporosis as Calcium has a profitable effect on BMD at every site for all ages.4 Several factors are responsible for the management of osteoporosis like recommended intake of calcium, regular physical activity, daily exposure with sunlight and consumption of other essential dietary elements (e.g.-vitamin D, vitamin K, sodium, protein) and phytonutrients (e.g.-soy compounds) for their protective properties should be counted for the nutritional management of osteoporosis. So the other components of the diet like minerals and vitamins should be considered for healthy bone in association with calcium and vitamin D.5 For optimizing healthy bone mass at all sites, there is some potentially important micronutrient like magnesium, potassium, vitamin C, vitamin K which should be consumed in the daily diet and these can be easily available by the consumption of a diet enriched with fruits and vegetables (5 servings per day).6&#xD;
&#xD;
Nutritional Management of Osteoporosis-&#xD;
&#xD;
Osteoporosis is a bone disorder that can be anticipated and managed with the help of accurate and early diagnosis. Unluckily, it is mostly undiagnosed until a fracture occurs. So a large number of the population should be encouraged to be screened for this disease should be increased. Determination of BMD is a major tool for the diagnosis of Osteoporosis.7 Modifications in the lifestyle pattern can decrease the risk of osteoporosis and osteoporotic fractures. It involves a balanced diet, active lifestyle, regular exercise, and prevention from fall, sudden strain or bumps.8A balanced diet and adequate nutrition play a major part in osteoporosis prevention and therapy. Among all the macro and micronutrients, Nutritional importance of calcium and vitamin D has been a major focus among all the macro and micronutrient for nutritional prevention of osteoporosis.9 In the last decades, 25% increased utilization of highly processed food and the confectionary product was recorded in the consumer&amp;#39;s diet while contradictory data shows that intake of dairy-based food product has reduced by 20%. Dietary supplements, including calcium, are increasingly popular, resulting in infinite consumption of vitamins and minerals, often without medical consultation. This imbalanced intake of nutrients results in body tissue acidification and intensifies Parathyroid activity that encourages a reduction in calcium from bones which may lead to bone-related disorders like osteoporosis.10&#xD;
&#xD;
A calcium-rich diet may not be effective due to the presence of dietary inhibitory factors like fibre and other Anti-Nutritional factors like phytates, oxalate etc which reduces the biological value of calcium and increases the excretion from the body.11 On the other side, researches show that the vast majority of people had no understanding of the role of vitamin D in keeping good calcium equilibrium in the body as an adequate supply of vitamin D in association with a calcium-rich diet is essential for protection from osteoporosis.12 Adequate and balanced nutrition for patients with an osteoporotic fracture is a significant element of an impactful rehabilitation program as inadequate nourishment of the patient can result in slow recovery and increase the susceptibility of further fractures.13&#xD;
&#xD;
Calcium and Bone Mineral Density&#xD;
&#xD;
Osteoporosis is a disease that can be avoided during skeletal development by attaining maximum bone mass, maintaining bone mass during adulthood, and decreasing bone density loss with advancing age. Adolescents and young adults should therefore be motivated to embrace healthy lifestyle habits for ideal skeletal health by raising the amount of weight-bearing activity, optimal nutritional calcium and vitamin D consumption, adequate nutrition and ideal body mass index, cessation of smoking, and mild alcohol, caffeine, and sodium consumption.14 Research shows that the important impact of physical exercise on bone mass during the development period of kids can enhance with appropriate calcium intake in daily diet.15&#xD;
&#xD;
To evaluate the relationship between calcium consumption and bone mineral density, substantial epidemiological information was collected. In a review of 52 calcium intervention research, 50 showed that adequate calcium intakes resulted in decreased bone remodelling, improved calcium retention, decreased bone loss associated with age, and decreased risk of fracture. The study also revealed that out of 86 observer research, 64 reported interactions with decreased danger of fracture, bone loss or enhanced bone mass in favour of enhanced calcium intakes.16 Calcium supplementation&amp;#39;s beneficial impacts were mainly attributed to a decrease in bone remodelling. Calcium supplements, however, may be connected with mild gastrointestinal disorders such as constipation, flatulence, nausea, stomach pain, and diarrhoea. Calcium can also interfere with iron and zinc intestinal absorption.17 While conflicting data of a systematic review concluded that there was no evidence of an association between lower risk of fracture and high intake of calcium.18 Calcium and vitamin D supplements are also available which is an inexpensive treatment for people living with osteoporosis and associated complications. Different studies have consistently shown that medication therapy decreases the risk of vertebral fractures by 30% to 70%, non-vertebral fractures by 15% to 20% and hip fractures by up to 40%.19 Calcium can lower the greater PTH concentrations in big enough doses and decrease the rate of bone remodelling.20 Calcium supplementation appears to enhance the effectiveness of anti-reabsorption treatment for bone mass, such as hormone replacement therapy (HRT) ( Table 1).21&#xD;
&#xD;
&#xD;
&#xD;
Vitamin D and Bone Mineral Density&#xD;
&#xD;
Sun exposure is very limited in India due to darker skin pigmentation; recent modernization of India has resulted in working indoors and reduced physical activity. The Indian women are less exposed to the sunlight due to their dressing pattern which covers most of their body parts and working indoors most of the time.22 So this metabolic bone disorder which progresses silently is widely prevalent in India and related fractures are the primary reason for morbidity and mortality among peri and postmenopausal women. Approximately 1.6 million hip fractures happen globally each year, ranging from 4.5 million23 million to 6.3 million 24 by 2050.&#xD;
&#xD;
Sensitive exposure to the sun (generally 5-10 min of arms and feet or hands, arms and face exposure, 2-3 times a week) and increased intakes of nutritional and supplementary vitamin D are sensible methods to ensure sufficient vitamin D.25 Vitamin D is a calcium absorption and bone mineralization secosteroid hormone that is favourably associated with bone mineral density.26 Human Vitamin D is produced by the body when the skin is subjected to ultraviolet rays of sunlight and 15 minutes of daily sun exposure meets the regular requirement of vitamin D. Fatty fish like salmon, fish oil, egg yolks, fortified milk and some other food products are also a good source of vitamin D.27 &#xD;
&#xD;
There have been various vitamin D supplementation epidemiological studies, typically combined with calcium (500 to 1200 mg / d). A study conducted among peri and premenopausal women shows that none of the diets analyzed provided the recommended daily quantities of vitamin D and only 29% of participants consuming vitamin D supplements. The result of the study shows that respondents have inadequate awareness about osteoporosis and its preventive measures.28 A big body of clinical information shows that a sufficient status of vitamin D as depicted by the concentration of serum 25-hydroxyvitamin D protects against osteoporosis by enhancing bone mineral density and decreasing the potential risk of fracture.29 30 This research highlights the prospective need for intervention research on the impacts of supplementing vitamin D on peak bone mass achievement.&#xD;
&#xD;
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&#xD;
Phosphorus- &#xD;
&#xD;
The impacts on bone parameters of elevated P consumption were contentious.&#xA0; Many studies report elevated Phosphorus consumption in respondents whose dietary Ca: P ratio is exceptionally small are detrimental to bone health However, there is powerful proof that elevated intakes of phosphorus in ordinary subjects with adequate intakes of calcium and phosphorus have no adverse effect on the calcium equilibrium.31On the other hand, recommended intake of phosphorus is essential during growth and development period for obtaining peak bone mass while low serum level of phosphorus will reduce the bone formation and mineralization.32The studies suggest a diet balanced with enrichment of calcium, moderated amount of protein and recommended amount of phosphorus for the attainment of peak bone mass and improved bone mineral density.33 Studies also revealed that reduced phosphorus consumption or negative phosphorus balance because of phosphorus present in food-bound with the supplemental calcium may result in phosphorus deficiency in the body, which could reduce the functions of osteoblast cells and increase the process of bone re-absorption.34The phosphorus-calcium proportion at any point of age is likely more crucial than phosphorus consumption alone ( Table 2).&#xD;
&#xD;
Sodium-&#xD;
&#xD;
Sodium is the reason behind the increased excretion of renal calcium. The mean urinary calcium loss is 1 mmol per 100 mmol sodium.35 According to the studies the bone mass will be reduced if the amount of absorbed calcium is lower than the amount required neutralizing these mandatory calcium losses that are associated with sodium intake.36In observational study among women, On the other side, salt was liable for a substantial shift in the bone calcium equilibrium, from positive to negative, when eaten as part of the diet with increased calcium intake but with low calcium consumption, the calcium equilibrium of the bone was negative in both elevated and reduced salt diets.37 Another study has revealed that reduced salt intake would improve the bone mass of Postmenopausal women with more or equal to 3.4g / day intake of sodium (8.5 g salt).38Recently, a study 39observed a major association of sodium with blood pressure and osteoporosis. In the study, the author observed that there was a negative association between increased sodium excretion and bone mineral density of the hip and spine, i.e. the higher the salt intake, the lower the BMD.&#xD;
&#xD;
Potassium-&#xD;
&#xD;
The main role of potassium is mainly associated with calcium homeostasis, especially urinary conservation and calcium excretion.40 There have been some studies related to potassium consumption and bone density of the Net Endogenous Acid Production (NEAP).41 42Additionally, higher consumption of potassium citrate with high sodium diet was responsible for the increased rate of bone re-modelling.37 Increased bone mineral density and decreased bone loss were correlated with enhanced potassium consumption through a diet rich in fruits and vegetables. 43 The need to assure a sufficient consumption of potassium from fruits and vegetables is a powerful rationale for the recommendation &amp;#39; 5 to 10 servings per day.44&#xD;
&#xD;
Magnesium-&#xD;
&#xD;
An epidemiological study found a negative association between lower hip and whole-body BMD and lower magnesium intake in post-menopausal women, but these findings of the study do not associate with increased susceptibility to fractures. A slightly higher magnesium consumption than the RDA is correlated with an enhanced risk of fractures of the lower arm and wrist that may be associated with more physical activity and falls.45 The latest research demonstrates that hypomagnesemia can lead to inflammatory illnesses that have a current bone loss connection. The oral intake of Magnesium supplement may help lower the detrimental effect of Osteoporosis.45 Only limited controlled magnesium supplementation clinical trials 46 have been conducted that were mainly efficient in magnesium depleted individuals. There is insufficient information available on the need and significance of magnesium in the general population for the prevention of osteoporosis (Table 2). The mechanisms responsible for the mineralization problems observed when magnesium is elevated are less explored. Overall, magnesium homeostasis control and maintenance is a useful intervention to preserve bone integrity.47&#xD;
&#xD;
Fluoride-&#xD;
&#xD;
Fluoride is a key trace element required for the maturation of the skeleton and dentistry.48 Epidemiological studies indicate no effect on bone mineral density or fractures connected with mild fluoride levels typically found in drinking water 49; nevertheless, some endemic elevated fluoride regions showed a greater rate of hip fractures. Fluorosis, a serious disease associated with extra-osseous calcification and brittle bones, starts with the ingestion of surplus fluoride. While some epidemiological studies reported contradictory fluoride therapy impact on bone mineral density and fracture risk as fluoride therapy improves spine and hip BMD, a small fluoride dose (&lt; or = 20 mg/day of fluoride equivalents) was correlated with a significant reduction in fracture danger. 50&#xD;
&#xD;
Vitamin K&#xD;
&#xD;
Vitamin K operates as a cofactor in bone metabolism-related enzymes (Booth, 1997). It decreased the excretion of urinary calcium and improves protein carboxylation such as osteocalcin (engaged in the formation of bones) 51. Observational studies indicate a positive association between bone density and vitamin K intake.52Studies have also shown that vitamin K supplementation leads to improvements in bone health. 53 Studies of epidemiology also found that long-term treatment adversely impacts the risk of vertebral BMD and fracture.54 In addition, a big proportion of undercarboxylated serum osteocalcin as seen with low serum vitamin K may be a predictor of the danger of fracture 55, 56, 57, although many of these research are confused with poor nutrition in general. &#xD;
&#xD;
Vitamin C&#xD;
&#xD;
Vitamin C plays an important role as a cofactor for collagen production and construction of hydroxyproline and hydroxylysine. Epidemiologic studies reveal a significant association between bone mass and vitamin C; Bone Mineral Density loss is inversely associated with intakes of vitamin C, and another study noticed that the rate of fractures is low with the higher consumption of vitamin C especially in Pre and Post-Menopausal women using concurrent estrogen therapy and calcium supplements.58-61&#xD;
&#xD;
Vitamin A-&#xD;
&#xD;
Vitamin A is a fat-soluble vitamin required for reabsorption of the bone and is also an essential nutrient for vision, development and infection control. The distinct kinds of vitamin A found in diet and nutritional supplements are retinol and &#x3B2;-carotene (and other carotenoids). According to some research, increased intake of vitamin A is deleterious to bone health and with the intake of more than 1500 &#x3BC;g RE associated with a 2-fold increased possibility of hip fracture in the U.S. and Sweden but not in Iceland or various U.S. trials.62 63 On the other side, studies indicate that osteoporosis and related fractures are not substantially associated with daily consumption of vitamin A as long as the concentration of serum 25(OH)D is retained at a mild rate of 50&#x2013;75 nmol / L. Fruit and vegetable vitamin A (carotenoids) is closely related to the mineral density of the bone64. &#xD;
&#xD;
Other Nutrients-&#xD;
&#xD;
The association between bone health and trace metals is still unidentified. Three studies among post-menopausal women have shown that intake of calcium with the combination of minerals like zinc, manganese, copper was capable to conquer bone loss from the spine.65According to studies, there is no recommended intake of Boron for healthy bone but in some studies, it was suggested that 3 mg daily intake of boron have a positive effect on bone health.66Copper&amp;#39;s severe deficiency has intense impacts on the bone as it is a significant component that many enzymes, including lysyl oxidase, need for collagen cross-linking. There is little confirmation that zinc affects bone mineral density, osteoporosis, and related fractures, but serious zinc deficiency can lead to poor growth and maturation of the bone. &#xD;
&#xD;
A cohort study among men and premenopausal women revealed that there is a positive relationship between dietary silicon consumption and bone mineral density at the hip.67 Recent studies among males and females have found that insufficient vitamin B12 consumption was associated with decreased bone mass in males and females, and osteoporosis in older females but not males.68 Whether organizations like this are an indication of poor nutrition and frailty generally is unidentified. Similarly, bone mineral density is considerably correlated with dietary iron consumption at all locations in another research (Table 2). 69&#xD;
&#xD;
Management of Osteoporosis- Other than Nutrients-&#xD;
&#xD;
Age and Menopausal Status In females, age-related bone loss is higher than in males. By the era of 80, the quantity of cortical and trabecular bone lost is about 40% of the premenopausal BMD peak. 70According to the epidemiological study, there was an adverse correlation between women&amp;#39;s age and bone mineral density.71Another comparable report among Indian females over the era of 50, in which an age-dependent decrease in BMD was observed, was tested by digital X-ray radiogrammetry.72 Another research also showed an important correlation between increased age and low bone mineral density.73Similarly, women&amp;#39;s menopausal status also correlated with bone health as Indian women showed an important statistical association between osteopenia incidence and osteoporosis and menopause achievement.74While research also disclosed that the incidence of osteopenia among females over 35 years of age was high, which in subsequent years of life may lead to osteoporosis.75&#xD;
&#xD;
So based on the available literature it is concluded that advanced age and attainment of menopause is significantly associated with the prevalence of osteoporosis and this increases the requirement of awareness programs regarding preventive measures of osteoporosis to reduce the prevalence of low bone mineral density among the younger women which facilitates the development of osteoporosis in aged women especially after menopause.76&#xD;
&#xD;
Physical Activity-&#xD;
&#xD;
Bone and muscle movement is needed to accelerate the body&amp;#39;s calcium absorption. Community studies have revealed that physical activity and fitness reduce the risk of osteoporosis and fractures and associated injuries.77 Studies have shown that bone mineral density can be preserved or improved with therapeutic exercise in post-menopausal women.78Higher leisure time, sports, household chores and fewer hours of daily sitting were considerably correlated with lower risk of osteoporosis and linked fractures.76&#xD;
&#xD;
Genetic Factors-&#xD;
&#xD;
Studies have shown that osteoporosis has a large genetic component.77Genetic variables affecting the acquisition of maximum bone mass account for a significant percentage of the variation in bone mineral density (BMD), although the extent to which genes also add to bone loss variability is debatable. Parental history of fracture (especially hip fracture) confers and increases the danger of fractures autonomous of bone mineral density. In addition, the family history impact is not a particular but site-specific predisposition to fractures. But the information on the impact of family history on low bone mineral density incidence is still not a well-documented osteoporosis risk factor. &#xD;
&#xD;
Conclusion-&#xD;
&#xD;
So the other components of the diet like minerals and vitamins should be considered for healthy bone in association with calcium and vitamin D while consideration of other factors like Age, Menopausal Status, Behavioral and Genetic factors is also very important in the effective management of Osteoporosis. For optimizing healthy bone mass at all sites, there is some potentially important micronutrient like magnesium, potassium, vitamin C, vitamin K which should be consumed in the daily diet and these can be easily available by the consumption of a diet rich in fruits and vegetables (5 servings per day). Awareness of the significance of sufficient calcium and vitamin D consumption (easily observed by serum 25(OH) D) for optimal bone health, as well as the prevention from falls and fractures, should be the major concern for the management of osteoporosis. Healthcare professionals and policymakers should also pay attention to create awareness regarding responsible factors for osteoporosis other than nutrients like physical activity, genetic factors and age-related factors like menopausal status.&#xD;
&#xD;
Acknowledgement-&#xD;
&#xD;
I am highly thankful to all the researchers for their valuable research in the field of management of osteoporosis which was quoted while writing this review paper. I also want to extend my appreciation to ACARS Global Network Private Limited for their continuous support and financial assistance.&#xD;
&#xD;
Conflict of Interest-None&#xD;
&#xD;
Funding Information-&#xD;
&#xD;
The financial assistance for this research paper associated with the ACARS Global Network Private Limited and I want to acknowledge their continuous support.&#xD;
&#xD;
Author&#x2019;s Contribution-&#xD;
&#xD;
&#xD;
	&#xD;
	Pallavi Singh- All the information related to the Nutritional Management of Osteoporosis was collected and reviewed by the author.&#xD;
	&#xD;
	&#xD;
	Virginia Paul- Valuable guidance provided by the author. She was also involved in the review and editing process.&#xD;
	&#xD;
	&#xD;
	Aditya Kumar Singh Pundir- He was actively involved in the review and editing process.&#xD;
	&#xD;
&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Toxicity of Adulterants Mixed with Lawsonia Inermis Linn over Human Health&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>62</FirstPage><LastPage>68</LastPage><AuthorList><Author>Amit Chauhan</Author><AuthorLanguage>English</AuthorLanguage><Author> Varsha Chauhan</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Natural products are a significant source of synthetic and traditional herbal medicine and are the primary source of the health care system. The traditional medicinal methods, especially the utilization of medicinal plants play a vital role in covering the basic health requirements in developing countries. Objective: Henna is a traditional cosmetic agent used to stain hair, skin, and nails worldwide. Henna (Lawsonia inermis) is eminent of the Lythraceae&#x2019;s family that imparts a red-brown colour. Monetary, it is available in numerous types and colours e.g. dried leaves/ hair dye. Its mixture along with water is applied on body parts and hairs for few hours to obtain the colour. Methods: To make it economical and inexpensive, few chemical additives such as para-phenylenediamine have recently been mixed with henna. It achieves the same cosmetic effect in only 30 minutes but can cause severe adverse reactions. Paraphenylenediamine (PPD) has been mixed with natural henna to provide an ebony colour instead of the orange/reddish colour given by natural henna. Results: The other explanation behind adding p-phenylenediamine to the natural henna is to speed up the tattooing process, while natural henna staining takes 4 to 12 hours. The addition of PPD can help to reduce the time from an hour/ two for a longer-lasting effect as well. It has been observed to cause severe haemolytic anaemia and renal tubular necrosis in animals. Henna may cause haemolysis in patients with G6PD (glucose-6-phosphate dehydrogenase) enzyme deficiency in regions where it is commonly utilized. Conclusion: The principle behind this study is to understand the hazardous effects of adulterants mixed with Heena on the human body, either it is an immediate effect or a gradual effect on the body. Thus, Lawsonia Inermis can also work as a steady poison for an individual.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Lawsonia inermis L., Heena, G6PD (glucose-6-phosphate dehydrogenase), (PPD) Para-phenylenediamine etc</Keywords><Fulltext>&#xD;
INTRODUCTION &#xD;
&#xD;
Natural products are a significant source of synthetic and traditional herbal medicine and are the primary source of the health care system. The traditional medicinal methods, especially the utilization of medicinal plants play a vital role in covering the basic health requirements in developing countries.1 Plants have been utilized in form of medicines since immemorial time. In Europe, henna was popular among females connected to the aesthetic movement and the Pre-Raphaelite artists of England in the 1800s. Henna is known as an essential ancient dye, evidence being the Egyptian mummies found in the tombs that had their nails dyed with henna. Consequently, the relics from the excavation at Mohanjodaro and Harappa (Indus Valley Civilization), Ajanta Caves Painting and Mughal dyeing, printing, and painting, show the use of natural dyes such as Madder, Indigo, and Henna. Henna leaves have been extensively utilized. &#xD;
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India has rich heritage of utilizing medicinal plants in traditional medicines such as Ayurveda, Siddha, and Unani besides folklore practices.2 A diverse range of plants may be incorporated in herbal preparations, and many of them can have serious toxic side effects. The utilization of Ephedra has documented or its effect on cardiovascular health, including death, which&#x2019;s why prohibited to sale in the United States. Some herbal preparations cause dangerous drug interactions, primarily by altering the expression of liver enzymes. Alternative medicines and supplements have also been linked with hepatotoxicity, nephrotoxicity, neurotoxicity, carcinogenicity, and allergic reaction.3 Herbal drugs or medicinal plants, their extracts, and their isolated compound have demonstrated a spectrum of biological activities.4&#xD;
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Similarly, Lawsonia inermis linn. is a well-known plant usually grown in houses.5 Lawsonia inermis Linn. is commonly known as henna, which is recognized in the traditional system of medicine.6 As a cosmetic for staining hands, palms, hairs, and other body parts during religious festivals and marriages, and so on.7 Henna has been utilized as a cosmetic hair dye for 6,000 years.8 &#xA0;The plant of Lawsonia Inermis linn is shown below in figure no.1,&#xD;
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LAWSONIA INERMIS LINN&#xD;
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Lawsonia inermis Linn. (Lythraceae), henna is a biennial dicotyledonous herbaceous shrub.5,6 Lawsonia inermis Linn. is a perennial plant that belongs to Lythraceae, also known as the loosestrife family.7,8 It is also known as Alcanna spinosa, Casearia multiflora, Lawsonia alba, Lawsonia speciosa, Lawsonia spinosa, Lawsonia, and Rotantha combretoides. It has its local names e.g. Arabic: henna; Bengali: mendi, mehedi; English: Camphire, Egyptian-privet, henna, Jamaica-mignonette, mignonette-tree; French: henn&#xE9;; German: Hennastrauch; Hindi: mehndi; Sanskrit: Mendika, Telugu: Goranti, Malayalam: Mailanchi, Indonesian: inai, pakar kuku; Portuguese: h&#xE9;sia, hena, alfeneiro; Spanish: alcana, alhe&#xF1;a; Swedish: henna; Vietnamese: nhu&#xF4;m m&#xF3;ng tayl&#xE2; m&#xF2;n.9,10,11 &#xD;
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PRODUCTION OF LAWSONIA INERMIS LINN&#xD;
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Henna requires less water than traditional crops and is sustainable for agriculture in semi-arid regions.12 Lawsonia inermis frequently cultivated in India, Persia, and along the African coast of the Mediterranean Sea, widely cultivated as an ornamental hedge and dye plant.13,14 It was distributed in Africa: Egypt, Ethiopia, Somalia, Sudan, Zaire, Niger, Benin, Burkina Faso, Cote D&amp;#39;Ivoire, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Nigeria, Senegal, Sierra Leone, Togo, South Africa, Comoros, Seychelles; Asia: India, Pakistan, Sri Lanka. It is widely cultivated in tropical regions of the world, the Southern areas of the Middle East, the Arabian Peninsula, North, and East Africa, and South Asia.&#xD;
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CHEMICAL CONSTITUENTS&#xD;
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	Leaves: 2-Hydroxy-1,4-napthoquinone, 1,4dihydroxynaphthalene, 1,4-naphthoquinone, 1,2-dihydroxy-glucoyloxynaphthalene, luteolins, apigenin, and their glycosides, esculetin, fraxetin, scopletin, &#x3B2;-sitosterol, tannin, gallic acid, glucose, mannitol, fat, resin and mucilage.&#xD;
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	Barks napthoquinone, isoplumbagin, triterpenoids-Hennadiol, aliphatics (3-methylnonacosan-1-ol)&#xD;
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	Flowers essential oil (0.02 %) rich in ionones (90 %), &#x3B2;-ionones.&#xD;
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	Roots 24&#x3B2;-ethylcholest-4-en-3&#x3B2;-ol&#xD;
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	Seeds Linoleic acid, Arachidic acid, Stearic acid, Palmitic acid&#xD;
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	Whole plant Laxanthone I, Laxanthone II, Laxanthone III, n-Triacontanol.15-18 The henna plant is shown below in figure no.2;&#xD;
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A new sterol, namely lawsaritol has been isolated from the roots of Lawsonia inermis. Its structure has been elucidated as 24&#x3B2;-ethylcholest-4-en-3&#x3B2;-ol based on spectral analysis and chemical reaction.20,21&#xD;
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These compounds exhibit in form of antimicrobial, anti-sickling, macrophage-stimulating, hepatoprotective, Analgesic, Anti-inflammatory, antipyretic, anticomplementary, cytotoxic, antioxidant, protein glycation inhibitory, Antituberculostatic, Antidiabetic, Antiulcer, Antiarthritic, Memory enhancing, Antiurolithiatic, Nematicidal effect, Antiparacidal, Antitrypanosomal, Molluscicidal, Antifertility, Ovicidal, Antidermatophytic activity, Anticonvulsant, Antisickling, and immunomodulatory property.22&#xD;
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CLASSIFICATION&#xD;
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&#xA0;There are three different types of henna, Neutral henna, Red henna, and Black henna. &#xD;
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	Neutral henna: A green powder that scents similar to freshly cut grass cannot be henna /neutral. It is identified as Cassia obovata, contains anthraquinones, specifically chrysophanic acid, an identified antifungal, antimicrobial, and antibacterial compound. Cassia obovata does not color hair. &#xD;
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	Red henna, a green powder that scents like hay, is Lawsonia inermis, commonly named henna. Henna will stain hair red-orange, but this stain is translucent and will combine with natural colour. The leaves of the henna plant have a red-orange dye molecule that is Lawsone, a naphthoquinone compound.19-22&#xD;
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	Black henna: A green powder that scents like frozen peas, is neither henna nor black. It is indigo, Indigofera tinctorial.23&#xD;
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Lawsonia inermis Linn contains a red-orange pigment known as Lawsone, the molecule of which is also called hennotannic acid.24 Lawsone is the main constituent responsible for the dying properties of the plant.25 When henna leaves are smushed in an acidic medium and applied to the skin, the lawsone molecules migrate from the henna paste, the cuticle, traverse the outermost layer of the hair, and stain the hair. Prolonged applications of henna result in diffusion of the pigment deeply into the hair,26 a burgundy organic compound that has an affinity for bonding with protein.30 The dried and powdered leaves are mixed with warm water to form a mud-like paste, which is placed on the hair for 30&#x2013;40 min to dye it. The colouring action is due to, which is naturally present as a glucoside and as the aglycone in the plant leaves.27 The chemical structure of lawsone compounds and schematic diagram of Heena dying hairs are given below in figure no.3 &amp; figure no.4;&#xD;
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SIDE-EFFECTS OF RED HENNA&#xD;
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Contact allergy&#xD;
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Red henna is generally considered safe. Yet a few reports of contact allergic reactions, despite its extensive use exits. For instance, it has been assessed that at least half of the population of India has been presented to henna at some time in life, so it can be assumed that its sensitizing potential must be negligible. It is typically expected that the allergen in henna is Lawsone. However, this compound has been tested in only a few studies. In this manner, in most cases, the actual allergen stayed unknown, and some cases of contact allergy may have been caused by other ingredients of the plant or substances included later, for instance, essential oils. &#xD;
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Immediate reactions&#xD;
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Immediate-type hypersensitivity to henna has been reported rarely. It is an occupational hazard for hairdressers in the form of presumably IgE-mediated reactions, with symptoms like running nose sneezing, conjunctivitis, dry cough, dyspnoea, swelling of the face, or generalized urticaria. The main event for sensitization is the inhalation of a henna powder dispersed in the air.&#xD;
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MISCELLANEOUS SIDE-EFFECTS&#xD;
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Extravagant floral henna tattoo patterns on both forearms and hands may cause issues with peripheral venous cannulation&#x2014;a metabolite of naphthalene and a powerful oxidant of G6PD &#x2013;deficient cells. The topical application of henna may, therefore, cause life-threatening haemolysis in children with glucose-6-phosphate dehydrogenase deficiency. Signs and symptoms may include pallor, vomiting, jaundice, anaemia, lethargy, tachycardia, poor peripheral perfusion, shock, and even death. &#xD;
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PPD (PARA-PHENYLENEDIAMINE)&#xD;
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The hypersensitivity reaction to PPD sold as &#x2018;black henna&#x2019; and applied to the skin as body art is given in figure no. 5. The above image of a woman&#x2019;s arm blistering from an application of &#x2018;black henna,&#x2019; a paste with little or no henna, but a high content of para-phenylenediamine. &#x2018;Black Heena&#x2019; temporary tattoos are created with a paste containing 12.5% to 80% PPD. &#xA0;Para-phenylenediamine has been conflated with henna as &#x2018;black henna&#x2019; since the 1970s and has popularized around the world for celebratory and festival skin adornment. Estimated that 150,000,000 individuals had been sensitized to PPD, and a much larger number had been sensitized through cultural use. A sensitization test in Manchester, UK, found the sensitization rate among children had risen from 3% in the 1990s to 8% in 2005 to 16% in 2014. &#xD;
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It was reported that allergic reactions are mostly caused by some ingredients added by the so-called &#x201C;artists.&#x201D; The ingredients are generally colouring agents such as diaminotoluenes and diaminobenzenes. Para-phenylenediamine (PPD) is a typical diaminobenzene and is one of the most popular ingredients. The allergic reactions caused by PPD include acute inflammatory reactions, eczematous hypersensitivity reactions, photo aggravated reactions, granulomatous reactions, lichenoid reactions, and pseudolymphomatous reactions. It was accounted that the long duration of skin contact, the high concentrations of sensitizing materials, and the absence of a neutralizing agent dramatically increases the risk of skin sensitization. Therefore, the Food and Drug Administration (FDA) approves henna only for use as a hair dye, not for direct application to the skin. The unapproved use of a color additive makes these products adulterated and, therefore, illegal.&#xD;
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Therefore, It can be assumed that natural henna is a feeble skin allergen. PPD (p-phenylenediamine) is an aromatic amine compound; its chemical formula is C6H8N2, and its molecular weight is 108.15 g/mol. It can be easily observed in figure number 6 of a youngster before and after the application of hair dye.&#xD;
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It is a white to light purple powder that darkens on exposure to air. It is primarily utilized as an element of oxidative hair colouring products at a maximal concentration of 4.0%; still, after mixing in a 1:1 ratio with hydrogen peroxide before use, this concentration will be 2% at the time of application to the hair. It oxidizes, turning first red, then browns, then finally black. &#xD;
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Black henna contains p-phenylenediamine (PPD), an aromatic amine that reacts with components containing at least one aromatic ring in their structures. A black and long-lasting stain is created in minutes, rather than hours, when PPD mixed with henna is applied in decorative patterns to the skin. The utilization of PPD is the leading cause of allergic contact dermatitis or severe allergic reactions from henna tattoo mixtures. Allergic reactions may present as itching, blistering, depigmented skin patches, and even permanent scarring, which are treated with antibiotics and corticosteroids. &#xD;
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Notwithstanding hair dyes, PPD may also be found in fur or textile dyes. para-Phenylenediamine is also utilized as a developing photographic agent as well as an antioxidant in rubber compounds. &#xA0;People may be occupationally exposed to PPD during its manufacture or use, and the exposure may occur through inhalation, skin or eye contact, and ingestion. &#xA0;Short-term exposure to high levels of PPD may cause extreme dermatitis, eye irritation and tear, gastritis, asthma, tremors, renal failure, vertigo, convulsions, and coma in humans. &#xA0;The Concentration of PDP in Henna Samples are given below in graph number 1; &#xD;
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Apart from the use of PPD, many other chemicals, including p-methylaminophenol, p-aminobenzene, p-toluene diamine, benzene, petrol, butane, hydroquinoneandisobutyl p-aminobenzoate are added to natural henna and have been associated with contact dermatitis38&amp;41. &#xD;
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COMPLICATIONS OF HENNA &#xD;
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Although most of the complications of henna come from topical applications for traditional events or temporary tattoo. Somewhere, other complications have occurred after the oral ingestion of henna e.g.&#xA0; Allergic contact dermatitis, Immediate-type hypersensitivity with urticarial, Erythema multiforme, Post-inflammatory hypo-or hyperpigmentation, Hypertrichosis Keloids, Hemolysis, Vasculitis and renal impairment, Teratogenicity etc.27-30 &#xD;
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Most pregnant women believe that natural treatments are not dangerous and do not have any side effects for either the mother or the fetus, and due to such questionable beliefs may attempt to self-medicate with herbal medicines or other such preparations. The potential effects of Lawsonia inermis extract on the gestation of mice embryos in pregnant mice. The results indicated that the use of Lawsonia inermis during pregnancy might cause abortion, and therefore, the researchers of the study highly suggest that Lawsonia should be utilized with great caution or else considered to be counter-indicated for pregnant individuals.&#xD;
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HENNA AND G6PD DEFICIENCY&#xD;
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People along with homozygous G6PD deficiency are called Favism. Who is suggested not to use henna to dye their hairs? It is a genetically inherited anomaly on the X chromosome and henna can cause hemolytic anaemia. Such people who have this deficiency because of the G6PD enzyme results in leaving the blood cells vulnerable to oxidative hemolysis. A doctor can diagnose G6PD deficiency with a blood test and can advise on these risks. If an individual has G6PD deficiency, physicians advise an individual to avoid any food items. The homozygous condition of G6PD deficiency is often common in human being. Males of a certain age of ten years; are the most vulnerable to oxidative hemolysis from it. 22&#xD;
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Though the appearance of green colour urine after dyeing hair with henna is harmless, the appearance of blood in one&#x2019;s urine is potentially dangerous and should be brought to the attention of a physician to see whether the individual might have homozygous G6PD deficiency. A simple blood test will confirm whether have G6PD Deficiency, or whether there is blood in urine from some other condition.28 The health risks involved in the pre-mixed paste, not the natural henna; therefore, consumers are advised to avoid henna with synthetic additives. Otherwise, some pastes have been noted to contained synthetic: disperse orange dye, silver nitrate, pyrogallol, carmine, and chromium. &#xA0;These have been observed to be a cause of allergic reactions, chronic inflammatory reactions/ late-onset allergic reactions to hair-dressing materials and textile dyes. For this situation, one has to be careful while buying henna from the market. &#xD;
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In a case, a 15-year old girl died of laryngeal oedema and pulmonary congestion, consistent with anaphylaxis, following conscious ingestion of an unknown amount of henna in a suicide. Acute haemolysis can take place in G6PD-deficient individuals after applying henna dye to the skin. Observed symptoms are anaemia, reticulocytosis, and indirect hyperbilirubinemia. At postmortem physical examination, no traumatic conditions were found. The only pathologic autopsy findings were laryngeal oedema and pulmonary congestion. It was also determined that the stomach contained henna staining. Autopsy findings were consistent with anaphylaxis47. Henna may cause haemolysis in patients with G6PD (glucose-6-phosphate dehydrogenase) enzyme deficiency in regions where it is commonly utilized. In another case of acute kidney injury was recorded in a 34-year-old man with G6PD deficiency from Yangon, Myanmar, after ingesting a herbal remedy of boiled henna leaves. He developed hemoglobinuria, and he underwent five sessions of hemodialysis. His condition improved within seven with full recovery.13 &#xD;
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Two siblings, an 11-year-old male, and a 7-year-old girl were admitted to our hospital with a history of vomiting, paleness, dark and low amount of urine, and jaundice without fever, which had begun six hours ago. The patients were told to have ichthyosis Vulgaris disease. Although they were taken to paediatricians many times and were administered various medications for this disease, their skin lesion had persisted. It was observed that henna mixed with water was applied to the whole-body skin lesions by their mother six hours ago. The patients had no complaints, except skin lesions (ichthyosis Vulgaris) until six hours after henna was applied from throat to soles. Six hours after the topical henna mixture application, vomiting and paleness developed. As soon as these complaints developed, their mother washed their whole body covered with the henna mixture. They were the second and third children of a consanguineous marriage with no family history of similar conditions, and they had six healthy siblings. The other siblings had no history of henna application. On physical examination of the 11-year-old male patient, anthropometric measurements were normal; the axillary temperature was 36.6 &#xB0;C, blood pressure was 110/65mmHg, and heart rate was 142/min. His general appearance was exhausted, very icteric, and pale. Skin from his throat to soles had been dyed red-brown. His liver was 3.5 cm palpable, and his spleen was unpalpable. &#xD;
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Laboratory evaluation showed haemoglobin 6.7 g/dl, Hct 18.8%, WBC 15 200/mm3 and platelets 340000/mm3. In peripheral smear, of leucocytes, 42% were PMNL, 58% were lymphocytes. Eighteen per cent of cells were normoblasts; platelets were adequate and clustered. Anisocytosis and fragmented erythrocytes were present. There was no spherocytosis or elliptocytosis. Reticulocytosis was detected (10%). The osmotic fragility test and sickling test were negative. G6PD screening revealed a deficiency. The direct Coombs test was negative. Urea, creatinine, blood glucose, CK, and electrolytes (NA, K, Ca) were normal, total bilirubin: 8 mg/dl, direct bilirubin: 2.2 mg/dl. After a blood transfusion, haematocrit increased to 22.4%. Subsequently, Hb became stabilized, transaminases, direct, and indirect bilirubin levels fell gradually, and the patient was discharged after four days.29,30&#xD;
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CONCLUSION&#xD;
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Body craftsmanship and decoration is a desideratum present in ancient and modern civilizations, due to different motivations and perceptions. Since the last few years, the use of tattoo and piercing increased, mainly in adolescents and young people, as a popular form of self-expression, evidencing the need for identification and body control against modern alienation. People favour temporary and natural tattoos because they are considered safer than synthetic and long-lasting ones. However, reports on allergic and chronic inflammatory reactions are increasing that ask for higher quality controls. The case of henna shows that also the cosmetic sector requires adequate controls to avoid adulteration, usually considered safe, and polluting with toxic substances to enhance activity. Thus it is essential to verify the state, origin, and identity of the utilized raw material as well as of the marketed products.&#xD;
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Continuous use of such contaminated cosmetics could increase some metal levels in the human body beyond acceptable limits, as well as induction of severe allergic dermatitis in susceptible personnel due to unsafe constituents that were not mentioned on the constituent list of the black henna package. Putting henna on the dermal of these infants can cause their red blood cells to burst. For pregnancy or breastfeeding: It is unsafe to take henna by mouth if a woman is pregnant. There is little evidence that it may cause a miscarriage. It is also unsafe to take henna if a woman is breastfeeding.&#xD;
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ACKNOWLEDGEMENT: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript.&#xA0;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.&#xD;
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CONFLICT OF INTEREST:&#xA0; NA&#xD;
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SOURCE OF FUNDING: NA&#xA0;&#xA0; &#xD;
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ETHICAL CONSIDERATION: NA&#xD;
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	Gupta S, Ali M, Alam MS, Niwa M, Sakai T. 24&#x3B2;-Ethylycholest-4-en-3&#x3B2;-ol from the roots of Lawsonia inermis. Photochemistry; Pergamon Press Ltd; 1991 31(7);2558-2560. &#xD;
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	Kaur M, Dangi CB. S, Peter J, Jain S. Toxicity Profile of Ethanolic Extract of Lawsonia Intermis Leaves in Albino Wistar Rats. World J of Pharm Pharm Sci; 2014 3 (5 835-848.&#xD;
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	Rahmoun N, Otmani ZB, Boucherit A, Braham NC. Antifungal activity of the Algerian Lawsonia inermis (henna). Pharma Biol. 2013; 51(1); 131&#x2013;135. &#xD;
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	Sultana A, Khosru KH. Analgesic and Antidiarrhoeal Activities of Lawsonia Inermis. Int J of Pharma Sci&#xA0; Res. 2011; 2(12): 3183-3188. &#xD;
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	Wagini NH, Soliman AS, Hnafy YA.&#xA0; Some of the Phytochemical, Pharmacological and Toxicological Properties of Henna (Lawsonia inermis L.): A Review of Rec Rese. &#xA0;Sustainable Development of Natural Resources in the Nile Basin Countries. 2014; 14 &#x2013; 15.&#xD;
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	Garg RK, Tripathi R, Batav N, Singh RK. Phytochemical High-Performance Thin Layer Chromatography based Estimation of Lawsone in Lawsonia inermis (Henna) obtained from Two Natural Habitats and Dye Products Collected from Local Market. Medic Arom Plants (Los Angeles). 2017; 6 (3): 290. &#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>To Evaluate Marginal Fit of Single Implant-Supported Metal-Ceramic Crowns Fabricated by Direct Metal Laser Sintering and Lost Wax Technique: An In Vitro Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>69</FirstPage><LastPage>74</LastPage><AuthorList><Author>Harshita Narang</Author><AuthorLanguage>English</AuthorLanguage><Author> Urvashi Sukhija</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Porcelain fused to the metal prosthesis is one of the widely used dental prosthesis. The aim of this in vitro study is to check the marginal fit of a single implant-supported metal-ceramic crown fabricated by the direct metal laser sintering method compared with crowns fabricated using the lost wax technique. Materials and Method: The study conducted compares the marginal fit of single implant-supported porcelain fused to metal crown fabricated using the most ancient and conventional lost wax technique and the most recent yet emerging Direct Metal Laser Sintering (DMLS) technique. This study also compares both techniques based on the marginal fit of crowns. A total of 20 porcelain fused to metal crowns were prepared for this study. 20 implant abutments fixed into implant analogues, embedded into acrylic resin blocks were divided equally (n=10) into two groups Group A (lost-wax technique) and Group B (DMLS technique). On the abutments, crowns for the mandibular first molar were prepared by these two techniques. Four points were marked on each aspect (lingual, buccal, mesial and distal) of the crown at the level of the abutment, which was analyzed under a stereomicroscope at 65x. Three readings at each point were noted and the observations were statistically analyzed. Results: The lowest mean marginal discrepancy values (39.9 &#xB1; 1.8 &#xB5;m), (40.3 &#xB1; 1.5&#xB5;m), (39.2 &#xB1; 1.2&#xB5;m) and (37.3 &#xB1; 1.7&#xB5;m) were observed for Group B (DMLS) at all four points marked, respectively which were significantly better as compared to that of Group A (Lost-Wax) that showed (58.4 &#xB1; 1.2&#xB5;m), (55.5 &#xB1; 0.98&#xB5;m), (56.9 &#xB1; 0.91&#xB5;m) and (55.7 &#xB1; 0.92 &#xB5;m) values at the four marked points. Conclusion: The results revealed that the crowns fabricated by the DMLS technique provided better marginal fit as compared to the crowns fabricated by the Lost-Wax technique.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Implant-Supported crowns, Lost-wax technique, Metal-Ceramic crowns, Marginal fitting</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
To restore the lost functions, esthetics and phonetics, the use of dental implants has become a contemporary regime with unceasing development in the science of implantology and osseointegration.1 The increased demand in clinical applications has made many researchers conduct many scientific investigations leading to an evolution in implant systems, techniques of framework fabrication and treatment modalities. 1,2,3&#xD;
&#xD;
Porcelain fused to the metal prosthesis is one of the widely used dental prosthesis. For the long?term success of the prosthesis, a good marginal fit is a prerequisite. The appropriate seating of prosthesis to implant abutments is very essential to ensure the longevity of the treatment.4&#xD;
&#xD;
Various factors that affect the marginal fit of the implant-supported fixed prosthesis include; bone quality, adjacent teeth present, the diameter of the implant, implant-bone contact, abutment fixation into the implant, final impression material and technique, master cast produced, the accuracy of impression-transfer onto the cast, wax used for fabrication of pattern, investment used for casting, the alloy used for coping, properties of the alloy, the bulk of coping, type and brand of ceramic used, shrinkage and various properties of ceramic.&#xD;
&#xD;
Technology in dentistry is speed rocketing similar to other various fields. One of these technologies is &#x2018;Direct Metal Laser Sintering. This technique is based on an additive aspect of CAD/CAM technology. The reason why it is called 3D printing is that it built successive layers of 0.02-0.06 mm. Onto the powdered metal, a high beam laser is focused which helps to infuse the metal and forms the layer. This process of fusing the metal layer-by-layer is carried till the final dimensions are acquired. It doesn&#x2019;t require any milling machine as required in subtractive milling technology.&#xD;
&#xD;
For crown fabrication, an ancient yet conventional technique is used for decades that is &#x2018;Casting technique or Lost-Wax technique&#x2019;. It involves the preparation of a mould with the help of a wax pattern which is put in a burnout furnace and it leaves behind a cavity into which the molten metal can be poured for casting.5,6,7&#xD;
&#xD;
The main objective of this study is to compare the passive fit of the metal-ceramic crowns fabricated by the above mentioned two techniques, one of which is the oldest and conventional technique whereas, the other one is the latest digital technologies.&#xD;
&#xD;
MATERIAL AND METHODOLOGY&#xD;
&#xD;
The study compares the marginal fit of the single implant-supported metal-ceramic crowns fabricated by different techniques, that is the lost wax and the direct metal laser sintering technique.&#xD;
&#xD;
Preparation of the samples:&#xD;
&#xD;
After applying a coat of Vaseline on the inner walls of cylindrical metallic die into which modelling wax was melted. The solidified wax blocks were used as a mould. With the help of Vernier calliper (fixed at 1 inch/2.5cm), 2 perpendicular lines were drawn to mark the centre, where implant analogues were fitted. Impression transfer was attached to the analogue and with the help of a surveyor, the parallelism of the implant analogue was checked.&#xD;
&#xD;
A total of 20 samples were made similarly. All the moulds were acrylized in cold-cure acrylic resin. Tissue-level implant abutment with the shoulder was then placed over each analogue (Fig. 1).&#xD;
&#xD;
Grouping of samples: &#xD;
&#xD;
The prepared 20 samples were divided into two groups (n=10): &#xD;
&#xD;
&#xD;
	&#xD;
	Group A- Lost-Wax technique (LW)&#xD;
	&#xD;
	&#xD;
	Group B- Direct Metal Laser sintering technique (DMLS)&#xD;
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&#xD;
&#xD;
After grouping samples were numbered from 1 to 10 into groups (Group A: GA1-GA10 and Group B: GB1-GB10) respectively.&#xD;
&#xD;
The acrylic block samples were collected and points were marked over the shoulder of the abutment on 4 aspects that is, distal (D), mesial (M), lingual (L) and buccal (B) using diamond needle bur (Fig. 1).&#xD;
&#xD;
Preparation of wax pattern: &#xD;
&#xD;
The prepared samples were scanned with an extraoral scanner (Medit) (Fig. 2) Wax patterns for mandibular first molar were prepared for Group A using Computer Assisted Designing system (Exocad) to maintain a uniform thickness. The uniform cement gap was maintained at 0.02 mm from the top and 0.05 mm from the margins of the wax patterns. After the design was finalised, the STL (standard tessellation language) file was transferred to the Computer Assisted Milling system (Arum; Doowon) &#xA0;for milling.&#xD;
&#xD;
Preparation of Metal Copings:&#xD;
&#xD;
Group A (Lost-Wax):&#xD;
&#xD;
The casting was done with Ni-Cr alloy, the copings were checked for surface roughness. Air-borne abrasion material, (Al2O3 abrasive particles in sandblasting machine) and finishing &amp; polishing were done.&#xD;
&#xD;
Group B (DMLS):&#xD;
&#xD;
The CAD design prepared for Group A copings were used for copings of Group B. DMLS machine (HBD-100D) was used which included pre-sintered Co-Cr metal powder and laser beam. After the procedure was completed, the metal copings were retrieved and surface treated for a smooth surface with Al2O3 abrasive particles in sandblasting machine. The finished metal copings were then ready for ceramic application (Fig 3, 4).&#xD;
&#xD;
Ceramic application:&#xD;
&#xD;
Ceramic was applied over all the samples, imitating mandibular first molar crowns.&#xD;
&#xD;
Two-paste auto-mix system Resin-Modified Glass Ionomer Cement (RM-GIC) was was used to cement the crowns over abutments under constant finger pressure. Once the fit was ensured to be satisfactory, the samples were checked using a stereomicroscope at 65X at the marked 4 points. At each point, three readings were taken with the digital analyser. The readings at each point, were numbered (example: for point L- L1, L2, L3 and so on) and were tabulated accordingly.&#xD;
&#xD;
All the data were recorded and tabulated and statistical analysis was carried out using a t-test.&#xD;
&#xD;
RESULTS &#xD;
&#xD;
The readings obtained for each sample at each aspect were obtained and interpreted using a t-test. Based on readings and results obtained via t-test, the comparison was made for both the groups for individual aspects.&#xD;
&#xD;
For all the three readings obtained for all the samples at four aspects, the mean was calculated aspect-wise for each sample and the mean reading was put for the comparative analysis.&#xD;
&#xD;
At the Lingual (L) aspect, the t-test results (Table 1) show higher mean values for samples prepared under Group A (lost-wax technique) as compared to samples prepared under group B (DMLS technique). This implies less discrepancy at margins for the Group B samples, inferring Group B (DMLS technique) to be better than Group A (Graph 1).&#xD;
&#xD;
At Buccal (B) aspect, the t-test results (Table 2) show higher mean values for samples prepared under Group A (lost-wax technique) as compared to samples prepared under group B (DMLS technique). This implies less discrepancy at margins for the Group B samples, inferring Group B (DMLS technique) to be better than Group A (Graph 2).&#xD;
&#xD;
At the Mesial (M) aspect, the t-test results (Table 3) show higher mean values for samples prepared under Group A (lost-wax technique) as compared to samples prepared under group B (DMLS technique). This implies less discrepancy at margins for the Group B samples, inferring Group B (DMLS technique) to be better than Group A (Graph 3).&#xD;
&#xD;
At Distal (D) aspect, the t-test results (Table 4) show higher mean values for samples prepared under Group A (lost-wax technique) as compared to samples prepared under group B (DMLS technique). This implies less discrepancy at margins for the Group B samples, inferring Group B (DMLS technique) to be better than Group A (Graph 4).&#xD;
&#xD;
The mean values obtained for individual points are tabulated (Table 5). They show a comparison between each point as well as both the groups (Graph 5). The mean readings for group A are higher than the mean readings of Group B.&#xD;
&#xD;
The mean readings of the individual four aspects are depicted. This graph clearly shows the higher mean values for Group A (lost wax) as compared to Group B (DMLS).&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
The first permanent tooth to erupt in the oral cavity are mandibular first molars and are most often the first to be lost by the carious decay.5,7 It can be considered that an important role is being played by the first molars which no other tooth in the dental arches play.8&#xD;
&#xD;
The distinctiveness of the implant dentistry is restoring the functions, esthetics, comfort of the patient at the edentulous site regardless of atrophy, or any disturbance in the stomatognathic system.9&#xD;
&#xD;
For clinical acceptability of the fixed prosthesis (crowns), the marginal fit is one of the most important criteria. Dr. William H. Taggart in 1907 introduced the lost-wax casting technique for casting alloys.&#xD;
&#xD;
Since 19th century, CAD/CAM had put its feet into the dental industry. Dr. Duret was the first person to develop a dental CAD/CAM device. CAD-CAM has different forms of processing: subtractive (milling) and additive (DMLS). &#xD;
&#xD;
The present in-vitro study evaluates and compares the marginal fit of single implant-supported metal-ceramic crowns fabricated using conventional lost wax and DMLS techniques. A total of 20 single-implant supported mandibular first molar (#46) Porcelain fused to Metal (PFM) crowns samples were prepared.10&#xD;
&#xD;
After conducting the study, results showed significantly lower values for the Group B samples (39.23 &#xB5;m) that were fabricated with Direct Metal Laser Sintering (DMLS technique) as compared to Group A samples (56.48 &#xB5;m) fabricated with Lost-Wax technique, implying DMLS technique to produce better marginal fit of the prosthesis as compared to Lost-wax technique.&#xD;
&#xD;
The results of our study disagree with that conducted by Park J.K et al., Ullattuthodi S et al., Nesse H et al., &#xA0;and Katsoulis et al.11-14 All these researchers concluded in their studies that the conventional casting or lost-wax technique for fabrication of copings is better than CAD-CAM or DMLS technique. &#xD;
&#xD;
League R.C et al., Ortorp A et al., Suleiman S.H et al., Kilicarslan M.A et al., Harish V et al., Sundar et al. performed a study comparing laser sintering technique and lost-wax technique for fabricating metal copings.15-20 They all concluded in their study that DMLS provided less marginal gap and better internal fit for the copings. Similarly, Lovgren et al., Sharma M et al., Keles M et al., Gaikwad B.S et al., and Arora A et al., performed similar comparative studies.21-25 Likewise, they all concluded in their studies that DMLS fabricated better-fitted prosthesis as compared to lost wax or other fabrication techniques that were kept in comparison groups. So, these studies showed results that were in favour of the present study.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
The results revealed that the crowns fabricated by the DMLS technique provided better marginal fit as compared to the crowns fabricated by the Lost-Wax technique.&#xD;
&#xD;
Conflict of interest: nil&#xD;
&#xD;
Source of funding: self&#xD;
&#xD;
Authors contribution&#xD;
&#xD;
&#xD;
	&#xD;
	DR. Harshita NARANG- data collection&#xD;
	&#xD;
	&#xD;
	DR. Urvashi SUKHIJA- manuscript writing&#xD;
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&#xD;
&#xD;
&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3907</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3907</Fulltext></URLs><References>&#xD;
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	Brantigan JW, Brantigan John W. Prosthetic implant. United States patent US 4,834,757. 1989;30:1-7. &#xD;
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	Zaghloul HH, Younis FJ. Marginal Fit of Implant-Supported All-Ceramic Zirconia Frameworks. J Oral Imp. 2013;39(4):417-2&#xD;
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	Holden JE, Goldstein GR, Hittelman EL, Clark EA. Comparison of the marginal fit of pressable ceramic to metal-ceramic restorations. J Prosthodont. 2009;18(8):645-8. &#xD;
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	Anusavice KJ, Shen C, Rawls HR, editors. Phillips&amp;#39; science of dental materials. Elsevier Health Sciences. 2012;11th ed. 564-620. &#xD;
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	Shi X, Chang L, Zou G. Marginal adaptation of metal crowns: comparison of two production methods. Chinese J Tissue Eng Res. 2014;1(25):4014-19.&#xD;
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	Moore WD. The First Permanent Molar. J Am Dent Assoc. 1927;1;14(7):1213-221. &#xD;
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	Resnik R. Misch&amp;#39;s Contemporary Implant Dentistry E-Book. Elsevier Health Sciences; 2020;4th ed.1-30.&#xD;
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	Chen CJ, Papaspyridakos P, Guze K, Singh M, Weber HP, Gallucci GO. Effect of Misfit of Cement-Retained Implant Single Crowns on Crestal Bone Changes. Int J Prosthodont. 2013;1;26(2):135-137.&#xD;
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	Park JK, Lee WS, Kim HY, Kim WC, Kim JH. Accuracy evaluation of metal copings fabricated by computer-aided milling and direct metal laser sintering systems. J Adv Prosthodont. 2015;1;7(2):122-128. &#xD;
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	Ullattuthodi S, Cherian KP, Anandkumar R, Nambiar MS. Marginal and internal fit of cobalt-chromium copings fabricated using the conventional and the direct metal laser sintering techniques: A comparative in vitro study. J Indian Prosthodont Soc. 2017;17(4):373-380.&#xD;
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	Nesse H, Ulstein DM, Vaage MM, Oilo M. Internal and marginal fit of cobalt-chromium fixed dental prostheses fabricated with 3 different techniques. J Prosthet Dent. 2015;1;114(5):686-92. &#xD;
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	Katsoulis J, MericskeStern R, Enkling N, Katsoulis K, Blatz MB. In vitro precision of fit of computer?aided designed and computer?aided manufactured titanium screw-retained fixed dental prostheses before and after ceramic veneering. Clin Oral Impl Res. 2015;26(1):44-49. &#xD;
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	Oyague R.C, Lynch CD, Turrion AS, Lopez-Lozano JF, Torres-Lagares D, et al. Misfit and microleakage of implant-supported crown copings obtained by laser sintering and casting techniques, luted with glass-ionomer, resin cement and acrylic/urethane-based agents. J Dent. 2013;1;41(1):90-6.&#xD;
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	Ortorp A, Jonsson D, Mouhsen A, Von Steyern PV. The fit of cobalt-chromium three-unit fixed dental prostheses fabricated with four different techniques: A comparative in vitro study. Dent Mater. 2011;1;27(4):356-363. &#xD;
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	Suleiman SH, Vult von Steyern P. Fracture strength of porcelain fused to metal crowns made of cast, milled or laser-sintered cobalt-chromium. Acta Odontol Scand. 2013;1;71(5):1280-1289. &#xD;
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	Kilicarslan MA, Ozkan P, Uludag B, Mumcu E. Comparison of internal fit between implant abutments and cast metal crowns vs. laser-sintered crowns. J Contemp Dent Pract. 2014;1;15:428-32. &#xD;
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	Harish V, Mohamed Ali SA, Jagadesan N, Mohamed Ifthikar SS, Debasish Basak FH. Evaluation of internal and marginal fit of two metal-ceramic systems&#x2013;In vitro study. J Clin Diag 2014;8(12):1-12. &#xD;
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	Sundar MK, Chikmagalur SB, Pasha F. Marginal fit and microleakage of the cast and metal laser sintered copings&#x2014;An in vitro study. J Prosthodont Res. 2014;58(4):252-258. &#xD;
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	Lovgren N, Roxner R, Klemendz S, Larsson C. Effect of production method on surface roughness, marginal and internal fit, and retention of cobalt-chromium single crowns. J Prosthet Dent. 2017;1;118(1):95-101. &#xD;
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	Sharma M, Bansal A, Panthi S, Malik SS, Sharma A. To Evaluate the Marginal Fit of Metal Copings Fabricated by Conventional Casting Procedure and Direct Metal Laser Sintering Technology&#x2013;An In Vitro Study. Dent J Adv Stud. 2017;5(01):39-46. &#xD;
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	Keles MA, Turker SB. In Vitro Gap Changes After Porcelain Firing Cycles of Three and Four Unit of CAD/CAM Milling, Laser Sintering and Cast Metal-ceramic Restorations. Clin Exp Health Sci. 2019;9(3):271-277. &#xD;
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	Gaikwad BS, Nazirkar G, Dable R, Singh S. Comparative evaluation of marginal fit and axial wall adaptability of copings fabricated by metal laser sintering and lost-wax technique: An in vitro study. J Indian Prosthodont Soc. 2018;18(1):47-52. &#xD;
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	Arora A, Yadav A, Upadhyaya V, Jain P, Verma M. Comparison of marginal and internal adaptation of copings fabricated from three different fabrication techniques: An in vitro study. J Indian Prosthodont Soc. 2018;18(2):102-107. &#xD;
	&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>An In Vitro Assessment of Retention Force for Implant-Retained Overdentures Using All-Polyetheretherketone, Zirconia, and Titanium Attachments&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>75</FirstPage><LastPage>78</LastPage><AuthorList><Author>Mahalakshmi Gujjalapudi</Author><AuthorLanguage>English</AuthorLanguage><Author> Amit Kumar Verma</Author><AuthorLanguage>English</AuthorLanguage><Author> Swaroopkumar M Magar</Author><AuthorLanguage>English</AuthorLanguage><Author>  Doddy Lokanathan Balaji</Author><AuthorLanguage>English</AuthorLanguage><Author> Gagandeep Singh Dang</Author><AuthorLanguage>English</AuthorLanguage><Author> Atul Bhardwaj</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Numerous problems were described by complete denture wearers for example lack retention and stability of these dentures, thus decreasing chewing efficacy, and pain during mastication. These problems can be effectively overwhelmed with implant-assisted overdentures. Objectives: This study was done to assess the retention forces of all-zirconia (ZrO2 ), all-polyetheretherketone (PEEK), and titanium for two implant-retained mandibular overdentures. Materials and Methods: In each model, twenty-four similar acrylic resin mode positioned at the canine area. Models were categorized into 4 groups of 7 samples in each group; all all-zirconia (ZrO2 ), all-polyetheretherketone (PEEK), titanium and a combination of PEEK with zirconia. Alike experimental overdentures were prepared for all models. A universal testing machine was used for assessing the retention force, using the pull-off test in the existence of artificial saliva in-between the crowns. A higher score of retention force was noted at the beginning and after 540 cycles of insertion and elimination which mimicking 6 months of the clinical outcome of final retention. Obtained results were statistically evaluated. Results: Zirconia group conveyed the greatest initial force values. A combination of zirconia and PEEK was found to be effective. The final retention values of the PEEK and Zirconia groups were significantly decreased than initial values, while the insignificant loss of retention was observed with the Titanium group (P = 0.05). Conclusion: Zirconia (ZrO2 ) with PEEK combination is more preferred as a secondary telescopic. Despite the retention loss with time, even PEEK can be recommended as a secondary telescopic crown beside PEEK or ZrO2 primary crowns concerning the adequate early and final retention scores.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>PEEK, Retention force, Telescopic attachment, Zirconia</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Numerous problems were described by complete denture wearers for example lack retention and stability of these dentures, thus decreasing chewing efficacy, and pain during mastication. These problems can be effectively overwhelmed with implant-assisted overdentures.1&#xD;
&#xD;
Resilient telescopic supplements have been used since 1989, to retain overdentures for rehabilitation of the edentulous mandible. In cases of overdenture for long term success, two interforaminal implants with resilient telescopic attachments appeared to be an effective and efficient treatment option in cases of the severely atrophied edentulous mandible.2&#xD;
&#xD;
In 2000 using ceramic materials for the fabrication of telescopic attachments was first defined.&#xA0;Zirconia (ZrO2) is a ceramic material that is largely used in current years for medical devices, displaying excellent mechanical strength, high biocompatibility, and wear resistance. The use of tooth-coloured ceramic materials display a positive psychological outcome on patients and upholds improvements in oral hygiene.3&#xD;
&#xD;
Polyetheretherketone (PEEK) is a thermoplastic polymer, comprise of a molecular chain from an aromatic backbone that is connected by ketone and ether function group.4&#xA0;PEEK exhibits high biocompatibility and can be used for numerous dental conditions, such as dental implants, and provisional abutments.5,6&#xA0;&#xA0;&#xD;
&#xD;
The present study was done to evaluate the retention force of different CAD/CAM telescopic attachments (zirconia, PEEK, and titanium telescopic attachments) for retention of mandibular implant overdenture.&#xD;
&#xD;
MATERIALS AND METHOD&#xD;
&#xD;
In the present study twenty-one, acrylic resin models of edentulous mandible without alveolar undercuts were used. Every model was surrounded by a 2 mm layer of silicon soft liner material to mimic alveolar mucosa in accordance to El-Charkawi&#xA0;et al.7&#xA0;Two implants with 10 mm length and 4.5 mm diameter (dentium implants) were mounted in the canine area of the respective model with the help of a template guide,8&#xA0;later two dual abutments with 4.5 diameters, 1.5 gingival height and 4.5 lengths, were positioned into the implants. For overdenture construction, the resin models were duplicated. Models were divided into 4 groups; group zirconia, PEEK, titanium and PEEK+ zirconia materials.&#xD;
&#xD;
Fabrication and designing and of telescopic attachments&#xD;
&#xD;
Primary resilient telescopic crown construction was done with the succeeding parameters for all groups; 5 mm height (2 mm gingival height was paralleled and the occlusal 3 mm was tapered 4&#xB0;). The primary crowns were intended to ensure a shared path of insertion. The computer numeric control data were preserved as STL files. From semi-sintered ZrO2&#xA0;blanks (ZrO2, Kataya) the primary ZrO2&#xA0;crowns were milled and from BioHPP blanks (Bredent, UK) the primary PEEK crowns were milled. Using zinc phosphate cement on an abutment the primary crowns were cemented.&#xD;
&#xD;
Secondary resilient telescopic crown construction was done by scanning each model, followed by separate scans of each primary crown to improve the quality of data. The subsequent parameters were employed for designing secondary crowns; parallel walls with a minimal wall thickness of 0.5 mm and occlusal space (0.3 mm) built-in between the primary and secondary crowns.2&#xA0;Mechanical projections were added to the design of each secondary crown, and later secondary ZrO2&#xA0;and PEEK crowns were adopted.&#xD;
&#xD;
Secondary crown procedures&#xD;
&#xD;
The fitting area was altered by creating vent holes through the lingual flanges of each overdenture. Secondary crowns were built-in over the primary ones in the correct path of insertion and then picked up to the fitting surface of the overdenture using an auto polymerized acrylic resin. &#xD;
Measurement of retention force&#xD;
&#xD;
With auto polymerized acrylic resin a metallic cobalt chrome bar (2 mm, 15 mm, and 120 mm), with a grasping hook in the middle, was covered. 9 For measuring the retention force, models were placed and fixed in a universal testing machine (LLOYD instruments)&#xA0;then a pull-off test was performed with a load cell of 3.5 KN and a crosshead speed of 50 mm/min. Overdenture with each combination of secondary and primary telescopic crowns was exposed to 540 cycles of enclosure and exclusion representing 6 months of clinical service under the same circumstances. Then, the pull-off test was achieved again to assess the final retention.&#xD;
&#xD;
The obtained data were tabulated and statistically evaluated using the SPSS version 21(SPSS Inc., Chicago, Illinois, USA) using Shapiro&#x2013;Wilk test, Independent samples test, ANOVA was used followed by the&#xA0;post hoc&#xA0;Tukey test. P-value was lesser than 0.05 measured as statistically significant.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Table 1 indicated, the average values of initial and final retention values (telescopic attachment) in all groups. The highest mean initial retention value for all groups was observed in Group-I where the mean initial retentive force was 21.2550 N and the final one was 16.1140 N. However, mean initial retentive forces of group 2 (Titanium) and 3 (PEEK) 14.6310 N and 15.3530 N respectively and their final retentive forces were 14.4160N and 14.0470 N respectively. Group IV for the combination of Zirconia+ PEEK showed initial forces as 17.3430 N and 16.0340 N final forces.&#xD;
&#xD;
Comparison of mean values between initial and final retention values within each group using paired&#xA0;t-test&#xA0;showed that the final retention value for the PEEK and Zirconia and Zr+PEEK was significantly decreased by time (P&#xA0;= 0.0001, 0.0000 and 0.0001) respectively), but no significant loss in retention force value was observed for the titanium group where&#xA0;P&#xA0;= 0.057.&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Table 2 indicated the Initial and final retention values comparison among all groups. There was a significant variance in both initial and final retentions between every two groups using the Independent samples test.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
For achieving clinical performance and patient satisfaction of the prosthesis, it is necessary to maintain retention of the attachment system.3&#xD;
&#xD;
In the present study, the highest mean initial retention values were found in the Zirconia group followed by PEEK. Our results are in agreement with the&#xA0;in vitro&#xA0;study of Schubert&#xA0;et al.;10&#xA0;they observed that CAD-CAM fabricated PEEK secondary crowns can deliver sufficient retention force values.&#xD;
&#xD;
Final retention values of PEEK and Titanium groups were significantly decreased than initial values, while insignificant loss of retention was observed with the zirconia group; this may be owing to wear and alteration in surface topography of the secondary and primary crowns opposing areas. It was described that, during the function of telescopic attachment, frictional wear can occur.11,12&#xD;
&#xD;
Emera&#xA0;et al., assessed the changes in surface topography of all ZrO2, ZrO2-PEEK and all PEEK, telescopic attachments after simulated 6 months of using the overdenture.13 They determined that the PEEK and ZrO2&#xA0;combination for the fabrication of telescopic attachment was attended with superior variations in surface topography (mostly in secondary crowns) in association with all PEEK and all ZrO2&#xA0;telescopic connections.14, 15&#xD;
&#xD;
A significant change among the initial and final retention between all groups was observed due to significant wear that occurred in all groups after simulating 6 months of overdenture.16&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
It can be concluded that ZrO2&#xA0;is further desired as a secondary telescopic crown. Although the loss of retention over time, PEEK can still be used as a secondary telescopic crown against titanium&#xA0;or PPEK primary crowns regarding the acceptable initial and final retention values.&#xD;
&#xD;
Conflict of interest: nil&#xD;
&#xD;
Source of funding: self&#xD;
&#xD;
Authors contribution&#xD;
&#xD;
&#xD;
	&#xD;
	Dr. Gujjalapudi&#xA0; M- Editing&#xD;
	&#xD;
	&#xD;
	Dr. Amit Verma- Manuscript writing&#xD;
	&#xD;
	&#xD;
	Dr. Swaroopkumar M Magar- Data collection, investigation&#xD;
	&#xD;
	&#xD;
	Dr. Balaji- Review&#xD;
	&#xD;
	&#xD;
	Dr. Gagandeep Singh Dang- Review&#xD;
	&#xD;
	&#xD;
	Dr. Atul Bhardwaj- Editing&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3908</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3908</Fulltext></URLs><References>&#xD;
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	Heckmann SM, Schrott A, Graef F, Wichmann MG, Weber HP. Mandibular two-implant telescopic overdentures. Clin Oral Implants Res. 2004;15:560-569.&#xD;
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	Weigl P, Hahn L, Lauer HC. Advanced biomaterials used for a new telescopic retainer for removable dentures. J Biomed Mater Res. 2000;53:320-336.&#xD;
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	Kurtz SM, Devine JN. PEEK biomaterials in trauma, orthopaedic, and spinal implants. Biomater. 2007;28:4845-4869.&#xD;
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	Merk S, Wagner C, Stock V, Eichberger M, Schmidlin PR, et al. Suitability of secondary PEEK telescopic crowns on zirconia primary crowns: The influence of fabrication method and taper. Materials. 2016;9:908-917.&#xD;
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	Stock V, Wagner C, Merk S, Roos M, Schmidlin PR,&#xA0;et al. Retention force of differently fabricated telescopic PEEK crowns with different tapers. Dent Mater J. 2016;35:594-600.&#xD;
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	El-Charkawi H, Zekry K, Elwaked M. Stress analysis of different osseointegrated implants supporting distal extension prosthesis. J Prosthet Dent. 1994;72: 1-5.&#xD;
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	Ebadian B, Talebi S, Khodaeian N, Farzin M. Stress analysis of mandibular implant-retained overdenture with independent attachment system: Effect of restoration space and attachment height. Gen Dent. 2015;63:61-67.&#xD;
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	El Mekawy N, Khalifa A, Abdualgabbar E. The influence of palatal coverage on the retention force and fatigue resistance of mini dental implant maxillary overdenture. J Oral Hyg Health. 2016;4:200-208.&#xD;
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	Schubert O, Reitmaier J, Schweiger J, Erdelt K, G&#xFC;th JF. The retentive force of PEEK secondary crowns on zirconia primary crowns over time. Clin Oral Investig. 2019;23:2331-2338.&#xD;
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	Bayer S, Kraus D, Keilig L, G&#xF6;lz L, Stark H, Enkling N. Wear of double crown systems: Electroplated vs. casted female part. J Appl Oral Sci. 2012;20:384-391.&#xD;
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	Majcher A, Le?niewska-Kochanek A, Mierzwi?ska-Nastalska E. A method and a device for the evaluation of the retention of telescopic dental crowns. J Mech Behav Biomed Mater. 2017;69:362-367.&#xD;
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	Emera R, Elgamal M, Albadwei M. Surface wear of all zicronia, all PEEK and zirconia-peek telescopic attachments for two implants retained mandibular complete overdentures.&#xA0;In -vitro&#xA0;study using the scanning electron microscope. IOSR J Dent Med Sci. 2019;18:59-68.&#xD;
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	Turp I, Bozda? E, S&#xFC;nb&#xFC;lo?lu E, Kahruman C, Yusufo?lu I, Bayraktar G. Retention and surface changes of zirconia primary crowns with secondary crowns of different materials. Clin Oral Investig. 2014;18:2023-2035.&#xD;
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	Rutkunas V, Mizutani H, Takahashi H. Influence of attachment wear on retention of mandibular overdenture. J Oral Rehabil. 2007;34:41-51.&#xD;
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	Lughi V, Sergo V. Low-temperature degradation &#x2013; ageing &#x2013; of zirconia: A critical review of the relevant aspects in dentistry. Dent Mater. 2010;26:807-820.&#xD;
	&#xD;
&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Urinary Tract Infections Among Patients of Bladder Outlet Obstruction&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>79</FirstPage><LastPage>84</LastPage><AuthorList><Author>Shakya BK</Author><AuthorLanguage>English</AuthorLanguage><Author> Jindal RP</Author><AuthorLanguage>English</AuthorLanguage><Author> Sahota SK</Author><AuthorLanguage>English</AuthorLanguage><Author> Jindal N</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Bladder outlet obstruction (BOO) is defined as blockage at the neck of the urinary bladder. This is one of the most common conditions in elderly men. BOO results from several etiologies, which may be functional or anatomic. However, the main cause of BOO remains benign prostatic hyperplasia (BPH), secondary to BOO and carcinoma prostate. The complication of BOO can be devastating and long term. The resulting obstruction frequently produces lower urinary tract symptoms (LUTS) and becomes the main cause of lower urinary tract infections (LUTI). Material and Methods: In this cross-sectional study, a total of 100 consecutive patients of BOO who presented to our tertiary care hospital were enrolled in this study. After recording the demographic profile their mid-stream urine samples were collected and cultured for bacterial pathogens. The bacterial isolates were identified using standard microbiological methods and tested against a wide spectrum of antimicrobial agents using Kirby Bauer&#x2019;s method following the Clinical &amp; Laboratory Standards Institute (CLSI) guidelines. Results: Out of the 100 patients studied, 78% had BPH, and urine culture was positive in 74%. Most of these patients were more than 50 years of age group (90.5%) (Mean age= 61.2 years). There were 97.3% males and 2.7% of females. BPH was the most common cause of UTI as compared to the other causes of BOO (p=0.00001). Escherichia coli 46(62.1%) was the most common uropathogen causing UTI followed by Klebsiellapneumoniae 12(16.2%), Pseudomonas aeruginosa 10(13.5%), and the gram-positive organisms (Staphylococcus aureus, CoNS, Enterococcus faecalis 2.7% each). The study of their antimicrobial susceptibility showed that antimicrobial resistance to two or more drugs was present in the gram-negative (68/74) and grampositive (6/74) isolates. Conclusion: The present study shows that BPH continues to be the most frequent cause of BOO. There is a high prevalence of UTI in these patients which is caused by multidrug-resistance organisms. This study has important implications in the treatment of urinary tract infections among BOO patients in our region.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Bladder outlet obstruction (BOO), Benign prostatic hyperplasia (BPH), Multidrug-resistant (MDR), Urinary tract infection  (UTI), Lower urinary tract syndrome (LUTS), Uropathogens</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Bladder outlet obstruction (BOO) is defined as blockage at the neck of the urinary bladder. This is one of the most common conditions in elderly men.1As the age expectancy is increasing the number of men affected by BOO is expected to rise. The greatest increase is anticipated in developing countries like India.2 BOO results from several etiologies, which may be functional or anatomic. The various reported causes of BOO are benign prostatic hyperplasia (BPH), carcinoma prostate, bladder stone, bladder carcinoma, posterior urethral valve, dysfunctional voiding, neurogenic-based detrusor-sphincter dyssynergia (DSD), bladder neck stenosis and obstruction from stress urinary incontinence surgery.3-4 However, the main cause of BOO remains benign prostatic enlargement, secondary to BPH and carcinoma prostate. BPH is a condition inevitably associated with ageing. Fifty per cent of men over the age of 40 develop BPH.5-6 In contrast, BOO is a poorly understood condition in females. It is much rare in them as compared to males and has the aetiology of bladder neck stenosis, urethral stricture, urethral diverticulum and retroverted uterus.7&#xD;
&#xD;
The Complication of BOO can be devastating and long term.&#xA0; BOO can permanently damage all parts of the urinary system.8The obstruction frequently produces lower urinary tract symptoms (LUTS) which can have a significant negative impact on the quality of life.9-11 There is urine stasis from incomplete voiding and the resultant residual urine serves as the medium for bacterial growth which leads to urinary tract infection (UTI). Lower UTI involves infections from the urinary bladder downward and includes urethritis, cystitis and prostatitis. Asfo-Adjeiet al. reported a 76.6 % incidence of urinary tract infections among their BOO patients and the main risk factor identified was catheterization.12 Most of these infections are caused by a few genera of the family Enterobacteriaceae and the common uropathogens reported are Escherichia coli, Pseudomonas spp., Staphylococcus aureus, Enterococcus species, Klebsiella spp. and Proteus spp.13-15 The microbes causing infection differ in their susceptibility towards various antimicrobial drugs from place to place and time to time. The emergence of multiple drug resistance strains causing UTI is also escalating. It is a big challenge in our country because of the irrational use of antibiotics.&#xD;
&#xD;
Hence, the present study was undertaken with aim of determining the proportion of UTI and various uropathogens causing it in the clinically suspected patients of BOO attending the urology department of our tertiary care centre. There is a paucity of such studies from this area of Punjab (North India).&#xD;
&#xD;
MATERIAL AND METHODS&#xD;
&#xD;
This prospective cross-sectional study was conducted on a total of 100 consecutive patients of&#xA0;&#xA0; BOO who were attending the urology department of our tertiary care centre. Ethical approval of this study was obtained from the institutional review committee (BFUHS/2K19p-TH/8906). After recording the demographic profile of the patients in the prescribed Performa, their urine samples were collected, using all the sterile precautions.&#xD;
&#xD;
The patients were asked to collect midstream urine samples in sterile containers, which were transported to the microbiology department within 2 hours of collection. The urine specimen was processed within 30 minutes of arrival in the laboratory. Specimens were initially inoculated on a standard culture media, Cystine&#x2013;Lactose&#x2013;Electrolyte-Deficient (CLED) agar, using a standard calibrated loop. Following incubation in an ambient air incubator at 35-370 C for 18 hours colonies were counted and counts of &#x2265;105 CFU/mL were assessed as significant bacteriuria. The bacterial growth was identified based on their colonial morphology, Gram&#x2019;s staining, and biochemical reactions which included the Catalase test, slide and tube Coagulase test, Oxidase test, Indole test, MR test, Citrate utilization test, Triple sugar iron test (TSI). Oxidation/fermentation test, Urease test, Nitrate reduction test, VP (Voges-Proskauer) test.16-17The isolated and identified colonies were then tested for antimicrobial susceptibility on Mueller Hinton agar using the Kirby-Bauer disc diffusion method according to Clinical Laboratory Standard Institute (CLSI) guidelines.18 The antibiotic discs and their concentration used in the study were Ampicillin (2&#xB5;g), Cefoxitin (30&#xB5;g), Cefotaxime (30&#xB5;g), Ceftriaxone (30&#xB5;g), Ceftazidime (30&#xB5;g), Cefepime (30&#xB5;g), Gentamicin (10&#xB5;g), Amikacin (30&#xB5;g), Imipenem (10&#xB5;g), Norfloxacin (10&#xB5;g), Ciprofloxacin (10&#xB5;g), Levofloxacin (10&#xB5;g), Piperacillin-Tazobactam (100/10&#xB5;g), Amoxicillin-Clavulanic acid (30&#xB5;g/10&#xB5;g), Nitrofurantoin (300&#xB5;g), Vancomycin (30&#xB5;g), Linezolid (30&#xB5;g), High-level Gentamicin (120&#xB5;g), Colistin/Polymyxin B (100 unit) for Staphylococci, MIC (minimum inhibitory concentration) of Vancomycin was determined and value of &#x2264;2 &#xB5;g/ml was considered as sensitive.&#xD;
&#xD;
Data so obtained was analyzed using Microsoft Excel software and Statistical Package for the Social Sciences (SPSS). The Chi-square test was employed to study the association of current LUTI status with other factors. The variables were compared using cross-tabulation statistical methods and the p-value </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3909</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3909</Fulltext></URLs><References>&#xD;
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	Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. The J Urolo. 1984 Sep 1;132(3):474-9.&#xD;
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	Irwin DE, Kopp ZS, Agatep B, Milsom I, Abrams P. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. Bri J Urol Int. 2011 Oct;108(7):1132-8.&#xD;
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	Wein AJ, Levin RM, Barrett DM. Voiding function: relevant anatomy, physiology and pharmacology. In: Gillenwater JY, Grayhack JT, Howards SS, Duckett JD editors. Adult and Pediatric Urology.1st ed. Chicago: Yearbook Medical Publishers; 1987. p.800-62.&#xD;
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	Dmochowski RR. Bladder outlet obstruction: etiology and evaluation.&#xA0;Rev Urol. 2005;7Suppl 6:S3-13.&#xD;
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	H&#xF8;lund B. Latent prostatic cancer in a consecutive autopsy series. Scand J Urol Nephrol. 1980 Jan 1;14(1):29-35.&#xD;
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	Franks LM. Benign nodular hyperplasia of the prostate- a review. Ann R CollSurg Engl. 1953;14(2):92-106.&#xD;
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	Carr LK, Webster GD. Bladder outlet obstruction in women.&#xA0; Urol Clin Nor Ame. 1996 Aug 1;23(3):385-91.&#xD;
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	Shetty A, Pandit A, Majeed A. Incidence and aetiology of bladder outlet obstruction in Mangalore, Karnataka. Ame Health Ssc. 2014;1(1):65-7.&#xD;
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	Gyasi-Sarpong CK, Nkrumah B, Yenli EM, Appiah AA, Aboah K, Azorliade R et al. Resistance pattern of uropathogenic bacteria in males with lower urinary tract obstruction in Kumasi, Ghana. Afr J Microbiol Res. 2014 Sep;8(36):3324-9. &#xD;
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	Coyne KS, Sexton CC, Irwin DE, Kopp ZS, Kelleher CJ, Milsom I. The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study. Bri J Urol Int. 2008;101:1388-95.&#xD;
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	Irwin DE, Milsom I, Kopp Z, Abrams P. Symptom bother and healthcare-seeking behaviour among individuals with overactive bladder. Eur Urol. 2008;53:1029&#x2013;37&#xD;
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	Asafo-Adjei K, Mensah JE, Labi AK, Dayie NT, Donkor ES. Urinary tract infections among bladder outlet obstruction patients in Accra, Ghana: aetiology, antibiotic resistance, and risk factors. Dis. 2018 Sep;6(3):65.&#xD;
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	Gupta V, Yadav A, Joshi RM. Antibiotic resistance pattern in uropathogenic. Ind J Med Microb. 2002 Apr 1;20(2):96.&#xD;
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	Collee JG, Miles S, Watt B. Tests for identification of bacteria. In: Collee JG, Marmion BP, Fraser AG, Simmons A editors. Mackie and McCartney practical medical microbiology. 14th ed. London: Churchill Livingstone; 2015;131-50.&#xD;
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	Koneman EW, Allen SD, Janda WM, Schreckenberger PC, Winn WC Jr. The Enterobacteriaceae. In: Color atlas and textbook of diagnostic microbiology. 7th ed. Philadelphia: Wolters Kluwer. 2017.p.214-80.&#xD;
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	CLSI. Performance standards for Antimicrobial Susceptibility Testing. 30th ed. supplement M100. Wayne, PA: Clinical and Laboratory&#xA0;Standards&#xA0;Institute;&#xA0;2020.&#xD;
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	Gyasi-Sarpong CK, Yenli EM, Idriss A, Arhin&#xA0; AA,&#xA0; Aboah K,&#xA0; Azorliade R et al. Bacterial urinary tract infections among males with lower urinary tract obstruction at KomfoAnokye. Open J Urol. 2012;2:131-6.&#xD;
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	Katakwar P, Thakur R. Clinical study and management of bladder outlet obstruction. Int Surg J. 2017 Mar 25;4(4):1272-5.&#xD;
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	Jarvis TR, Chughtai B, Kaplan SA. Bladder outlet obstruction and BPH. Curr Blad Dysf Rep. 2014 Dec 1;9(4):372-8.&#xD;
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	Ahmad S. Pattern of urinary tract infection in Kashmir and antimicrobial susceptibility. Bangladesh Med Res Coun Bull. 2012;38(3):79-83.&#xD;
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	Hussain S. Increasing Antibiotic Resistance in the Uropathogens. Asi J Phar. 2019 Feb 9;13(01).&#xD;
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	Singh RK, Haque SS. antibiotic susceptibility patterns in commonly isolated pathogens in east Indian population. Adv Biochem Biotechn. 2019 Mar 20. &#xD;
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	Pontefract B, Madaras-Kelly K.&#xA0; Linezolid for Treatment of Urinary Tract Infections Caused by Vancomycin-resistant&#xA0;Enterococci. Open Forum Infect Dis. 2019 Oct 23;6(2):537. &#xD;
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&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Platelet and Coagulation Parameters in Pregnancy Induced Hypertension and Eclampsia -&#xA0;A Tertiary Hospital Based Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>85</FirstPage><LastPage>92</LastPage><AuthorList><Author>Sharma B</Author><AuthorLanguage>English</AuthorLanguage><Author> Arora S</Author><AuthorLanguage>English</AuthorLanguage><Author> Kumar R</Author><AuthorLanguage>English</AuthorLanguage><Author> Bali IK</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Pregnancy-induced hypertension (PIH) is defined as newly diagnosed hypertension that occurs in pregnancy after 20 weeks of gestation and disappears following delivery of the baby. The inclusion of platelet and coagulation parameters along with routine investigations helps in the early prediction of the severity of PIH and Eclampsia. Aim: To know the changes in platelet and coagulation parameters in PIH and Eclampsia which can help in timely treatment and thus can help in the reduction of maternal and perinatal deaths associated with PIH and eclampsia. Material and Methods: The study was undertaken at the Department of Pathology, Shree Guru Gobind Singh Tricentenary Medical College and Hospital, Gurugram for 1 year on 56 patients diagnosed with PIH and Eclampsia. Results were compared with 56 normotensive pregnant females. Results: Mean Bleeding Time, Clotting Time was found to be normal in all patients of PIH and Eclampsia; but Prothrombin Time, activated partial thromboplastin time were significantly found to be higher and decreased platelet counts were observed with increasing grades of PIH and Eclampsia. Conclusion: Platelet and Coagulation Parameters In Pregnancy-induced hypertension and Eclampsia &#x2013; A Tertiary Hospital Based Study.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Coagulation profile, Platelet parameters, Pregnancy-induced hypertension</Keywords><Fulltext>INTRODUCTION &#xD;
&#xD;
Pregnancy-induced hypertension (PIH) is defined as newly diagnosed hypertension that occurs in pregnancy after 20 weeks of gestation and disappears following delivery of the baby. Out of all the haematological changes that happen in PIH associated cases, thrombocytopenia is the most widely recognized haematological abnormality. The degree of thrombocytopenia increases with the severity of the disease.1&#xD;
&#xD;
The most common medical disorder associated with pregnancy is Pregnancy-induced hypertension which leads to multi-organ failure in the mother and the hallmark placental lesion in preeclampsia is acute atherosclerosis of the decidual arteries which leads to poor placental perfusion causing intrauterine growth restriction, fetal distress which can ultimately result in fetal death. Worldwide, PIH is considered a leading cause of maternal and perinatal morbidity and mortality.2&#xD;
&#xD;
Thrombocytopenia is more commonly seen in women who develop severe preeclampsia and eclampsia and women with the underlying disease of the chronic vascular system are more commonly affected with thrombocytopenia. Pre-eclampsia is an important health issue that needs to be dealt especially in developing countries.3-6&#xD;
&#xD;
Preeclampsia can be diagnosed by persistently increased blood pressure during pregnancy and also during the postpartum period with associated proteinuria associated with thrombocytopenia and kidney or liver functions derangements etc.8&#xD;
&#xD;
As per recent data according to National Health Portal, In India, the prevalence of hypertensive disorders of pregnancy was reported in 7.8% cases whereas 5.4% of the study population had associated preeclampsia. HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome and Eclampsia are the serious complications of pre-eclampsia. Preeclampsia and later development of eclampsia results in the most serious outcomes in mother and baby and are associated with vasospasm, vascular lesions in multiple organs, increased activation of platelets and subsequently cause coagulation system activation in the microvasculature.&#xD;
&#xD;
Hypercoagulability is constantly associated with hypertensive disorders of pregnancy and particularly associated with pre-eclampsia. Thus, routine coagulation profile testing is commonly required in these patients to look for any evidence of Disseminated intravascular coagulation (DIC) and HELLP syndrome.8&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
A Prospective Observational study was done on a total of 112 pregnant females with 56 Normotensive Pregnant females were taken as controls and 56 patients diagnosed with Pregnancy Induced Hypertension (PIH) as cases. Investigations were done in the Department of Pathology, FMHS, SGT Hospital, Gurugram on the cases who were admitted for delivery in the department of Obstetrics and Gynecology. The data was collected from the patients&#x2019; records. &#xD;
&#xD;
Approval for waiver of patients consent and patient information sheet was obtained from Institutional Ethical Committee since the study involved the data available in the record that were anonymized and coded to delink with any identity of the patient. 10-15&#xD;
&#xD;
Patients were divided into a total of 5 study groups: Normotensive Pregnancies Group, Gestational hypertension group, Mild Preeclampsia Group and Severe Preeclampsia Group as per Williams Obstetrics Textbook 25th edition 2018 table 40-1 classification given by American College of Obstetricians and Gynecologists and the fifth group as Eclampsia. Eclampsia is defined as preeclampsia complicated by seizures -&#xD;
&#xD;
1. Gestational Hypertension: Diagnostic criteria:&#xD;
&#xD;
New-onset hypertension developing after 20 weeks of gestation in a previously normotensive woman having BP 140/90 mmHg and without proteinuria.&#xD;
&#xD;
2. Pre-eclampsia: Diagnostic criteria:&#xD;
&#xD;
1. 20 weeks of gestation&#xD;
&#xD;
2. Blood pressure of 140/90 mmHg or greater when readings are taken twice, six hours apart. &#xD;
&#xD;
3. Proteinuria of 1+ or greater by dipstick method or &#x2265; 300mg/24h or Urine protein: creatinine ratio &#x2265;0.3.&#xD;
&#xD;
Preeclampsia is further categorized into- Mild Pre-Eclampsia with Systolic BP between 140-160 mmHg and Diastolic BP 90-110 mmHg and Severe Pre-Eclampsia with Blood Pressure greater than 160/110 mmHg and other associated signs and symptoms. 16-19&#xD;
&#xD;
Eclampsia: Preeclampsia associated with seizures.&#xD;
&#xD;
1) PERIOD OF STUDY: 1 year.&#xD;
&#xD;
2) INCLUSION CRITERIA:&#xD;
&#xD;
i) Pregnant women with more than 20 weeks of gestation with pregnancy-induced hypertension.&#xD;
&#xD;
ii) Normotensive pregnant women with more than 20 weeks of gestation.&#xD;
&#xD;
3) EXCLUSION CRITERIA:&#xD;
&#xD;
Pregnant women--&#xD;
&#xD;
i) With Pre-existing/Chronic Hypertension cases.&#xD;
&#xD;
ii) With known bleeding disorders.&#xD;
&#xD;
iii) On anticoagulant therapy.&#xD;
&#xD;
iv) In Labor.&#xD;
&#xD;
v) With established DIC.&#xD;
&#xD;
vi) Pre-existing Renal Disease.&#xD;
&#xD;
Following Routine Blood investigations were done-&#xD;
&#xD;
1. Platelet Count- By using Sysmex XN 550 Six-part Hematology analyzer.&#xD;
&#xD;
2. MPV (Mean platelet volume) &#x2013; By using Sysmex XN 550 Six-part Hematology analyzer.&#xD;
&#xD;
3. PDW (Platelet distribution width) &#x2013; By using Sysmex XN 550 Six-part Hematology analyzer.&#xD;
&#xD;
4. Bleeding time (BT) - By Duke&#x2019;s method.&#xD;
&#xD;
5. Clotting time (CT) - By Wright&#x2019;s capillary tube method.&#xD;
&#xD;
6. Prothrombin time (PT) &#x2013; By using ERBA Manhelm ECL 412.&#xD;
&#xD;
7. Activated partial thromboplastin time (aPTT) &#x2013; By using ERBA Manhelm ECL 412.&#xD;
&#xD;
STATISTICS:&#xD;
&#xD;
Statistical analyses were compiled by using Excel sheets and the data collected was transferred to the latest version of Statistical Package for Social Services (SPSS) software and the Chi-square test was used as a test of significance for categorical variables. A P-value less than 0.05 was considered statistically significant. 19,20,21&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Platelet count was found to be less than one lakh in about 3.5% of gestational hypertension patients, 16.6% cases of severe preeclampsia and was found to be less than 1 lakhs in 50 per cent of eclampsia cases. Maximum cases of gestational hypertension 82.1% and 83.3% of cases of both mild and severe preeclampsia showed platelet count between 1.0 -2.5 lakhs. The result was statistically significant as shown in Table 1 and Figure 1.&#xD;
&#xD;
Mean platelet volume (MPV) was found to be increased in 28.5% cases of gestational hypertension and increased in 44.4% of the mild preeclampsia patients and 50% of severe preeclampsia and eclampsia patients, but this increase in mean platelet volume was not found to be statistically significant as shown in Table 2 and Figure 2.&#xD;
&#xD;
Platelet distribution width (PDW) - 35.7% of cases with gestational hypertension, 33.3% of the cases with mild preeclampsia and 33.3% cases of severe preeclampsia and 25% of eclampsia cases showed results range between 12 to 14 fl. Results were not significant as shown in Table 3 and Figure 3.&#xD;
&#xD;
Prothrombin time (PT)- The mean prothrombin time of patients with gestational hypertension was 16.5 secs, mild preeclampsia patients were 17.6 secs and severe preeclampsia patients was 18.8 secs and 15 secs in the eclampsia group. 57.1% of cases with gestational hypertension, 83.3% of cases with preeclampsia and 100% cases of severe preeclampsia and eclampsia showed prolonged prothrombin time. Results were statistically significant as shown in Table 4 and Figure 4.&#xD;
&#xD;
Activated partial thromboplastin time (APTT) - The mean activated partial thromboplastin time in patients with gestational hypertension was 33.5 secs, mild preeclampsia patients were 38.7 secs and severe preeclampsia patients was 41.8 secs and 40 secs in the eclampsia group. 50% of gestational hypertension cases, 66.7% of the mild preeclampsia cases and 100% cases of both severe preeclampsia and eclampsia showed prolonged prothrombin time. There was a statistically significant difference between study groups as shown in Table 5 and Figure 5.&#xD;
&#xD;
Bleeding time (BT)- The Bleeding time was prolonged for more than 5 min in 28.5% of the gestational hypertension patients, 61.1% of the mild preeclampsia patients and 50% of the patients with severe preeclampsia and eclampsia. Results were not statistically significant as shown in Table 6 and Figure 6.&#xD;
&#xD;
Clotting time (CT) - The clotting time was more than 5 mins in 35.7% of cases of gestational hypertension and was found to be 66.67% of the mild preeclampsia patients and severe preeclampsia patients and 50% of the eclampsia study group. Results were not found to be statistically significant as shown in Table7 and Figure 7.&#xD;
&#xD;
DISCUSSION - &#xD;
&#xD;
Hypertensive disorders are the most important cause of perinatal and maternal mortality and morbidity. Cases of Pregnancy-induced hypertension develop a variety of haematological changes with thrombocytopenia being the most common haematological abnormality. &#xD;
&#xD;
The mean platelet count in our study in normal cases at term pregnancy was found to be 2.85 lakhs/cumm, in the Gestational hypertension study group was 2.01 lakhs/cumm and was 1.81 lakhs/cumm in mild preeclampsia and 1.66 lakhs/cumm in severe eclampsia cases and 1.23 lakhs/cumm in eclampsia group, indicating a significant decrease in mean platelet counts with the increasing grades of pregnancy-induced hypertension cases. Our observations were consistent with the following studies. 22-26 &#xA0;&#xD;
&#xD;
Shete et al.22 studies done in 2013 showed the mean platelet count in normal pregnancy to be 3.41 lakhs/cumm and in severe PIH and Eclampsia cases, it was 1.27 lakhs/cumm with a significant P-value </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3910</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3910</Fulltext></URLs><References>&#xD;
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	Meshram DP, Chavan YH, Kadam PN, Panchal MG, Ramteke DJ. Maternal and foetal outcomes in pregnancy induced hypertension -A hospital based study. Int J Phar Sci Invention. 2014;3:23-6.&#xD;
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	Chauhan P, Rawat U, Bisht V, Purohit RC. Comparison of coagulation profile in pre-eclamptic and eclamptic patients with normotensive pregnant patients. J Evol Med Dent Sci. 2014;3:3208-15.&#xD;
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	Leduc L, Wheeler JM, Kirshon B, Mitchell P, Cotton DB. Coagulation profile in severe preeclampsia. Obstet Gynecol. 1992;79:14-8.&#xD;
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	National health portal [Internet].Preeclampsia [ UPDATED 2016 June 01;cited 2016 june01]. Available at https://www.nhp.gov.in/disease/gynaecology-and-obstetrics/preeclampsia&#xD;
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	Agarwal S, Buradkar S. Coagulation studies in toxaemia of pregnancy. J Obstet Gynaecol Ind. 1978; 27:992-6.&#xD;
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	Chavan SS, Patil SL.Study of role of thrombocytopenia in predicting severity of Preeclampsia. Medpulse-Int Med J. 2015;2(9):557-9&#xD;
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	Nirmala T, Kumar PL, Vani BR, Murthy SV, Geetha RL. Study of coagulation profile in pregnancy-induced hypertension (PIH). Indian J Pathol and Oncol. 2015;2(1):1-6&#xD;
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	Sharma UK, Kouli R, Sonowal R, Saikia P. Coagulation parameters in pre-eclamptic and eclamptic patients - A comparative study of 90 cases. Int J Contemp Med Res. 2016;3(8):2235-8&#xD;
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	Chaware SA, Birare SD, Naigaonkar NV, Mahule SK. Comparative study of coagulation profile in Pre-Eclamptic and Eclamptic Patients with normotensive pregnant patients:2 Year Study. Int J Contemp Med Res. &#xA0;2017;6(2):445-9&#xD;
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	Sameer MA, Meshram DP, Deshpande SA, Sadhu D, Pandit S. Role of platelet count as important prognostic marker in pregnancy induced hypertension. IOSR J Dent Med Sci. 2014;13:39-43.&#xD;
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	Mohapatra D, Priyadarsini N, Behera M, Panda P, Mishra T. Hematological parameters in the assessment of pregnancy induced hypertension. Int J Pharm Bio Sci. 2015;6:854-9.&#xD;
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	Shah AR, Chaudhari SN, Shah MH. Role of platelet parameters in diagnosing various clinical conditions. Natl J Med Res. 2013;3:162-5.&#xD;
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	Anjali NS, Garkal KD, Deshmukh PR. Physiological parameters in pregnancy induced hypertension. Int J Recent Trends Sci Techn. 2013;7:24-5.&#xD;
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	Rupakala BM et al. Hypertensive disorders of pregnancy cases Int J Reprod Contracept Obstet Gynecol. 2018;7(3):848-54&#xD;
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	Mishra DP, Choudhury S, Tudu B. Evaluation of coagulation indices in preeclampsia and eclampsia. J. Evid. Based Med. Healthc. 2019;6(17):1316-20&#xD;
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	Annam V, Srinivasa K, Yatnatti SK, Suresh DR. Evaluation of platelet indices and platelet counts and their significance in preeclampsia and eclampsia. Int J Biol Med Res. 2011:2(1):425-28.&#xD;
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	Shetty J, Rao S, Kulkarni MH. Hematological Changes in Pregnancy-induced Hypertension. Int J Sci Stud. 2016;4(5):216-21.&#xD;
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	Sameer MA, Meshram DP, Deshpande SA, Sadhu D, Pandit S. Role of platelet count as an important prognostic marker in pregnancy-induced hypertension. IOSR J Dent Med Sci. 2014;13:39-43.&#xD;
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	Mushtaque T. A comparative study of coagulation profile in term normal pregnancy, preeclampsia and eclampsia (doctoral dissertation).Available at http://localhost:8080/xmlui/handle/123456789/8903&#xD;
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	Do?an K, Guraslan H, Senturk MB, Helvacioglu C, ?dil S, Ekin M. Canplatelet count and platelet indices predict the risk and the prognosis of preeclampsia. Hypertens Pregnancy. 2015;34(4):434&#x2013;42.&#xD;
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	Ceyhan T, Beyan C, Baser I, Kaptan K, Gungor S, Ifran A(2006). The effect of preeclampsia on complete blood count, platelet count and mean platelet volume. Ann Hematol. 2006;85:320&#x2013;2.&#xD;
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	Mishra DP, Choudhury S, Tudu B. Evaluation of coagulation indices in preeclampsia and eclampsia. J. Evid. Based Med. Healthc. 2019;6(17):1316-20. &#xD;
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	Bhutani K, Vij C, Kaur M, Bedi GK. Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement. Int J Cur Res Rev 2018;10(9):27.&#xD;
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	National&#xA0; Ethical&#xA0; Guidelines by ICMR on biomedical research 2017, chapter&#xA0; 5, Informed consent process Box 5.2 (Conditions for granting a waiver of consent).&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Study of Causes of Otalgia in Ear and Non-Ear Diseases&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>93</FirstPage><LastPage>95</LastPage><AuthorList><Author>Bryan Joel Devaraj</Author><AuthorLanguage>English</AuthorLanguage><Author> Meenakshi M</Author><AuthorLanguage>English</AuthorLanguage><Author> Deepak Raj K</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Otalgia is defined as ear pain, it is one of the most common complaints with which a patient presents to ENT OPD or emergency department Aims and Objectives: To identify causes of otalgia in the ear and non-ear diseases in patients visiting the ENT OPD of Saveetha Medical College and Hospital in Tamilnadu, India. Methodology: The study was conducted on 40 patients who visited the ENT OPD of Saveetha Medical College and Hospital with an earache. Patient&#x2019;s details such as age, sex, complaint, causes and physical finding were recorded in an excel sheet and. The study tools used in the study are clinical examination and investigations. Result: The leading cause of otalgia was found to be non-ear diseases (60%) from the study done on 40 patients with an earache in the ENT OPD of Saveetha Medical College and Hospital. Dental pain was the leading cause and was to be the cause in males predominantly over females by three times. Otitis externa was the leading cause of ear diseases followed by acute otitis media, chronic suppurative otitis media and by impacted wax. Conclusion: Since the last century there have been many studies to show the non-ear causes of otalgia which is caused by referred pain from other sites which are connected with the ear by different nerves, Since classifying the cases of otalgia as those caused by ear and non-ear-diseases will help in the assessment and treatment of the pain.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Primary otalgia, Classification of otalgia, Observational study, Ear pain, Causes of otalgia, Non-ear causes of otalgia,  Referred pain</Keywords><Fulltext>Introduction:&#xA0;&#xD;
&#xD;
Otalgia is defined as ear pain, it is one of the most common complaints with which a patient presents to ENT OPD or emergency department. There are two distinct types of otalgia, primary otalgia where the underlying pathology is in the ear and secondary otalgia where the underlying cause is elsewhere. The origin of pain may be in the ear, structures around the ear or other head and neck structures. This is due to the complex nervous connections in the head and neck areas, the ear, the pharynx and the nose.1 The primary causes of otalgia are often benign and can be easily identified on examination such as trauma, infection, lodging of foreign bodies, otitis media, otitis externa, acute otitis media, discharge and primary neoplasms which can be identified through otoscopy. The secondary causes of otalgia are considered only when the cause is not obvious and cannot be identified by primary investigations, these causes include barotrauma, dental inflammation and infection, temporomandibular joint disorders, trigeminal neuralgia, head and neck cancers, arytenoid arthritis.&#xA0;Certain grave diseases such as temporal arteritis and malignant neoplasms present as ear pain.1,2&#xD;
&#xD;
&#xA0;Objective: &#xD;
&#xD;
&#xD;
	&#xD;
	To find the most common cause of ear pain in ear pathology&#xA0;&#xD;
	&#xD;
	&#xD;
	To find the most common cause of ear pain in non-ear pathology&#xA0;&#xD;
	&#xD;
&#xD;
&#xD;
&#xA0;Methodology: &#xD;
&#xD;
It is an observational study conducted in 2020 on 40 patients who visited the ENT OPD of Saveetha Medical College and Hospital with an earache after obtaining Institutional ethical committee clearance(SMC/IEC/2020/03/321). Those patients with a previous history of head and neck surgeries were excluded from the study. All patients underwent thorough ENT examination, head and neck examination and investigation to find the cause of their otalgia. The patient&#x2019;s details such as age, sex, complaints, findings from examination and investigations and the cause of otalgia were all recorded in an excel sheet and tabulated. &#xD;
&#xD;
&#xA0;Results: &#xD;
&#xD;
In the ENT OPD of Saveetha Medical College and Hospital in 2020, 40 patients with otalgia were studied. The causes of otalgia were diagnosed and were categorized into non-ear diseases and ear diseases it was found that most common cause of otalgia is non ear pathology, 60% (24) cases. The ear causes of otalgia were about 40% (16) cases (Figure 1). &#xD;
&#xD;
&#xD;
&#xD;
These non-ear cases were referred to other departments for a thorough examination and confirmation of the cause of otalgia. The most frequent non-ear causes were toothache (20%) with male dominance in the cases with a ratio of 3:1, followed by cervical spine lesions (12.5%) with the cause being more frequent in women with a ratio of 4:1, followed by TMJ arthritis and tonsilitis (10%) both with an equal number of cases in both sexes in the prior and a male dominance seen in the latter, pharyngitis (5%) is seen in equal numbers in both sexes and the least cause being carcinoma of larynx (2.5%) (Table I).&#xD;
&#xD;
&#xD;
&#xD;
The major cause among ear diseases was otitis externa (30%) followed by acute otitis media (25%) and chronic suppurative otitis media (25%) and impacted wax (20%) being the least cause in patients with earache (Figure 2).&#xD;
&#xD;
&#xD;
&#xD;
Discussion:&#xA0;&#xA0; Otalgia is one of the most uncomfortable experiences for all age groups making them seek the doctor in almost all cases. This is due to the complex innervation of the ear. The outer, middle and internal ear are all complex and small structures that are very sensitive.2 In our study, 55% of patients with ear pain, the pain was caused by non-ear diseases which is much less than the study conducted by Mohammed et al, where among 770 patients suffering from otalgia, 12.2% had the referred type of pain.3In this study non-ear causes of otalgia are seen more in men (55%) than in women (45%) which is consistent with the Kiakojoori et al. study which is of 60% men and 40% women.4 In our study the most prevalent cause is dental (20%) which is following study by Mohammed et al.3 In a study conducted by Kim et al., toothache was accounted for as the most common cause of referred otalgia.5In a study conducted by Zhraa et al. the second most frequent nerve pathways to cause secondary otalgia is cervical spine lesions (24.3%) which is consistent with our findings where cervical spine lesion causes referred otalgia in 12.5% of the cases.6 In Behnoud et al study the most common cause is a temporomandibular joint which is against our study where it causes referred otalgia in 10% of the cases.3 In our study there is one case of carcinoma which is consistent with the study conducted by Reiter et al. which reports a case of carcinoma manifesting as a non-ear disease cause of otalgia. In a study conducted by Mulwafu et al. among 17 patients with carcinoma, 33% of the cases suffered from referred otalgia.7 In a study conducted by Mohammed et al., 1% of the non-ear cause of referred otalgia was due to carcinoma which is lesser than our study with 2.5% of the cases.2 In a Similar study by Neilan et alpatients presenting with otalgia posting diagnostic challenges, undergo a detailed history and examination to find the aetiology to be secondary causes of otalgia as seen in our study.8 Referred otalgia has been a well-known condition of the ear since early 1910. The results from our study are similar to another study conducted by Chen et al., which shows that in recent decades the development of CT and MRI technology has helped in identifying the cervical lesions causing otalgia which contributes to about 12.5% of the cases.9 In our study 10% of the cases are due to TMJ disorder caused otalgia, due to the affected complex synovial system, articulating ligaments and masticatory muscles which in par goes with a study done by Shalender Sharma et al.10&#xD;
&#xD;
Conclusion:&#xA0;&#xD;
&#xD;
In this study, it is seen that non-ear diseases are the leading cause of otalgia than ear diseases. Thus, making it important to note that dental hygiene has to be checked in patients with otalgia. To diagnose the cause other than dental, different parts sharing the nervous connections are to be examined for identification and confirmation of cause to provide suitable treatment. Simple awareness of ear hygiene and methods to keep the ear clean can bring about a large reduction in the ear causes of otalgia. A thorough diagnostic study of the structures surrounding and in and around the ear required to detect malignancies.&#xD;
&#xD;
Acknowledgement:&#xD;
&#xD;
I would like to thank the faculty of the Department of Otorhinolaryngology of Saveetha Medical College and Hospital for their constant support and guidance in the completion of the research. I would like to thank all others who were involved directly and indirectly in the study and also the patients who participated in the study.&#xD;
&#xD;
Conflict of interest: Nil&#xD;
&#xD;
Source of funding: Nil&#xD;
&#xD;
Authors contribution:&#xD;
&#xD;
Bryan Joel Devaraj&#x2013; Data collection, Writing the manuscript.&#xD;
&#xD;
Dr. Meenakshi.M &#x2013; Data collection, Writing the manuscript, Study design, Final draft correction and review.&#xD;
&#xD;
Dr. Deepak Raj. K&#x2013; Writing the manuscript, Study design, Final draft correction and review.&#xD;
&#xD;
Key points: &#xD;
&#xD;
&#xD;
	&#xD;
	60% of the study participants had a non-ear pathology that caused the otalgia and 40% had an ear pathology that caused the otalgia.&#xD;
	&#xD;
	&#xD;
	Otitis externa is the most common ear pathology that caused otalgia among the study participants.&#xD;
	&#xD;
	&#xD;
	The most frequent non-ear cause of otalgia was toothache.&#xD;
	&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3911</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3911</Fulltext></URLs><References>&#xD;
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&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Strategies in The Management of Acute Appendicitis Among South Indian Population-Comparison of Modified Ripasa and Alvarado Scores&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>96</FirstPage><LastPage>100</LastPage><AuthorList><Author>Kannappan M</Author><AuthorLanguage>English</AuthorLanguage><Author> Ravindra Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author> Dhanapal RR</Author><AuthorLanguage>English</AuthorLanguage><Author> Ramakrishnan R</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Modified RIPASA, ALVARADO, Acute Appendicitis, Laparoscopic Appendicectomy</Keywords><Fulltext>INTRODUCTION&#xD;
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Acute appendicitis is the most common cause of abdominal pain in both developed and developing countries. The lifetime risk of acute appendicitis in males and females is 8.6%, 6.7%, respectively with a lifetime risk of having an appendectomy reported to be 12% for men and 25% for wome.1,2&#xD;
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Though being very common in surgical practice, the diagnosis of acute appendicitis remains elusive even to the best of clinicians; hence the time tested clinical scoring system ALVARADO, which incorporates 6 clinical findings and 2 laboratory results and gives a total score of 10,&#xA0; is used in segregating patients into high, moderate and low suspicion of appendicitis. But in equivocal cases, still, imaging techniques are also used generously to prevent negative appendectomies and avert the risk of perforation. But a recent study has suggested that such indiscriminate use of CT imaging may lead to early low-grade appendicitis and unnecessary appendectomies which would otherwise be resolved spontaneously by antibiotics therapy.3 To mitigate this low sensitivity and specificity a new scoring system was devised in Malaysia, namely RIPASA. &#xD;
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The RIPASA score is a simple and easy to use the quantitative scoring system and most of the 14 clinical parameters are easily obtained from a good clinical history and examination. The RIPASA scoring system includes more parameters than the Alvarado system and the latter did not contain certain parameters such as age, gender, and duration of symptoms before presentation. These parameters are shown to affect the sensitivity and specificity of the Alvarado scoring system in the diagnosis of acute appendicitis. This also includes a urinalysis, which can be easily performed on the spot. Hence a score can be obtained quickly and a rapid diagnosis made without having to wait for the full investigations to be available when a score of &gt;7.5 is obtained. The additional parameter that is unique to our local population consists of foreign nationality, as the probability of acute appendicitis among foreign nationals presenting with RIF pain is high. The RIPASA score has been shown to have significantly higher sensitivity, specificity and diagnostic accuracy compared to Alvarado Score, particularly when applied to Asian population.4The modified RIPASA scoring&#x2019;s sensitivity and specificity is tested in the Indian population in this study.&#xD;
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MATERIALS &amp; METHODS&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The study was done after obtaining the Institutional Ethics Committee&#x2019;s clearance (IEC ref no. CSP MED/15/OCT/25/91). All patients who presented to Sri Ramachandra Institute of Higher Education and Research (SRIHER), with a history and clinical features suggestive of acute appendicitis were included in the study. The study was done from April 2015 to October 2017.&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; All patients above the age of 18 years with history and clinical features suggestive of acute appendicitis were included in the study. Patients willing to participate in the study with no previous history of acute appendicitis were also included in the study. Patients excluded from the study were those not willing to participate and those with other coexistent pathologies.&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; All patients were scored using both Alvarado [Table 1] and Modified RIPASA [Table 2]. The removal of foreign NRIC (which amounts to a value of 1) from the original RIPASA score will be the modification made in this study.&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; All patients underwent Laparoscopic appendicectomy by standard three-port technique under general anaesthesia.5 A 10mm port was placed at the umbilicus and pneumoperitoneum created with carbon dioxide and two more 5 mm ports placed in the right and left iliac fossa to perform appendicectomy [Figure 1].&#xA0; The histopathology reports of the appendicectomy specimen were collected. Acute appendicitis was diagnosed based on neutrophilic infiltration in the muscular propria [Figure 2].&#xD;
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The data were reported as the mean, +/- standard deviation or median, depending on their distribution. The individual characteristics of both the scores were statistically grouped using frequency tables. The chi-square test was used to assess differences in categorical variables between groups. The sensitivity and specificity of both scores were calculated. Statistical analysis was performed using SPSS software (version 17).&#xD;
&#xD;
RESULTS&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Our study had 109 patients who underwent Laparoscopic Appendicectomy based on clinical and radiological evidence, of which 68 were male and 41 were female. All patients underwent ultrasound imaging and 58% of them had an equivocal or negative ultrasound report and needed CT scans to confirm the diagnosis of acute appendicitis. On histopathological analysis, 98 patients biopsies were proven to be appendicitis and 11 patients had negative appendectomies. Out of the 98 cases, 41 was reported as acute appendicitis, 24 as appendicitis with periappendicitis, 31 as acute suppurative and 2 as gangrenous appendicitis. Out of the 11 negative appendectomies, 9 were reported as reactive lymphoid hyperplasia and 2 was reported as eosinophilic appendicitis &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The cut-off score to diagnose acute appendicitis in Modified RIPASA was fixed at 7.5. The percentage of patients who had a score of above 7.5 in the modified RIPASA was 84.4% (9 2 patients). 17 patients had a score below 7.5, which amounted to 15.6% of the total cases. The cut-off score to diagnose acute appendicitis in ALVARADO was fixed at 7. The percentage of patients who had a score of above 7 in Alvarado was 66.1% (72 patients). 37 patients had a score below 7, which amounted to 33.9% of the total cases.&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; On evaluating the Modified RIPASA score with the histopathological report in diagnosing appendicitis, the sensitivity is 90.82%, Specificity is 72.73%, Positive predictive value is 96.74%, Negative predictive value is&#xA0; 47.06%, Positive likelihood ratio is 3.33 and Negative likelihood ratio is 0.13. By chi-square test, the P value was 0.000, which is highly significant [Table 3].&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; On evaluating the ALVARADO score with the histopathological report in diagnosing appendicitis, the Sensitivity is 68.37%, Specificity is 54.55%, Positive predictive value is 93.06%, Negative predictive value is 16.22%, Positive likelihood ratio is 1.50 and Negative likelihood ratio is 0.58. By chi-square test, P-value was 0.128, which is significant [Table 4].&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; A Receiver Operating Characteristic (ROC) curve showed the area under the ROC curve for RIPASA is significantly higher than Alvarado&#x2019;s area under the curve [Figure 3]. This signifies that RIPASA has a higher statistical significance in predicting acute appendicitis.&#xD;
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DISCUSSION&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Acute appendicitis is essentially a clinical diagnosis with a lifetime risk of approximately one in seven.3 The earlier the diagnosis of acute appendicitis is made the risk of complications can be reduced. On the other hand, overdiagnosis of acute appendicitis could also increase the rate of negative appendectomies. Scoring systems are very useful, especially in equivocal cases that are encountered now and then. Widely used scores like Alvarado, which aid in the diagnosis of acute appendicitis, have been developed in and for a Caucasian population. A new scoring system RIPASA for the Asian population was devised, which was evaluated in this study.&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In our study, a total of 109 patients were included. There is a male predominance noted in the incidence of acute appendicitis. There was an incidence of 62.4% in males when compared to a 37.6% incidence in the female population. This increase in male incidence was noted in similar studies such as Chong et al, Cuscheri A et al and other published data.3,6 The mean age noted in our study was 31.05 years. The incidence in various parts of the world like Poland, Turkey and the United States all remain high in this age group of patients.7,8&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The entire study population was scored with both Alvarado and Modified RIPASA. The Alvarado score&#x2019;s cut off was set at a score of 7 and above for a diagnosis of acute appendicitis. This data was analyzed in comparison with the histopathology reports. The sensitivity and specificity were calculated at 68.37% and 54.55% respectively. The positive predictive value was 93.06% and the negative predictive value was 16.22%. The P-value calculated by the Chi-square tests gave a P value of 0.128, which was statistically significant. Nanjundaiah et al. and Hasan et al. reported similar sensitivities and specificities.9,10&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; As part of the evaluation of acute right iliac fossa pain all the patients included in the study underwent ultrasound examination of the abdomen. In 42% ultrasound showed features suggestive of acute appendicitis. 58% of the patients required CT abdomen to diagnose appendicitis. CT was found to significantly increase the accuracy of diagnosing acute appendicitis, which was similar in comparison to other studies such as Park JS et al.11&#xD;
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The cut off for Modified RIPASA score was set at a score of 7.5 and above. The sensitivity and specificity were calculated at 90.82% and 72.73% respectively. The positive predictive value was 96.74% and the negative predictive value was 47.06%. The P-value calculated by the Chi-square tests gave a P value less than 0.000, which was highly significant. Similar studies like Ravi et al. reported a sensitivity of 84.2% and a specificity of 100% for RIPASA.12&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; On comparing both the scores the sensitivity and specificity were higher for the Modified RIPASA score. The positive predictive value was higher for Alvarado and the negative predictive value was higher for the Modified RIPASA score. Both P values suggested statistical significance; however, the P-value for Modified RIPASA was highly significant (P &lt; 0.000). This statistical significance is further backed up by the receiver operator curve (ROC) graph, which shows a larger area under the curve for Modified RIPASA (0.818) when compared to Alvarado (0.615).&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; This study, along with various other quoted articles, suggests that the Alvarado score is not very sensitive in an Asian population as compared to a Western population.13 On the other hand the Modified RIPASA score seems more sensitive and specific in the Asian population.14&#xD;
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The authors who have devised the score suggest it uses many parameters important for the diagnosis of acute appendicitis, such as age, sex and duration of symptoms, which are not present in the Alvarado and Modified Alvarado scores.3 The local inflammatory indicators such as Rovsing&#x2019;s sign and guarding were also included in the score. The original RIPASA score had scored residential foreigners as one; since our study was based on an Indian population and no foreigners were included we decided to omit the score. This is based on the fact that the diet of the Western population is low in dietary fibre and high in saturated fatty foods. This puts this in a higher incidence of acute appendicitis. Thus the Modified RIPASA was concluded to be a more applicable and useful score in an Indian population.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The Modified RIPASA score has shown a promising result in the South Indian population with higher sensitivity and specificity than ALVARADO. The various parameters required in the score can easily be obtained from a simple history and physical examination. In a resource-limited set-up, this score can help us to stratify patients based on the need for further evaluation, thereby reducing unnecessary admissions. The difference in diagnostic accuracy between Modified RIPASA and Alvarado was statistically significant (P value</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3912</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3912</Fulltext></URLs><References>&#xD;
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	Erdem H, &#xC7;etink&#xFC;nar S, Da? K, Reyhan E, De?er C, Aziret M, Bozkurt H, Uzun S, S&#xF6;zen S, ?rk&#xF6;r&#xFC;c&#xFC; O. Alvarado, Eskelinen, Ohhmann and Raja Isteri Pengiran Anak Saleha appendicitis scores for diagnosis of acute appendicitis. World J Gastroent. 2013 Dec 21;19(47):9057- 9062.&#xD;
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	Malik MU, Connelly TM, Awan F, Pretorius F, Fiuza-Castineira C, El Faedy O, Balfe P. The RIPASA score is sensitive and specific for the diagnosis of acute appendicitis in a western population. Int J Color Dis. 2017 Apr 1;32(4):491-7.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Comparison of Caries Assessment Spectrum and Treatment Needs (Cast) Index with Def Index in Measuring Dental Caries Among Three to Six-Year-Old School Children: A Descriptive Cross-Sectional Survey&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>101</FirstPage><LastPage>106</LastPage><AuthorList><Author>Vemagiri Charan Teja</Author><AuthorLanguage>English</AuthorLanguage><Author> KS Uloopi</Author><AuthorLanguage>English</AuthorLanguage><Author> C Vinay</Author><AuthorLanguage>English</AuthorLanguage><Author> Ch Anusha</Author><AuthorLanguage>English</AuthorLanguage><Author> P Brahmanna  Chowdary</Author><AuthorLanguage>English</AuthorLanguage><Author> JT Pavithra</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Widely used def index for the assessment of caries around the world, is facing criticism on various limitations. WHO, ICDAS II and puff/PUFA indices had their own merits and demerits. Furthermore, the caries assessment indices documented in the literature does not cover the total caries spectrum. That necessitated the development of a comprehensive but realistic caries assessment index called the &#x201C;Caries Assessment Spectrum and Treatment Needs (CAST) index.&#x201D; Objective: To compare CAST and def indices in measuring dental caries among 3-6-year-old school children in and around Bhimavaram town, Andhra Pradesh, India. Methods and Material: A single examiner conducted a descriptive cross-sectional survey among 898, 3-6-year-old school children at randomly selected schools. Caries experience was recorded in a structured proforma using CAST and def indices. Descriptive statistical analysis was done. Inter and intragroup comparison were made by Kruskal Wallis ANOVA and Mann Whitney U tests respectively. Correlation between def and CAST indices was explored by Spearman&#x2019;s rank correlation coefficient. Results: Caries prevalence with CAST index (45.7%) was marginally higher compared with def index (44.7%). No significant difference was found between mean deft scores measured with CAST and def index (p=0.87). The high statistically significant difference in mean def scores with def index and the def component of CAST index for 3, 4, 5 and 6-year age groups was observed (p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>CAST index, Def index, Dental caries, Caries prevalence, Correlation coefficient, ICDAS index</Keywords><Fulltext>Introduction:&#xD;
&#xD;
Dental indices are widely used for quantifying dental caries.1 Amongst numerous indices available, DMFT and def indices1 are commonly used. However, the paradigm shift in curative to preventive dentistry2 and management protocols led to the development of new indices named International Caries Detection and Assessment System (ICDAS),3Pulpal involvement-Ulceration-Fistula-Abscess (PUFA/pufa)4and Pulpalinvolvement-Root Sepsis (PRS)4 indices. But none of these indices gained attention globally.2,3&#xD;
&#xD;
No index available described the total picture of caries progression which is beneficial for epidemiological surveys.5 So, to visualize the entire caries spectrum, Caries Assessment Spectrum and Treatment Needs (CAST) index were developed which unfolds caries in an increasing level of severity.6&#xD;
&#xD;
A paucity of literature is evident regarding the characteristics of the CAST index, its diagnostic precision and its reliability for use in different populations. Hence the present study was designed with a primary objective to compare the CAST index with def index in measuring dental caries among 3-6-year-old school children. The secondary objective was to measure the complete range of carious lesions using the CAST index. It was null hypothesised that CAST index was inferior to def index in detailing the caries spectrum while the alternate hypothesis was kept as CAST index gives a more detailed picture of dental caries than the def index&#xD;
&#xD;
Material and Methods:&#xD;
&#xD;
The present descriptive cross-sectional study was conducted among 3-6-year-old school children in and around Bhimavaram, Andhra Pradesh, India between December 2014 to July 2015 for eight months. The study was approved by the Institutional Ethical Review Board (IEC/IRB NO: VDC/IEC/2014-16). The purpose and nature of the study were explained and prior permission from school authorities and a written informed consent from their parents were obtained. Selection of schools was done randomly based on the availability of children with only fully erupted deciduous dentition on the day of examination. Children with erupted first permanent molar, congenitally missing teeth and who require special health care needs were excluded from the study. &#xD;
&#xD;
Before the original research, the investigator was trained and calibrated for two weeks, recording &#x201C;def&#x201D; and &#x201C;CAST&#x201D; indices under the guidance of the staff in charge to assess the intra examiner variability. The investigator had first carried out an oral examination on twenty subjects with dental caries. Then the same subjects were reexamined after two days and the results of two examinations were compared to assess intraexaminer variability. The Cohen&#x2019;s kappa coefficient (K) value for intraexaminer agreement for both the indices was established at 0.93 (95% Confidence interval (CI = 0.791 -0.968), Z=1.96), (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3913</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3913</Fulltext></URLs><References>&#xD;
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&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Treatment-seeking Behaviour of Diabetes Patients of Meerut, Uttar Pradesh During Lockdown Phase of Covid 19 Pandemic&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>107</FirstPage><LastPage>112</LastPage><AuthorList><Author>Parashar Pawan</Author><AuthorLanguage>English</AuthorLanguage><Author> Sharma Saurabh</Author><AuthorLanguage>English</AuthorLanguage><Author> Bansal Rahul</Author><AuthorLanguage>English</AuthorLanguage><Author> Kumar Deepak</Author><AuthorLanguage>English</AuthorLanguage><Author>  Ahmad Sartaj</Author><AuthorLanguage>English</AuthorLanguage><Author> Nasser Kaynat</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Uncontrolled T2DM (Type 2 Diabetes Mellitus) has emerged as one of the major risk factors for mortality in patients with COVID-19. The National lockdown has produced various lifestyle and health behaviour changes among diabetic patients. Aim: The present study was done to assess the treatment-seeking behaviour of diabetic patients during the lockdown phase of the Covid 19 pandemic in Meerut city. Methods: A descriptive cross-sectional study was done by using a predesigned, pre-validated online questionnaire. The study was conducted among conveniently selected 190 follow up T2DM patients from urban and rural health practice area of the community medicine department of a private medical college of Meerut, U.P. Simple descriptive tables and Chi-square test was used for statistical analysis. Results: During the lockdown phase, 110(57.9%) patients decreased physical activity whereas 68 (35.8%) patients did not follow dietary restrictions However, 159 (83.7%) of the patients were taking pharmacological treatment regularly. There was a significant association between the regularity of treatment and variables like education, occupation, total monthly income, residence, cost of treatment and blood test frequency. The diabetic patients faced the problem of the availability of physicians for consultation (38.9%) during the lockdown. Conclusion: The lockdown did not have much adverse effect on the regularity of treatment. The regularity of treatment was significantly associated with a sociodemographic profile and health awareness of diabetes patients. The patients had problems in following maintaining a healthy lifestyle during the lockdown. The patients had problems in assessing affordable healthcare during the lockdown.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Covid 19, India, Lockdown, Treatment seeking behaviour, Type 2 Diabetes</Keywords><Fulltext>Introduction:&#xD;
&#xD;
After the COVID-19 epidemic, the Indian Government initiated a nationwide lockdown from March 25, 2020, and continued till 31st May 2020. The lockdown was imposed in India to prevent the spread of Covid 19 among people. During the lockdown phase, people stayed inside their homes, except for carrying out essential activities. The government initiated unlock phase from June 1st 2020 gradually in which activities were permitted in areas other than containment zones in a phased manner.1 However, very few relaxations were given in the Meerut district due to the high number of Covid 19 cases during unlocking phase.&#xD;
&#xD;
During this pandemic, uncontrolled T2DM (Type 2 Diabetes Mellitus) has emerged as one of the risk factors for COVID-19 patients mortality. According to estimates, the prevalence rate of diabetes in urban areas of India is9% whereas the prevalence rate of diabetes in rural areas of India is 3%.2,3India has 65 million adults of age &#x2265;20 years with diabetes. India has the largest number of people with diabetes in the world and is considered as Diabetic Capital of the world.2,3&#xD;
&#xD;
T2DM is a lifestyle disorder in which proper lifestyle play important role in its management. Reports from various countries showed that the sudden lockdown and unlock phase has disrupted the physical activity, sleep, employment mental and emotional well-being of many individuals.4 Another study revealed that income, expenditure and accessibility to the healthcare of people were reduced due to lockdown in Kerala.5 There was disruption of healthcare services and the loss of continuum of care of diabetic patients during lockdown which could negatively impact on health-seeking behaviour of diabetes patients.6However, the exact impact of these disruptions on the treatment-seeking behaviour of T2DM patients during the lockdown phase in Meerut, Uttar Pradesh is not known. Therefore, the present study was conducted to study the lifestyle and treatment-seeking behaviour of diabetes patients during the lockdown in Meerut District, Uttar Pradesh. The study also tried to analyze various health-related challenges faced by diabetes patients during the lockdown in Meerut District, Uttar Pradesh.&#xD;
&#xD;
Methodology&#xD;
&#xD;
A cross-sectional study was conducted among diabetic patients residing in the field practice area of the community medicine department of Subharti medical college, Meerut. The study protocol was approved by the Institute Ethics Committee (Approval No. SMC/UECM/2020/119/95).&#xA0; A total of 190 follow up patients with T2DM (Type 2 Diabetes Mellitus) residing in the field practice area of the department of community medicine a Subharti medical college, Meerut were selected conveniently for conducting the study. The patients were included by conveniently sampling as randomization was not possible due to lockdown. The follow-up case of T2DM of the age group of 18-75 years having valid email or WhatsApp number were included in the study. The diabetes patients, who were critically ill, were excluded from the study. Patients with gestational diabetes mellitus were also excluded from the study. &#xD;
&#xD;
&#xA0;A predesigned, pre-validated close-ended online questionnaire was developed to determine treatment-seeking behaviour among diabetes patients. The various sociodemographic indicators like age, sex, education, residence, occupation, total monthly income, family type and family history and health awareness variables like addiction, dietary habit, body mass index (BMI), frequency of blood sugar investigations, cost of treatment were included in the questionnaire. The patients who were taking pharmacological treatment either oral hypoglycemic or through insulin injections or both, from a public or private clinic or hospital regularly were categorized under regular treatment. The patients who were not taking pharmacological treatment not regularly were categorized under irregular treatment.7,8The patients were allowed to fill in multiple responses about reasons of irregularity of treatment (if applicable), lifestyle changes and problems faced during lockdown by them. The data was collected from July 2020 to September 2020.&#xA0; For statistical analysis, the data was entered and analyzed using the statistical package SPSS Version 20. Results were tabulated in percentages, mean, standard deviation. A Chi-square test was applied to test the significance. P-value of &lt; 0.05 was considered significant.&#xD;
&#xD;
Results:&#xD;
&#xD;
The sociodemographic characteristics of diabetic patients are described in Table 1. In our study, 51 patients were above 60, 84 patients of age group 46-60 years, 49 patients belonged to 30-45 years and the rest 6 were below 30 years. The male patients were 97 whereas the female patient was 93. The most of patients (143) were living in urban areas whereas only 47 patients were living in rural areas. Illiterate study subjects were 48 (25.3%) where graduate diabetic patients were 44(23.2%). In the occupation category, maximum diabetic patients were housewives followed by business and service. The family status of 113(59.5%) patients was joint whereas the family status of 77(40.5%) patients was nuclear. The family history of&#xA0; 99 (52.1%) patients was positive whereas the rest of the patients had a negative family history. The various other sociodemographic variables and association of these variables with the regularity of treatment is shown in Table 1. The association between regularity of treatment and sociodemographic variables like residence, education, occupation, total monthly income, family type and family history was found statistically significant with p-value 0.000, 0.018, 0.036, 0.000, 0.026,0.000 respectively. The association between regularity of treatment and sociodemographic variables like age and sex was not found statistically significant with p-value 0.999, 0.645 respectively.&#xD;
&#xD;
Table 2 depicted the association of health awareness of diabetic patients with the regularity of treatment. In our study, 156 (82.1%) patients had no addiction. Regarding BMI, 68.9% of patients had BMI &gt;25.0 whereas 14.7% had BMI between 23.0-24.9. The no vegetarian dietary habit was practised by 82(43.2%) patients whereas vegetarian dietary habit was practised by 108 (56.8%) patients. The blood sugar was investigated in more than one month time by 88 (46.3%) patients whereas 53 (27.9%) investigated blood sugar monthly and was investigated by the rest of the patients in less than one month time. The average cost of a maximum number of patients (117) was between Rs.1000-5000. The various other personal attributes of diabetic patients and the association of these variables with the regularity of treatment are shown in Table 2. The association between regularity of treatment and variables like BMI, the frequency of blood sugar investigation, the monthly cost of treatment was found statistically significant with p-value 0.003, 0.000, 0.000 respectively. The association between regularity of treatment and variables like addiction and the dietary habit was not found statistically significant with p-value 0.071, 0.151 respectively.&#xD;
&#xD;
In our study, 159 (83.68%) patients were taking pharmacological treatment regularly whereas 31(16.32%) patients were not taking pharmacological treatment regularly. Table 3 depicted various reasons regarding the irregularity of treatment. The most common reason for irregularity were financial constraints, lack of support from family members and carelessness. The carelessness included reasons like forgetfulness and lack of time etc. The lockdown was considered as the main reason for irregularity by7 (3.68%) patients.&#xD;
&#xD;
Fig 1 depicted that only 7(3.68%) patients increased physical activity or exercise during lockdown whereas 110(57.89%) patients decreased their physical activity. 89 (46.84%) patients followed dietary restrictions whereas 68 (35.79%) patients did not follow dietary restriction due to lockdown. The increase in yoga/meditation activity was observed by 14&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; (7.37%) patients and a decrease in yoga/meditation activity was observed by 7(3.68%) patients. Only 13(6.84%) patients observed no effects of lockdown on their lifestyle.&#xD;
&#xD;
Fig 2 depicted that 103(54.21%) did not face any problem regarding the treatment of diabetes during the lockdown. However,74(38.95%) diabetic patients faced problems regarding the availability of a doctor for consultation. The problems regarding the availability of drugs and diagnostic tests were faced by 25(13.16%) patients. The cost-related problems were faced by 27 (14.21%) patients. Only 6 (3.15%) patients considered that following a healthy lifestyle during lockdown was a problem.&#xD;
&#xD;
Discussion&#xD;
&#xD;
The regularity of the treatment&#xD;
&#xD;
In our study, the regularity of the treatment was practised by 83.7 % which was similar to findings of various other studies.7-10 Another study also revealed that during lockdown drug adherence was not a problem for most diabetic patients.11The regularity of treatment was comparatively better in urban, educated and patients have high monthly income and patients belonging to nuclear families (Table 1). Another study also supported our findings that patient education and socioeconomic status played a very important role in compliance with medical treatments in diabetic and hypertensive patients.12,13 These studies also revealed that health awareness was an important pillar of prevention and management of Type 2 Diabetes Mellitus. Similar to the findings of these studies, the current study found that addiction, BMI and frequency of blood sugar investigation had a significant association with the regularity of treatment.&#xD;
&#xD;
The reasons for irregularity of drug treatment were cost of treatment and accessibility of health facility. Similar reasons for not taking treatment regularly were reported in a study done on Malasia.8 The income of many families was reduced and many health centres and private clinics were not accessible during the lockdown which resulted in the irregularity of treatment in many patients.&#xD;
&#xD;
The carelessness was also the important reason for the irregularity of treatment in our study. Another study also observed that forgetfulness due to work was the main reason for drug non-compliance in diabetic and hypertensive patients.13 The lockdown was considered as the main reason for the lesser number of diabetes patients. Thus, we can conclude, lockdown did not have much adverse effect on the regularity of drug treatment of diabetic patients. &#xD;
&#xD;
Problems faced by diabetic patients during lockdown &#xD;
&#xD;
In our study, 38.95% of patients faced problems in consultation with physicians. Similar to the finding of a study from South India.14 The main reason behind the availability of physician was that most of the government health facilities were engaged in management of Covid 19 Pandemic. The accessibility to the private health sector was also lower during lockdown In Meerut city. Therefore, measure like the use of telemedicine for consultation of Diabetes patients should be adopted. Our study also observed that the availability of drugs and diagnostic tests, financial resources for diabetes treatment were problems for a minority of patients. Likewise, a study from AIIMS Bhopal observed that regularity of pharmacological treatment, availability of drugs and diagnostic tests and cost of drugs were not constraints for the majority of patients during the lockdown in India.11&#xD;
&#xD;
In our study, the patients could not follow a healthy lifestyle. 110(57.89%) patients decreased their physical activity. 89 (46.84%) and 68 (35.79%) patients did not follow dietary restriction due to lockdown. An increase in yoga/ meditation practices was done by only 7.37% Another study from AIIMS Bhopal observed similar findings that adherence to a healthy lifestyle posed problems to the patients during the lockdown. The increase in yoga/ meditation was practised by fewer patients.11 In contrast to this, the diabetic patients were able to maintain diet and exercise schedule as usual.6,15 These finding suggested that more metacentric studies should be conducted to study the effect of lockdown on the lifestyle of diabetic patients. These findings also suggest that there is a need for counselling for diabetic patients for maintaining a healthy lifestyle during the lockdown as diet and physical exercise or yoga are also important components of prevention and management of Diabetes.16,17&#xD;
&#xD;
Conclusion: &#xD;
&#xD;
The lockdown had not much adverse impact on the regularity of pharmacological treatments among diabetic patients. The health awareness, socioeconomic status of diabetic patients played important role in the regularity of diabetic treatment during the lockdown. However, the non-pharmacological part or lifestyle management was ignored by diabetic patients during the lockdown. Only some patients were able to maintain physical activity and diet plan during the lockdown. Therefore, diabetes patients should be counselled for adopting a healthy lifestyle in future despite lockdown or any other such restrictions. The diabetic patients faced problem in consultation with physicians for their treatment during the lockdown. This problem provides us with an opportunity to adopt measures like telemedicine in our health system for the prevention and management of diabetes patients.&#xD;
&#xD;
Acknowledgement:&#xD;
&#xD;
The Authors acknowledge the diabetic patients who had truly given their views regarding treatments seeking behaviour been in the study. The authors also acknowledge the efforts of health workers of the urban health training centre (UHTC), rural health training centre (RHTC) of the medical college who played important role in the data collection during the study. The authors also acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript.&#xA0;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.&#xD;
&#xD;
Prior publication: Nil&#xD;
&#xD;
Funding Support: Nil&#xD;
&#xD;
Conflicts of interest: Nil&#xD;
&#xD;
Permissions: Nil&#xD;
&#xD;
Individual Author Contribution: All authors contributed equally in the every part of the study.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3914</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3914</Fulltext></URLs><References>1.Ahmed WN, Arun CS, Koshy TG, Nair A, Sankar P, Rasheed SA et al. Management of diabetes during fasting and COVID-19eChallenges and solutions. J Fam Med Prim Care 2020;9(8):3797e806. &#xD;
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2. India State-Level Disease Burden Initiative Diabetes Collaborators. The increasing burden of diabetes and variations among the states of India: The Global Burden of Disease Study 1990?2016. Lancet Glob Health. 2018;6:e1352?62&#xD;
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3. Kumar P, Agarwal N, Singh CM, Pandey S, Ranjan A, Kumar D. Diabetes and quality of the life-a pilot study. Int J Med Sci Public Health. 2016;5:1143-7.&#xD;
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4. Ammar A, Trabelsi K, Brach M, Chtourou H, Boukhris O, Masmoudi L et al. Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insights from the ECLB-COVID19 multicentre study. Biol Sport. 2021;38(1):9e21. &#xD;
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5. Sujathan PK, Azad P. Social impact of lockdown in Kerala: a case study (April 25, 2020). Available at SSRN:https://ssrn.com/abstract=3587603.&#xD;
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6. Ghosh A, Arora B, Gupta R, Anoop S, Misra A. Effects of nationwide lockdown during COVID-19 epidemic on lifestyle and other medical issues of patients with type 2 diabetes in north India [Published online ahead of print, June 2020]. Diabetes Metab. Syndr. 2020;14(5):917e20. &#xD;
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7. Bhosale S, Pawar AT, Kumar KD. Healthcare-seeking behaviour among diabetic patients in Kozhikode, Kerala. Int J Med Sci Public Health. 2017;6(10):1524-7. &#xD;
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8.Abidin SI, Sutan R, Shamsuddin K. Prevalence and determinants of appropriate health-seeking behaviour among known diabetics: Results from a community-based survey. Adv Epidemiol. 2014;10(11):58-86.&#xD;
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9. Mookambika RV, Nelson SB, Ashok VG. A study on diabetic care among diabetic patients in a tertiary care health centre. Int J Contemp Med Res. 2016;3(10):3091-2.&#xD;
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10. Mangaiarkkarasi A, Nitya S, Ali RM, Ramaswamy S. A study to assess the knowledge, attitude and practice about diabetes among diabetic patients in Pondicherry. Res J Pharm Biol Chem Sci. 2012;3(4):1185-96.&#xD;
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11. Joshi R, Atal S, Fatima Z, Balakrishnan S, Sharma S, Joshi&#xA0; A. Diabetes care during COVID-19 lockdown at a tertiary care centre in India. Diabetes Res Clin Pract.2020 Aug;166:108316.&#xD;
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12.Tabassum N, Rao RL. A study on adherence to therapy among hypertensives in urban slums of Hyderabad. Int J Health Sci Res. 2017;7:180?6.&#xD;
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13.Kotian SP, Waingankar P, Mahadik VJ. Assessment of compliance to treatment of hypertension and diabetes among previously diagnosed patients in urban slums of Belapur, Navi Mumbai, India. Indian J Public Health. 2019;63:348-52&#xD;
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14.Olickal JJ , Chinnakali P,&#xA0; Suryanarayana BS,&#xA0; Ulaganeethi R,&#xA0; Kumar SS, Saya GK. Effect of COVID19 pandemic and national lockdown on persons with diabetes from rural areas availing care in a tertiary care center, southern India. Diab Metab Syndr: Clin Res Rev.2020; 14: 1967e-1972&#xD;
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15. Nachimuthu S, Vijayalakshmi R, Sudha M, Viswanathan V. Coping with diabetes during the COVID - 19 lockdown in India: results of an online pilot survey. Diabetes Metab. Syndr. 2020;14(4):579e82. &#xD;
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16. Kumar D, Ahmad S, SharmaS. A review article on relation between metabolic syndrome, general wellbeing and yogic lifestyle.&#xA0; Subharti J of Interdisciplinary Research 2019; 2( 2) :5-10.&#xD;
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17. Sahay BK. Role of Yoga in Diabetes. J Assoc PhysiciansIndia. 2007;55:121-6.&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>What is the Understanding of Antibiotics among Parents of Young Children? Findings of a Cross-sectional Study Conducted in a Tertiary Care Hospital in South India&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>113</FirstPage><LastPage>118</LastPage><AuthorList><Author>Aishwarya STY</Author><AuthorLanguage>English</AuthorLanguage><Author> Ganesan DK</Author><AuthorLanguage>English</AuthorLanguage><Author> Jain T</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Antibiotics were considered the greatest invention in the 20th century. Antibiotic resistance is an alarming issue in developing countries and the major reason contributing to this is the irrational use because of the lack of knowledge. Aim: To understand the level of knowledge and the usage pattern of Antibiotics among Parents of Young Children attending a Tertiary care Hospital Methodology: The present study was a cross-sectional study conducted among the parents of children attending the Pediatric Out-patient department in a tertiary care hospital in Kancheepuram district, Tamil Nadu. A total of 133 participants were surveyed using a semi-structured and a pre-tested questionnaire to find out their understanding of Antibiotics. Results: Among the 133 participants, around 23.4% of parents correctly identified antibiotics are used against bacterial infections, and only 16.6% of people knew about the term antibiotic resistance. About 60% of parents said that they never used leftover antibiotics. People with low socio-economic status were found to have a lack of knowledge regarding antibiotics and they misuse them without knowing the consequences. Conclusion: We need to invest more time in educating and creating awareness regarding the judicial use of antibiotics and to check unprescribed dispensing of antibiotics.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Antibiotic resistance, Attitude, Knowledge, Practice</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Antibiotics were considered to be the greatest invention in the 20th century for treating bacterial infections.1 However, rampant and irrational use of antibiotics for any clinical condition will emerge as a worldwide issue of antibiotic resistance in the future. The World Health Organization (WHO) defines antimicrobial resistance as a microorganism&#x2019;s&#xA0;resistance to an antimicrobial drug&#xA0;that was once able to treat an infection by that microorganism. Resistance arises as a consequence of mutations in microbes and selection pressure from antibiotic use that provides a competitive advantage for mutated strains.2&#xA0;A person cannot become resistant to antibiotics. Resistance is a property of the microbe, not a person or other organism infected by a microbe.WHO has warned about the excessive use of antibiotics, where minor infection and injury won&#x2019;t be manageable with the help of antibiotics in the future.&#xD;
&#xD;
There is increasing bacterial resistance due to improper management and weak implementation of Health policy.3 The major cause of mortality in children in developing countries like India is Acute Respiratory Infections (ARI). Upper respiratory tract infections are the most common case where antibiotics are prescribed in the Pediatrics Age group.4 There should be an awareness of the consequences of unnecessary prescription of antibiotics among&#xA0; Physicians, and the General public should also be conscious of this matter.5&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xA0;Viral infections are the most common (which do not require antibiotics) and bacterial infections carry less than 5% complicated problems, therefore, antibiotics should be used judiciously. &#xD;
&#xD;
Knowledge of antibiotics is well known to be poor among the general public. As India is ranked the world&#x2019;s largest consumer of antibiotics for human health, the misuse of antibiotics is striking in India. The rules by the Drugs and Cosmetics Act stated only qualified medical practitioners can prescribe medicine, but it is not practised everywhere instead, without valid prescription the people who do not hold any formal degree and are not trained in allopathic medicine prescribe drugs and misuse it as part of their regular practice.6 The rate of self-medication is found to be rising around the world including India.7 Because of these factors, it is necessary to investigate and prevent these detrimental practices. Thus, the present study was undertaken to find out the current understanding of antibiotics.&#xD;
&#xD;
MATERIAL AND METHODS&#xD;
&#xD;
Study Design: This is a Hospital-based cross-sectional study conducted among parents of children who attended the pediatric outpatient department (OPD) of a Tertiary Care Hospital in Kancheepuram district, Tamil Nadu. &#xD;
&#xD;
Ethical Clearance number: SMC/IEC/2020/03/407&#xD;
&#xD;
Study period:&#xD;
&#xD;
The study was conducted for 2 months between February and March 2020.&#xD;
&#xD;
Study Population:&#xD;
&#xD;
We included the Parents of Children who attended the Pediatric OPD of a Tertiary care hospital during the above-mentioned study period. Children who were accompanied by guardians and grandparents were not included in our study. Parents who refused to participate were also excluded from the study.&#xD;
&#xD;
Sample size:&#xA0; 133 willing parents of young children were included in our study.&#xD;
&#xD;
Study procedure:&#xD;
&#xD;
Approval from the Institutional Health Research Ethics Committee was obtained before the commencement of the study.&#xA0; The interview was conducted in the OPD and this was done after the parents sought consultation from the doctors for their child. Before the interview began, verbal consent was obtained by informing them about the nature and purpose of the study. Face-to-face interaction with each participant was done to collect data. If both the parents of the child were present then whoever was willing among them was taken for the data collection. Counselling &amp; Health education was given about the knowledge of Antibiotics and their resistance to the parents after the completion of the interview.&#xD;
&#xD;
Study tool: &#xD;
&#xD;
The study tool consisted of the semi-structured pretested questionnaire which consisted of questions that were adopted from previous studies. 8,9 A pilot study was undertaken with 10 participants to test the validity and reliability of the data collection tool and to identify possible field problems and modifications were made accordingly.&#xA0; The questionnaire consists of several sections: Socio-demographic characteristics; Knowledge; Attitude, and Practice.&#xD;
&#xD;
Data Analysis:&#xD;
&#xD;
Data were entered in an Excel spreadsheet (Microsoft, Redmond, WA, USA). Data were analyzed using Statistical Package for Social Sciences version 20 (IBM, Armonk, NY, USA). Proportions were used to describe the socio-demographic variables and the Chi-square test was used to measure the association between the variables. p-values &lt; 0.05 were considered statistically significant.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
A total of 133 participants participated in the interview. Out of the 133 participants,68.4% were females and 31.6% were males. The majority (53%) of the participants were between the age group of 21-30 years and very few (4%) in the age group of 41-50 years. Education level was grouped as Illiterate, Primary school, High school, Intermediate/diploma, Graduate and then, Professional degree, of these 133 respondents, 3.7% were Professional degree holders, 21.8% were graduates.1/3rd (33%) of parents were residing in a rural area and the remaining 67% were from an urban area. The majority (40%) of participants belonged to the lower-middle-class group in the Socioeconomic status classification. [Table:1]. &#xD;
&#xD;
Out of the total, nearly 1/4th (23.4%) of parents knew antibiotics were used against bacterial infections, while 27.8% of parents thought it is used against viral infections, and 42.8% thought it can be used in all conditions.&#xA0; The majority (78.2%) of Parents also preferred antibiotics whenever their child fell sick without knowing that it is used only against bacterial infections. Moreover, only 16.6% of parents knew about the term antibiotic resistance. Nearly 2/3rd of the parents (72%) felt that antibiotics do not cause any harm after excessive use. The majority (96%) of the participants said that they complete the course duration of antibiotics as prescribed by the doctor and 60% of the parents say they never used leftover antibiotics for their child from the previous prescription. 44.4% of the parents thought that the efficacy is better if the antibiotics were newer and costlier. The majority of the people didn&#x2019;t know about the adverse effects of antibiotic use but some people who knew said it causes diarrhoea (37%), and skin rashes (20%) respectively [Table 2].&#xD;
&#xD;
Based on their responses to all the questions in this study, the respondents were classified into having good knowledge (&gt;50% correct responses) and poor knowledge (</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3915</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3915</Fulltext></URLs><References>&#xD;
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	Agarwal S, Yewale VN, Dharmapalan D.&#xA0;Antibiotics use and misuse in children: A knowledge, attitude and practice survey of parents in India.&#xA0;J Clin Diagn Res. 2015;9(11): SC21SC4.&#xD;
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	Yu M, Zhao G, Lundborg CS, Zhu Y, Zhao Q, Xu B. Knowledge, attitudes, and practices of parents in rural China on the use of antibiotics in children: a cross-sectional study. BMC Infect Dis. 2014;14(1):112.&#xD;
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	Waaseth M, Adan A, R&#xF8;en IL, Eriksen K, Stanojevic T, Halvorsen KH, et al. Knowledge of antibiotics and antibiotic resistance among Norwegian pharmacy customers - a cross-sectional study. BMC Public Health. 2019;19(1):66. &#xD;
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	ElongEGA, Ebongue OC, Penda IC,&#xA0; Nga NE, MpondoME,Moukoko ECE. Knowledge, practices and attitudes on antibiotics use in Cameroon: Self-medication and prescription survey among children, adolescents and adults in private pharmacies. PLoS One. 2019;14(2): e0212875.&#xA0;&#xA0; &#xD;
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	Andreas R, Vassiliki P, Adamos H, Sotiria P, Maria T, George S, et al. Descriptive study on parents&#x2019; knowledge, attitudes and practices on antibiotic use and misuse in children with upper respiratory tract infections in Cyprus.&#xA0;Int J Environ Res Public Hea.&#xA0;2011; 8:3246&#x2013;62.&#xD;
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	Chinnaswamy B, Sadasivam K, Ramraj B, Pasupathy S. Knowledge, attitude and practice of parents towards antibiotic usage and its resistance. Int J Contemp Pediatrics.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; 2016; 1:256-61.&#xD;
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	Vandenberg C, Niswander C, Carry P, Bloch N, Pan Z, Erickson M, et al. Compliance With a Comprehensive Antibiotic Protocol Improves Infection Incidence in Pediatric Spine Surgery. J Pediatr Orthop. 2018;38(5):287-292. &#xD;
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	Hoppe JE, Blumenstock G, Grotz W, Med C, Selbmann HK. Compliance of German pediatric patients with oral antibiotic therapy: results of a nationwide survey. The Pediatr Infect Dis J. 1999;18(12):1085-91.&#xD;
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	Shamsher R, Sudhir S, Nuwara H, Knowledge, attitude and practice of parents regarding antibiotic use in children. Int J Contemp Pediatrics 2019; 6:2282-6. &#xD;
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	Basu R, Rao R, Sarkar A, Kongbrailatpam B. Prevalence and Antimicrobial Susceptibility pattern of extended-spectrum Beta-Lactamase producing Klebsiella pneumoniae isolated from respiratory samples in a South Indian Tertiary Care Hospital. Int J Cur Res Rev 2013;5(19):81-87.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Relationship of Diabetes-specific Knowledge, Self-care Practices with Glycaemic Control: Urban and Rural Distinction in India&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>119</FirstPage><LastPage>127</LastPage><AuthorList><Author>Sudhanshu Ashok Mahajan</Author><AuthorLanguage>English</AuthorLanguage><Author> Jayashree Sachin Gothankar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Quintessential information on knowledge and self-care practices about diabetes is rare in India and is critical to design general wellbeing strategies planned for forestalling and controlling diabetes. Aim: The present study was undertaken to assess and compare the knowledge of diabetes and self-care practices and their association with control of blood sugar levels in urban and rural areas in the Pune district, in India. Methodology: A study was conducted at 4 sites from urban and rural areas of the Pune district, in India. One registered private physicians&#x2019; clinic from each study site i. e. from 2 wards and two villages were randomly selected. Methods and Material: Considering the 69% prevalence of good self-care practices in type 2 diabetics and requiring precision of 10%, the sample size of 200 was calculated. A predesigned, pretested questionnaire was filled by interview technique. Statistical significance between the two variables was tested using the Chi-square test and Fisher&#x2019;s exact test. The correlation was tested by using Pearson&#x2019;s correlation coefficients. Results: The mean total knowledge score of urban diabetics (7.52) was more than the mean total knowledge score (6.62) of the rural diabetic. (p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Urban-Rural, Type 2 diabetes, Knowledge, Self-care</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Papyrus Ebers was the first name given to diabetes by an Egyptian physician Hey-Ra (1552 BC).1 Diabetes is the third most common health disorder worldwide and the fourth leading cause of death.2 The World Health Organization estimates that diabetes mellitus affects at least 285 million people and causes 3.2 million deaths, six deaths every minute and 8700 deaths every day, and this figure will increase by 70% in developed countries, and by 42% in developing countries by 2030.3&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; India with its dubious distinction of being designated, &#x201C;The Diabetic Capital of the World&#x201D; is presently estimated to have over 30 million individuals affected by this deadly disease.4As per the WHO report 2012 if India doesn&#x2019;t wake from its slumber, by 2025, each fifth diabetic on earth would be an Indian.5The prevalence of diabetics in Indian adults was found to be 2.4% in rural and 4-11% in urban dwellers.6&#xA0; &#xD;
&#xD;
Diabetes is one of the fastest-growing challenges in the 21st century and the stream of the diabetes epidemic is changing at a great rate.7 Once a disease of the West, diabetes has now spread to each nation on the planet. Once &#x201C;a disease of affluence,&#x201D; it is now increasingly common among the poor.8 Very high levels of diabetes have been reported in urban areas of India but little data are available for rural regions where &gt;70% of the population lives.9Rural populations are at a high risk of developing diabetes mellitus as a result of the shift in epidemiology from communicable disease to non-communicable disease.10&#xD;
&#xD;
Diabetes self-care is extremely complex, requires life-long commitment and modification of one&#x2019;s lifestyle. Good self-care practices and adherence to the recommendations have been found to associate with good blood sugar control.11&#xD;
&#xD;
Despite the abundance of studies on diabetes, there is limited information available on the knowledge and self-care practices with comparison in urban and rural areas. To address this demand, the present study was undertaken with the aims and objectives of&#xD;
&#xD;
&#xD;
	&#xD;
	&#xA0;To assess and compare the knowledge of diabetes and self-care practices in urban and rural areas in Pune district and&#xD;
	&#xD;
	&#xD;
	&#xA0;To determine the association of knowledge and self-care practices of diabetes with control of blood sugar levels.&#xD;
	&#xD;
&#xD;
&#xD;
MATERIAL AND METHODS&#xD;
&#xD;
An OPD-based, cross-sectional study was executed amongst type 2 diabetes mellitus inside the urban and rural district, Pune, to evaluate their knowledge regarding the disease and the self-care practices that have been followed by them and those have been correlated with their control of diabetes (Hba1c). Considering the 77%12 prevalence of self-care practices in type 2 diabetics and requiring precision of 12%, the sample size of 82 was calculated using the formula, 4&#xA0;pq/l2. Thus, the study was conducted among 200 patients (100 from urban and 100 from rural) with a known history of type 2 diabetes, who were 30 years of age and above and residing in that locality for more than a year. The type 2 diabetics excluded those who were pregnant, had steroid-induced hyperglycaemia and were unable to give informed consent.&#xD;
&#xD;
Selection of study population from urban and rural areas &#xD;
&#xD;
Selection of study population from urban areas:&#xD;
&#xD;
There are 15 regional ward offices under Pune Municipal Corporation.13 Out of the 2 wards viz. Bibwewadi and Dhankawdi were selected by random sampling technique. A list of registered private physician&#x2019;s clinic/s from each selected ward was obtained. One registered private physician&#x2019;s clinic from each&#xA0; Bibwewadi and Dhankawdi ward was selected purposively.&#xD;
&#xD;
Selection of study population from rural areas:&#xD;
&#xD;
There are 15 talukas in the Pune district.14 Out of 15, 1 taluka viz. Bhor was selected by random sampling technique. There are 194 villages under Bhor taluka.15 Out of the 2 villages viz. Nasrapur and Narhe were selected purposively as they owned a better private medical facility. A list of all registered private physician&#x2019;s clinic/s was obtained from each of these selected rural villages and one registered private physician&#x2019;s clinic was selected randomly from each village.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; After obtaining Institutional Ethics Committee clearance BVDU/MC/61 from Bharati Vidyapeeth Deemed to be University Medical College and Hospital, the permission of consulting physician/in-charge of clinics was obtained. All the known type 2 diabetic patients coming in the selected clinics in the study period were fully informed regarding the purpose of the study. The patient information sheet was explained to each patient and written consent was obtained before data collection. Patients were examined and interviewed at the time of the respective clinic&#x2019;s timings. The Interview was started with a general discussion to build rapport with the subjects and to gain confidence. A predesigned, pretested questionnaire was filled by interview technique to collect socio-demographic information, personal history, general examination, diabetes-related information, knowledge regarding diabetes, and the self-care practices that were followed by them. Anthropometry included measurement of height and weight.&#xA0; The questionnaire was reviewed by three experts before being utilized &#x2013; a public health expert, a diabetologist, and a statistician and their proposals were used for improving the questionnaire thus ensuring consensus validity of the instrument. Initially, a pilot study was done on 10% of type 2 diabetic patients in urban and rural clinics of the Pune district outside the study area. &#xD;
&#xD;
Knowledge was assessed using closed-ended questions, and the study subjects were classified as having adequate, inadequate-poor and no knowledge depending on the score obtained. Details regarding self-care practices were also collected.&#xD;
&#xD;
Biochemical tests were done by organizing a health camp on a predetermined date in selected urban and rural clinics. Blood samples of all selected type 2 diabetics were collected by a trained nurse. For each patient, blood samples were obtained in the morning after 10 hours fast, from the antecubital vein in a sitting position for determination of HbA1c level. Glycosylated haemoglobin was estimated using high-performance liquid chromatography on National Glycohemoglobin Standardisation Program certified instruments16 from a registered laboratory. &#xD;
&#xD;
The data were collected and entered in Microsoft Excel Office 2015 and SPSS statistics version 20 was used for statistical analysis. The data were expressed in suitable tabular formats. Percentage, mean and standard deviation were calculated. Statistical significance between the two variables was tested using the Chi square test and Fisher&amp;#39;s exact test. The correlation was tested by using Pearson&amp;#39;s correlation coefficients. p-value </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3916</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3916</Fulltext></URLs><References>&#xD;
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	Khatib N, Qazi Z, Gaidhane A, Waghmare T, Goyal R. Risk factors of type-2 diabetes mellitus in rural Wardha: A community-based study. Int J Diab Devel Coun. 2008;28(3):79.&#xD;
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	Wagh S, Bhagat S, Bankar N, Jain K. Role of Vitamin-C Supplementation in Type II Diabetes Mellitus. Int J Curr Res Rev. 2020;12(13):61-64.&#xD;
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	Hu F. Globalization of Diabetes: The role of diet, lifestyle, and genes. Diabetes Care. 2011;34(6):1249-1257.&#xD;
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	Dasappa H, Prasad S, Sirisha M, Ratna Prasanna SVN, Naik S. Prevalence of self-care practices and assessment of their sociodemographic risk factors among diabetes in the urban slums of Bengaluru. J Family Med Prim Care. 2017 Apr-Jun;6(2):218-221.&#xD;
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	About PMC [Internet]. Pmc.gov.in. 2021 [cited 9 February 2021]. Available from: https://www.pmc.gov.in/en/about-pmc.&#xD;
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	Pune Tehsil Map, Talukas in Pune [Internet]. Mapsofindia.com. 2021 [cited 9 February 2021].&#xA0;&#xD;
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	Villages &amp; Towns in Bhor Taluka of Pune, Maharashtra [Internet]. Census2011.co.in. 2021 [cited 9 February 2021]. Available from: https://www.census2011.co.in/data/subdistrict/4198-bhor-pune-maharashtra.html&#xD;
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	Muninarayana C, Balachandra G, Hiremath SG, Iyengar K, Anil NS. Prevalence and awareness regarding diabetes mellitus in rural Tamaka, Kolar. Int J Diabetes Dev Ctries. 2010 Jan;30(1):18-21. &#xD;
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	Geer E, Shen W. Gender differences in insulin resistance, body composition, and energy balance. Gender Med. 2009;6:60-75.&#xD;
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	Chaurasia N, Thapa B, Patil B, Khandekar S, Angolkar M, Narasannavar A et al. Knowledge of Urban Population Regarding Diabetes Mellitus and its Complication: A Community Based Study. J Nobel Med Coll. 2014;3(1):62-65.&#xD;
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	Hawal N, Kambar S, Patil S, Hiremath M. Knowledge, attitude and behaviour regarding self-care practices among type 2 diabetes mellitus patients residing in an urban area of South India. Int Multi Res J .2013;2(12)371-374.&#xD;
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	Gholap MC, Mohite VR. To assess the knowledge and practice regarding foot care among diabetes patients at Krishna hospital, Karad. Ind J Sci Res. 2013 Jul 1;4(2):69-75.&#xD;
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	Niazi A, Kalra S. Diabetes and tuberculosis: a review of the role of optimal glycemic control. J Diab Metab Dis. 2012;11(1): 281-285.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Assessment of Teachers&#x2019; Awareness Towards Dental Traumatic Injuries in School Children&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>128</FirstPage><LastPage>131</LastPage><AuthorList><Author>Shreyas N Shah</Author><AuthorLanguage>English</AuthorLanguage><Author> Prashant Viragi</Author><AuthorLanguage>English</AuthorLanguage><Author> Sandeep Sharma</Author><AuthorLanguage>English</AuthorLanguage><Author> Asha Nara</Author><AuthorLanguage>English</AuthorLanguage><Author>  Azhar Mohammed</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The teeth are the most commonly affected part of the body during accidents. Traumatic injuries can be in the form of tooth fracture to avulsion. Teachers awareness and attitude regarding student&#x2019;s traumatic dental injuries has a major role in the early management of these cases. Objectives: Present research was done to assess teachers&#x2019; awareness of dental traumatic injuries in school children. Materials and Method: This study consists of 2500 school teachers of both genders (males- 1320, females- 1180). A self-designed questionnaire was administered using the cluster random sampling method and awareness was assessed. Statistical evaluation was done using SPSS version 19.0 ((IBM Chicago, USA) with a Chi-square test to record attitude and awareness. Result: The result showed that 1070 (42.8%) had previous experience of dental trauma in school children. 1040 (41.6%) teachers supervise the students during sports activities, 1720 (68.8%) replied that they would like to have educational training regarding the management of dental traumatic injuries. The difference was significant (p&lt; 0.05). 1430 (57.2%) thought that the broken tooth part is important. Conclusion: It was concluded from our finding that, participants had average knowledge about dental trauma in school children and most of the teacher showed interest to have educational training regarding the management of dental traumatic injuries.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Awareness, Children, Dental emergencies, management, Teachers, Traumatic injuries</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Children and mishaps are indivisible. Trauma is more likely to occur when kids are playing. The teeth are the most commonly affected part of the body during accidents. Sports injuries are an unavoidable part of life, especially in childhood. For the dentist, parents and society, traumatic dental injuries are the main pediatric distress. Children spend most of their time in schools; hence they are more liable to have trauma. 1 &#xD;
&#xD;
Dental traumatic injuries are one of the major reasons for mortality and morbidity of teeth, particularly anterior teeth. Dental traumatic injuries are extremely established from infancy to adolescence. Recent researches have demonstrated, dental injuries are quite common among the 8&#x2013;12 years of age group. Injuries to tooth and supporting structures may range from slight tooth fracture to wide-ranging dentoalveolar injuries leading to Ellis class IV or even avulsion. The management of these injures may require extensive skill and money. Repeated recalls may be required adding additional burden to parents. 2,3&#xD;
&#xD;
Dental traumatic injuries are more common among boys than girls because boys are involved actively in contact sports and outdoor games. Most commonly traumatized teeth are central incisor in maxilla followed by central incisor, lateral incisor in the mandible and lateral incisor in the maxilla. 4 Teachers awareness and attitude regarding student&#x2019;s traumatic dental injuries have a major role in the early management of cases. Lack of knowledge can lead to delay in providing emergency treatment to children resulting in severe complications. 5 The present study planned to assess teachers&#x2019; awareness of dental traumatic injuries among school children.&#xD;
&#xD;
MATERIALS &amp; METHODS&#xD;
&#xD;
Present research comprised of 2500 school teachers of both genders (males- 1320, females- 1180). All participants were intimated concerning the usefulness of the study and informed agreement was acquired. Ethical approval was attained from the institutional ethics committee. A self-designed questionnaire was administered using the cluster random sampling method. The closed-ended questionnaire with yes/no answers was categorized into 3 portions. In the first part participants&#x2019; information for example name, age, gender, education level and earlier experience of dental trauma were noted. In the second portion knowledge and awareness based questions were asked and in the third part attitude of participants towards the education of dental trauma, management was evaluated.&#xD;
&#xD;
Inclusion criteria include; those who are willing to participate and available on the day of study, primary school teachers. An exclusion criterion includes; those who were not willing include in the study. Conversant approval was obtained from all the participants previous to the study.&#xD;
&#xD;
All participants were instructed to respond appropriately. Results thus received from participants were tabulated and statistical evaluation was done using SPSS version 19.0 ((IBM Chicago, USA) with a Chi-square test to record attitude and awareness. P-value was considered statistically significant at a value lesser than 0.05.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Table 1 shows that there were 1320 (52.8%) males and 1180 (47.2%) in the study, maximum participants were in age group 30- 40 years 1230 (49.2%) followed by 20-30 years 640 (25.6%), 40-50 years 380 (15.2%) and &gt;50 years 250 (10%). 1720 (68.8%) teachers had &gt;7 years and 780 (31.2%) teachers had &lt; 7 years of experience. 1650 (66%) teachers were graduate and 850 (34%) were postgraduate. 1070 (42.8%) had previous experience of dental trauma in school children. The variance was substantial (P&lt; 0.05).&#xD;
&#xD;
Table 2 indicated that 1040 (41.6%) teachers supervise the students during sports activities while 1180 (47.2%) do not and 280 (11.2%) sometimes. 825 (33%) had and 1675 (67%) had no first aid dental trauma management training, 740 (29.6%) replied that they can and 1760 (70.4%) cannot manage dental trauma in school, 650 (26%) teachers were and 1850 (74%) were not satisfied with their knowledge regarding dental traumatic injuries. 1720 (68.8%) replied that they would like to have educational training regarding the management of dental traumatic injuries. The variance was substantial (P&lt; 0.05).&#xD;
&#xD;
Table 3 indicated that 1430 (57.2%) thought that the broken tooth part is important, 1235 (49.4%) responded that they would try to catch out fractured tooth segment. 1250 (50%) found milk, 725 (29%) water and 525 (21%) cotton as media of storage. Most of the participants 1045 (41.8%) replied that the ideal time for replacing the tooth is 1 hour followed by 1- 2 hours by 735 (29.4%) and &gt; 2hours by 720 (28.8%). The variance was substantial (p50 years (10%). 68.8% of teachers had &gt;7 years of experience. While assessing the educational qualification we found that 1650 teachers were graduate and 850 were postgraduate. 1070 had previous experience of dental trauma in school children. Sharma et al found that 136 teachers out of a total of 285 teachers had &lt; 6 years teaching experience, 68 had 6-10 years, 39 had 11-15 years, 23 had 16-20 and 19 teachers had &gt; 20 years of experience. Most of the teachers replied that the upper front teeth are most frequently traumatized teeth. The authors found that female teachers were more knowledgeable than male teachers. 8 &#xD;
&#xD;
We found that most (47.2%) of teachers do not supervise the students during sports activities. We observed that 1675 (67%) had no first aid dental trauma management training. Most of the teachers (70.4%) cannot manage dental trauma in school and 1850 (74%) were not satisfied with their knowledge regarding dental traumatic injuries. Nirwan et al., in their study, evaluated awareness regarding dental traumatic injuries in 278 teachers and observed that a maximum of the teachers had acknowledged poor knowledge concerning dental trauma, with a mean knowledge of 10.56 &#xB1; 2.58. 9 &#xD;
&#xD;
We found that a maximum of the teachers had deprived knowledge concerning fracture tooth segment, their storage and importance. A significant difference was found. Kaul et al. evaluated knowledge of school teachers concerning the management of dental traumatic injuries (DTIs) in 400 school teachers and found that it was not satisfactory. 74.9% of women were below 50 years of age. 70.3% had not received any first aid training and 73.4%) had not witnessed any dental trauma accident in school. It was found that most of the teachers were approving for taking instant professional discussion for the emergency supervision.10 &#xD;
&#xD;
Awad et al. included 292 teachers from various schools. 95% were females and 5% were males. It was found that 50% of teachers had first aid training regarding dental traumatic injuries. Teachers had inadequate knowledge about tooth avulsion and first aid training was not related to correct replies to the management of avulsed teeth (p&lt; 0.05). The majority of the teachers responded that they do not have satisfactory knowledge about dental traumatic injuries in contrast to physical education teachers and administrators. Most of the younger teachers desired to have future education on dental traumatic injuries management. 11 Chandukutty et al., and Daupare et al., evaluated the teacher&amp;#39;s awareness about traumatic injury and observed poor knowledge and attitude regarding traumatic dental injuries similar to our findings. 12, 13, 14Anandet al., also found poor knowledge among physical teachers about dental injuries and suggested for motivational programs to improve knowledge. 15&#xD;
&#xD;
Knowledge regarding dental traumatic injuries may help teachers to ensure timely and efficient management of emergencies. Dental trauma may involve deciduous as well as permanent teeth. Thus large scale educational programmes can provide useful knowledge and awareness among school teachers.&#xD;
&#xD;
Dental trauma in school children is quite common. Teachers should have sufficient knowledge and awareness about dental traumatic injuries. Large scale studies are required in future to provide useful information. &#xD;
&#xD;
The shortcoming of the study is that only private school teachers were enrolled on the study. The study was based on the response given by participants, which may vary from person to person. The type of tooth fracture was not recorded. &#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
It was concluded from our finding that, participants had average knowledge about dental trauma in school children and most of the teacher showed interest to have educational training regarding the management of dental traumatic injuries.&#xD;
&#xD;
Conflict of interest: None declared&#xD;
&#xD;
Financial support: Nil&#xD;
&#xD;
Acknowledgement: Nil&#xD;
&#xD;
Authors contribution&#xD;
&#xD;
Authors contribution&#xD;
&#xD;
1. Dr. Shreyas N SHAH- manuscript writing&#xD;
&#xD;
2. Dr. PRASHANT VIRAGI- data collection&#xD;
&#xD;
3. Dr. SANDEEP SHARMA- review&#xD;
&#xD;
4. Dr. ASHA NARA- interpretation&#xD;
&#xD;
5. Dr. AZHAR MOHAMMED &#x2013; editing&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3917</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3917</Fulltext></URLs><References>&#xD;
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	Sharma A, Gupta R, Sharma S, Fatema K, Boini S. Dental trauma management and it&#x2019;s awareness in school teachers: A survey in Burhanpur, Madhya Pradesh, India. Int J Appl Den Sci. 2018; 4(4): 371-375. &#xD;
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	Nirwan M, Syed AA, Chaturvedi S, &#xA0;Goenka, P, SharmaS. Awareness in primary school teachers regarding traumatic dental injuries in children and their emergency management: A survey in South Jaipur. Int J Clin Ped Dent. 2016;9(1):62-66. doi:&#xA0;10.5005/jp-journals-10005-1335&#xD;
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	Kaul R, Jain P, Saha N, Goswami&#xA0; S,&#xA0;Mukhopadhyay&#xA0;S,Saha S, et al. Evaluation of knowledge, awareness, and attitude toward emergency dental trauma management among the school teachers of Kolkata. Indian J Dent Res. 2017;28:595-603. doi: 10.4103/ijdr.IJDR_118_17.&#xD;
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	Awad MA, AlHammadi E, Malalla M, Maklai&#xA0;Z,&#xA0;Tariq&#xA0;A,&#xA0;Al-Ali&#xA0;B, et al. Assessment of elementary school teachers&#x2019; level of knowledge and attitude regarding traumatic dental injuries in the United Arab Emirates. Int J dent. 2017; 2017. Article ID 1025324, 7 pages. https://doi.org/10.1155/2017/1025324&#xD;
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	Chandukutty D,Peedikayil FC,&#xA0;Premkumar CT, Narasimhan D,&#xA0; Jose D.Awareness of Dental Trauma Management among School Teachers of Kannur, Kerala, India. J ClinDiagn Res.&#xA0;2017 Feb; 11(2): ZC08&#x2013;ZC12.&#xD;
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	Daupare S, Narbutaite J. Primary school teachers&amp;#39; knowledge and attitude regarding traumatic dental injuries. J Indian Soc Pedod Prev Dent. 2020;38:216-21&#xD;
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	Sharma R, Mallaiah P, Kadalur UG, Verma S. Knowledge and Attitude of School Teachers with regard to Emergency Management of Dental Trauma in Bangalore City. Int J Oral Health Med Res. 2016;3(1):38-43.&#xD;
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	Anand A, Mukherjee CG,Shukla JN, Sharma S. Knowledge and Awareness Regarding Traumatic Dental Injuries in School Children among Physical Education Teachers in Patna: A Cross-Sectional Study. Int J Stud Sci. 2016;4(1):51-54.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Pigmented Basal Cell Carcinoma -&#xA0;A Rare Case Report&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>132</FirstPage><LastPage>134</LastPage><AuthorList><Author>Irri H</Author><AuthorLanguage>English</AuthorLanguage><Author> Rajendran S</Author><AuthorLanguage>English</AuthorLanguage><Author> Narasimhalu CR</Author><AuthorLanguage>English</AuthorLanguage><Author> Sonti S</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Basal cell carcinoma is the most common skin cancer. Pigmented basal cell carcinoma is a very rare variant of Basal cell carcinoma with increased pigmentation. Intermittent ultraviolet radiation exposure is the predominant risk factor. Due to its multiple and varied clinicopathological presentations, its diagnosis becomes difficult. A case of multiple pigmented BCC is reported in a 64-year-old man on the right cheek. The diagnosis was established based on histopathology and dermoscopy findings. Result: Dermoscopy showed a maple-leaf like a pattern, blue-grey globules, ulceration and vessels. Histopathological examination showed an island of basaloid cells with peripheral palisading, melanin clumps in the stroma, with retraction artefacts. Conclusion: Dermoscopic analysis of the pigmented basal cell carcinoma eliminated the need for biopsy leading to early diagnosis and prompt intervention. Thus dermoscopy should be used as a routine tool in suspected skin lesions.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Pigmented basal cell carcinoma, Skin cancer, Dermoscopy, Basal cell carcinoma, UV radiation, Basaloid cells</Keywords><Fulltext>INTRODUCTION: Basal cell carcinoma(BCC) is the most common nonmelanoma skin cancer with negligible mortality.1 However they exhibit significant morbidity if diagnosed late or left untreated. Pigmented basal cell carcinoma is a very rare variant accounting for about 6% of total cases of BCC.2Pigmented basal cell carcinoma is commonly seen among black, Hispanic, and Asian individuals.3 They are less frequent in Caucasians. It mostly presents in the elderly with male preponderance attributable to their increased years of exposure to UV radiation. Biopsy of the lesion followed by histopathological examination have been the mainstay in diagnosis. Recently dermoscopy has become an important diagnostic tool aiding in differentiating pigmented BCC from melanoma&#xD;
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CASE REPORT: A 64-year-old male presented to skin OPD with chief complaints of dark coloured skin lesion over the right cheek of more than 3 years in duration and a similar lesion smaller in size which developed 6 months ago below and behind the right ear. A gradual increase in size was observed in the new lesion with mild itching. There was no appreciable increase in its colour.&#xD;
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On clinical examination, two well-defined plaques with irregular borders, with a central pinkish hue and surrounding hyperpigmentation, size measuring 4.5x3 cm and 1.5x1cm were noted above the right angle of the mandible and right infra auricular area respectively (Fig 1). The surface showed irregular pigmentation and was not tender or indurated on palpation. Differential diagnosis of basal cell carcinoma, squamous cell carcinoma and malignant melanoma were considered. Dermoscopic analysis was done which showed the absence of pigment network, focal area of ulceration, arborizing vessels, bluish-grey globules and leaf-like structures on the older plaque (Fig 2). Whereas the new plaque showed an absence of pigment network with multiple ulcerations and bluish-grey globules (Fig 3). To confirm the diagnosis a punch biopsy was performed and sent for histopathological examination.&#xD;
&#xD;
Histopathology showed an island of basaloid cells with peripheral palisading, and melanin clumps in the stroma, with retraction artefacts forming clefted spaces (Fig 4).&#xD;
&#xD;
DISCUSSION: Basal cell carcinoma is a skin cancer originating from pluripotent cells in the basal layer of the epidermis or follicular structures. Non pigmented basal cell carcinoma is much more common than its pigmented counterpart. Pigmented basal cell carcinoma is a rare variant in which melanin is produced by melanocytes that colonize the tumour and in melanophages located in the surrounding stroma. It is a slow-growing, locally invasive tumour.4 Intermittent, intense exposure to ultraviolet rays from the sun plays a major role along with other risk factors like skin type 1 (never tans, always burns), red or blonde hair, and blue or green eyes in the development of basal cell carcinoma.5 In western literature BCC showed a female preponderance whereas in Indian literature there is a male preponderance.6The risk of basal cell carcinoma is high among males above 60 years, the most common site being the middle third of the face but can occur anywhere on the sun-exposed parts of skin.7Which is in line with our case, where a 65 years old man who was a farmer presented with a lesion on the face. A differential diagnosis of pigmented basal cell carcinoma and melanoma was considered. &#xD;
&#xD;
Hence a noninvasive diagnostic aid was considered. Dermoscopy helps in the diagnosis of basal cell carcinoma from other pigmented lesions. Menzies&#xA0;et al. proposed a simple dermatoscopic method for diagnosing pigmented BCCs. This method has a sensitivity of 97% and a specificity of 92% and 93% for differentiating pigmented basal cell carcinoma from melanoma.8 According to this diagnostic method, pigmented BCC must have a negative feature i.e absence of pigment network and presence of one of the following six criteria: maple leaf-like areas, blue-grey ovoid nests, ulceration, arborizing vessels, spoke wheel areas, multiple blue-grey dots/globules.9,10 This case fits well into the criteria with the absence of pigment network and presence of maple leaves like areas, focal ulceration, blue-grey globules and arborizing vessels.&#xD;
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The clinical and dermoscopic diagnosis was further substantiated with histopathological evidence consistent with pigmented BCC. Plastic surgeons and Oncologist&#x2019;s help were sought for further management and the patient is being followed up.&#xD;
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CONCLUSION: This report describes a pigmented variant of BCC, which is a rare manifestation, diagnosed with classical histopathology and dermoscopy findings. Knowledge of dermoscopic findings in pigmented BCC helps to avoid unnecessary biopsies, aids in early diagnosis and management of the patient. Though a widely used modality it should be incorporated into daily clinical practice to enhance diagnostic accuracy. &#xD;
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Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript.&#xA0;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.&#xD;
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Conflict of interest &#x2013; Nil&#xD;
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Source of funding&#xA0; - Nil&#xD;
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Author&#x2019;s contribution: &#xD;
&#xD;
&#xD;
	&#xD;
	H. had contributed to the diagnosis and drafted the article. Rajendran S, Sonti S. has made a substantial contribution to the diagnosis or design of the article. Narasimhalu CR. had revised it critically for important intellectual content and approved the version to be published. clearance: Nil&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3918</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3918</Fulltext></URLs><References>&#xD;
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	Deepadarshan K, Mallikarjun M, Abdu NN. Pigmented basal cell carcinoma: a clinical variant, report of two cases. J Clin Diagn Res. 2013;7(12):3010&#x2013;3011.&#xD;
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	Khot K, Deshmukh SB, Alex S. Pigmented basal cell carcinoma: an unusual case report. J Case Rep. 2015;4(1):189-92.&#xD;
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	Abudu B, Cohen PR. Pigmented Basal Cell Carcinoma Masquerading as a Melanoma. Cur. 2019;11(4): e4369.&#xD;
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	Jain M, Madan NK, Agarwal S, Singh S. Pigmented basal cell carcinoma: Cytological diagnosis and differential diagnoses. Ind J Cytol. 2012;29(4):273.&#xD;
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	Wong CS, Strange RC, Lear JT. Basal cell carcinoma.&#xA0;Bri Med J.2003;327(7418):794-798. &#xD;
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	Nandyal SS, Puranic RB. Study of the demographic profile of skin tumours in a tertiary care hospital. Int J Curr Res Rev. 2014;6(16):24-28.&#xD;
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	Nagi R, Sahu S, Agarwal N. Unusual presentation of pigmented basal cell carcinoma of the face: a surgical challenge. J Cont Drug Res. 2016;10(7): ZJ06-7.&#xD;
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	Lallas A, Apalla Z, Argenziano G, Longo C, Moscarella E, Specchio F, Raucci M, Zalaudek I et al.&#xA0;The dermatoscopic universe of basal cell carcinoma. Derm Pract Concept 2014;4(3):11&#x2013;24.&#xD;
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	Senel E. Dermatoscopy of non-melanocytic skin tumours. Ind J Derm Ven Leprol 2011;77(1):16.&#xD;
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	Rambhia KD, Shah VH, Singh RP. Dermoscopy of pigmented basal cell carcinoma. Pigm Int. 2018;5(2):123-4.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Measurement of Oxidized LDL and Remnant Lipoprotein Cholesterol Associated with High-Sensitive C-Reactive Protein in Coronary Heart Disease&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>135</FirstPage><LastPage>141</LastPage><AuthorList><Author>Karini Keerthi</Author><AuthorLanguage>English</AuthorLanguage><Author> Thirunavukkarasu Jaishankar</Author><AuthorLanguage>English</AuthorLanguage><Author> Kasthuri Natarajan</Author><AuthorLanguage>English</AuthorLanguage><Author>  Balasubramanian Kannan</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: LDL-C undergoes modification to form Oxidized LDL a crucial occurrence in the oxidation hypothesis of atherogenesis. Oxidized LDL and RLP-C stimulates the immune and inflammatory reactions and promotes atherosclerosis. Because of its lesser size along with high cholesterol content, and increased residence period in blood the remnant lipoproteins are highly atherogenic. Remnant lipoproteins enter into the arterial wall easily and taken up directly by macrophages lead to the formation of foam cells, thus initiating the lipid-laden plaque. Oxidized LDL along with remnant lipoprotein cholesterol and hs-CRP play a crucial role in the progression of coronary heart disease. Objective: The objective of the study is to measure the level of circulating Oxidized LDL and Remnant Lipoprotein Cholesterol associated with High-Sensitive C-Reactive Protein in Coronary Heart Disease Materials and Methods: This cross-sectional study was conducted on 91 CHD patient and 91 healthy control in the age group of 25 to 55 years and were age and sex-matched. After overnight fasting body fluid samples were collected for analysis for Lipid Profile, oxidized LDL and hs-CRP. ox-LDL and hs-CRP measured by ELISA method and Lipid Profile are measured using Auto Analyzer AU480. Results: The mean level of oxidized Low-Density Lipoprotein level in CHD was elevated (40.89&#xB1;8.69) and statistically significant (p-value </Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Oxidized Low-Density Lipoprotein, Remnant lipoprotein cholesterol, Coronary Heart Disease, Glycosylated Hemoglobin,  high-sensitivity C-reactive protein</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
In developed and developing countries the prevalence of CHD is the most important cause of death in India by 2020. In the adult population, more than 7 million deaths are caused by CHD (21.9 % of total deaths, expected to increase to 26.3 % by 2030 worldwide. 1 Remnant lipoprotein cholesterol which is mostly found in fasting and non-fasting triglyceride-rich lipoproteins (TRLs).&#xA0; In fasting state as VLDL-C and IDL-C along with the non-fasting state as VLDL, IDL and chylomicron remnants.2Like LDL-C, Remnant cholesterol promoting inflammatory reaction and atherogenic process along with accumulating and infiltrating the endothelial barrier in the arterial wall. Low-density lipoprotein cholesterol along with remnant cholesterol are causally accompanying coronary heart disease. &#xD;
&#xD;
Remnant particles are larger than LDL and carry &#x2264;40 times as much cholesterol per particle and more atherogenic than LDL.3 Increased oxidative stress and formation of superoxide anion in vascular cells stimulate the alteration of LDL-C to atherogenic oxidized LDL.4 In the vessel wall, uptake of scavenger receptor on monocyte-derived macrophages caused by the elevated level of RLP-C and LDL oxidation, leads to foam cells accumulation along with fatty streak formation.5 In the Pathogenesis of coronary heart disease CRP plays a significant role. C- reactive protein is a pentraxin family of protein, an acute phase reactant with a molecular weight of 23kDa. It is a highly sensitive marker for inflammation.6The level of CRP rises drastically during the inflammatory process. The elevated concentration of hs-CRP directly implies subclinical inflammation in individual.7&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
Remnant lipoprotein cholesterol along with oxidation of LDL associated with local and systemic inflammatory reaction linked to the risk of CHD along with low-grade inflammation.8&#xD;
&#xD;
We assessed each correlation between remnant lipoprotein cholesterol and ox-LDL associated with hs-CRP in the CHD subject.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
This cross-sectional study was conducted from Jun 2019 to Dec 2019 at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India on subjects attending the Cardiology and medicine outpatient. Totally 182 subjects were included who were age and sex match in the age group 25-55 years. 91 CHD subjects and 91 normal healthy subjects were selected as control. The control subjects were also taken from Master health check-up Programme and medicine OP in SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India. This study follows the Declaration of Helsinki and was approved by the institutional ethical committee at SRM Medical College Hospital and Research Centre (ECN: 1513/ICE/2018). Written informed consent was collected from all participants at the time of enrollment. Based on coronary angiography, the CHD patients were selected. Serum glucose value is above the normal and below the diabetic level diagnosed both males and females coronary heart disease patient and patients with chest pain, ECG and ECHO, changes, increased cardiac markers such as creatinine phosphokinase (CPK-MB) and troponin level. The control group consists of Normal healthy individuals. The subjects who were on treatment for renal failure, cancer, autoimmune diseases, surgery, fever, alcoholics, smokers, pregnancy and patients with corticosteroids, estrogen, anti-retroviral drugs psychotropic medications. Thyroid, arthritis, rheumatoid arthritis, acute/chronic infection patients were excluded&#xD;
&#xD;
We did the study on both NGT &amp; IGR subjects.&#xD;
&#xD;
Criteria that we followed to rule out glucose status are&#xD;
&#xD;
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	Fasting plasma sugar levels are between 110 to 126 mg/dl&#xD;
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	2hrs postprandial&#xA0; levels are in between 140-199 mg/dl&#xD;
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	HbA1c levels less than 4&#xD;
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During the period of enrolment, Medical and demographic data were collected. By using a questionnaire during the clinical appointment the basic info on age, gender along with the history of diabetes, hypertension, and the use of medications were collected. Before shifting the data to the database. Questionnaires were assessed by an expert questioner for lost data and its entirety. Information on laboratory reports was noted for all the subjects. The physical examination consists of the 12-lead relaxing electrocardiogram. In the morning, fasting samples from cases and healthy controls were taken from the antecubital vein. At 2500 RPM the blood was centrifuged for 15 minutes; and serum was separated and used for the assessment of glucose and routine lipid profile includes plasma total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), TC/HDL-C ratio, LDL-C/HDL-C ratio and HbA1c were measured. BMI was calculated as weight in kilograms/(height in meters)2. Lipid Profiles were estimated using Direct Antibody Inhibition. TC was estimated by the enzymatic end-point cholesterol esterase-peroxidase method. Triglycerides were estimated by the enzymatic end-point glycerol oxidase-peroxidase method (Beckmann Coulter AU480 Analyzer). By using High-pressure liquid Chromatography, the levels of haemoglobin A1c (HbA1c) were measured. &#xD;
&#xD;
The RLP-C was calculated by using the formula: RLP-C=TC-(HDL-C+LDL-C) [9]. Ox-LDL and High sensitive C - reactive protein were measured by ImmunoTurbidometry in Marketable ELISA Kit.&#xD;
&#xD;
Statistical Methods&#xD;
&#xD;
By using a statistical package for social service (SPSS 16.0) the Data were analyzed. The data from the study were shown as mean and standard deviation. p-value was </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3919</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3919</Fulltext></URLs><References>&#xD;
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	Vinodhini VM, Keerthi K, Kumar JS and Subramaniyam G. Assessment of Remnant Lipoprotein Cholesterol (RLP-C) Levels and its Correlation with Carotid Intima-Media Thickness in Insulin Resistant Type 2 Diabetes Mellitus Patients. J Clin Diagn Rese. 2019 May, Vol-13(5): BC29-BC31&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Comparative Efficacy of Regular and Musical Toothbrush in Supragingival Plaque Removal in Children - A Randomized Clinical Trial&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>142</FirstPage><LastPage>147</LastPage><AuthorList><Author>Sarojini Ramya Pillay</Author><AuthorLanguage>English</AuthorLanguage><Author> Jessy P</Author><AuthorLanguage>English</AuthorLanguage><Author> Subhabrata Maiti</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Children routinely present with unsatisfactory oral hygiene due to a lack of interest in brushing twice daily. Motivation serves to be an integral part of health promotion to children at the learning phase of their life. Aim: The purpose of this study was to clinically evaluate and compare the efficacy of musical toothbrush over regular toothbrush in supragingival plaque removal among children of age 6-11years Materials and Methods: 42 children aged 6-11 years who fulfilled the criteria enrolled on a single-blind, randomized study. The Eligible subjects were randomly assigned into two groups by a second examiner one group used a musical toothbrush and another group used a regular toothbrush for the duration of the study. Subjects were instructed to brush their teeth at home twice daily for 2 minutes each day for the 45-day study period. At 0 day and after 15, 30 and 45days, the plaque was assessed following 24 hrs of no oral hygiene. At each visit plaque removal was evaluated using disclosing solution before and after subjects had brushed their teeth for 2 minutes under supervision. The plaque build-up was noted using the Quigley-Hein plaque index. Independent &#x2018;T&#x2019;test and paired T-test was used to compare the outcome variables within and across the two groups. Results: Greater mean changes in whole mouth plaque reduction were seen for Group 2 (musical group) when compared to that of Group 1(regular group) at days 15, 30 and 45 (P</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Children, Motivation, Musical toothbrush, Plaque Removal, Tooth brushing, Supragingival plaque</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
School going age is regarded as the influencing stage in a child&#x2019;s life where lifelong sustainable oral health-related behaviour, belief, and attitude can be established with a long-lasting impact.1 Effective plaque control and good oral hygiene maintenance play a solid role in maintaining oral health and prevention of these diseases which can be achieved primarily by effective tooth brushing.2,3,4 Also regular removal of supragingival plaque has been shown to reduce counts of pathogenic species both supra- and sub-gingivally.5,6 Various chemical and other mechanical methods have been advocated for this purpose, but tooth brushing has been cited as the gold standard and most commonly used effective and safest therapeutic method in removing plaque.7,8,9&#xD;
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It is generally known that tooth brushing by young children under the age of 10 years is inefficient due to lack of motivation and poor manual dexterity at this age.10-13 It has been shown that tooth brushing practised by the majority of the population is unsatisfactory. De La Rosa suggested that an average child removes only about 50% of the plaque present on teeth.14 Therefore poor oral hygiene occurring due to increased plaque and calculus deposits with increasing age has been reported among children and adolescents.15,16,17 This could be attributed to the fact that there is a lack of motivation among them to follow the practice of brushing as a regular habit and also they consider it as tedious.18 Majority of children show noncompliance towards brushing and they try to hide themselves from daily brushing task because they consider it as a tedious procedure which makes them dislike the brushing habit. At one point they tend to fail in developing a child&#x2019;s interest in brushing. The level of oral hygiene achieved by an individual is dependent on a variety of factors such as motivation, duration &amp;frequency.19,20 &#xA0;It is important to gain a child&#x2019;s interest in brushing by introducing some new devices that the child can enjoy brushing. To make the tooth brushing habit more interesting to children and to gain their attention, a toothbrush with a music system has been used in this study. The use of musical talking toothbrush in children helps to overcome the problem of lack of motivation. The musical toothbrush has been developed specifically to appeal to children, with appropriately sized brush heads and features to introduce a &#x201C;fun&#x201D; aspect to tooth brushing. With this brush, the music plays when the child starts brushing and continues for up to 2 minutes until the music stops. This method is proposed to inculcate a habit of 2 minutes of tooth brushing among them. The previous literature says that music among children while brushing creates a positive mood, attention, and learning practices in the children. 21 Also to date few reported studies have been done to compare musical and regular toothbrush. Keeping this in mind, our objective of the study was to clinically evaluate and compare the efficacy in the plaque scores among the musical toothbrush over the regular toothbrush group among 6&#x2013;11?year?old children. &#xD;
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MATERIALS AND METHODOLOGY&#xD;
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Study population: This study comprises 42 healthy kids (17 boys and 25 Girls) who fulfilled the inclusion criteria along with parental consent formed the sample for the study. &#xD;
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Approval: The study was undertaken with the understanding and written consent from the parents of each participant. The study design was approved by the Institutional Ethical Review Board, Saveetha Dental College, Chennai (IHEC/SDC-UG-1558/19/175).&#xD;
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Inclusion criteria:&#xD;
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	Children between 6 to 11 years of age were selected for the study.&#xD;
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	Children who were interested to participate in the study.&#xD;
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	Cooperative children were included.&#xD;
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	Patients who never used any other form of toothbrush before were included.&#xD;
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	Patients with a minimum of twenty teeth present in their oral cavity.&#xD;
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Exclusion criteria:&#xD;
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	Patients with poor oral hygiene with extrinsic stain and/or calculus deposits.&#xD;
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	Evidence of major oral hard or soft tissue lesions.&#xD;
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	History of a significant adverse event, allergy, or irritation that was due to oral hygiene products was eliminated.&#xD;
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	Fixed or removable orthodontic appliances.&#xD;
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	Medically compromised patients and disabled patients were excluded.&#xD;
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	Subjects with severe crowding.&#xD;
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	Children under any form of regular drug therapy were excluded from the study.&#xD;
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Experimental procedure:&#xD;
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Based on eligibility criteria, 42 participants were divided into two groups. The subjects were randomly assigned into two groups by a second examiner; Group 1 assigned a regular toothbrush (oral B-Chhotabheem) and Group 2 were assigned musical tooth (Aqua white musical chhotabheem). Group 1 brushed used regular toothbrush and Group 2 used a musical toothbrush. Only the second examiner knew which child had been given which brush, and was not involved in the recording of clinical parameters. And all clinical parameters were recorded by the first examiner. The children were taught the proper technique (horizontal scrub technique), and instructed on the proper use of their respective toothbrushes and performed their first brushing at the study site under supervision. They were then instructed to brush at home for two minutes twice daily for 45 days. They were also provided with standard fluoride toothpaste (Cheerio) and a diary to note any comments about their brushing experience. To achieve a standardized condition, each participant was provided with a common dentifrice. Also, their parents underwent training session on the brushing technique, using demonstration models. The children were familiarized with the disclosing agent, before the commencement of the study with the help of demonstrations.&#xA0; The subject&#x2019;s parents were instructed to monitor tooth brushing and advised not to use another form of oral hygiene measures.&#xD;
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Instructions:&#xD;
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	Subjects were asked to use only the given brushes following the specified taught technique.&#xD;
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	Subjects were instructed to refrain from using any other oral hygiene products during the study.&#xD;
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	Informed to brush twice daily each time for 2 min with the given dentifrice only.&#xD;
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	Return for regular periodic examination on 15th day,30th &#xA0;and 40th day.&#xD;
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	Advised not to use any medication which could have an inhibitory effect on plaque.&#xD;
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	Refrain from brushing or any other forms of oral hygiene measures 24 hr before every recall visit.&#xD;
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Clinical Assessments&#xD;
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The clinical parameters were measured at 0 days, 15th day and 30th day and 45th day by the first examiner using Plaque Index (Quigley and Hein), The children were asked to refrain from all oral hygiene procedures for 24hr before every recall visit. The subjects brushed their teeth for 2 min under supervision using the assigned toothbrush and toothpaste. This was an examiner blinded study, so the brushing occurred at the study site in a separate room. Whole mouth plaque was assessed as described above, before and after the supervised 2min tooth brushing at each visit. Pre and post brushing plaque was scored using the Quigley Hein Plaque Index. Subjects swished with 5 ml of disclosing solution for 15 seconds, expectorated, and then rinsed with 10 ml of water for 10 seconds and expectorated. Plaque removal was assessed at each visit (day 0, day 15, day 30, day 45) following 24 hrs of no oral hygiene.&#xD;
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On day &#x201C;0&#x201D;&#xD;
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All the individuals who participated in the study were advised to refrain from brushing their teeth for 24 hr before their appointment on the day &#x201C;0&#x201D;. The plaque was disclosed by using a disclosing solution in the form of a rinse for all individuals. The pre brushing plaque score was recorded in the prepared pro forma by using the Quigley-Hein plaque index. Following this, the individuals were instructed to brush with the allocated toothbrush and toothpaste and the brushing technique in which they were instructed (Group 1 and Group 2) for 2 min. Re-examination was done after disclosing plaque, and the plaque score was recorded using the Quigley-Hein Plaque index. Further, the individuals were instructed to use the allocated toothbrushes using the prescribed brushing technique at home daily for 2 min and were given appointments on the 15th, 30th, and 45th&#xA0;days.&#xD;
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On the 15th&#xA0;day, 30th&#xA0;day, and 45th&#xA0;day:&#xD;
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The same investigational measures were carried out, and the Plaque index was evaluated and measured as that has done on the day &#x201C;0&#x201D;. Long term efficacy was evaluated by recording plaque scores following 24hrs of no oral hygiene at day 0 to day 45 and the values were obtained&#xD;
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STATISTICAL METHODS:&#xD;
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.The data collected were entered in the Microsoft Excel sheet following which statistical analyses were carried out using SPSS (Statistical Package for Social Sciences) Version 24.0 (IBM Corporation, Chicago, USA). The mean plaque scores were calculated using descriptive statistics. To assess variance in performance between 0, 15, 30 and 45 days, an independent t-test was carried out for comparing the plaque index among the two groups at each measurement day. Paired t-test was used to analyse the mean plaque score between visits. The level of statistical significance was set at 5% (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3920</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3920</Fulltext></URLs><References>1.Kwan SY, Petersen PE, Pine CM, Borutta A. Health?promoting schools: An opportunity for oral health promotion. Bull World Health Org. 2005;83:677?85.&#xD;
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2.NageshwarIyer, ShaluChandna, AshishLoomba. Plaque removal efficacy of Colgate 360 toothbrush: A clinical study. Contemp Clin Dent.2016; 7:317-21.&#xD;
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3. Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st &#xA0;century--the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol. 2003; 31(Suppl 1): 3-23.&#xD;
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4. Macpherson LM, Anopa Y, Conway DI, McMahon AD National supervised tooth brushing program and dental decay in Scotland. J Dent Res. 2013; 92(2): 109-113.&#xD;
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5.Haffajee AD, Thompson M, Torresyap G, Guerrero D, Socransky SS. Efficacy of manual and powered toothbrushes. Effect on clinical parameters. J Clin Periodontol. 2001;28:937-46.&#xD;
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6. O&amp;#39;Leary TJ, Drake RB, Naylor JE. The plaque control record. J Periodontol. 972;43:38. &#xD;
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7. Sicilia A, Arregui I, Gallego M, Cabezas B, Cuesta S. A systematic review of powered vs. manual toothbrushes in periodontal cause-related therapy. J Clin Periodontol. 2002;29 (Suppl. 3):39-54.&#xD;
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8 . Hayaski H, et al. Tooth brushing for oral prophylaxis.Jpn Dent Sci Rev. 2014; 50:69-77.&#xD;
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&#xA0;9.&#xA0; Sharma NC, Qaqish J. A Clinical Evaluation of the Plaque Removal Efficacy of Five Manual Toothbrushes. J Clin Dent.2010; 21:8-12.&#xD;
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10. Grossman E, Proskin H. A comparison of the efficacy and safety of an electric and a manual children&#x2019;s toothbrush. J Am Dent Assoc.1997;128:469-74.&#xD;
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&#xA0;11. Unkel JH, Fenton SJ, Hobbs G Jr, Frere CL. Tooth brushing ability is related to age in children. ASDC J Dent Child.1995; 62:346-348.&#xD;
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12. Bastiaan RJ.The cleaning efficiency of different toothbrushes in children. J Clin Periodontol. 1986;13:837?40&#xD;
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13. Benson BJ, Kenyon G, Grossman E. Plaque removal efficacy of two children&#x2019;s toothbrushes: A one-month study. J Clin Dent. 1993;4:6-10&#xD;
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14. &#xA0;De la Rosa M, Zacarias Guerra J, Johnston DA, Radike AW. Plaque growth and removal with daily tooth brushing. J Periodontal. 1979;50:661-4.&#xD;
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15. Mbawalla HS, Masalu JR, Astr&#xF8;m AN. Socio-demographic and behavioural correlates of oral hygiene status and oral health-related quality of life, the Limpopo?Arusha school health project (LASH): A cross-sectional study. BMC Pediatr. 2010;10:87.&#xD;
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16. Saied?Moallemi Z, Virtanen JI, Vehkalahti MM, Tehranchi A, Murtomaa H. School-based intervention to promote preadolescents&#x2019; gingival health: A community trial. Community Dent Oral Epidemiol. 2009;37:518?26.&#xD;
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17. World Health Organization. Information Series on School Health: Oral Health Promotion Through Schools. Geneva: World Health Organization. 2003.&#xD;
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18. Sandstr&#xF6;m A, Cressey J, Stecks&#xE9;n-Blicks C . Tooth-brushing behaviour in 6-12year olds.Int J Paediatr Dent. 2011;21(1): 43-49.&#xD;
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19.&#xA0;Sharma S, Yeluri R, Jain A, Munshi A. Effect of toothbrush grip on plaque removal during manual tooth brushing in children. J Oral Sci 2012; 54(2):183-190.&#xD;
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20.Stecks&#xE9;n-Blicks C, Sunneg&#xE5;rdh K, Borss&#xE9;n E (2004). Caries experience and background factors in 4-year-old children: Time trends 1967-2002. Caries Res. 38(2): 149-155&#xD;
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21. Stacey R, Brittain K, Kerr S. Singing for health: An exploration of the issues. Health Educ. 2002;102:156?62.&#xD;
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22.Claydon N, Addy M. Comparative single-use plaque removal by toothbrushes of different designs. J Clin Periodontol.1996; 23:1112-1116.&#xD;
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23.Sharma NC, Goyal CR, Qaqish JG, Cugini MA, Thompson MC, Warren PR, et al. Single-use plaque removal efficacy of three power toothbrushes. Journal of the dent.2005; 33:11-15.&#xD;
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24. &#xA0;Sharma NC, Goyal CR, Qaqish JG, Cugini MA, Thompson MC, Warren PR, et al. Plaque removal efficacy of two electric toothbrushes with different brush head design. J dent.2005; 33:17-21.&#xD;
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25.Mescher KD, Brine P, Biller I. The ability of elementary school children to perform sulcular tooth brushing as related to their hand functionality. Pediatr Dent. 1980; 2:31-36&#xD;
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26. Agerholm DM. A clinical trial to evaluate plaque removal with a double-headed toothbrush. Br Dent J. 1991;170:411&#x2013;3. &#xD;
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27. Silverstone LM, Tilliss TS, Cross-Poline GN, Van der Linden E, Stach DJ, Featherstone MJ. A six-week study comparing the efficacy of a rotary electric toothbrush with a conventional toothbrush. ClinPrev Dent. 1992;14:29&#x2013;34. &#xD;
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28. Tritten CB, Armitage GC. Comparison of a sonic and a manual toothbrush for efficacy in supragingival plaque removal and reduction of gingivitis. J Clin Periodontol. 1996;23:641&#x2013;8. &#xD;
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29. Shibly O, Schifferle RE, Ciancio SG, Tarakji M, Mather ML. A clinical comparison of 2 electric toothbrush designs. J Clin Periodontol. 1997;24:260&#x2013;3. &#xD;
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30. Killoy WJ, Love JW, Love J, Fedi PF, Tira DE. The effectiveness of a counter-rotary action powered toothbrush and conventional toothbrush on plaque removal and gingival bleeding. A short term study. J Periodontol. 1989;60:473&#x2013;7. &#xD;
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&#xA0;31.Ganesh M, Shah S et al The effectiveness of a musical toothbrush for dental plaque removal: A comparative study. J Ind Soc Pedod Prev Dent.2012; 30(2):139-45&#xD;
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32. Nivedha S, Parangimalai D, Madan K. Effectiveness of Musical Toothbrush on Oral Debris and Gingival Bleeding among 6&#x2013;10-Year-Old Children: A Randomized Controlled Trial. Indian J Den Res. 2019;30(2):196-99&#xD;
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33. Hogenesa M, Oersb BV, Diekstrac RF. The impact of music on child functioning. Eur J Soc Behav Sci. 2014;10:1507-26.&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Determination of Gamma-Glutamyltransferase in Type 2 Diabetes Mellitus and its Relation with Disease Treatment&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>148</FirstPage><LastPage>151</LastPage><AuthorList><Author>Arvind Kumar Kushwaha</Author><AuthorLanguage>English</AuthorLanguage><Author> Karanpreet Bhutani</Author><AuthorLanguage>English</AuthorLanguage><Author> Suvarna Prasad</Author><AuthorLanguage>English</AuthorLanguage><Author>  Punam Rani</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Diabetes Mellitus is one of the most common metabolic disorders. Various pathogenic processes are involved in the growth of diabetes; insulin deficiency,insulin resistance. Oxidative stress can also play a role in the cause and pathophysiology of diabetes. Gamma-glutamyltransferase (GGT) has a pivotal role in the maintenance of intracellular antioxidant defences through its mediation of extracellular glutathione transport into most types of cells. Gamma-glutamyltransferase enzymatic activity may also be indicative of an early risk of inflammation. Aims and Objectives: To study the levels of Gamma-glutamyltransferase, FBS, HbA1c in type 2 diabetes patients. To find out correlations if any between the Gamma-glutamyltransferase Level with FBS, HbA1c. To evaluate GGT levels in controlled and uncontrolled cases of type 2 diabetic patients. Material and Methods: In this study, 100 study subjects with age above 40 years were divided into two groups - 50 patients having type 2 DM (the study group) and 50 healthy individuals (the control group). From the venous blood, serum gamma-glutamyltransferase was measured using a semi-auto analyser (ErbaChem 5 plus) using commercially available kits.FBS was measured by Erba XL (EM 360), HbA1c was measured by SD Biosensor. Ethical clearance was taken vide letter number 1397. Results: The mean value of GGT in the study group was 68.34 and in the control group it was 31.22 (p-value </Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Type 2 Diabetes mellitus, Gamma-glutamyltransferase, FBS, HbA1c, Insulin resistance, Oxidative stress</Keywords><Fulltext>Introduction&#xD;
&#xD;
Diabetes Mellitus (DM) is a group of metabolic diseases characterized by the increased level of blood glucose resulting from a deficiency in insulin secretion, dysfunction of insulin action or both. Diabetes Mellitus is one of the most common metabolic disorder, there are approximately 200 million Diabetics in the world; thus creating a need to understand the aetiology of the disorder and the factors affecting its onset. Various pathogenic processes are involved in the growth of diabetes; these range from autoimmune loss of the beta cell of the pancreas with consequent insulin deficiency to abnormalities that result in resistance to insulin activity.1&#xD;
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The Gamma-glutamyltransferase (GGT) is an enzyme of molecular weight 68,000 Dalton found in many tissues, e.g. liver, gallbladder, spleen, pancreas and kidneys that play a fundamental role in the metabolism of glutathione as an anti-oxidant agent.2, 3&#xD;
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Gamma glutamyltransferase has a pivotal role in the maintenance of intracellular antioxidant defences through its mediation of extracellular glutathione transport into most types of cells.4,5,6Oxidative stress is associated with several pathological conditions, such as inflammation, carcinogenesis, ageing, atherosclerosis, and reperfusion injury.7 Oxidative stress can also play a role in the cause and pathophysiology of diabetes.8,9&#xD;
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Aim and objectives&#xD;
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	To study the levels of Gamma-glutamyltransferase, FBS, HbA1c in type 2 diabetes patients. &#xD;
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	To find out the correlation between the Gamma-glutamyltransferase Level with FBS, HbA1c. &#xD;
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	To evaluate GGT levels in controlled and uncontrolled cases of type 2 diabetes patients.&#xD;
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Material and Methods&#xD;
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Study area &#xD;
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The present study was undertaken in the Department of Biochemistry in collaboration with the Department of Medicine, M.M Institute of Medical Sciences and Research, MMDU, Mullana, Ambala. &#xD;
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Study design &#xD;
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Case-Control Study &#xD;
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Study period &#xD;
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This study was conducted from July 2018 to June 2020. &#xD;
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Selection of patients &#xD;
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In this study, 100 study subjects with age above 40 years were divided into two groups -&#xA0; 50 patients having type 2 DM (the study group) and 50 healthy individuals (the control group).&#xD;
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Study population &#xD;
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A detailed history regarding the present or past illness was taken, the general physical examination, local examination and the systemic examination were done as per the Performa.&#xD;
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Inclusion criteria&#xD;
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	Subjects &#xA0;diagnosed with type 2 Diabetes&#xD;
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	Age above 40 years &#xD;
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Exclusion criteria &#xD;
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	Type 1 Diabetes &#xD;
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	Patients less than 40 years &#xD;
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	Patients suffering from chronic renal failure, on renal replacement therapy &#xD;
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	Patients with a history of alcohol abuse &#xD;
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	Patients with hepatocellular diseases, smoking &#xD;
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	Pregnancy &#xD;
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Collection and processing of blood sample &#xD;
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5 ml of venous blood sample was collected from the antecubital vein of the subjects in a disposable syringe under aseptic conditions and transferred to a sterile, dry and acid-washed vial for biochemical analysis. The blood was allowed to stand for half an hour. After the clot formation, the supernatant was centrifuged to perform the GGT estimation.&#xD;
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2ml of venous blood sample in EDTA vial was collected. The supernatant was centrifuged to perform the blood glucose and HbA1c estimations.&#xD;
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Details of investigations &#xD;
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Estimation of Gamma-glutamyl transferase10&#xD;
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Method- SZASZ method&#xD;
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Estimation of blood glucose by GOD-POD method11&#xD;
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Method-Trinder&#x2019;s&#xD;
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Estimation of HbA1c by SD Biosensor12&#xD;
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Results&#xD;
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The majority of subjects of the study group had serum Gamma-glutamyltransferase in the range &gt;52 IU/L (78.0%). While the control group had the majority of subjects with Serum gamma-glutamyltransferase in the range 21-52 IU/L (66.0%).On comparing the data statistically, a highly significant difference was observed among the groups (p </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3921</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3921</Fulltext></URLs><References>&#xD;
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	Guyton AC and Hall JE. Text Book of Medical Physiology. 11th Edition, Elsevier Saunders, Philadelphia, 2006 p. 188.&#xD;
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	Raikwar V, Vinod Dangi, Aprrorva S. Liver function test parameters in patients having type 2 diabetes mellitus and hypertensive diabetes. Int J Med Res. 2018;3(1):10-12.&#xD;
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	Maithri CM, Manoj P, Mahadev SK, Tejaswani. Association of gamma-glutamyltransferase activity with fasting glucose among first degree relatives of type 2 diabetes patients. Int J&#xA0; Clin Biochem Res. 2019;6(4):458&#x2013;63.&#xD;
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	Aggarwal J, Singh N, Kumar M. Analysis of serum gamma-glutamyl transpeptidase level as a marker for the detection of type 2 diabetes mellitus in Okhla industrial area. Int. J.&#xA0; Clin Biochem Res. 2019;6(3):336-9&#xD;
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	Meena SK, Meena A, Ahuja J. A study of gamma-glutamyltransferase in type 2 diabetes mellitus and its risk factors.Int J Clin Biochem Res. 2012;4:89-95.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Anaesthetic Management of a Patient with Multiple Cerebral Hydatid Cyst with Intraventricular Extension: A Case Report&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>152</FirstPage><LastPage>155</LastPage><AuthorList><Author>Latwal BS</Author><AuthorLanguage>English</AuthorLanguage><Author> Chaubey K</Author><AuthorLanguage>English</AuthorLanguage><Author> Singam AP</Author><AuthorLanguage>English</AuthorLanguage><Author> Verma N</Author><AuthorLanguage>English</AuthorLanguage><Author> Bansal AP</Author><AuthorLanguage>English</AuthorLanguage><Author> Shiras P</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Cerebral hydatid cyst, Hydatidosis, Echinococcosis, Hydrodissection, Anaphylaxis</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
One of the worldwide zoonoses affecting humans is Hydatid disease (also known as hydatidosis or echinococcosis). Echinococcus granulosus, a tapeworm, is the causative organism of Hydatid disease. Mostly domestic Carnivores, such as dog, are the definite hosts whereas all mammals are intermittent host most commonly sheep and goats. Humans get this infection either by direct contact with the dog or by eating food that is contaminated with faeces of the dog which contains the parasite&#x2019;s ova. It is more prevalent in areas where livestock and dogs are raised together. Any organ in the body can be affected by hydatidosis but the liver is most commonly affected.1,2 Other sites are lungs, kidneys, adrenals, pancreas, spleen and brain (least common).2 Cerebral hydatidosis represent only up to 1% to 2% of all hydatid disease cases and thus is a rare manifestation of echinococcosis.2,3,4 The incidence of intracranial hydatid disease in India is 0.2%.5 Cyst excision with due care of not to rupture the cyst is the treatment of Hydatid cyst. An alternate option is to aspirate the cystic contents, done in deep-seated cysts and where excision is impossible.1&#xD;
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Here we present a case of cerebral hydatidosis in a 20-year-old female.&#xD;
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CASE REPORT:&#xD;
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A 20-year-old female presented with complaints of severe headache, nausea and giddiness for 1 month. It was occasionally associated with non-projectile and non-bilious vomiting. On general examination, the patient was thin built with a weight of 52kg and a height of 152 cm. Her pulse rate was 88/ min, her blood pressure was 110/72 and she was maintaining saturation of 98% to 100% on room air. She was conscious and oriented to time, place and person with a GCS of 15/15. CNS examination showed the power of 4/5 of all four limbs with no sensory deficits. Fundoscopy was done to rule out papilloedema. Her routine blood investigations like complete blood count, kidney and liver function tests showed normal values. Her x-ray of the chest (PA view) and USG abdomen and pelvis were normal and there were no abnormal findings. Liver enzymes levels and PT/INR were also normal like other laboratory reports. MRI contrast of the brain revealed a multiloculated multicystic lesion in the left lateral ventricle and adjacent left the periventricular deep white matter with multiple rounded cystic components [Fig 1]. In the post-contrast study, the lesion shows mild enhancement of septa and wall of the lesion with associated significant mass with midline shift towards the right side and perilesional oedema. There is an associated midline shift of 17 to 18 mm. The neurosurgery team planned for an elective craniotomy and cyst excision.&#xD;
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ANAESTHETIC MANAGEMENT:&#xD;
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On shifting the patient to the operation theatre, all monitors were attached including arterial BP monitor and reading noted. Two wide bore Intravenous (IV) cannula secured. Anaphylactic covers were given prophylactically with Inj. Hydrocortisone 100mg IV and Inj. Dexamethasone 8mg IV. Antianaphylacticmeasures were kept ready which includes adrenaline, antihistaminics and steroids. To treat anaphylactic reactions if presented intraoperatively, drugs like inj. Avil (Pheniramine maleate) and salbutamol (inhaler) were also arranged apart from other emergency medications (epinephrine, atropine and sodium bicarbonate). Antibiotics and antiepileptic were also given before induction. After giving Inj. Glycopyrrolate 0.004mg/kg IV, Inj. Midazolam 0.05mg/kg IV, Inj. Fentanyl 2microgram/kg IV patient was induced with Inj. Propofol 2mg/kg IV and inj. Vecuronium 0.1mg/kg IV and sevoflurane of MAC up to 1 - 1.2 in a way to keep ETCO2 between 35 to 45mmHg. The patient got intubated with an endotracheal tube of size 7.5. Left temporoparietal craniotomy was performed. Brain wasrelaxed well. Cortisectomy was done along the inferior parietal lobule. At a depth of around 4 cm anteriorly, a cyst capsule was identified [Fig 2]. Hypertonic saline patties were used to separate the cyst capsule from the brain parenchyma. Hydrodissection was done and two cysts were excised. The posteriorly and inferiorly left ventricle was present. Ventricle decompressed and CSF was released. Ventricle flushed with 3% NaCl and hydrocortisone solution. Later superior-anteriorly, evidence of calcified portion with another 2 more cysts was present. While separating the 3rd cyst capsule at the frontoparietal area, the cyst got ruptured. Cyst contents were aspirated with controlled spillage of contents in surrounding brain parenchyma. Both the cyst was excised and the whole surgical field was irrigated with 3% saline (sodium chloride), betadine and hydrocortisone solution. Haemostasis attained. Dura closed in a watertight fashion. Close monitoring was done during and after the rupture for any signs of anaphylactic reactions. Intraoperative vitals were maintained and remained within normal limits. The patient was haemodynamically stable and there was no increased airway pressure. Hypertonic NaCl (200 ml) was used as irrigation fluid during the surgery and was continuously suctioned out. The sodium level in the blood was frequently monitored to prevent hypernatremia. There was approximately 400 to 500 ml of blood loss during the surgery and was replaced with 1 unit of PRC and other iv fluids. Postoperatively the patient was reversed with Inj. Myopyrolate 0.05mg/kg IV and extubated after fulfilling all extubation criteria and had an uneventful recovery ( Figure 2). The patient was shifted to Neuro ICU for postoperative observation where she was managed with Antibiotics, antiepileptic, analgesic, antacids and other supportive measures. Corticosteroid cover postoperatively continued and tapered off slowly and then stopped. The patient was neurologically and haemodynamically stable and shifted to the ward on the second post-op day. The patient was discharged on postoperative day 6. Her histopathology report was suggestive of a hydatid cyst ( Figure 3).&#xD;
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DISCUSSION:&#xD;
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Cerebral hydatidosis is very rare, with 1-2% incidence of all hydatid disease cases.4 They are mainly located in the parietal lobe, in the supratentorial compartment.2,6 Skull, cavernous sinus, eyeball, brainstem, extradural, cerebellum and ventricles are the other less common sites.2,3,5Cerebral involvement occurs mainly in the pediatric age groups and is rare in adults.5 Solitary intracranial cysts are common than multiple intracranial cysts. Cerebral hydatid cysts are classified as primary (single) or secondary (multiple).6,7,8 Primary cerebral hydatid cysts are formed because of the direct larval infestation in the brain parenchyma without any other organ involvement. Primary cysts contain scolices, which are fertile. Therefore rupture of a primary cyst can cause dissemination and recurrence. Multiple cerebral hydatid cysts are rare and are usually secondary resulting from the rupture of a solitary primary cerebral hydatid cyst or can result from embolization of cyst in some other organ. These secondary cysts are infertile and lack live scolices.3,6,7 Primary multiple hydatid cysts are extremely rare. The patients usually present with headache, nausea and vomiting (due to raised Intracranial tension), neurological deficits (due to local compressive effects), hemiparesis, visual disturbances like double vision and seizures according to cyst&amp;#39;s size, number, location and host immune response to the cyst.3,9&#xD;
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Surgery aims at the intact delivery of cerebral hydatid cysts in all cases. Many surgical techniques are used for removing the hydatid cyst. The most popular and recommended is Dowling&#x2019;s hydro dissection technique where irrigation with normal saline is used to deliver the cyst.3,6,7,8,10 Another method is direct puncture with aspirating the cystic contents via a small hole created in the cyst wall and removal of the cyst.6 In our case, hydro dissection was done by 3% hypertonic saline, which by keeping the cyst in a hyperosmolar environment decreases the tension inside the cyst. The incision and retraction of the cerebral cortex to reach the cyst wall may lead to (transient or permanent) neurological deficits.2Hydrodissection of the cyst gently by irrigating fluid between cyst wall and brain interface is suggested if the cyst is separated from the brain.6,8,10In our case, the surgeon used Dowling&#x2019;s hydro dissection technique for the intact removal of hydatid cysts. &#xD;
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Aims of anaesthesia are to keep the brain in a relaxed state intraoperatively and to hinder the patient movement during the procedure and to provide a surgical field that is devoid of bleeding thus assisting the surgeon to excise the cyst smoothly.6 Some of the anaesthetic challenges which may occur during manipulation and resection of hydatid cyst include hemodynamic instability, anaphylaxis due to the rupture of the cyst and massive bleeding due to the relieving of pressure from the vessels after the excision of the cyst.7-10 &#xD;
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To prevent or avoid the recurrence of hydatid cysts due to the rupture and release of protoscolices of the parasite various sporicidal agents can be used. One such sporicidal agent is hypertonic saline which is very effective but can cause hypernatremia which may lead to seizures and dehydration of brain cells.11 Hence frequent intraoperative and postoperative serum sodium monitoring is required. To prevent these complications, a lesser concentration of hypertonic saline (3%) was used and monitored serum sodium level at regular intervals. Hydrogen peroxide (H2O2) is also an acaricidal agent.12Oxygen released from H2O2exhibits sporicidal action. In some studies, it was found that hydrogen peroxide can cause gaseous embolism and hemodynamic instability.12&#xD;
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Some of the complications which can occur perioperatively are rupture of the hydatid cyst, allergic or anaphylactic reaction, subdural effusion, subdural hematoma, epidural hematoma, bacterial infection, seizures and pneumocephalus.1,4,6 Allergic reaction, ranging from mild hypersensitivity to life-threatening anaphylaxis, is the major complication that occurs due to the accidental rupture of hydatid cyst intraoperatively.1 Rupture results in the release of highly antigenic contents of the hydatid cyst into the bloodstream leading to IgE mediated anaphylactic reactions which cause hypotension (severe) and bronchospasm (increasing airway pressure).1,6,8 In case of accidental rupture of hydatid cyst, the cyst contents should be suctioned out carefully and irrigate the entire operative field with 3% hypertonic NaCl.3,7 Definite treatments for life-threatening anaphylaxis include - administration of intravenous epinephrine with 100% oxygen administration and Hydrocortisone and massive fluid resuscitation.1,6 Medical treatment with albendazole is beneficial both pre and postoperatively.1,2,3&#xD;
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CONCLUSION:&#xD;
&#xD;
Here, we successfully managed a case of multiloculated multicystic hydatid disease in the left lateral ventricle and adjacent left the periventricular deep white matter in a 20-year-old female with complaints of headache, giddiness, nausea and vomiting. During the extrusion of the third cyst, it was accidentally ruptured which was controlled and managed immediately in an effective manner. Conclusively, a combination of thorough preoperative evaluation, intraoperative monitoring and management to maintain stable haemodynamics and postoperative management and care are essential in such patients for better outcome.&#xD;
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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.&#xD;
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CONFLICT OF INTEREST: NONE&#xD;
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SOURCE OF FUNDING: NIL&#xD;
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AUTHORS CONTRIBUTION:&#xD;
&#xD;
BASANT SINGH LATWAL &#x2013; PRIMARY AUTHOR, DATA COLLECTION AND ANALYSIS, COMPILATION, CASE MANAGEMENT IN THE OT &#xD;
&#xD;
KASHISH CHAUBEY &#x2013; CORRESPONDING AUTHOR, DATA COLLECTION AND ANALYSIS, COMPILATION, CASE MANAGEMENT IN THE OT&#xD;
&#xD;
AMOL P SINGAM &#x2013; DATA INTERPRETATION, HEAD OF THE TEAM SUPERVISING THE CASE, FINAL REVIEW OF THE CASE REPORT TO BE PUBLISHED&#xD;
&#xD;
NEETA VERMA &#x2013; DATA ANALYSIS AND INTERPRETATION, CONCEPTION OF OR DESIGN OF THE CASE REPORT&#xD;
&#xD;
AYUSH PAL BANSAL &#x2013; DATA COLLECTION, ANALYSIS AND INTERPRETATION&#xD;
&#xD;
SHIRAS P- COLLECTION, ANALYSIS AND INTERPRETATION.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3922</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3922</Fulltext></URLs><References>1. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Nashibi M, Tafrishinejad A, Hussain Khan Z. Deep Seated Cerebral Hydatid Cyst and Its Anesthetic Considerations: A Case Report. Archiv Neurosci.. 2020 Jan 31;7(1).&#xD;
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2. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Dr. Babita, Dr. Shobhapurohit, Dr. Bhupendrasingh. Anaesthetic Management of intracranial Hydrated Cyst, A Patient of Disseminated Hydatid Disease&#x203E;A Case Report. Ind J Appl Res. 2014;4(5). &#xD;
&#xD;
3. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Kandemirli SG, Cingoz M, Olmaz B, Akdogan E, Cengiz M. Cerebral Hydatid Cyst with Intraventricular Extension: A Case Report. J Trop Pediat. 2019;65(5):514&#x2013;519. &#xD;
&#xD;
4. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Tuzun Y, Kadioglu HH, Izci Y, Suma S, Keles M, Aydin IH. The clinical, radiological and surgical aspects of cerebral hydatid cysts in children. Pediat Neuros. 2004;40(4):155&#x2013;160. &#xA0;&#xD;
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5. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Pandey S, Pandey D, Shende N, Sahu A, Sharma V. Cerebral intraventricular echinococcosis in an adult. Surg Neurol Intern. 2015;6. &#xD;
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6. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Panda NB, Batra YK, Mishra A, Dhandapani SS. A giant intracranial hydatid cyst in a child: Intraoperative anaesthetic concerns. Ind J Ana. 2014;58(4):477. &#xD;
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7. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Yurt A, Avc? M, Sel&#xE7;uki M, &#xD6;zer F, &#xC7;amlar M, U&#xE7;ar K, et al. Multiple cerebral hydatid cysts: report of a case with 24 pieces. Clin Neur Neuros. 2007;109(9):821&#x2013;826. &#xD;
&#xD;
8. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Gupta S, Desai K, Goel A. Intracranial hydatid cyst: a report of five cases and review of the literature. Neur Ind. 1999;47(3):214. &#xD;
&#xD;
9. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Padayachy LC, Dattatraya M. Hydatid disease (Echinococcus) of the central nervous system. Child&#x2019;s Nerv Syst. 2018;34(10):1967&#x2013;1971. &#xD;
&#xD;
10. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Carrea R, Dowling jr E, Guevara JA. Surgical treatment of hydatid cysts of the central nervous system in the pediatric age (Dowling&#x2019;s technique). Ped Neuros. 1975;1(1):4&#x2013;21. &#xD;
&#xD;
11. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Albi A, Baudin F, Matmar M, Archambeau D, Ozier Y. Severe hypernatremia after hypertonic saline irrigation of hydatid cysts. Anesth Analg. 2002;95(6):1806&#x2013;1808. &#xD;
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12. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Ouerghi S, Abdelhafidh K, Merghli A, Smati B, Boudaya MS, Lamine K, et al. Iatrogenic gas embolism after use of hydrogen peroxide in the treatment of lung hydatid cyst: a report of 2 cases. La Tunisie Med. 2010;88(11):851&#x2013;854. &#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Preparation and Evaluation of Antimicrobial Activity of Metal Oxide Nanoparticles of Nickel, Copper and Zinc&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>156</FirstPage><LastPage>160</LastPage><AuthorList><Author>Budde Kumara Swamy</Author><AuthorLanguage>English</AuthorLanguage><Author> Raju Bura</Author><AuthorLanguage>English</AuthorLanguage><Author> Ramreddy Godela</Author><AuthorLanguage>English</AuthorLanguage><Author> K. Venkata Ratnam</Author><AuthorLanguage>English</AuthorLanguage><Author>  K. Suresh Babu</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Metal oxides, Nanoparticles, Annellation, NiO, CuO, ZnO and Antimicrobial activity.</Keywords><Fulltext>INTRODUCTION &#xD;
&#xD;
Research in the field of nanotechnology is existing for centuries and helped in the production of various types of materials at the nano scale. These materials are particulate substances with dimension &lt; 100nm. The field of nanotechnology mainly encompasses biology, physics, chemistry and material sciences and it develops novel therapeutic nano-sized materials for biomedical and pharmaceutical applications.1 Metal oxide nanoparticles have been a hotspot in nanomaterials research due to the wide range of application. Progress in synthesizing metal oxide nanoparticles is phenomenal due to its application in electronics, optics, energy storage industry and catalysis.2-5 Since 1980, efforts have been made to invent synthetic methods for nanoparticles with desired properties. Synthesis of the nanomaterials is categorized into two types, the top-down approach and the bottom-up approach. Wet chemical synthesis approaches have been realized to produce the desired size and shape of metal oxide nanoparticles in a reproducible manner. Control over size and shape is achieved by a better understanding of elementary events, the mechanism by conversion of the precursor, surface stabilizing agent, and reagent in the system and its correlation with growth and nucleation rate.6The antimicrobial properties of silver oxide, copper oxide, zinc oxide and nickel oxide have been previously reported.7-10 The bactericidal effectiveness of metal nanoparticles has been suggested to be due to both their size and high surface-to-volume ratio. Such characteristics should allow them to interact closely with bacterial membranes, rather than the effect being solely due to the release of metal ions.11,12&#xD;
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Owing to the increasing importance of the metal oxide nanoparticles as anti-microbial agents as suggested by a handful of literature our group is vigorously involved in the development of new metal oxide nanoparticles at different temperatures that can be applied as anti-microbial agents with sub-micromolar activity against tested bacterial strains. This manuscript reports the synthesis, anti-microbial and antioxidant capacity of the NiO, CuO and Zn On a noparticles calcinated at different temperatures.&#xD;
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MATERIALS AND METHODS&#xD;
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Experimental&#xD;
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Synthetic grade Nickel Nitrate Hexahydrate (Ni(NO3)2&#xB7;6H2O), Copper Nitrate Trihydrate (Cu(NO3)2&#xB7;3H2O) and Zinc Nitrate Hexahydrate (Zn(NO3)2&#xB7;6H2O) were procured from Merck, India. Sodium hydroxide purchased from SD fine chemicals, India. X-ray diffraction (XRD) of metallic and bimetallic nanoparticles was determined by using PANanalytical &#x2018;X&#x2019;PERT-PRO XRPD of Cu Ka radiation (l = 0.15406 nm) with a scanning rate of 20/min and 2? ranging from 100 to 800.&#xD;
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Preparation of Metal Oxide Nanoparticles&#xD;
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For the preparation of three different grades of metal oxide nanoparticles via the annellation of corresponding metal hydroxides, 0.1M concentration of precursors, Nickel Nitrate Hexahydrate (Ni(NO3)2&#xB7;6H2O), Copper Nitrate Trihydrate (Cu(NO3)2&#xB7;3H2O) and Zinc Nitrate Hexahydrate (Zn(NO3)2&#xB7;6H2O) were reacted individually with 1M solution of NaOH. The resulted In-situ generated hydroxide form of three metals were subjected for annellation at temperatures 2500C, 4500C, 6500C to generate the different grades of respective metal oxides NiO, CuO, and ZnO.13,14,15,16&#xD;
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AntimicrobialAssay17&#xD;
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Test Microorganisms and Growth Media&#xD;
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The bacterial and fungal strains were obtained from the department of microbiology, Osmania University.StreptococcusPyogenes (MTCC 442), Bacillus cereus (MTCC 1305) Salmonella enterica (MTCC 1253) and Pseudomonas aeruginosa (MTCC 2453), Aspergillusniger and Candida albicans were chosen based on their clinical and pharmacological importance. Incubation of bacterial stock is done at 37&#xB0;C for 24 hrs. on nutrient agar. The bacteria were grown on Mueller-Hinton agar plates at 37&#xB0;C. The stock cultures were maintained at 4&#xB0;C. For the growth of fungi, Potato Dextrose agar was used.&#xD;
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Procedure for Antimicrobial assay&#xD;
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Preparation of Discs:&#xD;
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Insert Whatman No. 1 filter of 5mm disc size in a clean and dry petri dish and then autoclaved. The discs were later soaked in the compound solution for 5 hrs and shade dried later. The concentration is about 0.1 gm/ 1 ml per disc. Carefully transfer the disc onto the cultured petri dish. We use paper disc dipped in ethanol as positive control are prepared and used as positive control and streptomycin in the concentration of 100&#x3BC;g/ml and Nystatin in the concentration of 10&#xB5;g/ml were employed as negative controls for the Antibacterial and Antifungal activity respectively.&#xD;
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Testing of Antimicrobial activity&#xD;
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LB agar prepared and the medium is sterilized for 30 mins at 121&#xB0;C for testing antibacterial activity. The test plates are prepared by pouring 10 ml of the medium into a petri dish of 10 cm diameter under aseptic condition. They were left undisturbed for 2 hrs to allow the medium for solidification. (containing suspension) of Streptococcus Pyogenes, Bacillus cereus, Salmonella enterica and Pseudomonas aeruginosa, Aspergillusniger and Candida albicans was poured onto the plates separately containing solidified agar media. The prepared sterile filter paper discs were impregnated with the compound solution and shaken thoroughly and these test plates incubated for a period of 48 hrs in BOD at 37&#xBA;c for the development of inhibitory zones and the average of 2 independent readings for each organism in different compound solutions were recorded. &#xD;
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Measuring the diameter of inhibition zone&#xD;
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The measurement of inhibition zones is noted after one day at 37&#xB0;C for bacteria. A plastic ruler is used to measure and record the diameter of the inhibition zone. 5 paper disc are placed on a single Petri plate.&#xD;
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RESULTS &#xD;
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Synthesis&#xD;
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Stable Nanoparticles of NiO, CuO and ZnO were synthesized at different temperatures by the annellation of corresponding metal hydroxides generated In-situ, in the reaction mixture using the Sol-gel method. Three different grades of the nanoparticles having variable size ranges were obtained based on the annellation temperature. The mean particle size of the synthesized nanoparticle and their FWHM and 2-THETAvalues were enumerated in Table-1.&#xD;
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NiO nanoparticles resulted with a mean particle size ranges from 3.02 nm to 19.66 nm, CuO nanoparticles size ranges from 17.36 nm to 31.36 nm and ZnO nanoparticles size ranges from 9.33 nm to 66.69 nm.&#xA0; The XRD results proclaim that the annellation of the metal hydroxide at different temperature produced nanoparticles of varying sizes. This suggests that the temperature affect the size of nanoparticles produced via the Sol-Gel method. SEM analysis results provided the morphology of the synthesized nanoparticles. Results revealed that the nanoparticles annealed at 6500C provided spherical morphology while the annellation at temperatures 250 and 4500C produced the particle with irregular shapes.&#xA0;&#xA0; &#xD;
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Antimicrobial activity&#xD;
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The compounds were screened for their antibacterial activity (zone of inhibition) against Streptococcus Pyogenes (MTCC 442), Bacillus cereus (MTCC 1305) Salmonella enterica (MTCC 1253) and Pseudomonas aeruginosa (MTCC 2453), along with Antifungal activity againstAspergillusniger and Candida albicans strains using disc diffusion method according to the literature protocol. The antibacterial activity of the synthesized metal oxide nanoparticles was compared with standard drugs treptomycin at a concentration of 0.1gram/ml and the results of Antibacterial and Antifungal activity (zone of inhibition) have been presented in Table 2 and 3 respectively. &#xD;
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	Antibacterial studies using CuO, ZnO and NiO nanoparticles against Gram-Positive and Gram-Negative bacteria&#xD;
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Based on the test results, it is evident that the CuO nanoparticles have displayed superior antibacterial activity than the remaining NiO and ZnO nanoparticles on both gram-positive and gram-negative strains. Cu nanoparticles especially those nanoparticles calcinated at the temperature of 6500C (CuO 650) has possessed the highest antibacterial activity against all bacterial strains tested. ZnO and NiO particles disclosed antibacterial activity majorly against gram-positive strains. Zone of inhibition data of all the tested nanoparticles displays that the nanoparticles have superior inhibition capacity on all bacterial strains when compared to the pure forms of metal oxides. Based on earlier studies.18 The reasons might be whenever nanoparticle enters into the bacterial cell, the death of bacteria is due to either high production of ROS inside the bacterial cell leads to the creation of high oxidative stress or binding of copper nanoparticle to functional groups like carboxyl or amino present in peptidoglycan which is a component of the cell wall of bacteria. In the present study, we propose that the reason for the superior antibacterial activity of copper nanoparticles might be there is a strong affinity towards the functional groups like amino or carboxyl or mercapto. Results suggest that the nanoparticles are calcinated at temperature 4500C and 6500C were possessed more antibacterial activity potential than the pure metal oxides and are synthesized at 2500C. This increased activity can be comprehended and attributed to the decreasing size and spherical shape of the nanoparticles generated at much higher temperatures. The compounds CuO 250, CuO 650 showed good activity against bacterial strains salmonella and pseudomonas also. The results were shown in Table-2&#xD;
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Possible mechanisms of invade of Nanoparticles (NPs) on Bacteria19&#xD;
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Besides, the above findings interestingly raise some facts about the behaviour of nanoparticles to bacteria. The first one is, by comparing the zone of inhibition by Gram-positive to Gram-negative bacteria concerning the use of different types of nanoparticles, the results dig out NPS shows high bactericidal activity on Gram-positive than Gram-negative bacteria. Based on earlier reports, this is due to a structural difference in the cell wall of bacteria and it plays a crucial role in the binding of nanoparticle to the cell surface which confirms the complexity of the cell wall of Gram-negative higher than Gram-positive bacteria. Anyhow in Gram-negative bacteria having Lipoproteins(LPS), phospholipids etc form a strong barrier which repels NPs and in another way the Gram-positive bacteria possess a high negative charge on the surface which helps to attract NPs resulting metal NPs, from metal Oxide NPs, enters into the cell through diffusion using porins as ionic channels and shows strong bactericidal effect. The second one, by comparing of results of zone inhibition data (table-3) to particle size (table 1), we confirm that the small size nanoparticles shows high bactericidal effect. This size effect of NPS explained that the adsorption of nanoparticles increases with a decrease in size, resulting from a high bactericidal effect. In general, nano-size renders more surface area which facilitates high adsorption. Hence NPs enters into the cell through adsorption leads to damage of enzyme activity, affecting the normal physiological processes like protein synthesis, DNA replication, and finally inhibiting the bacteria. Meanwhile, there is direct interaction of NPs with functional groups carboxyl (&#x2013;COOH) groups, amino (&#x2013;NH) and mercapto (-SH) is possible for inhibition of enzyme meant for the certain physiological process. Ultimately based on results, we confirm that extent of the zone of inhibition of bacterial growth depends on either variability in the cell wall of bacteria or the size of the nanoparticle or both. &#xD;
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	&#xD;
	Antifungal studies using CuO, ZnO and NiO nanoparticles&#xD;
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The results of Antifungal activity evaluated on the fungal strains Aspergillusniger and Candida albicans displayed in Table 3. Results disclose that NiOnanoparticles synthesized at temperatures 4500C and 6500C (NiO450 and NiO 650) exhibited the highest activity against Aspergillusniger with a zone of inhibition of 8.4 mm and 8.7 mm respectively and CuO 650 also showed good inhibition of 7.5mm. Against Candida, albicansZnOnanoparticles synthesized at temperatures 4500C and 6500C (ZnO 450 and 650) displayed a superior activity zone of inhibition of 6.5 mm and 7.5 mm respectively and the compound NiO 650 and CuO 650 also displayed good inhibition against Candida albicans ( Table 3).&#xD;
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&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
Out of the three metal oxides, NiO nanoparticles produced with relatively low sizes. Comparatively, metal hydroxides calcinated at 6500C produced the lowest sizes of the metal oxide nanoparticles concerning all metals employed concerning the other annellation temperatures 4500C and 2500C. CuO nanoparticles have shown greater antibacterial activity than the remaining NiO and ZnO nanoparticles on both gram-positive and gram-negative strains. The compounds CuO 250, CuO 650 and NiO 450 showed the highest Antifungal activity against strains when compared with the standard drug Nystatin. Among all the synthesized nanoparticles NiO 650 exhibited the highest activity against both fungal strains (Table-3). The highest activity of the NiO nanoparticles against fungal strains might be due to their relatively low particle size, and spherical shape that can easily penetrate the fungal cell wall.&#xD;
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CONCLUSION &#xD;
&#xD;
By annealing at three different temperatures (250, 450, and 6500C) CuO, NiO, and ZnO nanoparticles were synthesized employing the sol-gel method from the metal hydroxides. The antibacterial and antifungal activities of the synthesized nanoparticles were evaluated against different gram-positive, gram-negative and fungal strains. CuO nanoparticles possessed higher activity against bacterial species while NiOnanoparticles displayed good Antifungal activity. Results suggest that the nanoparticles calcinated at higher temperatures like 450, and 6500C were displaying higher antimicrobial activity relative to the pure metal oxides and those calcinated at 2500C. &#xD;
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ACKNOWLEDGEMENTS&#xD;
&#xD;
The authors are very much thankful to the Secretary of MLR group of Educational Institutions Sri MarriRajashekar Reddy for his constant help, support and encouragement to the academics generally and research particularly. The authors are also thankful to him for providing a suitable research lab facility at MLR Institute of Pharmacy College, and Mari Laxman Reddy Institute of Technology and management, Dundigal, R.R.District, Hyderabad. We would also like to thank the department of microbiology, Osmania University, Hyderabad for providing bacterial and fungal strains for Anti-micro bacterial studies.&#xD;
&#xD;
CONFLICT OF INTEREST&#xD;
&#xD;
No conflict of interest from all the authors&#xD;
&#xD;
SOURCE OF FUNDING&#xD;
&#xD;
No funding was granted from any authority. It is a self-financed research work&#xD;
&#xD;
AUTHORS&#x2019; CONTRIBUTION&#xD;
&#xD;
Kumara SwamyBudde has prepared a plan of work and execution. Dr.VenkataRatnam has supported and suggested the activity-related information. Raju BuraSureshBabuK and Ramreddygodela were helped in the preparation of nanoparticles and their evaluation of activity behaviour.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3923</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3923</Fulltext></URLs><References>&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Anxiety Among the Nursing Students During the Initial Clinical Experience&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>161</FirstPage><LastPage>165</LastPage><AuthorList><Author>Rodrigues Lavina</Author><AuthorLanguage>English</AuthorLanguage><Author> Peter Deepa</Author><AuthorLanguage>English</AuthorLanguage><Author> Kuriakose Abin</Author><AuthorLanguage>English</AuthorLanguage><Author> Rashmi Shwetha</Author><AuthorLanguage>English</AuthorLanguage><Author>  Mathias Nancy Priya</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Anxiety, Stress, Nursing students, Initial clinical experience, Selected college, Mangaluru</Keywords><Fulltext>INTRODUCTION &#xD;
&#xD;
Stress is a perceived concept, that it can be caused by anything that one feels unbalances the harmony in life. 1 Anxiety is an emotional response to the anticipation of danger, the source of which is mostly unknown or unrecognized.2&#xA0; Anxiety disorders&#xA0;are the foremost common of all mental illnesses and affect 25 percent of all teens and 30 percent of all teen girls. One in fourteen young Australians (6.9%) aged 4-17 experienced an anxiety disorder in 2015. This can be corresponding to approximately 278,000 young people.4&#xD;
&#xD;
According to researchers who looked at&#xA0;mental health data&#xA0;for high school and college students from 1938 to 2007, the majority of the young people report symptoms of mental illness generally, and anxiety in particular. They are seeing more descriptions of feelings like isolation, sensitivity, being misunderstood, narcissistic, worry, sadness, low self-control, and general dissatisfaction.5&#xD;
&#xD;
NEED FOR THE STUDY&#xD;
&#xD;
Nursing students report greater levels of stress than the overall population of college students, partly because of competition for entering into programs, course structure, long hours of clinical practice, ward management and caring for sick persons. Excessive anxiety in nursing students can have a negative impact on health, academic, economic as well as patient care outcomes, still, impact future role transition into professional practice; including burnout and poor job performance. 6 &#xD;
&#xD;
Several studies have shown that nursing students have a higher level of stress and anxiety. A cross-sectional study was carried out among 661 Baccalaureate nursing students in Hong Kong revealed that, the prevalence of depression, anxiety, and stress among these students at 24.3%, 39.9%, and 20.0%, respectively. Female nursing students have reported anxiety and stress symptoms, while male nursing students were reported symptoms of depression than their batchmates.7&#xA0;&#xD;
&#xD;
Initial clinical experience is one of the most anxiety-producing components of the nursing program which has been acknowledged by nursing students. Lack of clinical exposure, unfamiliar ward setting, aggressive patients, fear of making mistakes during procedures, and being evaluated by faculty members was stated by the students as anxiety-producing situations in their initial clinical experience. If the stressors are identified and interventions are provided at the earliest, many physical and psychological consequences of stress may be reduced and student nurses will be able to lead an efficient life.8&#xD;
&#xD;
Objectives of the study &#xD;
&#xD;
&#xD;
	&#xD;
	To assess the level of anxiety among the nursing students during the initial clinical experience &#xD;
	&#xD;
	&#xD;
	To find the association between the level of anxiety among the nursing students during the initial clinical experience with selected demographic variable.&#xD;
	&#xD;
&#xD;
&#xD;
HYPOTHESES:&#xD;
&#xD;
H1: &#xA0;&#xA0;&#xA0;&#xA0;&#xA0; There is a significant association between the level of anxiety among the nursing students and selected demographic variables.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
A nonexperimental descriptive survey design was adopted for the study.&#xA0; The total sample comprised of 100 BSc Nursing and GNM Nursing students who met the inclusion criteria were selected using a simple random technique. The data collection instruments were Demographic Performa and Zung Self-Rating Anxiety Scale (SAS). Ethical clearance was obtained from the Institutional Ethics Committee letter no: FMMCIEC/CCM/100/2018. The investigator explained the need and importance of conducting the study to the participants. Informed consent was taken from the participants and confidentiality was assured.&#xA0; Data was collected using demographic proforma and Zung Self-Rating Anxiety Scale. The data collected was then compiled for data analysis.&#xD;
&#xD;
Description of the tool:&#xD;
&#xD;
Part-I: Demographic Performa: This tool consists of 11 items seeking information about- gender, age, residence, course, family type, sibling, religion, income per month, clinical experience, experience of caring for the sick in the family and relatives in the medical field.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
Part- II: Zung Self-Rating Anxiety Scale (SAS): This self-report scale was developed by Zung MD (1929-1992) which consists of 20 items, 15 positively and 5 negatively stated items. The participants&amp;#39; responses are categorized into A little of the time, Some of the time, Good part of the time and Most of the time. The maximum total score is 80. The negatively stated items were scored reversely. The test-retest reliability of the tool was found to be 0.91. The Cronbach&#x2019;s alpha was found to be 0.89.&#xD;
&#xD;
RESULTS:&#xD;
&#xD;
Section A: Description of demographic variables of the sample&#xD;
&#xD;
The results of the study revealed that the majority of the samples were females (94%) and (77%) were hostelers. About age, most of the samples (53%) were at 18 years of age, and the highest number of the sample (93%) were living in a nuclear family. With regarding the sibling 9% of samples does not have sibling, 44% of samples have one, 19% of the sample have two and 23% of the sample have three or more sibling. About religion, the majority of the sample (85%) were Christians. 13% of the sample belonged to the Hindu religion and only a few (2%) of the sample were Muslim. Data presented reveals that 35% of the sample had an income below rupees 10000/ per month. Regarding the experience of caring for the sick, 49% of the sample had experience in caring for the sick at home. The data also revealed that 55% sample having relatives working in the medical field. &#xD;
&#xD;
Section B: Level of anxiety among the nursing students during the initial clinical experience&#xD;
&#xD;
&#xD;
&#xD;
The data in table 1 depicts the mean anxiety level of students shows 83% of the students are having a normal range of anxiety whereas the least number (17%) of the students are having mild to moderate level of anxiety with Mean &#xB1;SD (1.17&#xB1;0.318). &#xD;
&#xD;
Section C: Association between anxiety among the nursing students and selected demographic variables&#xD;
&#xD;
To find out the association Chi-square test or Fisher&#x2019;s exact test was done. To test the statistical significance the following null hypothesis was formulated:&#xD;
&#xD;
H0: There is no significant association between the level of anxiety among the nursing students and selected demographic variables.&#xD;
&#xD;
&#xD;
&#xD;
It is evident from table 2 that there was a significant association between anxiety and number of siblings (p=0.004)&#xA0; at 0.05 level of significance whereas no association was found between anxiety and other demographic variables, like gender, area of residence, course of study, family type, religion, monthly income, clinical experience of caring sick and relatives working in the medical profession.&#xA0; Hence the research hypothesis was accepted for the number of siblings whereas the other variables research hypothesis was rejected.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
Description of demographic variables&#xD;
&#xD;
The demographic findings of the present study depict the majority of the samples are females (94%) with the age of 18 years (53%), 11% of the samples with 17 years and 23% of samples are with 19 years of age. Majority of the sample (93%) belongs to a nuclear family and 9% of samples does not have sibling, 44% of samples have one sibling, and 23% of the sample have three and more sibling. About experiences of caring for the sick at home, 49% of the sample has experience whereas 23% of the samples do not have any experience in caring sick. The data also showed 55% of samples have relatives working in the medical field.9 &#xD;
&#xD;
A similar study was conducted on depression, anxiety and stress among undergraduate nursing students in a Public University in Sri Lanka. 92 undergraduate nursing students who participated in the study revealed that 30.4% males and 69.6% were females ranging from 21 to 27 years. The mean age of the sample was 24.1 years (SD &#xB1; 1.6). The majority of the respondents were Sinhalese (98.9%). Buddhist was a major religion (96.7%). The majority of the respondents was from the fourth-year class (32.6%) and lived in university accommodation (87%). The highest number of the respondents&#x2019; parents had a secondary level education: 62.0% and 66.3%, respectively. From the sample, 19.6% of the participants stated that their monthly family income was not sufficient to meet their family expenditure.10,11&#xD;
&#xD;
Level of anxiety among the nursing students during the initial clinical experience&#xD;
&#xD;
The present study depicts the mean anxiety level of students shows 83% of the students are having a normal range of anxiety whereas the least number (17%) of the students are having mild to moderate level of anxiety with a Mean &#xB1;SD (1.17&#xB1;0.318).&#xD;
&#xD;
The findings of the present study are congruent to a descriptive correlation study which presented data from 61 nursing students using survey questionnaires that captured demographic data and included the Trait Anxiety Scale and the Clinical Experience Assessment form. Analyses of data indicate that 36% of the students experienced a moderate level of anxiety. Clinical experiences related to arriving late, being observed by instructors, responding to initial experiences, having a fear of making mistakes, and talking to physicians were the most anxiety-producing for these students.12,13&#xD;
&#xD;
Association between anxiety among the nursing students and selected demographic variables&#xD;
&#xD;
The present study showed a significant association between anxiety and number of siblings (p=0.004)&#xA0; at 0.05 level of significance whereas no association was found between anxiety and other demographic variables, like gender, area of residence, course of study, family type, religion, monthly income, clinical experience of caring sick and relatives working in the medical profession. Hence the research hypothesis was accepted for the number of siblings whereas the other variables research hypothesis was rejected.14,15,16&#xD;
&#xD;
In contrast to the present study findings, a&#xA0; study that was conducted on nursing students anxiety in a clinical setting showed that the association between anxiety level and gender of participants was significant (p = 0.030).&#xA0; The male students were mostly affected. The result of the study alarms that, out of 28 male students, 6 students had severe anxiety, Students had moderate while 12 students had mild level of anxiety. The Association between the level of anxiety with the age of the participants was not significant (p = 0. 819), but 77.1% of students of the age of 21-25 years were affected.&#xA0;&#xA0; Association between mode of finance and anxiety level was slightly significant with (p = 0.065) as students with self-finance mode were mostly affected by different levels of anxiety. It is also worth mentioning that, all those students who had a severe level of anxiety were in self-finance mode.17&#xA0; &#xD;
&#xD;
LIMITATIONS&#xD;
&#xD;
&#xD;
	&#xD;
	Information for this study was elicited from a self-selected sample; therefore information from the non-respondents cannot be collected.&#xD;
	&#xD;
	&#xD;
	The finding of the study could not be generalized because of the small sample size &#xD;
	&#xD;
	&#xD;
	The study was limited to assess the level of anxiety; there was no intervention was carried out to reduce the anxiety among the nursing students.&#xD;
	&#xD;
&#xD;
&#xD;
Keeping in view the findings of the study, the following recommendation is made for future research.&#xD;
&#xD;
&#xD;
	&#xD;
	Additional research using a large sample could be performed to enhance the generalizing of the findings. &#xD;
	&#xD;
	&#xD;
	Interventional&#xA0; studies&#xA0; could be performed to overcome anxiety issues of the students &#xD;
	&#xD;
	&#xD;
	A similar comparative study could be performed to assess the level of anxiety in different settings of the hospital.&#xD;
	&#xD;
	&#xD;
	Studies to identify the factors that can enhance learning in clinical settings.&#xD;
	&#xD;
	&#xD;
	The study can be replicated by conducting qualitative studies.18&#xD;
	&#xD;
&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Although the majority of the students (83%) had a normal range of anxiety whereas the least number (17%) of the students are having mild to moderate level of anxiety with a Mean &#xB1;SD (1.17&#xB1;0.318). Chi-square and Fisher&#x2019;s exact tests were used to find the association between anxiety and selected demographic variables showed a significant association between anxiety and number of siblings (p=0.004)&#xA0; at 0.05 level of significance whereas no association was found between anxiety and other demographic variables, like gender, area of residence, course of study, family type, religion, monthly income, clinical experience of caring sick and relatives working in the medical profession. Hence the research hypothesis was accepted for the number of siblings whereas the other variables research hypothesis was rejected. The study concluded that the teaching and training given to the nursing students before the clinical experience was adequate and appropriate.&#xD;
&#xD;
ACKNOWLEDGEMENT: &#xD;
&#xD;
The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript.&#xA0;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&#xD;
&#xD;
FINANCIAL SUPPORT AND SPONSORSHIP &#xD;
&#xD;
Received the funding from Father Muller Research Centre, FMMCH, Mangalore&#xD;
&#xD;
CONFLICTS OF INTEREST&#xD;
&#xD;
The author has declared no conflicts of interest.&#xA0; The Principal Investigator is grateful for the contributions received from the co-investigators: Peter Deepa and Mathias Nancy Priya were helped in data collection and coding the data into the master data sheet, Kuriakose Abin helped in result analysis, Rashmi Shwetha contributed to the discussion and conclusion of the study findings.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3924</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3924</Fulltext></URLs><References>&#xD;
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	Nott L. Teens Are Feeling More Anxious Than Ever [Internet]. Promises Behavioral Health. 2013 [cited 2018 Jan 9]. Available from: https://www.promisesbehavioralhealth.com/addiction-recovery-blog/teenagers-are-feeling-more-anxious-than-ever/&#xD;
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	Papastavrou E, Lambrinou E, Tsangari H, Saarikoski M, Leino-Kilpi H. Student nurses experience of learning in the clinical environment. Nurse Educ Pract. 2010 May;10(3):176-82. &#xD;
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	Cheung T, Wong SY, Wong KY, Law LY, Ng K, Tong MT, et al. Depression, Anxiety and Symptoms of Stress among Baccalaureate Nursing Students in Hong Kong: A Cross-Sectional Study. Int J Environ Res Public Health. 2016;13(8):779. &#xD;
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	Wedgeworth M. Anxiety and education: An examination of anxiety across a nursing program. J&#xA0;Nurs Educ Pract 2016 May 25;6(10):23. doi:&#xA0;https://doi.org/10.5430/jnep.v6n10p23&#xD;
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	Baraz S,&#xA0;Memarian R,&#xA0;&#xA0;Vanaki Z.&#xA0; Learning challenges of nursing students in clinical environments: A qualitative study in Iran. J Edu Health Promot [serial online] 2015 [cited 2019 August 8]; 4: 52. Available from:&#xA0;https://www.jehp.net/text.asp?2015/4/1/52/162345&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effect of Yoga Training on the Visual and Auditory Reaction Time in Young Adults -&#xA0;A Pilot Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>166</FirstPage><LastPage>169</LastPage><AuthorList><Author>Shobana R</Author><AuthorLanguage>English</AuthorLanguage><Author> Maheshkumar K</Author><AuthorLanguage>English</AuthorLanguage><Author> Bagavad Geetha M</Author><AuthorLanguage>English</AuthorLanguage><Author> Padmavathi R</Author><AuthorLanguage>English</AuthorLanguage><Author>  Venkateswaran S T</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Reaction time (RT) is used to assess sensory-motor performance of an individual. Regular yoga practices produce a better improvement in the health of individuals with and without ailments. Hence this study was taken to find the effect of regular form of long term yoga training on reaction time in young adults. Aim: To evaluate the long term effects of Yoga practice Visual and Auditory Reaction time in young adults Materials &amp; Methods: This Pilot study includes 80 normal subjects in the age group 18-30 years consist of yoga group (n- 40) subjects were regularly practising yoga and the control group (n-40) subjects were normal healthy volunteers. Auditory (ART) and visual reaction time (VRT) was recorded in the darkroom preferably in the morning with an empty stomach. Result: Subjects in the yoga group (192.56 &#xB1; 18.70 and 224.59&#xB1;32.66 msec) showed significant (p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Yoga, Visual and Auditory Reaction time, Sensory-motor performance, Long-term yoga practice, Cognitive function,  Young adults</Keywords><Fulltext>Introduction:&#xD;
&#xD;
Reaction time (RT) is the time taken for the initial response to a particular stimulus. It can be used as one of the tools to measure the status of mental health and provides an indirect index of the processing capability of the central nervous system(CNS) and sensorimotor performance. 1 It can be influenced by yoga because it enhances physical &amp; mental health and increases the performance of the practitioners.2 Mental health is a state of wellbeing in which the individual realizes his or her abilities, can cope with normal stress in life, can work rewardingly.3Anxiety, stress, the disturbing feeling of well-being and altered personality are associated with most chronic lifestyle disorders like diabetes, heart diseases, respiratory diseases, and psychiatric disorders. 4Yoga is an ancient science involving the various form of practices such as asana (posture), pranayama (breathing exercise) and meditation (concentration technique)&#xA0; to awake ourselves and brings symmetry between psychic and somatic aspects of body functions.5,6&#xA0; Regular practise of any type of yoga influence cognitive functions by improving memory, strategic planning and concentration.7 It is associated with self-esteem and higher academic performance which will be useful in modern curriculum.8 &#xA0;Previous studies have shown the short term (immediate, 3 months &amp; 6 months) effect of various yogic techniques on RT in healthy and various disease conditions but no studies, to our knowledge, available on the long term effect of yoga on RT. 9,10 Hence this study was undertaken on people practising yoga regularly as part of their curriculum. &#xD;
&#xD;
Materials &amp; Methods:&#xD;
&#xD;
This present study was done on 80 normal healthy volunteers in the age group 18-30 years. Regularly yoga practising students (n=40) were selected from government yoga and naturopathy medical college, Chennai and age and gender-matched control (n-40) not doing any kind of regular physical activity or prior yoga practice are taken from Sri Ramachandra Medical College &amp; Research Institute. Institutional ethics committee clearance was obtained (IEC reference no: CSP-MED/15/AUG/24/01). Informed written consent was obtained from all the participants after explaining the detailed procedure. Visual (VRT) and auditory reaction time (ART) was measured by using the instrument PC 1000 Hz reaction time analyzer in the morning with an empty stomach in a dark room.11 PC 1000 Hz reaction timer is an in house build add the device, used for measuring the auditory and visual reaction time.&#xA0; It&#x2019;s a 1000 hertz square wave oscillator that has a soft key for the start and stops function. It has two components (A &amp;B) connected. The first component (A) has a start button that will be out of the view from the subjects and it is controlled by the examiner only. The second component (B) has a stop button that will be operated by the subjects. Also, it has a small red LED light for visual stimulus and headphone (1000 hertz&#x2019;s tone) which receives auditory stimulus respectively. Red light is selected for the experiment as the maximum number of cones is activated to red, persists for a long time in the retina. 12 Component A and component B is in turn connected to a personal computer that has audacity sound software installed in it.&#xA0; Audacity city software records the reaction time in 0.001-sec accuracy in wave format. Minimum three trials were given for both VRT and ART measurement and the average time was considered for the final VRT and ART value in msec.&#xD;
&#xD;
STATISTICAL ANALYSIS: &#xD;
&#xD;
Data expressed as mean and SD. Independent t-test and One-way ANOVA followed by posthoc test (Tukey HSD) were used for the comparison of mean in between the group using R free statistical software version 3.1.1.&#xD;
&#xD;
Results:&#xD;
&#xD;
Table 1 shows the baseline anthropometric and cardiovascular parameters. Heart rate (72.49&#xB1;9.71 vs 68.28&#xB1;8.04 bpm), SBP (114.86&#xB1;9.25 vs 108.58&#xB1;6.58 mmHg) and DBP (71.29&#xB1;8.82 vs 68.43&#xB1;4.80 mmHg) decreased significantly (P1 yr) practitioners. The female participants in the present study showed a reduction(not significant) in RT in both the yoga group and control group which is similar to that of previous findings.14 It may be due to time lag between the presentation of a stimulus and the beginning of a muscle contraction, which was slower in females. 14,15 RT is one of the methods to assess the person&#x2019;s central processing speed and coordinated peripheral response and it is important for drivers, pilots, surgeons etc. 16 Many factors influence RT like gender, age, fitness and health, muscle strength and distraction. 17 Shortened RT after yoga training is probably due to increase in muscle tone, greater arousal, the faster rate of information processing, increase in sensory-motor conduction velocity. 18 Faster reactivity after a long term of yoga practice may be due to the modulation of activity at ascending reticular activating system and information processing at the primary thalamocortical level. 10 Cohen et al., 2009 in their study found that cerebral blood flow has increased following the yoga training and have a greater impact on the right hemisphere, especially in the frontal lobe. 19 Now, it can be emphasized that the enhancement in the reaction time may be connected to the above changes because the frontal lobe is the one that acts as working memory, logical thinking, etc. 20 It clearly understands that a calm and peaceful mind will be able to process the task much faster and respond appropriately than a restless one. Consistent practice of yoga would bring coordination and psychosomatic integration.&#xD;
&#xD;
Conclusion:&#xD;
&#xD;
The results of present study show that regular practice of Yoga enhances processing ability of the central nervous system, and thereby reaction time has been shortened among the practitioners. Hence yoga can be implemented in today&#x2019;s school and college curriculum for better academic performance and wellbeing of the students.&#xD;
&#xD;
&#xA0;Acknowledgements&#xD;
&#xD;
We would like to sincerely thank all the participants in this study for actively volunteering to undergo the cognitive tests. &#xD;
&#xD;
Conflict of interest.&#xD;
&#xD;
The authors declare that they have no competing interests&#xD;
&#xD;
Source of Funding &#xD;
&#xD;
Nil &#xD;
&#xD;
Authors&amp;#39; contributions&#xD;
&#xD;
BGM and RP conceptualized the study. SR and KM played a key role in data collection, data entry and data analysis.&#xA0; RP provided intellectual input throughout the study. SR MK, BGM and RP closely supervised data collection, data entry, data analysis and contributed immensely in writing and editing the manuscript. All authors read and approved the final manuscript.&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3925</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3925</Fulltext></URLs><References>&#xD;
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	Senel O, Eroglu H. Correlation between reaction time and speed in elite soccer players. Age. J Rehab Med. 2006;21:3-2.&#xD;
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	Esculier JF, Vaudrin J, Beriault P, Gagnon K, Tremblay LE. Home-based balance training programme using Wii Fit with balance board for Parkinson&amp;#39;s disease: a pilot study. J Rehab Med. 2012;44(2):144-50.&#xD;
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	Bagya DA, Ganesan T, Maheshkumar K, Venkateswaran ST, Padmavathi R. Perception of stress among yoga trained individuals. Nat J Phys, Pharm Pharmac. 2018;8(1):47-50.&#xD;
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	Kuppusamy M, Kamaldeen D, Pitani R, Amaldas J, Ramasamy P, Shanmugam P, Vijayakumar V. Effects of yoga breathing practice on heart rate variability in healthy adolescents: a randomized controlled trial. Integra Med Res. 2020;9(1):28-32.&#xD;
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	Kumar AP, Omprakash A, Kuppusamy M, Maruthy KN, Sathiyasekaran BW, Vijayaraghavan PV, Ramaswamy P. How does cognitive function measured by the reaction time and critical flicker fusion frequency correlate with the academic performance of students?. BMC Med Educ. 2020;20(1):1-2.&#xD;
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	Kuppusamy M, Kamaldeen D, Pitani R, Amaldas J, Ramasamy P, Shanmugam P, Thirupathy VS. Effect of Bhramari pranayama practice on simple reaction time in healthy adolescents&#x2013;a randomized control trial. Int J Adol Med Hea. 2020 Jun 6;1(ahead-of-print).&#xD;
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	Kumar AP, Kumar KM, Padmavathi R. Validation of PC 1000 Hz reaction timer with Biopac&#xAE; MP 36 for recording simple reaction time. Indian J Physiol Pharmacol. 2019;63(2):138-44.&#xD;
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	Balakrishnan G, Uppinakudru G, Girwar Singh G, Bangera S, Dutt Raghavendra A, Thangavel D. A comparative study on visual choice reaction time for different colours in females. Neur Res Intern. 2014:16;2014.&#xD;
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	Nambinarayanan T, Thakur S, Krishnamurthy N, Chandrabose A. Effect of yoga training on reaction time, respiratory endurance and muscle strength. Ind J Physiol Pharmacol. 1992;36(4):229-33.&#xD;
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	Cohen DL, Wintering N, Tolles V, Townsend RR, Farrar JT, Galantino ML, Newberg AB. Cerebral blood flow effects of yoga training: preliminary evaluation of 4 cases. The J Altern Complem Med. 2009;15(1):9-14.&#xD;
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	Hall, J.E., Guyton and Hall textbook of medical physiology. Philadelphia, PA: Saunders Elsevier, 2011. 107: p. 1146.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Study of Anthropometric Measurements of Anterior Cruciate Ligament and Corresponding Femoral Intercondylar Notch in Human Cadavers in Indian Population&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>170</FirstPage><LastPage>176</LastPage><AuthorList><Author>Bharambe Vaishaly Kishore</Author><AuthorLanguage>English</AuthorLanguage><Author> Gangani Seherish Karim</Author><AuthorLanguage>English</AuthorLanguage><Author> Anand Shubhangi</Author><AuthorLanguage>English</AuthorLanguage><Author>  Vanshikha Gupta</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Damage to the Anterior Cruciate ligament (ACL) is a very frequently occurring injury. There are reports of the possibility of this injury being associated with the narrow intercondylar notch of the femur Aims: To measure and correlate the dimensions of the Anterior Cruciate ligament and intercondylar notch of the femur in the Indian population. Methodology: 25 knee joints in formalin-fixed cadavers were dissected and anterior cruciate ligaments and corresponding intercondylar notches were measured using vernier callipers. Results: The average length and width of ACL were found to be 38.8 and 9.6 mm. The standard deviations were found to be 2.3 and 1.7 respectively with standard errors being 0.46 and 0.34 respectively. The average width of the intercondylar notch was found to be 11.9, 15.8 and 14.3 mm in the lower, middle and upper parts of the notch respectively. Conclusion: The findings were compared with those of other authors and it was found that the length of ACL was found to be more and the width of the femoral intercondylar notch was found to be less in the Indian population than those reported by other authors. In the present study, 52% of the intercondylar notches had a width less than 17mm. A positive correlation was found between the length of ACL and the width of the middle part of the intercondylar notch. The authors state that it is possible that long ACL may compensate for narrow intercondylar notch and that a finding of short ACL and narrow intercondylar notch may be necessary risk factors for ACL tears.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords></Keywords><Fulltext>Introduction:&#xD;
&#xD;
All ligaments of the knee are crucial for the functioning of the knee joint.1Out of all the ligaments found supporting and acting at the knee joint, the anterior cruciate ligament (ACL) is the one that is most frequently injured. Damage to the ACL is a very frequently occurring sports-related injury. 2 Thus ACL repair surgeries are also becoming very frequent. 3It has been reported that reconstruction of the ACL is the sixth most common surgical procedure performed by sports medicine experts.1The repair of the ACL requires detailed knowledge of its anatomical morphology.4&#xD;
&#xD;
Several researchers have indicated that a smaller intercondylar notch can lead to contact with the ACL predisposing to an ACL injury during movements at the knee joint. 5, 6 Shepstone et al stated that the morphology of the intercondylar notch is related to the functioning and damage to the ACL. The injured ACL is, in turn, a known predisposing factor for osteoarthritis.7&#xD;
&#xD;
A cadaveric study was carried out by Wilson and Barhorst.8 It investigated the possibility of intercondylar notch impingement of the anterior cruciate ligament in six cadaveric knees, three female and three male on exposure to impingement force. They found that the impingement occurred more frequently in female than in male knees. However, the authors concluded that the small sample size limited the conclusivity of the results.&#xD;
&#xD;
Tillman et al studied the intercondylar notch geometry and found that the notch shape index for males, exceeded that for females and the intercondylar notch was less round in the females and could play a role in ACL injury. The authors stressed the necessity to further investigate the geometry of intercondylar notch and ACL.9&#xD;
&#xD;
The present research attempts to study the morphology of ACL and femoral intercondylar notch and by comparing them both, the study will attempt to give an insight into ACL injuries about intercondylar notch impingement.&#xD;
&#xD;
Objectives&#xD;
&#xD;
The objectives of the present study were to dissect the ACL and measure the length and width of the ACL in a state of flexion and to study the intercondylar notch by measuring the width of the intercondylar notch in the upper, middle and lower regions of the notch. The study finally attempted to perform a correlate and analyse between the ACL measurements, the notch size and ACL injuries.&#xD;
&#xD;
Methodology&#xD;
&#xD;
The study was carried out after obtaining clearance from the ethical committee. The study is observational descriptive study design.&#xD;
&#xD;
Sample size: A sample size of 25 lower limbs was calculated. The study was conducted on bodies that were donated after taking the consent of the donor and donor family, for purpose of Anatomical dissection and research.&#xD;
&#xD;
Inclusion and exclusion criteria: The lower limbs were obtained from formalin-fixed adult cadavers. Inclusion criteria for a limb to be selected for the study were that on examination the limb did not have any damage or injuries in the area to be dissected or any visible abnormality of the knee joint. Limbs with damage or injuries or having knee joint related abnormalities were excluded from the study. Instruments used were gloves, scalpel, blunt and tooth forceps, fine small scissors, digital vernier calliper, goniometer and bone saw. For photography, a 16-megapixel camera was used.&#xD;
&#xD;
Once selected, each lower limb was labelled separately for identification. Dissection of the lower limb was commenced with a skin incision. The upper incision was taken horizontally midway in the thigh and the lower incision midway in the leg region. The incision almost completely encircled the thigh and leg remaining incomplete posteriorly. The two incisions were joined by a vertical incision anteriorly to complete an &#x201C;I&#x201D; shaped incision. The overlying skin was removed in form of two flaps starting from the &#x201C;I&#x201D; shaped incision thus exposing the patella and the region above and below it.&#xD;
&#xD;
The muscles, ligaments, patella and joint capsule were identified and observed for any abnormalities. All the soft tissue around the knee capsule was removed along with the patella. The major ligaments of the knee i.e. the ACL, posterior cruciate ligament (PCL), medial and lateral menisci and medial and lateral collateral ligaments were preserved.&#xD;
&#xD;
The knee was flexed at around 90&#xB0; flexion. The synovial membrane covering the ACL was removed. The ACL was dissected in detail till it was well delineated. It was photographed and any variations were noted.&#xD;
&#xD;
The femoral intercondylar notch was measured. The height of the intercondylar notch was measured. Its width at the upper and lower ends and the width in the middle of the notch was measured. &#xD;
&#xD;
The findings of measurements of intercondylar notch and ACL were fed in a Microsoft Excel spreadsheet and analyzed statistically. &#xD;
&#xD;
Results: &#xD;
&#xD;
The measurements of the ACL in all 25 cases are given in table 1. The mean, standard deviation and the standard error of the mean are also given in the table. The dissected ACLs can be visualized in Figure 1, 2.&#xD;
&#xD;
The width of the intercondylar notch is given in table 2 in the upper, middle and lower region of the notch. In each case, the mean, standard deviation of the mean and the standard error of the mean are also given in the table. In the case of specimen number 17, the intercondylar notch had been cut open during the study and hence the intercondylar notch could not be measured reliably.&#xD;
&#xD;
Discussion:&#xD;
&#xD;
The number of ACL injuries has been observed to have increased in the last two decades. This has been observed to be especially true in the case of young children and adolescents. This could be because of more number of younger individuals entering into competitive sports.10 However, a smaller diameter of the ACL has been reported to be associated with an ACL injury.11 In their study, Mahajan et al took the measurements of the ACL by use of ultrasonography. Other authors too have corroborated this finding that ACL injured patients often have small-sized ACLs.12, 13 Many authors have based their observations on the fact that there is a difference in the rate of ACL injuries in males and females. Sutton and Bullock reported that females have a three times higher rate of ACL injury compared to males. This was probably because of increased quadriceps angle and increased posterior tibial slope they stated.14 A combination of various pressure influences leads to mechanical loading that leads to ACL rupture. 15,16,17,18&#xD;
&#xD;
Length and width of ACL:&#xD;
&#xD;
The present study was a cadaveric study in which the ACLs were measured by the process of dissection. The average length and width of ACL were found to be 38.8 and 9.6 mms. respectively with the standard deviation being 2.31 and 1.74, and the error of the mean being 0.46 and 0.34 respectively. &#xD;
&#xD;
In a study carried out by Saxena et al. the length and width of ACL was found to be 32.5 and 9.38 respectively.19In a study by Jayagandhi et al. the average length of the ACL was found to be 32.2 mms while in a study by Odenston et al. it was found to be 31 mms.20, 21&#xD;
&#xD;
Thus in the present study, the length of the ACL was found to be more than the reports by other researchers. Understanding the length of ACL will assist surgeons in ACL reconstructive surgery. Knowing the size of ACL helps the surgeons to select grafts for ACL reconstruction surgery.&#xD;
&#xD;
Mahajan et al stated that smaller ACL is seen among subjects with ACL injuries.11 The incidence of ACL tears is 2.3 times higher in females than in males.22, 23, 24 Chandrashekhar et al reported that the ACL length was found to be smaller in females than that in males.15As stated, in the present study the length of the ACL was found to be more than the reports by other researchers. Thus it would appear that chances of ACL injuries can be lesser in the present set of knee joints studied.&#xD;
&#xD;
Width of Intercondylar notch of femur:&#xD;
&#xD;
In the present study the mean intercondylar width was found to be in the range between 11.94 mm at the lower end of the notch, 15.83 mm in the middle and 14.34 mm at the upper end of the intercondylar notch. &#xD;
&#xD;
In a study by Shelbourne et al., the middle intercondylar width was found to be 15.5 mm and 18 mm in the case of females and males of the African American part of the study group respectively.6 The similar measurements of the white females and males were found to be 14.1 mm and 16.9 mm respectively.6 The authors noted that there were reports that white female basketball players had a 6.5% higher incidence of ACL tears compared to their African American counterparts.25 In the present case the sex of the cadavers being dissected could not be determined in all cases as some of the lower limbs had been disarticulated from the hip.&#xD;
&#xD;
The present study shows the average width of the intercondylar notch to be 15.8 mm which is lesser than the width in the case of African Americans as well as white Americans participating in the study carried out by Shelborne and the findings reported by Ouyang et al in the Chinese population.6, 26(Table 3) Femoral intercondylar notch has been often indicated as a possible risk factor in cases of ACL injury. However, it is still not proved that a narrow notch leads to ACL tears. There have been many studies that have reported a narrow notch as being the risk factor for ACL injuries.27, 28Many of these studies have been conducted on X-ray films or CT scan images. While there are studies that implicate the intercondylar notch as a possible risk factor, there are few studies that state that there is no correlation between ACL injury and size of the intercondylar notch (Figure 3).29-32&#xD;
&#xD;
&#xA0;In the present study, the authors report findings where the intercondylar notch has been measured directly on the femur bone. Lund-Hanssen et al. reported that when the intercondylar notch width was less than 17 mm, chances of ACL injury increased by 6 times compared to those with the wider intercondylar notch.33 In the present study 52% of the intercondylar notches studied had a width less than 17mm. &#xD;
&#xD;
The ACL measurements in the lower limbs dissected in the present study sample were more than that reported by other researchers and indicating lesser chances of ACL tears which counters the above statement concerning the width of the intercondylar notch. Mahajan et al. have stated the higher incidence of ACL tears is associated with a shorter length of ACL( Figure 4).34&#xD;
&#xD;
Correlation between the parameters studied i.e. length and width of ACL and the width of the intercondylar notch was analyzed by applying correlation analysis. Table 4 shows the results of the correlation analysis of the length and width of the ACL and the width of intercondylar notches of the femur at all 3 levels i.e. upper, middle and lower applied to present findings. A positive correlation was found between the length of the ACL and the width of the intercondylar notch of the femur as measured in the middle of the notch. No comparative studies in this regard were found in the literature. However, a study by Stijak et al. found a positive correlation between the width of ACL and the intercondylar notch in the males.35,36&#xD;
&#xD;
The authors in the present study would like to state that it is possible that long ACL may compensate for narrow intercondylar notch and that a finding of short ACL and narrow intercondylar notch may be necessary risk factors for ACL tears. This hypothesis may need further research.&#xD;
&#xD;
Limitations of the study: The small sample size and inability to differentiate the findings of the sex of the lower limbs being studied are the limitations of this study.&#xD;
&#xD;
New topics for research: The study puts up a hypothesis wherein there is a need to explore the possibility of correlation of both short ACL and narrow intercondylar notch coexisting in ACL injuries.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
In the present study, the length of ACL was found to be more and the width of the femoral intercondylar notch was found to be less in the Indian population than those reported by other authors and 52% of the intercondylar notches had a width less than 17mm. A positive correlation was found between the length of ACL and the width of the middle part of the intercondylar notch. It may be concluded it is possible that long ACL may compensate for narrow intercondylar notch and that a finding of short ACL and narrow intercondylar notch may be necessary risk factors for ACL tears. &#xD;
&#xD;
Acknowledgement&#xD;
&#xD;
The authors acknowledge the immense help received from the scholars whose articles are cited and included in the 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.&#xD;
&#xD;
Conflict of interest&#xD;
&#xD;
The authors declare that there is no conflict of interest &#xD;
&#xD;
Source of funding:&#xD;
&#xD;
NIL&#xD;
&#xD;
Individual Author&#x2019;s contribution&#xD;
&#xD;
All the authors have contributed to dissection, collection of data, its analysis and final discussion and manuscript writing.&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3926</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3926</Fulltext></URLs><References>&#xD;
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	Davis I., Ireland M. L., Hanaki S. ACL injuries: the gender bias. J Orthop Sports Physical Ther. 2007;37(2):p. A1. doi: 10.2519/jospt.2007.0301. PubMedCrossRefGoogle Scholar&#xD;
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	Saxena A, Ray B, Rajgopal KV, D&#x2019;Souza AS,PyrtuhS.Morphometry and magnetic resonance imaging of anterior cruciate ligament and measurement of secondary signs of anterior cruciate ligament tear. Bratisllek Listy.2012;113(1):539-543.&#xD;
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	JayagandhiS, NimVK, Kumar M, S Senthilkumar.The Morphometric Study Of Anterior Cruciate Ligament: A Cadaveric Study. Int J Anat Res. 2018;6(3.2):5581-86.&#xD;
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	Odensten M, Gillquist J. Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg Am. 1985 Feb; 67(2): 257-262.&#xD;
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	Oliphant JG, Drawbert JP. Gender Differences in Anterior Cruciate Ligament Injury Rates in Wisconsin Intercollegiate Basketball. J Athl Train. 1996 Jul-Sep; 31(3):245-247. &#xD;
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	Wirtz PD. High school basketball knee ligament injuries. J Iowa Med Soc. 1982 Mar;72(3):105&#x2013;106. &#xD;
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	Zelisko JA, Noble HB, Porter M. A comparison of men&amp;#39;s and women&amp;#39;s professional basketball injuries. Am J Sports Med. 1982 Sep-Oct;10(5):297&#x2013;299. &#xD;
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	Trojian T, Collins S. The Anterior Cruciate Ligament Tear Rate Varies by Race in Professional Women&amp;#39;s Basketball. J Iowa Med Soc. 2006. 34(6):895-8.&#xD;
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	Ouyang X, Yu HW, WangJ, Shi Dong Hong, XinF, Wang L.MRI measurement on intercondylar notch after anterior cruciate ligament rupture and its correlation, Exp Ther Med. 2016.11(4):1275-1278.&#xD;
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	Houseworth SW, Mauro VJ, Mellon BA, Kieffer DA.The intercondylar notch in acute tears of the anterior cruciate ligament: a computer graphics study. J Iowa Med Soc.1987;15(3):221-224.&#xD;
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	Anderson AF, Lipscomb AB, Liudahl KJ, Addlestone RB.Analysis of the intercondylar notch by computed tomography. Amer J Sports Med.1987;15(6):547-552.&#xD;
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	Souryal TO, Freeman TR, and Danie DM. Intercondylarnotch size and anterior cruciate ligament injuries in athletes:a prospective study. Am J Sports Med.1993.21(4):535-539.&#xD;
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	LaPrade RF, Burnett QM II,D. M. Daniel, &#x201C;Femoralintercondylar notch stenosis and correlation to anteriorcruciate ligament injuries: a prospective study. Am J Sports Med.1994;22(2):198-203.&#xD;
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	Ireland ML, Ballantyne BT, Little K, NI. S. McClay.A radiographic analysis of the relationship between the size and shape of the intercondylar notch and anterior cruciate ligament injury. Knee Surgery, Sports Traumatic, Arthrosc. 2001.9(4):200-205.&#xD;
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	Domzalski M, Grzelak P, GabosP. Risk factors for Anterior Cruciate Ligament injury in skeletally immature patients: analysis of intercondylar notch width using Magnetic Resonance Imaging. IntOrthop. Am J Sports Med .2010;34(5):703-7.&#xD;
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	Lombardo S, Sethi PM, Starkey C.Intercondylar notch stenosis is not a risk factor for anterior cruciate ligament tears in professional male basketball players: an 11-year prospective study. Am J Sports Med. 2005;33(1):29-34.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Human Papilloma Virus (HPV) - A Threat to Women Worldwide: Emerging Solutions for Cervical Cancer&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>177</FirstPage><LastPage>183</LastPage><AuthorList><Author>Nichila MP</Author><AuthorLanguage>English</AuthorLanguage><Author> Grace VMB</Author><AuthorLanguage>English</AuthorLanguage><Author> Wilson DD</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Human Papilloma Virus (HPV) is a papillomavirus that infects the skin and mucous membranes of humans. It impacts the health of women far more than it impacts men. Approximately 200 HPV types have been identified so far. Some HPV sub-types cause warts (verrucae) and certain others cause cancers including cervical cancer, while others have no symptoms. HPV is the most common sexually transmitted virus infecting human and presents as exophytic verrucous white or pigmented lesions with symptoms of bleeding and pain. The HPV infection and thereby cervical cancer incidence are found to be higher in underdeveloped countries. Aim and Objective: This review aims at summarising the new advancements in the solutions for cervical cancer especially, the HPV targeted therapeutic vaccine developments and prospects. Conclusion: The primary reason noted is the lack of access to screening and awareness about risk factors. However, the applicability of these screening in India is questionable. Furthermore, the women (especially Indians) psychologically don&#x2019;t like to have Pap smear when they don&#x2019;t have any abnormal symptoms. Moreover, the Pap smear test is not so efficient to screen before the onset of cervical lesions. More research is needed in screening methods so that best practices for prevention and management can be developed and implemented. Even though there are Food and Drug Administration (FDA) approved HPV vaccines like Gardasil, Gardasil 9, Cervarix, which prevent infection against various high-risk HPV types, HPV associated diseases remain a significant public health problem since the HPV vaccines do not treat the already infected individuals&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Cryo microscopy, Prospects, Human papillomavirus, HPV therapeutic, Vaccines, Phytochemicals, Progress in therapy</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Human papillomavirus (HPV) infections cause cervical, vulvar, vaginal, penile, anal, and a few head and neck (oropharyngeal) cancers. HPV is considered the major cause of the occurrence of various types of cancer and skin warts.1 &#xA0;The International Agency for Research on Cancer has found that the cancer sites of the cervix uteri, penis, vulva, vagina, anus and oropharynx, including the base of the tongue and tonsil, have a strong causal relationship with HPV.2 HPV is transmitted from skin and mucous membrane of an infected individual to a healthy one through direct sexual contact.3 According to NIH, Human Papilloma Viruses are considered to spread through direct sexual contact. HPV is a non-enveloped, epitheliotropic, double-stranded circular DNA virus, whose gene expression and the life cycle is tightly controlled by epithelial cell differentiation.4The sexually transmitted HPV types are categorised into low risk and high-risk HPV&#x2019;s based on their oncogenic potential. The low-risk HPV type causes genital warts and is considered non-cancerous lesions. The high-risk HPV types are potential tumour causing agents. HPV can be classified into two main phylogenetic genera namely &#x3B1;-HPV and &#x3B2;-HPV, which corresponds to the mucosal and cutaneous infection respectively.5 The CDC statistics revealed the occurrence of about 39,800 HPV-associated cancers in the United States each year from 2009 to 2013.6 They have highlighted that half of the population is affected by HPV and the recent research has focused on formulating therapeutic drugs, which produce cell-mediated immunity and strong therapeutic effects against established HPV infections and lesions.7&#xD;
&#xD;
In 2017, the WHO fact sheet revealed that the HPV infection does not show symptoms in most cases, and cervical cancer symptoms tend to appear only at an advanced stage. Hence, regular screening for HPV is important and it highlighted that 90% death by cervical cancer is in middle-income countries.8 Mortality due to cervical cancer is reduced in women who undergo regular pap screening test followed by diagnostic procedures and treatment. It has also been found that screening with Pap test and HPV DNA for every five years in women 30 years and older, is more sensitive in identifying the cervical abnormalities at an early stage and these two tests reduce the incidence of cervical cancer.9 The irony is that there is no HPV specific treatment even if it is identified upon screening to prevent the development risk of cervical cancer which is an alarming situation for women worldwide. The existing HPV managements are vaccination for only very few types and non-specific immune-stimulation regimen against HPV infection. Like the HIV, evolution into new sub-types of HPV is the real challenge of HPV vaccination as well as immunotherapy. Hence, understanding the mechanism of action of HPV will help in formulating better anti-viral therapeutic agents against HPV. Advancement in 3D microscopic view of HPV using a new imaging technique called cryo-EM or cryo microscopy has helped researchers to get a detailed view of HPV structure, the antigen-antibody binding, the epitope region, and the transformational changes that occur when the HPV virus binds to the cell. It was, therefore, suggested to have improved imaging to better research approaches in future.10 This review article highlights the HPV infection as a real threat for women and the various advancements in HPV research to solve the present challenges and their impact on cervical cancer management.&#xD;
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EPIDEMIOLOGY OF CERVICAL CANCER&#xD;
&#xD;
The leading genital cancer among women worldwide is cervical cancer and millions of new cases reported every year. An account of 239,000 deaths has been reported in 2015 and most of them are with squamous cell carcinoma. It differs in the geographic region. Among 100,000 women, 34.8 new cases and 22.5 deaths are reported in sub-Saharan Africa and 4.4 new cases and 1.9 deaths are reported in Western Asia. The cervical cancer rate is very lower in Northern America. The cervical cancer rate is very high in many countries of Central Asia compared to Europe. In Central Asian Countries, 25,700 cervical cancer cases were reported and 12,700 died of it. The mortality rate in Kyrgyzstan is 11.2 per 100,000 and in Tajikistan 4.9 per 100,000. Increasing morbidity, such as pain, bleeding, and kidney failure are the risk factors of cervical cancer and in poor countries; it is difficult to treat cervical cancer.11It was reported that 57,000 new cases and 311,000 deaths have occurred in 2018, and the highest cases reported in Eswatini at 6.5%. The global cervical burden can be contributed by India and China, 106,000 cases in China with deaths of 48,000 and 97,000 cases with 60,000 deaths in India.12 The WHO made a draft global strategy to be achieved within 2030 by focusing on three main factors as; prevention (90% of girls need to be vaccinated for HPV), screening (70% coverage for cancer and 90% coverage for pre-cancerous cervical lesions) and treatment at the early stage of cancer (Managing 90% of invasive cancer).13&#xD;
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THERAPY FOR CERVICAL CANCER&#xD;
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The promising results achieved in primary treatments of cervical cancer include surgery or a concurrent chemoradiotherapy regimen consisting of cisplatin-based chemotherapy with external beam radiotherapy and brachytherapy. The cisplatin plus Paclitaxel was found to show less toxicity than cisplatin plus fluorouracil,14 which implies that the plant-derived drug Paclitaxel is a good option for treating cervical cancer with reduced toxic effects. Intra-cavitary brachytherapy is an integral part of radiotherapy for locally advanced gynecologic malignancies.15 Treatments other than the primary surgical techniques, which need advanced training and equipment, include carbon dioxide laser ablation, Cavitron Ultrasonic Surgical Aspiration (CUSA), and Mohs surgery.16 Even though various advancements are found in the treatment process of cervical cancer, the recurrence rate is very high due to a specific set of complications. The present treatment methods are only killing the cancer cells and not eliminating the transforming HPV infection. Hence, future research should aim at finding cost-effective HPV targeted techniques to treat the HPV infection as well as to prevent the recurrence of such infections after treatment.&#xD;
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HPV SCREENING STATUS&#xD;
&#xD;
Women cervical cancer is the most common and globally positioned the fourth as per the IARC report 2019. To prevent it, the Director-General of WHO made a global call to follow strategies of preventing HPV by improving vaccination, treatment and screening at the early stage. It is predicted that, within the next 65 years, about 35-40 million cancer cases will be reported. Two HPV assays such as; Gene Xpertand care HPV have been prequalified by WHO for the screening of HPV to detect the risk of cervical cancer development at the earliest stage. For LMICs, both assays are used, but their price, management and sensitivity varied. The important tool required for effective screening is traceability, community education, provider training, operational management and quality control. To protect women from developing cervical cancer, it was highlighted that the screening for HPV is very important.17They have described the HPV based cervical cancer screening program: main interventions, ideal timelines and main bottlenecks.&#xD;
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There are over 150 serotypes of HPV, out of which only the high-risk serotypes are identified as potential cancer-causing agents.1 Regular screening of HPV is important for both the vaccinated and the non-vaccinated population because, vaccines will not protect the individuals who are already infected with HPV and also, the vaccine doesn&#x2019;t provide protection against other oncogenic HPV types. Hence, there is a need for screening at regular intervals for both men and women. There are three common types of screening techniques: Pap test, HPV DNA test, and visual inspection with acetic acid.18The use of the Pap test is not promoted nowadays because of its complexity and delay in managing the patients. Furthermore, HPV testing is easier to identify the positive cases. It has been found that HPV DNA and HPV RNA test detects precancerous lesions at an early stage. The US FDA has approved the HPV DNA test alone in 2014, as primary screening for cervical cancer in women, aged 25 and older.&#xD;
&#xD;
HPV screening by Pap test and HPV DNA test (co-testing) are reported to reduce cervical abnormalities.19 For stratifying CIN-3 risk, Pap cytology and HPV co-testing were considered valuable and the results taken in three-year interval revealed that the risk of CIN 3 was low in the individuals with negative pap test and HPV co-testing.20 However, it has been found that co-testing is associated with more false positives9, which may be due to genotypic variations of HPV. Various advanced screening techniques include human papillomavirus [HPV]-based screening with partial genotyping. For women testing positive for HPV16/18, colposcopy is carried out and Liquid-based cytology [LBC] for other oncogenic HPV types. For unscreened and under-screened women, HPV testing on self-collected cervicovaginal samples is done. Self-collection is restricted to the age group of women 30-74, who have never been screened for HPV.21 Other advanced HPV screening tests approved by FDA for specific HPV types include; i) Cobas HPV Test specific for HPV 18/16 (approved in 2011) 22, ii) Hybrid Capture 2 test which detects 13 types of "high-risk" HPV types (in 2003), iii) Aptima assay test to detect RNA synthesised when the HPV starts creating cervical cancer (in 2011)23 are highly sensitive and expensive. Hence, there is a need for the development of cost-effective screening techniques for all HPV types with high specificity and sensitivity to prevent false positive detection.&#xD;
&#xD;
HPV TREATMENTS&#xD;
&#xD;
There are various types of HPV infection; low-risk HPV infection generally causes warts in various parts of the body including genital region, foot corn, acne and squamous intraepithelial lesions (SIL). Treatment for these kinds of effects by HPV infection includes eliminating the visible lesions and boosting the host immune system to control the viral replication. Treatment of HPV is based on various factors like size, morphology, number and site of lesion, cost of treatment, adverse reaction, and previous treatment. No particular mode of treatment for all the type of HPV infection has been demonstrated.24 Based on the grade level, various treatment methods like cryotherapy, a loop electrosurgical excision procedure (LEEP) diagnostic excisional procedure (cone biopsy) are given.25 Pharmacological therapy for the treatment of HPV is classified into two categories namely, immune response modifiers and cytotoxic agents. These drugs are given cutaneously against anogenital warts or condylomata acuminate.26The main challenge in HPV treatment is the lack of in vitro HPV culture model to study the efficiency of treatments. Hence, no specific drug has been established yet. As a result, cervical cancer causes more than one quarter of a million deaths every year in underdeveloped and developing countries. In SIL patients, if the high-risk type HPV persists, it will be turned into neoplasia and invasive cervical cancer. &#xD;
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HPV VACCINATION AS A MODE OF TREATMENT&#xD;
&#xD;
The HPV vaccination is given as either a prophylactic vaccine or therapeutic vaccine. The prophylactic HPV vaccination using HPV antigens can reduce the prevalence of HPV infection and thereby, reduce the risk or incidence of cervical cancer development. The existing prophylactic vaccines induce immunity against the L1 protein of HPV particle (Immunization with VLP), but they don&#x2019;t give therapeutic effect on existing infection and established cervical lesions.27,28,29 In contrast, the therapeutic vaccines are targeted at inducing the cytotoxic cells like T-cells to eliminate the HPV infected cells. The present prevalence and persistence of HPV infection globally indicate that most of the underdeveloped areas have less or no exposure to the prophylactic vaccines and these are the places, which are infected epidemically by the HPV. HPV awareness and vaccination do not seem to reduce the HPV infection rate since, half of the population is already infected and may develop cervical cancer if they are not subjected to affordable screening and treatment procedures.30Hence, the therapeutic vaccination needs to be strengthened to act on established HPV oncogenic types. In 2016, a survey carried out in 1200 Korean representatives revealed that proper knowledge and awareness of HPV infection and vaccination programmes increase the willingness of the individuals to take up the HPV vaccine.31 The VLP vaccines do not protect all oncogenic types. Screening of cancer is very important in the reduction of cancer rate and is very less in many countries. The manufacturing cost of the VLP vaccines is very high and not very effective. For improving the HPV vaccination GAVI is an important tool.32,33&#xD;
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	Preventing HPV Infection by Prophylactic Vaccines&#xD;
	&#xD;
&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; To reduce HPV infection, prophylactic vaccines play an important role as it is eliciting a humoral immune response against HPV infection. There are two well established prophylactic HPV vaccines available to act against the L1 capsid proteins. The first developed quadrivalent vaccine was Gardasil&#xAE;, which has been available since 2006; it provides protection against HPV 6, 11, 16, and 18 for at least 8 years. The second was the Cervarix&#xAE;, which protects against two serotypes 16 and 18 for more than 9 years.33 Effectiveness of this HPV vaccine in providing prevention and long-term protection against genital warts was higher in individuals with three doses than one dose since the risk of genital warts rose with age.34 The effectiveness and immunogenicity study of a new version Gardasil 9&#xAE; was found to prevent effectively the 9 HPV serotypes such as HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58. This vaccine is cost-effective and approved for clinical use with a promise to prevent for at least 30 years 35, 36,37. However, a cross-reactivity challenge exists for all these prophylactic vaccines. The most adverse effect related to the injection site was mild or moderate in intensity due to the high amount of HPV virus particle and AAHS adjuvants. It has been found that the 9vHPV vaccine increased the overall prevention of cervical cancer from 70% to 90% approximately. Regular screening tests should be done to check HPV infection.38In over 100 countries prophylactic HPV vaccines that include Cervarix (2vHPV vaccine), Gardasil (4vHPV vaccine) and Gardasil 9 (9vHPV vaccine) are licensed since 2006. WHO confirms the efficacy, safety, and the duration of the prophylactic HPV vaccine. However, the HPV vaccines were terminated by the Japanese government due to the local pain syndrome. So the vaccination rate has decreased to 3.9% in Japan. The recent advancements are the development of neutralizing antibodies along with inactivated pathogens to induce the immunization of HPV vaccine with adjuvants. Immunoglobulin G serum response was promoted by 2vHPV vaccines and required for the production of T helper cell 1 biased cell response. 4vHPV vaccine also was found to produce T helper cell 2 biased cell responses.29&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In addition to this L1 based vaccine, later the L2 based vaccines using a conserved 11-200 or 20-38 amino acid chain of N-terminal region have been developed.30 L2 based vaccines provide cross-protection against different types of HPV while the L1 immune response is highly specific. For providing broad cross-neutralization activity, the RG1 epitope within the region is pivotal. Because of the simple format and protection against a wide range of HPVs, the L2s based vaccines are highly acceptable. Many HPV L1 VLP, and HPV L2 based vaccines are produced now usingS. cerevisia, Escherichia coli (E.coli),&#xA0; methylotrophic yeast species like Hansenulapolymorpha (H.polymorpha) and Pichiapastpris (P.pastoris) and undergoing preclinical or clinical studies.31 However, the immunogenicity is less for L2 based vaccines as a limiting factor for the success. A review article of 1998 has shown the milestone of prophylactic HPV vaccine development starting from the trial of monovalent HPV16 vaccine to the recommendation of an FDA approved vaccine 9vHPV in 2014 with second dosing in 2016 and the recent licencing of a novel E.coli produced bivalent HPV vaccine in China in 2020.39 However, the prophylactic vaccine coverage of all types of high-risk HPV, phylogenetic evolution, lack of awareness and vaccine cost are the challenges for developing countries.&#xD;
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	Elimination of HPV by Therapeutic Vaccines&#xD;
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&#xD;
There is a need for the formulation of therapeutic vaccines to treat the already existing HPV infection and the associated diseases. But there is no specific anti-viral drug and the vaccines can induce acquired cellular immune response, which recognizes the infected cells and kills them. Therapeutic vaccines, therefore, aim at inducing a cell-mediated immunity, to kill the target cell. Such vaccines can target all the proteins involved in the entire life cycle of the HPV in the epithelial cells. The L1 and L2 proteins are expressed only in terminal keratinocytes. Hence, the early genes E1, E2, E4, E5, E6, and E7 are ideal targets of therapeutic vaccine development. This can be achieved with HPV peptides, proteins, DNA and also by developing HPV immune-stimulated DC in vitro.22 Most of these vaccines target the oncoproteins E6 and E7, which are responsible for the malignant progression of HPV infection. There are different forms of therapeutic vaccines that are used in the clinical trial phase, and these include bacteria-based vaccines (Lm &#x2013;LLO-E7),23 Viral vector-based (TA-HPV),24 Nucleotide based (pNGVL4a-CRT/E7 &#x2013;DNA),25 whole cell-based (1, dendritic cell-based 2, tumour cell-based), peptide-based (HPV 16-SLP),26 protein(GTL001).27 The main strategies of HPV therapeutic vaccines are generating specific effectors T- Cell against the expression of oncogene E6 and E7. Recently, many clinical trials for therapeutic vaccines have been conducted with optimization to improve the efficacy. Shortly, the development of these drugs may pave the way for the eradication of HPV infection and associated diseases including deadly cancer.&#xD;
&#xD;
CHALLENGES IN HPV VACCINATION&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The most important issue is the lack of knowledge about HPV and its vaccines, so it should be addressed. Delivery of the vaccines should be affordable, available and acceptable. China approved many HPV vaccines but the availability is very less mainly in lower resources regions. In France, the delivery of HPV vaccines is below 20%. The major issue is that the women or girls are not taking the vaccine even it is given free of cost. HPV based self-sampling kits are available, which will improve participation as it is acceptable than the clinical sampling.28&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0; In Nigeria, the facilities are very less for cervical cancer screening and the awareness is also lower. So 97.9% of women are not screened for cervical cancer. Some of the issues include lack of screening service (44.2%), lack of knowledge (40.7%), reduction in decision-making ability (34.2%), cost of screening (30.1%), and the distance of the centre (23.5%). But the HPV related diseases can be compacted by cytology screening. It provides high sensitivity, high throughput, and negative predictive value. HPV worldwide have licensed two safer quadrivalent and bivalent vaccines. But the use of the vaccines is reduced due to the lack of knowledge and high cost. Cervarix and Gardasil vaccines are donated through GAVI INITIATIVE (Global alliance for vaccine and immunization) at lower price mainly to low-income countries. An issue stated by other countries is that those vaccines contain a high amount of aluminium salt which causes damage to the immune system especially in infants and children which leads to chronic illness.49Hence, new safer delivery regimens need to be invented.27-30&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The exact mechanism behind HPV integration with the host cells is not known yet. Understanding the HPV oncoproteins structure and mechanism of their interactions will help in the formulation of better medicines and effective prophylactic vaccines, which will help in the eradication of HPV shortly. The cryo-electron microscopic examination has given a better understanding of the structure of HPV 16 particle capsids and the structural conformational changes which occur when HPV binds to the cell10 and the results help in understanding the HPV uptake mechanism during the early stage of virus infection. This imaging technique will help in understanding the antigen-antibody interactions, thus more specific vaccines which prevent and cure HPV infection can be formulated in the future.31&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Based on the reviews summarized and presented at Asia-Oceanic Research Organization in Genital Infection and Neoplasia (AOGIN) 2018, and the 32nd International Papillomavirus Conference (IPVC), the Director-General of the World Health Organization (WHO) announced that cervical cancer can be cured affordably by implementing the draft static plans. Their main goal is to prevent cervical cancer by improving the vaccination among 90% of females globally. The prophylactic vaccination is implemented in high-income countries on large scale, however, the supply of HPV vaccines and the acceptance of the need for vaccination among young adolescent girls is the current challenge in these countries. It was highlighted that clinical validation such as dose efficacy, bridging, safety studies are required for the infant immunization against HPV. For LMIC, vaccinating the young girls at a large coverage (80-100% coverage and 70% screening twice per lifetime) should be prioritized, which can reduce cervical cancer from 16 per 100 000 to less than 4 per 100 000 in between 2020 and 2080.32&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; For treating HPV induced lesions, a therapeutic regimen plays a major role. It is possible to eradicate HPV-transformed cells through immune response produced by HPV genes that carry the recombinant vaccinia virus. The E2 of HPV is getting much attention as an effective target for developing therapeutic vaccines as it plays a major role in transmitting the HPV into the new cells in the cervix epithelium. Tumour can be eliminated through MVA E2 vaccines that stimulate the production of antibodies and cytotoxic cells that act directly on the transformed cells. MVA E2 vaccines are promising agents for preventing as well as treating cervical cancer and did not show any side effects when tested in the patient.21&#xD;
&#xD;
Current Status and Future Prospects of Cervical Cancer Therapy&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In Germany, the cervical cancer prevention analysis was attempted by Wolfsburg Pilot Project for non-hysterectomies women (30-70 years old), where cervical cancer diagnosed in the first screening compared with subsequent round was the primary focus. The women can freely choose HPV test or Pap smear under health insurance companies within a five years gap. The positive women are referred to colposcopy and the next screening should be after five years for negative women.12&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The current therapies for cervical cancer are only cytotoxic which causes injuries to normal cells. Furthermore, since the high-risk type HPV is the inducer of cervical cancer, the recurrence rate is also very high in cervical cancer treatment. Cisplatin, the key drug used for cervical cancer, gives rise to adverse side effects such as nephrotoxicity and neurotoxicity33,34. For pursuing better health, medicinal plants are nature&#x2019;s gift. Several studies have proven that plants contain bioactive compounds that can act against particular cancer. Allium Wallichil contains phytochemicals like cateroids, flavonoids, terpenoids, Paeoniasuffruticosa has phytochemicals such as polysaccharides (HSS, DASS, HBSS, CASC) and all these can suppress cervical cancer. Phytochemicals identified in Medicagoscutellata are trypsin inhibitor, which can decrease cervical cancer as well as other types of cancers. The bioassay-guided fractionation of these phytochemicals may achieve a better anti-cancer therapy.35 Black raspberries and their compounds are the promising ones for cervical cancer in chemoprevention. Boswellia Srerata can induce apoptosis and kill cancer cells by the hydro alcoholic compound.56 Furthermore cervical cancer treatment will be effective only when the causative HPV is targeted. But so far no drug formulation with anti-viral property is available for cervical cancer therapy. The efficient anti-viral potential of garlic extract containing allicin was shown by Weber and his research group in vitro on HeLa cell line.27&#xD;
&#xD;
The vaccines and screening programs have been developed in the area of HPV over the last 36 years. But the investigation is still going on for HPV related cancer and HPV infection. The most promising area of research worldwide is immunotherapy, but it has not been approved by FDA. Risk factor screening programs and global implementation of vaccines programs should be followed for the reduction of HPV associated cancer. Screening by HPV-FASTER and vaccination should be compelled to youngsters.28&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In future, if research is focused on understanding the mechanism of action of HPV in the host,&#xA0; it might pave way for formulating better therapeutics. More awareness should be given on the importance of vaccination at an early stage itself. There is a need to work towards formulating a single vaccine with high immunogenicity, specificity, safety and patient acceptance, which can act against all types of HPV. Continuous screening for HPV at regular intervals followed by HPV targeted treatment can reduce the deaths caused due to cervical cancer. Researchers are focussing on natural extracts for the treatment of cancer. Phyto-molecules have high biocompatibility and biodegradability that can increase efficacy in cervical cancer therapy. Research works are currently undergoing for the evaluation of phytochemicals that act against HPV in cervical cancer cells.&#xD;
&#xD;
Acknowledgement:&#xD;
&#xD;
The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript.&#xA0;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.&#xD;
&#xD;
Conflict of Interest:&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The authors declare that they have no conflict of interest in the writing and publishing of this review article.&#xD;
&#xD;
Funding for this study:&#xD;
&#xD;
Nil&#xD;
&#xD;
Authorship and Responsibilities:&#xD;
&#xD;
Nichila MP &#x2013; Data Collection and Writing&#xD;
&#xD;
Grace VMB &#x2013; Planning, Design and Writing&#xD;
&#xD;
Wilson DD - planning, Writing and Editing&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Comparative Evaluation of the Efficacy of 4% Articaine and 2% Lignocaine During Orthodontic Extraction: A Randomized, Double-Blind Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>184</FirstPage><LastPage>188</LastPage><AuthorList><Author>Jain M</Author><AuthorLanguage>English</AuthorLanguage><Author> Dogra N</Author><AuthorLanguage>English</AuthorLanguage><Author> Gupta M</Author><AuthorLanguage>English</AuthorLanguage><Author> Grover S</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Local anaesthetics block the peripheral nerves and are used to prevent pain, during surgical and dental procedures. The primary object of this investigation was to compare and evaluate the efficacy of 4% Articaine hydrochloride with 1:100000 adrenaline and 2% Lignocaine hydrochloride with 1:80000 adrenaline during orthodontic extraction of maxillary first premolar. Methods: This prospective randomized, double-blind study was conducted from February 2013 to September 2014 on 43 patients less than 40 years of age requiring bilateral maxillary first premolar extractions for orthodontic purposes. Each patient was randomly assigned to receive either 2% lignocaine hydrochloride or 4% articaine hydrochloride for premolar extraction of one side and another solution was administered for the premolar extraction of contralateral side spaced 1 to 3 weeks apart.In each patient, the difference in the pain levels,onset of anesthesia and duration of anesthesiawas assessed on the administration of lignocaine hydrochloride and articaine hydrochloride. Results: There was statistically no significant difference in pain levels between orthodontic extraction of maxillary first premolar between the Articaine and Lignocaine groups. (p&gt;0.05).The Articaine group had an earlier onset of anaesthesia after buccal infiltration and palatal infiltration as compared to the lignocaine group. The mean duration of anaesthesia was longer in the articaine group as compared to the highly significant lignocaine group. Conclusions: Articaine can be used as a suitable alternative to lignocaine in the extraction of maxillary premolars for orthodontic reasons with clinical advantages like faster time of onset, longer duration, and greater diffusing property over lignocaine.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Local anaesthetic, Lignocaine hydrochloride, Articaine hydrochloride, Orthodontic Extraction, Prospective study, Double blind study</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Ever since the introduction of synthetic local anesthetic agents in surgical practice, clinically adequate pain control with minimum side effects has been the goal and desirable prerequisite for painless procedures.1 The ability to provide safe, effective local anesthetic is the cornerstone of successful clinical and surgical practice. Local anesthetics form the backbone of pain control techniques in dentistry.2&#xD;
&#xD;
The history of local anaesthesia dates back to 1859 when cocaine was isolated by Niemann. Since the introduction of cocaine local anaesthesia (1886), and the subsequent development of procaine (1904) and other related type anaesthetics, dentistry has prided itself on being as close to &#x201C;painless&#x201D; as possible. In the late 1940s a new group of local anaesthetic compounds, the amide was introduced.&#xA0; The initial amide local anaesthetic, lidocaine (Xylocaine), revolutionized pain control. A new class of local anaesthetic was synthesized in 1943called Lidocaine. It was marketed under the proprietary nameXylocaine and successfully replaced procaine. Lidocaine was found to have faster action of action, longer duration of anaesthesia as compared to the esters .3&#xD;
&#xD;
In 1969, Carticaine was first prepared by Rushing and colleagues and had its generic name changed to Articaine when it entered clinical practice in Germany in 1976 as a local anesthetic.4Articaine differs from the previous amide local anaesthetic in being derived from a thiophene ring instead of the usual benzene ring which gives the molecule better diffusion properties as compared to lidocaine. It contains an additional ester group that is quickly hydrolyzed by plasma esterase which gives Articaine an elimination half-life of approximately 90 minutes.5,6&#xD;
&#xD;
The objective of this study was to evaluate the anaesthetic efficacy of 4% ArticaineHCl with 1:100000 adrenaline and 2% Lignocaine HCl with 1:80000 adrenaline in bilateral extraction of maxillary premolars for orthodontic purposes and also to compare both local anaesthetic agents for the difference in the pain levels, onset for of anaesthesia and duration of anaesthesia.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
This prospective randomized, double-blind study was conducted on 43 patients (28 females and 15 males), aged less than 40 years who reported bilateral orthodontic extractions of upper premolar teeth to the Department of Oral and Maxillofacial Surgery,&#xA0; from February 2013 to September 2014. &#xD;
&#xD;
Inclusion and exclusion criteria&#xD;
&#xD;
The participants were selected under the following criteria - age less than 40 years, American Society of Anesthesiologists Grade- I patients (a healthy individual with no systemic disease), having cooperative behaviour for dental treatment under local analgesia. But the participants - were excluded from the study under the following criteria - Medically compromised patients, pregnancy, history of allergy to lignocaine/articaine or any of the constituents in local anaesthetic solutions, age more than 40 years, and children below the age of reasoning infection/ inflammation near the site of injection, smokers, alcoholics.&#xD;
&#xD;
50 cartridges each containing 1.8 ml of 2 % lignocaine hydrochloride with 1: 80,000 epinephrine and 50 cartridges each of 1.7 ml of 4 % articaine hydrochloride with 1:1, 00,000 epinephrine were masked by coloured tapes of two different colour (blue and green) by the independent observer to prevent identification. Randomization codes were held by the staff member who was responsible for giving masked cartridges but had no role in drug administration or in assessing outcomes. Neither the patient nor the surgeon had any knowledge of the identity of the solution so that the double-blind nature of the trial was ensured. In all patients, a thorough medical history and preoperative radiographs (OPG) were taken. After a brief examination, patients who met all the criteria had the first treatment visit for the extraction of the upper first premolar teeth of one side and were randomly assigned to receive either 2% lignocaine hydrochloride with 1:80000 adrenaline (Lignocaine special, Septodont India private health care) or 4% articaine hydrochloride with 1:100000 adrenaline (Septanest, Septodont India private health care)for the first procedure and the other solution was administered for the extraction of upper first premolar of contralateral sides at no less than one week (to eliminate possible carry-over effects) and not greater than three-week interval. Before administration of local anaesthesia, each patient was explained about the Visual Analogue Scale (VAS). The patient was asked to mark the scale from &#x201C;0-10&#x201D; numerical rating in the language (English or Hindi) which the patient understood (Figure 1 ). To interpret the data VAS scale was divided into 4 categories. No pain corresponding to &#x201C;0&#x201D; on the scale. Mild pain corresponding to score &#x201C;1 to 3&#x201D; on the scale whereas moderate and severe pain corresponding to &#x201C;4 to 6&#x201D; and &#x201C;7 to 10&#x201D; on the scale.&#xD;
&#xD;
A standard maxillary infiltration injection containing either of the two solutions&#xA0; 0.8 ml solution of 1.7 ml of 4% articaine hydrochloride with 1:1,00,000 adrenaline or 1.8 ml of 2% lignocaine hydrochloride with 1:80,000 adrenaline was administered in the buccal vestibule using a self- aspirating syringe with 30-G needle ( {.31mm &#xD7; 25mm} DENJECT disposable needle 30G -L ). The injection target site was centred over the buccal root apices of the maxillary premolar. The lip was gently retracted, and the needle was placed gently into the alveolar mucosa (needle insertion phase) with a bevel directed towards the bone and was advanced within 2-3 seconds until the needle was estimated to be at or just superior to the apices of the tooth (needle placement phase). The anaesthetic solution was deposited over 1 minute (solution deposition phase). Pain on injection was rated by asking the patient to mark a standard numeric VAS scale immediately after buccal infiltration was completed. After depositing the anaesthetic solution the time to anaesthetic effect on the buccal and palatal side was recorded as the time elapsed from the full withdrawal of needle until the patient indicated the first evidence of Vincent&#x2019;s sign objectively. Subjective confirmation was done with a standard probe every 30 seconds until no response was recorded for 10 minutes on the buccal and palatal side using a stopwatch in minutes. Palatal infiltration was administered 10 minutes after buccal infiltration when it was observed that palatal anaesthesia was not achieved with buccal injection. If the patient complained of pain on the buccal or palatal side then the need for re-anaesthesia was considered. After palatal injection patient was again asked to mark the VAS scale to record the pain on palatal injection. The onset of palatal anaesthesia was checked on every 30 seconds till 10 minutes until no response was observed. After the successful anaesthesia had been achieved the tooth was extracted using a standard forceps&#x2019; technique under sterile aseptic conditions and a pressure pack was placed. Post-operative instructions were given and only analgesics (Tab. Ibugesic plus TDS &#xD7; 3 days) was prescribed. The duration of anaesthesia was recorded as the time from initial pain perception of the anaesthetic effect to the moment in which the effect began to fade. Patient marked fliers distributed to them representing the loss of intensity of heaviness (+ + + + + + to -), as the time elapsed from 30 minutes to 6 hours, after extraction, of 15-minute interval. This was also confirmed by a telephone conversation with the patient. Postoperative complications if present were observed. &#xD;
&#xD;
STATISTICAL ANALYSIS&#xD;
&#xD;
The data were entered in the Microsoft Excel spreadsheet 2013. The student&#x2019;s unpaired t-test analysis was performed using IBM SPSS Version 24.0 (Armonk, NY: IBM Corp.). The VAS scores by t-test were calculated. P-value 0.05) difference between the Blue (Articaine) and Green (Lignocaine) groups for pain on injection on the buccal and palatal sides.&#xA0; &#xD;
&#xD;
The mean for the onset of anaesthesia was calculated by paired T-test. Table 3 shows the mean onset of anaesthesia after buccal infiltration in the green (lignocaine) group which was 2.19 minutes as compared to the blue (articaine) group which was 1.56 minutes and the difference was statistically significant (p-value</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3928</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3928</Fulltext></URLs><References>&#xD;
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	Sreekumar K, Bhargava D. A Prospective double-blind study to assess the latency and efficacy of articaine and lignocaine in surgical removal of impacted mandibular third molars in Indian patients. J Stomat Occ Med. 2012; 5: 10-14.&#xD;
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	Sierra Rebolledo A, Delgado Molina E, BeriniAyt&#xED;s L, Gay Escoda C. Comparative study of the anaesthetic efficacy of 4% articaine versus 2% lidocaine in inferior alveolar nerve block during surgical extraction of impacted lower third molars. Med Oral Patol Oral Cir Bucal. 2007;12(2): E139-144.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Smooth Extubation &#x2013; Does Morphine Need a Comeback?&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>189</FirstPage><LastPage>193</LastPage><AuthorList><Author>Parthasarathy S</Author><AuthorLanguage>English</AuthorLanguage><Author> Subramanian VV</Author><AuthorLanguage>English</AuthorLanguage><Author> Ravishankar M</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Anaesthesia, General, Recovery, Extubation, Smooth, Opioids, Morphine</Keywords><Fulltext>INTRODUCTION: &#xD;
&#xD;
General anaesthesia with endotracheal intubation is one of the commonest modes of anaesthetic techniques used globally by all anesthesiologists. The act of removing the tube at the end of surgery and anaesthesia is termed extubation. A lot of complications are associated with the process of extubation.1 Even though a lot of literature is available on intubation and its side effects, not much is attainable on extubation. There are a few described complications associated with extubation like mechanical failure, cardiovascular stimulation, coughing, bucking, emergence agitation and pain to name a few.2&#xA0;&#xA0; These side effects can aggravate or worsen pre-existing systemic illnesses and make the recovery and extubation complicated. Smooth extubation has not been defined so far. We have tried to define it as a technique wherein the patient has adequate narcosis to respond to oral commands, tolerate the tube without coughing, having much pain or a surge in sympathetic stimulation. This cannot be achieved in all cases as it depends upon many factors like the size and duration of surgery and the amount of analgesia received. Extubation of a patient after completely reversing him and keeping him in deeper planes of anaesthesia is known as deep extubation. Neurosurgery and ophthalmic surgeries may require this technique to avoid bucking which in turn may undesirably increase the intracerebral and intraocular pressures.3 One of the potential pitfalls associated with this technique is in dealing with an unconscious patient with an unprotected airway. It is more feasible in patients with an easy airway and who are at minimal risk of aspiration. Many don&#x2019;t practice this technique for fear of respiratory complications and the need for close monitoring post-procedure.4 Innumerable techniques and drugs have been described to make the process smooth. Drugs like lignocaine (intravenous and into the ETT cuff), dexmedetomidine, synthetic opioids like fentanyl and remifentanil and a combination of them have been used to decrease the incidence of each of these complications.5 We have tried to analyze the pharmacology of the old drug morphine and its use in intraoperative analgesia (in a titrated manner) as well as in blunting the side effects which may hinder smooth extubation. Hence, we propose the need for the resurgence of the cost-effective drug morphine as a sole drug to answer the drawbacks of polypharmacy and to effectively achieve smooth extubation. &#xD;
&#xD;
DESCRIPTION OF A ROUTINE TECHNIQUE OF EXTUBATION: &#xD;
&#xD;
The plan of smooth extubation is unfortunately done approximately 10 &#x2013; 15 minutes before the end of the surgical procedure by most of us. The thought process of smooth extubation should begin right from the administration of the premedical drug and its appropriateness to the patient. The intraoperative events and the subtle modifications of pharmacology during the times will influence the process of extubation.6 Towards the end of the surgery, stopping the administration of inhalational agent plays a crucial role. The flows and the breathing system decide the steps which we may need to take. Factors that determine the time we need to stop administering the anaesthetic agent include the nature of the agent, type of surgery and level of analgesia (presence or absence of regional blocks). After the patient makes a few attempts to breathe and upon confirming at least 2 twitches on a train of four monitors, the reversal is administered and a thorough oropharyngeal suctioning is done. Elimination of the anaesthetic agent should be in synchronization with skeletal muscle recovery.5,6 The patient is usually positioned supine or but with a prone or a minimal head-up position in rare selected cases. Generally, 100% oxygen is administered, the cuff is deflated along with a positive pressure breath (preventing atelectasis). The plasters should be removed slowly to avoid any head and neck movements. The patients should obey oral commands, be able to sustain a spontaneous head lift for five seconds and breathe normally with adequate tidal volumes. These are a few of the classically described criteria for removing the tube. Removal of the tube is usually carried out at end-inspiration when the glottis is fully open to avoid trauma and laryngospasm7. The process will not be as easy as described in all the cases. The complications of extubation and their management are elaborated as follows. &#xD;
&#xD;
CARDIOVASCULAR RESPONSE: &#xD;
&#xD;
Cardiovascular complications after tracheal extubation are three times more common than those that occur during tracheal intubation. Hypertension and tachycardia associated with extubation are well-documented events. Tracheal extubation is known to produce a 10&#x2013;30% increase in both the arterial pressure and heart rate which usually lasts for 5&#x2013;15 min.8 Actually, the hemodynamic imbalance reflects sympathoadrenal response probably due to epi-pharyngeal and laryngopharyngeal stimulation. There is a distinct increase in plasma catecholamine levels and activation of both alphas- and beta-adrenergic receptors.9 This increase in blood pressure and heart rate is usually transient and similar to the one occurring during intubation. There is an increased chance of precipitation of adverse events like myocardial infarction, pulmonary oedema and stroke. This response can be obtunded by the administration of innumerable drugs. Among the beta-blockers, esmolol (1.5 mg/kg) and labetalol (0.25 mg/kg) attenuated the adverse hemodynamic response.10 Esmolol was more efficient than labetalol at extubation. The authors have deduced that labetalol blunts tachycardia better but esmolol blunts hypertension better.11 This may look different in the context of the pharmacokinetics of both drugs. In another study12 by Rehman et al 2015., the authors have concluded that metoprolol infusion was better than verapamil and placebo in controlling the hemodynamic response to extubation. This study was particularly done on hypertensive patients who underwent general anaesthesia. In these studies, there was no clear mention of smooth extubation though the time to extubate after administration of reversal were similar. In yet another study, the authors have noted in patients undergoing intracranial surgery, severe hypertension and/or tachycardia occurred in 92% of patients during extubation.13 Prophylactic esmolol infusion for the control of hemodynamic disturbances during extubation is feasible and safe. They deduced that the acceptable level for obtundation of sympathoadrenal response was evident at 100 micrograms/kg/min but they suggested that a rate of 200 micrograms/kg/min may be more effective. It has proved beyond doubt that with or without establishing complete analgesia, morphine attaches to the mu receptors in the central nervous system to attenuate the central sympathetic drive thereby causing hypotension and bradycardia. A few authors have demonstrated the action of morphine attenuating the surge of catecholamines after any insult.14 Morphine blunts the autonomic reflexes better than fentanyl in smaller doses. Even though fentanyl has got analgesic properties comparable with equipotent doses of morphine, the attenuation of the sympathetic surge and better narcosis put morphine ahead with regards to tube tolerance and hemodynamic stability. Intravenous lignocaine, magnesium and many other drugs have been described but they have not stood the test of time. Intravenous lignocaine has negligible analgesic activity against the nociceptive component of pain, even though it has antitussive and cardiovascular surge attenuation.15 Gosai et al 2015., have compared dexmedetomidine and intravenous lignocaine and established that dexmedetomidine is better in suppressing adrenal response to extubation.16 Excessive sedation and bradycardia and the hassle of setting up an infusion in selected cases makes dexmedetomidine less preferable for routine use. Even bolus doses of dexmedetomidine have to be given slowly and carefully to avoid side effects. This necessity of additional dexterity at the end of surgery and the excess cost is not needed in routine cases. To summarize, the prudent intraoperative administration of morphine is bound to take care of both the sympathetic surge and pain and hence the drug demands a resurgence in common clinical use. &#xD;
&#xD;
COUGH SUPPRESSANT: &#xD;
&#xD;
Cough is a forced expulsive manoeuvre, usually against a closed glottis and which is associated with a characteristic sound.17 If the patient cannot achieve full inspiration but expels forcefully with the endotracheal tube in situ, it&amp;#39;s termed as bucking even though clear-cut differences are lacking in the literature. Tube tolerance before extubation and the absence of bucking is one of the desirable qualities of smooth extubation. Coughing and bucking occur in 40 % of patients during emergence.18 In addition to discomfort, coughing has important pathological consequences: increased intrathoracic pressure with a resultant decreased venous return to the heart, increased intra-abdominal pressures and a decreased functional residual capacity. These changes may not augur well in a patient with significant cardiorespiratory disease. Lidocaine, remifentanil, dexmedetomidine and fentanyl are some of the drugs used to decrease the incidence of cough. Codeine and morphine are better antitussives than the newer drugs like fentanyl and remifentanil.19 Extubation times and hemodynamic stability are also vital in selecting an antitussive. Prolonged extubation times may hamper the case turnover of the operating room. An unrushed yet fast and smooth recovery is needed for a safer transfer of patients. Remifentanil and dexmedetomidine are prone to cause excessive bradycardia and hypotension which may not be suitable in patients with hemodynamic instability. The antitussive action of dexmedetomidine is less than morphine and thus cannot be considered as an alternative in this regard. Intracuff inflation with lignocaine-sodium bicarbonate combination has been studied as an effective antitussive measure. The mechanism of action seems to be the seepage of the local anaesthetic into the tracheal mucosa to numb the same.20 The procedure of inflating the cuff with lignocaine is not routinely practised and the fear of an anaesthetized tracheal mucosa at the time of extubation is not preferred by many anesthesiologists. Instead of using dexmedetomidine for sedation with negligible antitussive action, a narcotic analgesic like morphine with notable antitussive action seems to be a more suitable alternative. The use of morphine has effectively decreased cough21 even in patients with chronic obstructive lung disease which is not shared by other opioids. This clinical effect can be effectively used in the setting of extubation to avoid polypharmacy. &#xD;
&#xD;
EMERGENCE AGITATION: &#xD;
&#xD;
Emergence agitation is an undesirable immediate postanesthetic condition that occurs during recovery from general anaesthesia. It is typified by confusion, disorientation and violent behaviour. Even though it is common in pediatric patients, the incidence in adults is said to be between 4.7% and 21.3%.22 Emergence agitation can lead to serious sequelae like self-extubation, bleeding and removal of catheters. There is a risk that patients could fall off their beds.&#xA0; During this process, there is an increased risk for the medical staff to be injured. Even though many risk factors can increase the incidence of emergence agitation age, smoking, sevoflurane administration, pain and presence of endotracheal tubes or urinary catheters are some of the significant ones.23 The incidence of agitation is high in patients undergoing nasal surgeries when they have the endotracheal tube in situ. The administration of dexmedetomidine is associated with decreased incidence of this complication but the postoperative pain is not well controlled. Hence, the addition of fentanyl to dexmedetomidine becomes imperative. Tube tolerance can be achieved by adequate narcosis and analgesia. These two factors can be conveniently handled by a shot of parenteral morphine.&#xA0; PBK Chan(2002) found that 1 mg/ kg of intravenous propofol just before extubation decreased the incidence of agitation but it seems impractical in many settings.24 Extubation in a deep plane with an inhalational agent is suggested for certain cases but this is at the risk of having an unconscious patient with an unprotected airway. Yes, it may decrease the incidence of emergence agitation but at what cost? The knowledge of recovery time from agents is necessary to know when to switch off the dial. After receiving isoflurane a mean&#xA0;time&#xA0;of 108-minute of the institution of the agent in general&#xA0;anaesthesia, the&#xA0;time&#xA0;to&#xA0;eye-opening&#xA0;after discontinuing&#xA0;the inhalational agent was 18.5 minutes (range 11&#x2013;30, median 18 minutes).25 But in the case of desflurane, the meantime from discontinuation to eye-opening was 5.2 minutes (SD?=?1.6, range 3-10).26 This time was not related to the duration of anaesthesia (60-256 minutes), total fentanyl needed, nor the body mass index.&#xA0; This duration may vary with the use of low flow systems. The reversal agent neostigmine may take a mean time of 6.9 minutes to significantly reverse the neuromuscular blockade in non-obese routine cases.27 Hence, we need to synchronize the discontinuation of the inhalational agent and administration of the reversal agent. This comes with a blend of experience and knowledge. &#xD;
&#xD;
There are innumerable other drugs like nefopam, tramadol, clonidine etc which can decrease the incidence. All these techniques will end up using multiple agents. The need for such polypharmacy and its side effects is in question? Rapid awakening and pain have been associated with increased incidence of risks of emergence agitation. The combined effect of dexmedetomidine and fentanyl can be conveniently addressed by single narcotic morphine because pain and inadequate sedation are the prime reasons for emergence agitation. These effects are addressed by morphine as a single drug.&#xA0; The uncertainty remains: Can the drug combination with newer ones be replaced by a single old drug? &#xD;
&#xD;
AIRWAY OBSTRUCTION: &#xD;
&#xD;
Airway obstruction is a life-threatening complication that hampers smooth extubation. Laryngospasm, laryngeal oedema and vocal cord paralysis are some of the causes of upper airway obstruction occurring immediately after the following extubation. These are different topics that need to be discussed separately. It is also important to remember a few mechanical causes of airway obstruction with foreign bodies (throat packs, dentures and blood clots). All these conditions require immediate attention and action to relieve the obstruction28. The incidence of such complications is not going to modified by the administration of either novel assorted combinations or a unique old drug. To be precise, morphine alone is not going to affect the incidence of complications like airway foreign bodies.&#xA0; &#xD;
&#xD;
MECHANICAL CAUSES: &#xD;
&#xD;
In a few uncommon settings, the tube cannot be removed or pulled out. The pilot balloon and the inflation channel may be damaged thereby hindering deflation and removal. Herniation of the cuff and the adhesions to the tracheal wall may also be a reason. Even an abnormal fixation by a plaster may kink the tube. Most of these problems are not common in the era of disposable PVC tubes. The deflation of the cuff by a direct transtracheal puncture or with the help of a USG machine will help settle the problem in certain situations. In certain instances, reinflation, pushing the tube further and deflation and retrying for extubation may help. Tethering of the tube by surgical sutures will need re-exploration and cutting off the sutures to free the tube. Such mechanical causes may occur with any technique of drug administration7,29. Hence a cost-effective singular drug like morphine can be definitely preferred to polypharmacy.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
DISCUSSION AND ANALYSES:&#xD;
&#xD;
Smooth extubation is a long-quested phenomenon and to achieve the same in every case becomes a dream for every anesthesiologist. Yet, this aspect of anaesthesia is not studied much in detail. The complications which prevent smooth extubation can be mechanical causes like forgotten packs and trapped tube cuffs. These can be addressed after a timely diagnosis.&#xA0; The most common complications with disorderly extubation are cough, adrenergic response, pain and agitation. Intravenous lignocaine can counter both coughing and cardiovascular response but is inefficient in completely helping tolerate the tube due to the absence of narcotic property. For this to be achieved, a narcotic like fentanyl along with a sedative like dexmedetomidine need to be combined. Dexmedetomidine alone can cause bradycardia with less analgesic and narcotic component. The need for an infusion device makes dexmedetomidine more cumbersome. Inflation of the cuff with lignocaine can decrease cough but this may numb the tracheal mucosa which may prove counterproductive due to the risk of aspiration. The oldest known opioid, morphine, produces enough narcosis to make patients tolerate the tube yet conscious enough to answer oral commands. It produces significant analgesia and is an efficient antitussive.&#xA0; The problem of respiratory depression is equivalent to multiple doses of fentanyl; still, it is a better adrenergic suppressant than fentanyl. It has been pronounced for decades about the associated problem of nausea and vomiting with opioids. When compared to morphine, fentanyl produces a lesser incidence of nausea and vomiting at the cost of decreased pain relief. This morphine associated nausea is usually seen a few hours after administration especially in ambulated patients. Otherwise, the side effect profiles of both the drugs are similar. The question remains: Is Morphine the answer for smooth extubation than switching over to multiple newer drugs? Yes, thought should be given for the resurgence of morphine, at least in routine cases undergoing general anaesthesia to ensure cost-effective and comfortable extubation. &#xD;
&#xD;
CONCLUSION: &#xD;
&#xD;
Respiratory complications after tracheal extubation are three times more common than those occurring during tracheal intubation. It&#x2019;s essential to decrease the incidence of such complications and their associated morbidities. Extubation is also associated with adverse cardiovascular events and emergence agitation. Smooth extubation is desirable in every case. There is increased use of polypharmacy of fentanyl, lignocaine and dexmedetomidine to handle extubation. These drugs have their side effects other than escalating cost.&#xA0; Instead of multiple newer drugs addressing every component of adverse effects, it is possible to have the old warhorse morphine as a single drug to achieve smooth extubation in the majority of the routine cases. &#xD;
&#xD;
Conflict of interest &#x2013; NIL &#xD;
&#xD;
Source of Funding: NIL &#xD;
&#xD;
Acknowledgements: NIL &#xD;
&#xD;
Authors Contributions: &#xD;
&#xD;
Dr. SPS has designed the concept, written the script and searched the database. &#xD;
&#xD;
Dr V.V.Subramanian has helped in writing and editing the script. &#xD;
&#xD;
Dr MR has done the supervision and communication.&#xA0;&#xA0;&#xA0; &#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3929</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3929</Fulltext></URLs><References>1.Vaughan RS. Extubation &#x2013; yesterday and today. Anaesthesia 2003; 58:945&#x2013;50&#xD;
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2. Asai T, Koga K, Vaughan RS. Respiratory complications associated with tracheal intubation and extubation. Br J Anaesthesia. 1998; 80: 767&#x2013;75.&#xD;
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3.Ali IG: Smooth emergence from general anaesthesia by deep extubation with no touch maneuver regarding coughing in ophthalmic surgery. Ann Trop &#xA0;Public Health; 2019; 22(10): S291.&#xD;
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4.Sheta SA, Abdelhalim AA, Nada E. Evaluation of (no touch) Extubation Technique on Airway-Related Complication DuringEmergence from General Anesthesia. Saudi J Anesthesia 2011, Vol.5, 125.&#xD;
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5.Rani P, Hemanth Kumar VR, Ravishankar M, Sivashanmugam T, Sripriya R, Trilogasundary M. Rapid and reliable smooth extubation - Comparison of fentanyl with dexmedetomidine: A randomized, double-blind clinical trial. Anesth Essays Res. 2016;10(3):597-601. &#xD;
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6. Cavallone LF, VannucciA.Extubation of the difficult airway and extubation failure. AnesthAnalg2013;116:368&#x2013;383.&#xD;
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7.Swati Karmarkar, Seema Varshney, Tracheal extubation, Continuing Education in Anaesthesia. Critical Care Pain. 2008,( 8), 6: 214&#x2013;220.&#xD;
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8.Miller KA, Harkin CP, Bailey PL. Postoperative tracheal extubation. Anesth Ana. 1995; 80:149&#x2013;72.&#xD;
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9.Azhar R, Gauhar A. Haemodynamic Response to Tracheal Extubation: Verapamil versus Metoprolol. General Med. 2015;3:2.&#xD;
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10.Lim SH, Chin NM, Tai HY, Wong M, Lin TK. Prophylactic esmolol infusion for the control of cardiovascular responses to extubation after intracranial surgery. Ann Acad Med. 2000;29(4):447-451.&#xD;
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11.Dyson A, Isaac PA, Pennant JH, Giesecke AH, Lipton JM. Esmolol attenuates cardiovascular responses to extubation. Anesth Analg. 1990 Dec;71(6):675-8.&#xD;
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12.Azhar R, Gauhar A.&#xA0; Haemodynamic Response to TrachealExtubation: Verapamil versus Metoprolol. General Med. 2015; 4(5): 128.&#xD;
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13. Lim SH, Chin NM, Tai HY, Wong M, Lin TK. Prophylactic esmolol infusion for the control of cardiovascular responses to extubation after intracranial surgery. Ann Acad Med 2000 Jul;29(4):447-451.&#xD;
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14.Molina PE. Opioids and opiates: analgesia with cardiovascular, haemodynamic and immune implications in critical illness. J Intern Med. 2006 Feb; 259(2):138-154.&#xD;
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15.Tremont-Lukats IW, Hutson PR, Backonja MM. A randomized, double-masked, placebo-controlled pilot trial of extended IV lidocaine infusion for relief of ongoing neuropathic pain. Clin J Pain. 2006;22:266-71.&#xD;
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16.Gosai ND, Jansari AH, Solanki RN, Patel DP, Prajapati DN, Patel BM. A comparative study of the effect of dexmedetomidine and lignocaine on hemodynamic responses and recovery following tracheal extubation in patients undergoing intracranial surgery. Int J Basic Clin Pharmacol. 2015;4:371-5&#xD;
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17. Morice AH, McGarvey L, Pavord I; British Thoracic Society Cough Guideline Group. Recommendations for the management of cough in adults. Thorax. 2006 ;61(1):11-24.&#xD;
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18.Tung A, Fergusson NA, Ng N. et al. Pharmacological methods for reducing coughing on emergence from elective surgery after general anaesthesia with endotracheal intubation: protocol for a systematic review of common medications and network meta-analysis. Syst Rev. 2019;8:32.&#xD;
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19. Morice AH, Menon MS, Mulrennan SA, et al. Opiate therapy in chronic cough. Am J Respir Crit Care Med. 2007 Feb 15;175(4):312&#x2013;315.&#xD;
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20.Younes MM. Intracuff lidocaine 2% for prevention of postoperative cough and sore throat. Al-Azhar Assiut Med J. 2018;16:43-8.&#xD;
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21. Janowiak, P., Krajnik, M., Podolec, Z. et al. Dosimetrically administered nebulized morphine for breathlessness in very severe chronic obstructive pulmonary disease: a randomized, controlled trial. BMC Pulm Med. 2017; 17: 186 &#xD;
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22. Kim HJ, Kim DK, Kim HY, Kim JK, Choi SW. Risk factors of emergence agitation in adults undergoing general anaesthesia for nasal surgery. Clin Exp Otorhinolaryngol. 2015;8(1):46-51.&#xD;
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23.Lee SJ, Sun TY. Emergence agitation: current knowledge and unresolved questions. Korean J Anesthesiol. 2020;73(6):471-485.&#xD;
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24.Peter.B.K. Chan. On smooth extubation without coughing and bucking. Can J Anesth. 2002: 49:324.&#xD;
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25.Lin TC, Lu CC, Hsu CH, Pergolizz JV Jr, Chang CC, Lee MS, Ho ST. Awakening arterial blood and end-tidal concentrations of isoflurane in female surgical patients. Medic.2016 :95(30):e4370.&#xD;
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26.Lin TC et al. Duration effect of desflurane anaesthesia and its awakening time and arterial concentration in gynecologic patients. J Clin. 2013;68(10):1305-1311.&#xD;
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27.Srivastava A, Hunter JM. Reversal of neuromuscular block. Br J Anaesth. 2009;103(1):115-29.&#xD;
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28.Miller KA, Harkin CP, Bailey PL. Postoperative tracheal extubation.AnesthAnalg 1995; 80: 149&#x2013;72.&#xD;
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29.Najjar MF, Kimpson J. A method for preventing throat pack retention. AnesthAnalg. 1995; 80: 204&#x2013;12&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Comparative Study on the Effect of Kinesio taping with Rigid taping in Computer Professionals with Chronic Non-specific Low Back Pain&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>194</FirstPage><LastPage>199</LastPage><AuthorList><Author>Mohan P</Author><AuthorLanguage>English</AuthorLanguage><Author> Sudhan SG</Author><AuthorLanguage>English</AuthorLanguage><Author> A Thangamani Ramalingam</Author><AuthorLanguage>English</AuthorLanguage><Author> Dhasaradharaman K</Author><AuthorLanguage>English</AuthorLanguage><Author>  Suresh A</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Abnormal posture leading to back pain is a major work-related health problem, especially in software and IT-enabled services. Objective: It is intended to find out the effect of Kinesio taping compared with rigid taping in alleviating pain and disability for work-related chronic low back pain in computer professionals. Method: Study was conducted on 26 computer professionals with chronic low back pain, divided into two groups randomly and intervened with Kinesio taping(KT) in one group and rigid taping(RT) in another group. The outcome of pain and disability was measured using the McGill pain questionnaire and the Oswestry disability index. Both groups were compared for the mean difference and effect size on pain and disability by using ANOVA and Cohen&#x2019;s. Results: statistical analysis showed that KT or RT useful in reducing symptoms but there was a significant difference of P &#x2264;0.05 between the Kinesio tape group and the rigid tape group in terms of pain and disability. Conclusion: Kinesio taping was more effective than rigid taping in reducing pain and disability for computer users with chronic low back pain.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Chronic low back pain, Kinesio tape, Rigid tape, Work-related musculoskeletal disorder, Computer professionals</Keywords><Fulltext>Introduction&#xD;
&#xD;
Work-related pain is quite common for computer users as working for more than 40 hours a week may lead to musculoskeletal pain due to abnormal body posture and the tendency to develop injuries to muscles, joints, ligaments, and tendons. Computer work has created a new type of occupational health problems such as work-related musculoskeletal disorder. Abnormal posture leading to back pain is a major work-related health problem; especially in the software services industries.1 Non-specific low back pain was defined as &#x201C;not related to identifiable known specific pathology (e.g. infection, inflammatory process, tumour, osteoporosis, fracture or radicular syndrome).2 &#xA0;Chronic pain in the low back due to non-pathological origin is considered to be a complex multidimensional bio-psycho-social pain disorder, where precise aetiology remains undefined.3 Low back pain (LOW BACK PAIN) is a significant clinical, social, and financial problem with prevalence ranging from 8% to 56% in the USA and it is measured that 28% of people suffering from pain in low back sometime during their lives, 14% with episodes lasting at least two weeks, 8% &#xA0;throughout during employment in any given year.4 Among all sort of Musculoskeletal disorders the lower back pain is commonly seen in Information Technology employees. Low back pain is that the second commonest explanation for disability in adults who lost workdays in America, which was estimated to lose 149 million days of labour per annum which was further estimated to cost $200 billion annually to scale back the productivity.5&#xD;
&#xD;
The presence of computer within the workplace results in a group of weird characteristics of the workstation which require the workers to remain during a static posture for long periods and its most often cited risk factors resulting in musculoskeletal disorders. The presence of imbalance and abnormal strain on the musculoskeletal structure caused by deviation. Further, more computer usage is linked to Low back pain. Specifically, sitting for quite long hours combined with awkward postures or frequently working during a forward bent position has been found to extend the likelihood of Low Back Pain.6 Studies also indicated that specific tasks performed while sitting in an ergonomically unfit chair for extended periods were also related to low back pain.7 A slouched posture may be a quite abnormal sitting posture with the flexed lumbar spine that occurs during day-to-day sitting activities. As a result of this prolonged flexed posture, the neutral position is lost and therefore the spine is potentially exposed to injury. &#xD;
&#xD;
The risk of developing musculoskeletal injury for computer users significantly rises if their body mass index increases so employees with obesity are prone to develop low back pain due to postural abnormality.8 The McKenzie exercises are one among the foremost frequently used sort of physiotherapy for back pain. It is based totally on the identification of a directional preference for spinal movement and may form the idea for the prescription of exercises. Improvement in symptoms is subsequently assessed in terms of &#x2018;centralization&#x2019; a phenomenon that has been quite well documented. A recent systematic review of six trials concluded that there&amp;#39;s some evidence for the short term effectiveness of McKenzie approach for subacute and chronic back pain patients.9 Spinal stabilization exercises (including Pilates) for the management of back pain is gaining popularity, this exercise might help to improve postural control and correct imbalances of activity between more deeply placed stability muscles and more superficially placed mobilizing counterparts. Although intuitively a useful approach for non-specific low back pain patients, spinal stabilization exercises to date are supported by a number of pieces of evidence.&#xD;
&#xD;
Variety of physical modalities used for back pain such as transcutaneous electrical nerve stimulation (transcutaneous electrical nerve stimulation), heat/cold, traction, laser, ultrasound, short wave diathermy, interferential therapy, corsets and collars. There&#x2019;s limited evidence to suggest that electrotherapy (laser therapy, therapeutic ultrasound and transcutaneous electrical nerve stimulation) isn&amp;#39;t effective for reducing neck and back pain. However, the overall conclusions from systematic reviews are that there is insufficient evidence from good-quality studies to either support or refute the clinical use of physical modalities for patients with back or neck pain. The placebo effects of passive modalities may be a robust effect where both the therapist and the patient have faith within the treatment. However, dependency on physical modalities could encourage passivity, inactivity and disability behaviour. &#xD;
&#xD;
&#xA0;In India, the occupational health personnel are working on this group of modern occupational diseases, which are slowly taking their roots among the Ing=formation Technology professionals. If these problems are ignored, can cause serious injuries and forcing one to change their job.10.According to Borenstein, low back pain patients require regular physical activity to enable them to receive the most beneficial effect.11 Acute back pain seems to respond well to simple treatment measures, although there is a lot of variation in the benefit for individual patients. Various treatment methods being considered for nonspecific low back pain but the effectiveness of each method vary due to external and internal factors. Even though some scientific study has proven Kinesio or rigid tape application were useful but need to obtain concrete evidence which one will be more effective in managing low back pain. This study intended to explore the effectiveness of Kinesio taping compared with rigid taping for work-related lower back pain patients along with transcutaneous electrical nerve stimulation and exercise as common protocol. Thus, the objective of this study is to find out the effect of the Kinesio taping technique, along with transcutaneous electrical nerve stimulation and Exercise in reducing pain and disability on work-related low back pain for computer professionals.&#xD;
&#xD;
Methodology&#xD;
&#xD;
Subjects &#xD;
&#xD;
Employees who were working in medium and large scale information technology company were selected as the subject for the study who have more than 3 years of experience in a sitting job with computers for not lesson than 8 hours per day for 5 days a week. &#xA0;subjects with a history of chronic low back pain not less than 3 months 12,13were screened for Low back pain,26 Subjects who fulfilled inclusion criteria were recruited for this study and subjects with a history of disc prolapse, spondylolisthesis, SI Joint syndrome, recent surgical intervention, structural scoliosis and radiculopathy were excluded from the study. The subjects were blinded about the possible intervention effectiveness of Kinesio tape or rigid tape. Informed consent was taken from all subjects who participated in the study and allowed to withdraw at any time during the period of intervention on their own. 26 subjects were divided randomly into 2 groups as Group &#x201C;A&#x201D; (Kinesio Tape Group) and Group&#x201C;B&#x201D;(Rigid Tape group) consist of 13 subjects each. Ethical clearance was obtained from the institutional ethical committee with reference number EC/04-2019/PT/PhD-2 for this study.&#xD;
&#xD;
Procedure&#xD;
&#xD;
General clinical examination and musculoskeletal assessment were performed pain and disability measured by McGill pain questionnaire and Oswestry disability index respectively as baseline data before the intervention.&#xA0; Both groups underwent treatment for 2 weeks with 3 sessions per week, after the intervention post-test measurement was taken. Group A(KT) were given Kinesio tape long with transcutaneous electrical nerve stimulation and back exercise program, similarly Group B(RT) was treated by rigid tape along with transcutaneous electrical nerve stimulation and back exercise program. The exercise program includes strengthening abdominal muscles and core extensor muscles along with flexibility exercise. End of every session subjects was applied with Kinesio tape or Rigid tape in the lumbosacral region and asked to report every alternative day to the Department and retain the tape for 48 hours. Subjects were advised to do all the core stability and flexibility exercise at home. 14&#xD;
&#xD;
Kinesio Tape Procedure. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; KT tape is cotton elastic hypo allergic tape used for the intervention of Group A subjects. All subjects underwent allergic test before starting treatment whereas KT tape patch was applied in the anterior surface of the elbow and observed after 48 hours for any allergic reaction if anyone found allergic to KT tape were excluded from this study. The taping area was cleaned, free of hair and the lumbar spine was flexed to measure the required length of tape. Three I-Tapes were used whereas two vertical and one horizontal tape applied in the lumbosacral region. The first 4 cm to 5 cm of tape was removed from its backing, the base of the tape was applied to the origin of erector spinae to its insertion while the sacrum in the neutral position then the patient was asked to do a maximum flexion of the spine and the paper backing of the tape was removed, except final 4 cm to 5 cm the tape was applied on one side in the direction of the cranium, with a slight stretch of tape and at the end without stretch. The same procedure was then applied to the contralateral side. The third strip was applied horizontally where maximum pain was observed such as erector spinae or interspinous or quadratus lumborum muscle with more than 50% stretch. The tape was rubbed by hand several times to warm the adhesive film to attach with the skin surface the tape was retained for 48 hours before changing to the next session. 14&#xD;
&#xD;
Rigid tape procedure. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xA0;Hypo allergic under tape 50-mm strapping tape used over taping area before the rigid tape was applied. Subjects were in a lying prone or standing position whereas the Patient must be able to achieve a relaxed and pain-free extended lumbar posture (lordosis) while the tape was being applied and the tape was retained for 48 hours before changing to the next session. The spine is neutral to a slightly extended position with lumbar curvatures maintained, anchor strips were applied to the top and bottom of the area to be taped.&#xA0; An X was formed across the lumbar region from the top anchor to the bottom anchor, with the centre of the X overlying the L2&#x2013;3 region. The top and bottom of the X were then re-anchored. Movements were assessed for pain-free range of motion in flexion and side flexion. 15&#xD;
&#xD;
Transcutaneous electrical nerve stimulation (TENS) Procedure. &#xD;
&#xD;
Transcutaneous electrical nervous stimulator stimulates peripheral nerves via skin surface electrodes at well-tolerated intensities which deliver the low-frequency current through superficial electrodes placed on the skin around the affected area which induce a tingling sensation and disrupt the pain signal in the surrounding area. The dual-channel transcutaneous electrical nerve stimulation unit was used, out of which one channel is placed Para spinally at the level of origin of the sciatic nerve and the other two electrodes are placed at the inferior angle of the scapula. The machine Acupuncture &#x2013;like transcutaneous electrical nerve stimulation used, at low frequency (5-10Hz) for 30 minutes. 16 &#xD;
&#xD;
Exercise Protocol&#xD;
&#xD;
Exercise program mainly concerned with strengthening core muscles such as the&#xA0;pelvic floor&#xA0;muscles,&#xA0;transverse abdominals,&#xA0;multifidus,&#xA0;internal&#xA0;and&#xA0;external oblique,&#xA0;rectus abdominis,&#xA0;erector spinae&#xA0;(sacrospinalis) especially the&#xA0;longissimus thoracic, and quadratus Lumborum. The exercise was taught and performed five sessions per week for about two weeks supine abdominal draw, with double Knee to Chest, supine twist, prone bridging on Elbows, side bridging on the elbow, quadruped opposite arm/leg raise, Supine Butt Lift with Arms at Side, above given exercise performed 10 to 20 repetition per session. 17&#xD;
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&#xA0;Outcome measure&#xD;
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&#xA0;The McGill Pain Questionnaire consist of a three-part pain assessment tool that measures several dimensions of the patient&amp;#39;s pain experience.18 The first part consists of an anatomic drawing of the human form on which the patient marks where his or her pain is found.&#xA0; The second part of the MPQ permits the patient to record the intensity of his or her current pain experience. The third part of the MPQ would be a pain verbal descriptor inventory consisting of 78 descriptive adjectives. Subjects were informed to choose appropriate words matching his or her pain perception and circle it as every dimension was individually scored and summated for the total score. The score ranges from 0 to 78 as 0 is no pain and 78 maximum pain. The Oswestry Disability index Questionnaire (Fairbank, Couper, Davies &amp; O&#x2019;Brien, 1980) was developed in the late 1970s and has been widely used.&#xA0; Ten sections cover Pain, self-care, Lifting, Walking, Sitting, Standing, Sleeping, Sex Life, Social Life, and Travelling.19 All section had six statements describing the level of disability from 0 to 5 with the maximum score of 50 and the same was converted to a percentage score. 18,19&#xD;
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Statistical analysis&#xD;
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Baseline and post-intervention data were analysed by statistical software SPSS 18.0 for comparison of the mean difference between and within groups by ANOVA. The effect size of the intervention was calculated using cohen&#x2019;s d formula (Mean difference/pooled standard deviation).&#xD;
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Results&#xD;
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26 subjects were assigned into 2 groups with 13 subjects each, Group A underwent Kinesio tape intervention long with transcutaneous electrical nerve stimulation and exercise had 8 male participants and 5 female participants with a mean age of 31.8 and BMI of 24.5. Group B underwent rigid tape technique long with transcutaneous electrical nerve stimulation and exercise had 7 male and 6 female with a mean age of 30.3 and Body Mass Index of 24.1. Table 1 shows the total number of subjects with gender in both groups with percentage. Table 2 shows the age and BMI of all subjects with standard deviation.&#xD;
&#xD;
In Group A the mean value of baseline data for McGill pain score was 36.5and post-test measure was 12.7 when both data were compared for mean difference there was a high statistical significance P = 0.001 was found, similarly the disability score Oswestry Disability Index mean of baseline value was 52 and the post-test measure was 17 when both data were compared for the differences the P= 0.001 and it showed pain and disability considerably reduced after intervention of Kinesio taping. In Group B treated by rigid taping had a mean value of 41.5 and the post-test measure was 20.8 for pain score similarly the Oswestry Disability Index score of pre-test were 60 and post-test was &#xA0;22.7 when both data were compared for differences it showed statistical significance in both parameters P=0.001 for pain and disability that indicates rigid tape group was helpful managing pain and disability. Table 3 Describes meaning comparison of pain and disability within and between the Kinesio taping group and Rigid taping group.&#xD;
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When both groups were compared for statistical difference in pain and disability Kinesio tape group was better than the rigid tape group in reducing pain and disability as the level of significance between the group for McGill pain score P = 0.008 and Oswestry Disability Index score P = 0.05 it indicates Group A Kinesio taping along with transcutaneous electrical nerve stimulation and exercise was effective in work-related low back pain for computer professionals. Graph 1 shows the mean of pre and post measurements of Disability for the KT and RT group. Graph 2 shows the mean of pre and post measurements of pain for the KT and RT group.&#xD;
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Discussion &#xD;
&#xD;
&#xA0;The present study included subjects not less than 3 months of chronic LBA. Kinesio taping along with transcutaneous electrical nerve stimulation and exercise was effective in work-related low back pain for computer professionals. The statistical difference in the improvement of pain and disability was better in Kinesio tape than in the rigid tape group. Lower back pain was disabling and debilitating disorders for professionals who are working with desktop or laptop for more than 8 hours unless there was the attention given to prevent curate and rehabilitate, it&amp;#39;s going to affect the employees in terms of productivity lead to loss of Compensation for the employers. Low back pain is more in industrialized Western countries that is the second commonest problems.20 The latest pieces of evidence of low back pain are of mechanical origin and initially occurs between 25 and 55 years aged. There are lot of interventions found to be effective for the management of work-related pain in computer professionals but the specific and superior techniques which yield better result are under investigation for a longer duration. In this present study, the attempt was made to identify whether the conventional method of back pain treatment such as exercise program and transcutaneous electrical nerve stimulation along with Kinesio tape was effective. The afferent neural structure is stimulated through transcutaneous electrical nerve stimulation induces analgesia and additionally decreases the inflammation induces dorsal horn sensitisation (Sabino 2008), neurotransmitters like gamma-aminobutyric acid and glycine which are also involved in inhibition of nociceptive traffic, and modulation of the activity of the cells by supporting structure(glial cells) in the medulla spinalis, transcutaneous electrical nerve stimulation may produce all above effects to control pain.21,22,23&#xD;
&#xD;
The combination of transcutaneous electrical nerve stimulation and core stability exercise program along with the application of Kinesio tape or rigid tape was effective for chronic low back pain who are in a sedentary job. Kinesio tape supports injured muscles and joints and helps to relieve pain by lifting the skin by improved blood and lymph flow. A research study suggested that the Kinesio taping with a regular home exercise program for strengthening and flexibility reduces pain and disability.24 This present study found out rigid taping technique used for 2 weeks in lower back region Reduced pain and disability effectively, Rigid tape help to support lower lumbar region and stabilise Paraspinal muscles in contrast Kinesio tape helps to facilitate the back muscles and also reducing inflammation and promoting healing by improving blood circulation and lymphatic drainage. 24,25 &#xA0;Kinesio tape believed to reduce paravertebral muscle fatigue so it may be assumed to reduce musculoskeletal injury in computer professionals and also, facilitatory application provide adequate anticipatory postural control in back muscles to maintain correct posture during working hours.26&#xD;
&#xD;
Conclusion &#xD;
&#xD;
Both the kinesio tape group and rigid tape group were helpful to reduce pain and disability for subjects with work-related chronic low back pain in Computer professionals but the Kinesio tape group was better than the rigid tape group when compared for effectiveness.&#xD;
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Conflict of interest: No conflict of interest &#xD;
&#xD;
Acknowledgement: The authors thank the management of Garden city University to carry out this study.&#xD;
&#xD;
Funding Source: Self-financing &#x2013; No external funding source&#xD;
&#xD;
Author contribution: &#xD;
&#xD;
1. Prasanna Mohan - Conception and design of the study, analysis, and interpretation of data &amp; Drafting the manuscript&#xD;
&#xD;
2. Sudhan SG - Study design &amp; Acquisition of data, Drafting of the manuscript&#xD;
&#xD;
3 A Thangamani Ramalingam - Revision of the manuscript &amp; data analysis&#xD;
&#xD;
4 Kannan Dhasaradharaman-Data acquisition &amp; analysis&#xD;
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5. Anjali Suresh -Revision of the manuscript&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3930</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3930</Fulltext></URLs><References>1.Bhuyar P, Banerjee A, Pandve H, Padmanabhan P, Patil A, Duggirala S, et al. Mental, physical and social health problems of call centre workers.&#xA0;Indian Psychiatry J.&#xA0;2008;17:21&#x2013;5.&#xD;
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9.Kjellman G, Oberg B. A randomised clinical trial comparing general exercise, McKenzie treatment and a control group in patients with neck pain.&#xA0;J RehabilMed.&#xA0;&#xA0;2002;34:183&#x2013;90.&#xD;
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	Matsuo H, Uchida K, Nakajima H, Guerrero AR, Watanabe S, Takemura N, et al.&#xA0;Early transcutaneous electrical nerve stimulation reduces hyperalgesia and decreases activation of spinal glial cells in mice with neuropathic pain.&#xA0;Pain&#xA0;2014;155(9):1888?901.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Segmentation of Features Using Neural Network with Cardiac Dataset&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>200</FirstPage><LastPage>204</LastPage><AuthorList><Author>Ramamoorthy V</Author><AuthorLanguage>English</AuthorLanguage><Author> Deepa D</Author><AuthorLanguage>English</AuthorLanguage><Author> Cherukullapurath Mana S</Author><AuthorLanguage>English</AuthorLanguage><Author> Sivasangari A</Author><AuthorLanguage>English</AuthorLanguage><Author>  Samhitha BK</Author><AuthorLanguage>English</AuthorLanguage><Author> Judgi T</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: One of the most popular applications of Artificial Intelligence that has seen immense growth in the digital era is Deep Learning techniques where the system studies and improves its performance through progressive learning without any explicit programming. Deep learning is widely used in numerous applications and one of them being medical analysis. Feature extraction and Image classification are considered to be the most popularly used approaches done using the deep learning process. Method: In this paper, we will segment cardiac bi-ventricle from magnetic resonance (MR) images. The segmented images are then classified through Deep Neural Networks where the sequence of images is validated frame by frame. The efficiency of the proposed model is evaluated and is compared with other traditional Deep Learning processes. Result: Theexecutionof the model is more precise as the model uses an iterative approach for feature extraction in classifying images. Conclusion: It is observed that the proposed interactive model provides better performance.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Medical analysis, Classification, Deep learning, Segmentation, Artificial neural network, Feature extraction</Keywords><Fulltext>&#xD;
&#xD;
	&#xD;
	INTRODUCTION&#xD;
	&#xD;
&#xD;
&#xD;
The development of Artificial Intelligence has provided birth to a lot of brand-new solutions, from that the favourite solutions which are being developed currently are Machine Learning Approaches as well as Deep Learning Techniques. These mastering methods are commonly used within several fields such for instance healthcare picture evaluation1 automatic robot course preparing 2 flood detection within a specific area or city 3 and also acreage coverage category.4 Printer mastering strategy is a procedure for studying a certain undertaking with no man treatment as well as enhancing the overall performance just by constant mastering procedure. The mastering methods are of two types: supervised learning, 5 where the category classification is designed for the functions on the instruction dataset as well as unsupervised studying 6,7,8 exactly where absolutely no product labels are provided and also other method has to tag the characteristics on the dataset. This Include removal is a crucial practise within the entire printer mastering techniques.9 The extracted capabilities might subsequently be utilized for different methods as regression or classification. The utilization of ANNs is largely known as Deep Learning Approach. When the community striving to learn every single level quite profoundly requires the result of every level because they form the centre of upcoming coating methods. 10,11ANNs can serve as a classifier similar to the performance associated with a natural neuron Owning many levels attached by way of weights. 12&#xD;
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Within picture processing, the quantity of pixels (picture elements) is dependent on the type of picture. The impression is the imitation of truth that provides just as much info as you can approximately an item. The setup of neurons being created levels and also the hookup patterns created within as well as in between every level is known as Network Structures. ANNs have information processing components that could fix any kind of difficulty via pre-determined examples instead of pre-defined algorithms.13&#xD;
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Deep Learning Approaches discovers a distinguishing value in the area of healthcare reputation evaluation. Pictures about the measurement of different areas of the body based upon various scales such as macroscopic or microscopic are coined as biomedical photographs. These biomedical pictures are produced although numerous tools including Ultrasound devices as well as CT scanners. With this approach, we suggest a method of determining as well as segmenting cardiac bi ventricle offered by MR pictures. The suggested method applications of Region of interest (ROI) Algorithm which recursively processes the pictures within the data source to determine the malignant cells as well as sector it out of various other areas of the body. Other parts of the image are made of a few similar segments which are effective and recommended by numerous scientists, the methodologies &amp; algorithms employed within the suggested strategy as well as experimental outcomes.&#xD;
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	RELATED WORK&#xD;
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A lot of effective studies are suggested by different scientists for segmenting or maybe classifying a certain item or even a particular location coming from a picture. A semi instant segmentation technique suggested. Believed the number of tumour cells located inside the liver. 14 The borders of the tumour cells have&#xA0;Been pinpointed by a CT image. This task undertaken can use so much computation power and time. It is advertised to be effective in the process of locating the number of tumour cells present by segmenting them into segments. When it comes to hybrid picture segmentation, it is utilizing morphological algorithm for watersheds which consolidated advantage &amp; area-based methods.15 The method discovered to become effective because it decreased the quantity of false-positive detection. Radiation of sound aided to the aspect for tacitly enhancing the processing phase of computation.16Created an effective and also strong supervised reputation co segmentation design containing a method known as style incentive as well as an energetic contour version. The unit was examined on several pictures coming from a data source as well as may effectively match the typical items with little mistake fee.&#xD;
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Brain tumour as detected by Jason J. Corso in 17 by integrating segmentation with Bayesian model. A weighted aggregation algorithm was used for the detection of tumour cells. The performance evaluation was done on a larger dataset where stochastic models were used to extract the features. The model could be enhanced by providing an accurate boundary of the tumour cells. Concurrent image segmentation and bias adjustment were performed by Kaihua Zhang,18 where minimization of energy was performed by an efficient Bayesian Learning Approach. The technique stated that the experimental results were performed on a real dataset of images and produced an accurate intensity of homogeneity. Md. Badrul et al.19 classified lung cancer images from CT scans using the MLFFNN technique yielding a good accuracy of 96.67%. FFNN approach used in20describedtheclassificationtechniqueproducingan accuracy of 92%. Rajesh Kumar Tripathy 21combinedSVMwithLeastSquareandprovidedan accuracy of 95.34%. Persi et. al. 2013 22 used.&#xD;
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The particle swarm optimization technique for predicting heart disease yielding 92.2% accuracy. Deepa et.al.23 proposed an idea of detecting road damage by image processing in smartphone and sending the co-ordinate point to the cloud from cloud user can visualize the road where the damages there it will show in the map. From this can able to avoid the accidents etc.&#xD;
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Similarly Keerthi et.al24 talks about CNN to identify tumors that are dangerous in lung disease. The CNN technique has the lot features and standard representation pneumonic radiological complexity, fluctuation and classification of a lung nodule. Similarly, Vignesh et.al25 discussed fewer deployment in the cloud storage with low-cost replication, higher availability with better performance in geo-replicated systems by data centres with these benefits.&#xD;
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Further Ishwarya et.al26 proposed a project to reduce congestion in traffic and calculating current traffic with normal. If any unusual them emergency passes through the signals. Based on that solves the traffic problems.&#xD;
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	MATERIALS AND METHODS&#xD;
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Numerous feature extraction methods and classification techniques are used widely to identify and detect the location of malignant cells such as tumour cells in the human body. Various classifiers such as SVM, K-means clustering and decision trees that are used widely for image segmentation applications have been already discussed. The enhanced and efficient model designed in the current paper first extracts images from an MR image dataset. The images are then pre-processed where all the features of the images are extracted using neural networks. The preprocessing is initially done by medical image analysis where all the images are processed in such a way that it generates new fused images that have high quality when compared to the original images. These fused images are easier for training and classifying the classifier as it contains more spatial and spectral information. The validation of the data set is done frame by frame for a particular period. As the proposed model is an iterative process, the model tends to produce a more accurate result when compared with other existing classifiers. The various steps involved in the entire model is discussed as follows:&#xD;
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Image Acquisition: The scanned images obtained from patients suffering from cardiac stroke are collected from databases and hospitals. The file formats collected from the database are.jpeg,&#xA0;.tift, .png file formats and the file dimensions consist of rows and columns.&#xD;
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Image Pre-processing: The purpose of image-processing is to increase the quality of the image and to improve the features of an image for further processing. After the image acquisition stage, the images pass through the pre-processing stage. There will be a change in the output image for the given input image. The occurrence of this change is due to the reduction of noise and/or enhancement of contrast. Image pre-processing is needed to vary its lightning condition. Preprocessing entails Color Normalization, Edge Detection, Noise Reduction, as well Histogram Equalization. A lot of filter systems are accustomed to bringing down the outcome of interference over the picture. Intermediate Filter is utilized for Color Normalization and Noise Reduction. Gabor Filter has utilized for Edge Enhancement as well as Histogram Equalization. Picture Enhancement is used to enhance the notion of information of pictures. Additionally, it modifies the characteristics of a picture and also causes it to be ideal for a job. The highest Peak Signal to Noise Ratio (PSNR) is estimated for all the segments and various picture information is established. The established good signal-to-noise ratio (PSNR) is used with a phrase for relating the ratio in between the optimum probable worth (energy) of the power and a signal of distorting racket which affects the calibre of the representation of its.&#xD;
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Feature Extraction: It is a method of capturing the visual content of the image. It is extracted from the segmented image which includes area, perimeter, equivalent diameter, irregularity index, mean, standard deviation and entropy. ExtractedFeatures are used in a neural classifier to train the model in this way to increase accuracy and recognize a particular class as normal or abnormal. The classifier will assign the unknown object to the correct class depending on the extracted features (Fig. 1).&#xD;
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Segmentation of Malignant Cells: In this process, the homogeneous regions are obtained from the input image. The region so interesting images are found by using the process of segmentation. It reduces the number of pixels of an image to make it easier for the subsequent step of feature extraction and classification. Segmentation is tougher in MR scan images and when combined with a large amount of data because of the additional dimensions that need to be considered for the proximity calculation. Fig. 1 depicts the flow chart of the entire classification process.&#xD;
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In Fig. 2 we have depicted the entire architecture of how the classification is done. The Input image or a video frame is given from the scanner database. In the case of a video file from the scanner, it is split into multiple frames and then is first converted into greyscale. The discrete cosine transformation method is applied to the image when the contrast of the image is enhanced in such a way that even the small feature soft images are perfectly visible. Thenthefeaturesareextractedfor further study and then finally Medical Image Fusion is performed on the image to obtain the segmented image. Once the fused images are obtained it is then trained using neural networks which are responsible for extracting the features of the image. Then required performance and the error calculation is done for the entire model.&#xD;
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RESULTS&#xA0;&#xA0; AND DISCUSSION&#xD;
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The experiments are completed on the MATLAB R2018a version. The calculations are performed using the image Classification Learner Toolbox(ICLT) that is readily available in MATLAB.Initialstepistoinputanimagefromthe scanner database into the given tool. Fig 3 is a sample output image obtained after the classification using the neural network classifier. The cardiac bi-ventricle is can be easily detected from this classification.&#xD;
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As the next step, the RGB components are extracted from the image and then converted to a Grayscale image. The features are then trained with a neural networks classifier where some images are reserved for training and the rest of the images are used for testing of images. The classifier learns features from the given images and successfully classifies when any new image is given to it. It identifies where the image is benign or malignant. The accuracy of the neural network is observed with 99.69% whereas 99.9% specificity and 80.48% sensitivity. The segmentation of the cardiac bi-ventricle from the exact image gives us various parameters for measuring such as its intensity, volume, and size. This helps in diagnosing and treating cardiac-related issues more effectively. The results show the efficiency of the proposed approach.&#xD;
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	CONCLUSION&#xD;
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Numerous cancerous cells and tumour cells are prevailing in a lot of people nowadays. Early detection of these malignant cells could reduce the risk of loss of life to a greater extent. In this paper, we have suggested an efficient model of diagnosing cardiac bi-ventricle at an earlier stage by using Medical Image Analysis. The images obtained from MRI scanners are used for fusion in such a way that generates high image quality. The images are classified using deep neural networks. The region of Interest (ROI) algorithm is used to segment the area affected. These images are then used for further classification. Neural networks are used for classification and have obtained an accuracy level of about99.69%. As future work, we are currently working on improving the proposed algorithms to give better efficiency and more accurate predictions. &#xD;
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CONFLICT OF INTEREST&#xD;
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The authors declare that there is no conflict of interest involved &#xD;
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ACKNOWLEDGEMENT&#xD;
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We acknowledge the contributions made by peer researchers which motivate us to research this domain. &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; FUNDING &#xD;
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Not Applicable&#xD;
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AUTHOR CONTRIBUTION&#xD;
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	R. Vignesh &#x2013; Data Analysis &#xD;
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	D.Deepa &#x2013; Manuscript planning&#xD;
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	SujaCherukullapurathMana- Data Collection &#xD;
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	A.Sivasangari- Implementation&#xD;
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	B. KeerthiSamhitha -&#xA0; Analysis of Result&#xD;
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	T.Judgi- Manuscript Planning&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3931</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3931</Fulltext></URLs><References>[1]&#xA0; Rahman MM, Bhattacharya P, Desai BC. A framework for medical image retrieval using machine learning and statistical similarity matching techniques with relevance feedback. IEEE Transact Inf Techn Biomed. 2007 Jan 2;11(1):58-69.&#xD;
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[20]&#xA0; D Deepa and Vignesh, R. and A, Sivasangari A and Mana, Suja Cherukullapurath and Samhitha, B. Keerthi and Jose, Jithina, Visualizing Road Damage by Monitoring System in Cloud (2020). Int J Electrical Engg Tech. 11(4), 2020, pp. 191-203.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>The Association between Neutrophil-Lymphocyte Ratio and Clinical Factors Related to Stroke - A Prospective Cohort Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>205</FirstPage><LastPage>209</LastPage><AuthorList><Author>Badiger R</Author><AuthorLanguage>English</AuthorLanguage><Author> Sharma G</Author><AuthorLanguage>English</AuthorLanguage><Author> Chowdary S</Author><AuthorLanguage>English</AuthorLanguage><Author> Dulipalli VV</Author><AuthorLanguage>English</AuthorLanguage><Author> Akki S</Author><AuthorLanguage>English</AuthorLanguage><Author> Yadav I</Author><AuthorLanguage>English</AuthorLanguage><Author>  Gandhi A</Author><AuthorLanguage>English</AuthorLanguage><Author> Karekar S</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction and Objectives: Almost 56 million deaths that occur in every year, in that 10.8% of peoples had died due to stroke. One in five women and one in six men affected by this illness called stroke in their lifetime. Stroke is the leading cause of mortality and disability. NLR and inflammatory marker can be used as a simple and easy marker for prognosis and mortality. The study aims to investigate the role of the NLR ratio in acute ischemic stroke Second foremost reason for death in the global is known as Stroke. Materials and Methods: Patients with features of acute ischemic stroke were subjected to a detailed history, examination and thorough investigations. The diagnosis was made by clinical history, neurologic examination and neuroimaging. The severity of stroke at the time of admission was classified based on the National Institute of Health Stroke Scale. Modified Ranking Scale used to determine the functional outcome at discharge. Results: Out of 68 patients enrolled in the study, 13 patients (19.1%) had a mild stroke, 45 patients (66%) were affected by moderate stroke, 6 patients (8.8%) had moderate to severe stroke, and 8 patients (5.9%) were severely affected. In the Chi-Square analysis for the association between NLR and MRS, the Pearson chi-square analysis shows significant results (P-value =0.000</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Acute Ischemic Stroke, Neutrophil Lymphocyte Ratio, Modified Ranking Scale, National Institute of Health Stroke Scale,  Lymphocyte Monocyte ratio, Cerebrovascular events</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
World Health Organization reported that the fifteen lakh people in global had stroke yearly, among the affected people five lakh decease and five lakh will be eternally handicapped.1,2 Stroke is also a leading cause of adult disability. The research reports disability could have been prevented by 80 per cent through proper medical practices. AIS are insufficient arterial supply for cerebral perfusion, because of attenuated or occluded vessels flowing into or inside the brain. It has two types thrombotic and embolic strokes. The blood vessel becomes narrowed and the blood flow to the area beyond is less. Damaged areas of an atherosclerotic plaque lead to a blood clot - a thrombotic stroke. In an embolic stroke, blood clots or debris generated from any other part of the body may block and lead to narrower blood vessels.3,4 NLR ratio is the predominant marker for diabetes, renal failure, malnutritional status (mostly chronic), cerebrovascular events,&#xA0; COPD, Alzheimer&amp;#39;s and psychiatric illness, metabolic syndrome. Higher blood inflammatory effect on markers like &#x201C;highly sensitive C-reactive protein (hs-CRP)&#x201D; is noted as a possible risk for AIS/IHD independently.5,6&#xD;
&#xD;
METHODOLOGY&#xD;
&#xD;
SOURCE OF THE STUDY&#xD;
&#xD;
The primary data was collected from the patients who were admitted in the wards at KLES Dr. Prabhakar Kore Hospital serves also as Medical Research Centre, situated at Belgaum. Informed consent was taken and the database was collected specifically from acute ischemic stroke patients who were admitted to the hospital, within 72 hours of the onset of symptoms, aged above 18 years.&#xA0; The prospective study was for One year (1st January 2019 to 31st December 2019)&#xD;
&#xD;
Ethical clearance was obtained from the institutional ethical committee and informed consent was obtained from each participant before the study. Data from the patients such as demographic factors, comorbidities, duration of hospital stay, day-to-day life activities such as food habits and lifestyle of the patient was obtained. Blood samples were collected once the patient was admitted to finding the neutrophils and lymphocyte counts in their blood. Patients with features of acute ischemic stroke were subjected to a detailed history, examination and thorough investigations. &#xD;
&#xD;
Clinical history of the patient such as the severity of stroke during admission and the outcome of their health was collected in the database. Neurological examination and Neuroimaging diagnostic methods were used to diagnose the stages of severity of AIS. Based on the NIHSS, the intensity of stroke is classified and functional outcome at the time of discharge is determined using MRS. Patients are followed up in the hospital to retrieve clinical data from the time of admission until discharge. Information collected from the patients is maintained securely as per the informed consent.&#xD;
&#xD;
The defined co-morbidities include hypertension, type 2 diabetes mellitus, history of CVA, seizure disorder, history of preeclampsia, Ischemic heart disease, depression, hypothyroidism, and rheumatic heart disease. Patients with acute infarction, sub-acute infarction, as well as focal hyperacute infarction were identified and their infracted site was collected to analyse their severity of stroke. During the discharge day of the patient, the number of days the patient got admitted and stayed in the hospital for treatment was collected in the database. Inclusion criteria in this study were the patients with post-acute ischemic stroke admitted before 72 hrs of the onset of symptoms and above 18 years of age. Whereas Patient with a history of more than 3 days of onset of symptoms with a history of infection within 1 week of stroke or 72 hours of the onset of symptoms, with malignancies or haematological symptoms, taking immune suppressant drugs, having a history of recent stroke (for past 6 months) or with previous stroke disability, with the severe pulmonary disorder or chronic renal failure undergoing treatment.&#xD;
&#xD;
SAMPLING TECHNIQUE&#xD;
&#xD;
A prospective sampling technique was used in this study. The sample data was collected from the patients who are admitted to the hospital from the period of 1st January 2019 to 31st December 2019, specifically those who were admitted for acute ischemic stroke. Among 112 patients admitted at Karnataka Lingayat Education Society&#x2019;s Dr. Prabhakar Kore Hospital &amp; Medical research centre for acute ischemic stroke, 68 samples were enrolled and the patients, who have chronic renal failure, haemorrhage, malignancies etc. were excluded. Almost 60% of the samples were selected from the average admission cases in the previous year. &#xD;
&#xD;
RESULTS&#xD;
&#xD;
Among the 68 patients admitted to the hospital, 47 were male and 21 were female. The majority were in the age group of 46-60 years. 3 patients were alcoholic, 3 patients were smokers, 7 patients had the habit of tobacco chewing, 2 patients had habits in the past, and the remaining patients had 2 or more habits. 22 patients had the routine of eating only vegetarian foods, and 46 patients followed mixed routine in their eating habits.13 patients had only hypertension (HTN), 5 patients had only Type 2 Diabetes mellitus (T2DM), 12 patients had both HTN as well as T2DM, 8 patients had other comorbidities such as preeclampsia, mitral stenosis, hypothyroidism. The majority of the patients were observed without any comorbidities and counted to be 21 in number.NIHSS obtained on the admission of AIS patient showed that almost 13 patients were affected by minor stroke, 45 patients were affected by moderate stroke, 6 patients were found to be in the stroke scale of moderate to severe, and only 8 patients were severely affected.&#xD;
&#xD;
In distribution among MRSamong the enrolled patients, 12 patients showed no significant disability, 15 patient showed slight disability, 14 patients showed moderate disability, 13 patients showed moderately severe disability, 8 patients showed severe disability and one patient had passed away. Distribution of no. of days patients admitted in hospital results showed that 7 patients had stayed less than 4 days, 41 patients stayed in the range of 5-8 days, 17 patients stayed for 9-12 days, 2 patients stayed for 13-16 days and only one stayed for 18 days. In the Chi-Square analysis of the association between the lifestyle of the patients and their duration of hospital stay, the Pearson chi-square analysis showed significant results (P-value =0.016 </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3932</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3932</Fulltext></URLs><References>&#xD;
	&#xD;
	Feigin VL, Roth GA,&#xA0;Naghavi M,&#xA0;Parmar P,&#xA0;Krishnamurthi R,&#xA0;Chugh Set al., Global burden of stroke and risk factors in 188 countries, during 1990&#x2013;2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet Neurol. 2016. 15(9): &#xA0;913-924.&#xD;
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	&#xD;
	Chung JW, Ryu WS, Kim BJ, Yoon BW, Elevated Calcium after Acute Ischemic Stroke: Association with a Poor Short-Term Outcome and Long-Term Mortality. J Sci. 2015;17(1):54-59. &#xD;
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	&#xD;
	Heit JJ, Sussman ESandWintermark M, Perfusion computed tomography in acute ischemic stroke. Radio Clin. 2019. 57(6): 1109-1116.&#xD;
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	&#xD;
	Leigh R, Knutsson L, Zhou J&#xA0;and&#xA0;Peter CM, Imaging the physiological evolution of the ischemic penumbra in acute ischemic stroke. Radio Clin. &#xA0;2018. 38(9):1500-1516.&#xD;
	&#xD;
	&#xD;
	Nam KW, Kim TJ, Lee JS, Kwon HM, Lee YS, Ko SB et al., High neutrophil-to-lymphocyte ratio predicts stroke-associated pneumonia. Stroke. 2018. 49(8): 1886-1892.&#xD;
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	&#xD;
	Lee JH,&#xA0;Kwon KY,&#xA0;Yoon SY, Kim HS,&#xA0;and&#xA0;Lim CS, Characteristics of platelet indices, neutrophil-to-lymphocyte ratio and erythrocyte sedimentation rate compared with C reactive protein in patients with cerebral infarction: a retrospective analysis of comparing haematological parameters and C reactive protein. BMJ Open. 2014. 4(11): 182.&#xD;
	&#xD;
	&#xD;
	Segatore, M, Understanding central post-stroke pain. JNN, 1996. 28(1): 28-35.&#xD;
	&#xD;
	&#xD;
	Kotfis K,&#xA0;Bott-Olejnik M,&#xA0;Szyli?ska A,&#xA0;Rotter I, Could Neutrophil-to-Lymphocyte Ratio (NLR) serve as a potential marker for delirium prediction in patients with acute ischemic stroke? A Prospective Observational Study. J Clin Med. 2019. 8(7): 1075.&#xD;
	&#xD;
	&#xD;
	Yu S,&#xA0;Arima H,&#xA0;Bertmar C,&#xA0;Clarke S,&#xA0;Herkes G,&#xA0;Krause M et al. Neutrophil to lymphocyte ratio and early clinical outcomes in patients with acute ischemic stroke. J Neurol. 2018. 387: 115-118.&#xD;
	&#xD;
	&#xD;
	Zhang J, Ren Q, Song, Y, He M, Zeng Y, Liu Z, Xu J et al. Prognostic role of neutrophil-lymphocyte ratio in patients with acute ischemic stroke. J Med. 2017; 96(45): e8624. &#xD;
	&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Clinico-epidemiological Study of Patterns of Homicidal Head Injuries at a Teaching Hospital in West Bengal: An Autopsy-based Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>210</FirstPage><LastPage>213</LastPage><AuthorList><Author>Partha Sarathi Hembram</Author><AuthorLanguage>English</AuthorLanguage><Author> Shobhan Roy</Author><AuthorLanguage>English</AuthorLanguage><Author> Mainak Tarafder</Author><AuthorLanguage>English</AuthorLanguage><Author>  Saptarshi Chatterjee</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Homicide is a heinous crime with around 5,00,000 deaths per year worldwide. Head injuries are one of the most effective methods of homicide. The head is the vital and most vulnerable part of the body to sustain injuries. The type and size of intracranial haemorrhages, along with the association of skull fractures have an immense significance in the outcome of head injuries. Objectives: The present study is undertaken to analyse the profiles and patterns of head injuries in homicidal victims between 2008 to 2011. Methods: This is a cross-sectional descriptive study, which was conducted by analysing 59 cases of Homicidal Head Injuries, attended to Kolkata Police Mortuary for autopsy examination between 2008 to 2011. Results: The majority of the victims belonged to the 3rd and 4th decades, with male preponderance in all the age groups. Though the place of occurrence has got no significant implication on the pattern of homicidal head injuries, hard blunt weapons were most commonly used to inflict fatal blows. Basilar fractures of the anterior cranial fossa and the fissure fractures of the skull were most commonly encountered during the autopsy, with subdural haemorrhage being the most common among intracranial haemorrhages, being shortly followed by subarachnoid haemorrhages. Conclusion: The authors feel that homicide is an act of moment in mind, and to curb the menace of homicide, state and society should ensure education, employment and socioeconomic well-being, along with strict law enforcement.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Skull fractures, Basilar Fractures, Intracranial haemorrhage</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Homicide is the heinous, the cruellest and the severest form of violent crime, where one human being deprives another human being of his fundamental right to live.1 Global rise of homicides is concerning nowadays, with around 5,00,000 deaths per year worldwide.2 It may be a result of arguments between acquaintances, domestic violence, drug addiction, robbery and terrorism. Violent deaths are from a spectrum of physical, sexual, mental and reproductive health problems. The most vulnerable are the young offenders who are becoming increasingly violent and that are causes for concern too.1,2&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The head is the vital and most vulnerable part of the body to sustain injuries. Head injuries are one of the most effective methods of homicide. A craniocerebral injury due to blunt trauma causes more homicidal deaths, as compared to blunt trauma injury to other parts of the body.3 The type and site of intracranial haemorrhages, the presence or absence of skull fractures with their types are having imminent significance in the outcome of head injuries.3,4,5&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Besides being a useful indicator of social stress, the pattern of homicide also provides useful information for law enforcement strategies. Investigation of homicidal deaths can never be complete without a detailed post-mortem examination. The detailed analysis and scientific interpretation of autopsy findings are imperative to reconstruct the crime scene.6&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The present study is undertaken to analyse the profiles and patterns of head injuries in homicidal victims. The knowledge thus gained can be highlighted to reveal the magnitude of its impact on society, as well as to attempt a solution.7&#xD;
&#xD;
MATERIAL AND METHODS&#xD;
&#xD;
&#xD;
	&#xD;
	Place of study: Upgraded Department of Forensic Medicine and Toxicology, Medical College, Kolkata, West Bengal, India.&#xD;
	&#xD;
	&#xD;
	Period of study: 1st of January, 2008 to 31st of December, 2011&#xD;
	&#xD;
	&#xD;
	Study population: All the patients sent for autopsy examination at Kolkata Police Mortuary during the study period. &#xD;
	&#xD;
	&#xD;
	Sample size: All the victims of homicidal head injuries, attended to Kolkata Police Mortuary for autopsy examination between 2008 to 2011.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Inclusion criteria: All the cases of head injuries in homicidal deaths, which attended for the autopsy to the Kolkata Police Mortuary between 2008 to 2011, were considered for this study.&#xD;
	&#xD;
	&#xD;
	Exclusion criteria:&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Homicidal deaths, due to any cause, other than head injuries.&#xD;
	&#xD;
	&#xD;
	Any case subjected for autopsy with an alleged or suspected history of homicide, but which were later registered as non-homicidal based on the autopsy findings, circumstantial evidence and police investigation.&#xD;
	&#xD;
	&#xD;
	Cases with incomplete or inadequate data&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Study design: Cross-sectional descriptive study&#xD;
	&#xD;
	&#xD;
	Statistical analysis: All the data were manually checked and edited for completeness in a pre-determined format and were then coded for computer entry. Collected data were recorded in a Microsoft Excel worksheet and SPSS IBM 19. The data were collected, tabulated and statistically analyzed by applying a student&#x2019;s t-test. The p </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3933</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3933</Fulltext></URLs><References>&#xD;
	&#xD;
	Parmar DJ, Bhagora LR, &#xA0;Parmar RD. Recent trends of homicidal deaths in Bhavnagar region - A two-year retrospective study. Ind J Res. 2015;2(8):45-54.&#xD;
	&#xD;
	&#xD;
	Reza A, Mercy JA, Krug E. Epidemiology of violent deaths in the world. Ind J Res. &#xA0;2019;8(3):39-40.&#xD;
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	&#xD;
	NaikSG, NaikRK.Evaluation of head injuries with skull fractures in Homicidal deaths. Ind J Res. 2019;8(3):39-40.&#xD;
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	&#xD;
	MishraPK, Singh S. Fatal head injury in homicidal deaths in Bhopal region of Central India. Int J Pharm Bio Sci 2013;3(4):1103-8.&#xD;
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	&#xD;
	Buchade D, Mohite S. Pattern of injuries in Homicidal cases in Greater Mumbai: a three-year study. J Int For Med. &#xA0;2011;33(1):46-49.&#xD;
	&#xD;
	&#xD;
	Kasmaei VM,Asadi P, Zohrevandi B.An epidemiological study of traumatic brain injuries in the emergency department. Emergency 2015;4:266-74.&#xD;
	&#xD;
	&#xD;
	Hugar BS, Harish S. Pattern of Homicidal Deaths. J Int For Med. &#xA0;2017;32(3):194-98.&#xD;
	&#xD;
	&#xD;
	PateDJ. Analysis of Homicidal Deaths in and around Bastar region of Chhattisgarh. J Int For Med. 2012;34(2):139-42.&#xD;
	&#xD;
	&#xD;
	Chattopadhyay S, Tripathi. Skull fracture snd haemorrhage pattern among fatal and nonfatal head injury assault victims - a critical analysis. J Inj Violence Res 2010;2(2):99-103.&#xD;
	&#xD;
	&#xD;
	Rupani R, Verma A, Rathore S.Pattern of skull fractures in cases of Head Injury by blunt force. J Int For Med. 2013;35(4):336-38.&#xD;
	&#xD;
	&#xD;
	ManishK, JyothiNS, GuruduttaSP. Fatal head injuries in road traffic accidents in and around Davangere. Ind J For Med Path. 2012;5(2):61-65.&#xD;
	&#xD;
	&#xD;
	Al-Qazzaz MA, Jabor MA. Medico-legal study of intra-cranial causes of death. Egy J For Sci. 2014;4(4):116-23.&#xD;
	&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Inter-Rater Reliability of Edinburgh Visual Gait Score on Gait Analysis Among Elderly People&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>214</FirstPage><LastPage>217</LastPage><AuthorList><Author>Senthil Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author> Sathish Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author> Kotteeswaran K</Author><AuthorLanguage>English</AuthorLanguage><Author> Saravan Kumar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Gait, Edinburg visual gait score (EVGS), Elderly, Intraclass correlation</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
Elderly has been defined as people aged 65 years old, 65 - 74 years old are called as &#x201C;early elderly&#x201D; and those over 75 years old are called as &#x201C;late elderly&#x201D;. 1 The percentage of elderly people in the world population is expected to increase rapidly from 9.5% in 1995 to 20.7% in 2050 and 30.5% in 2150. 2&#xD;
&#xD;
The common physical health problems, impairments and disabilities among senior citizens include neurological problems like stroke, Parkinson&#x2019;s disease, dementia, Alzheimer&#x2019;s diseases .psychological disorder Depression and cognitive impairment. Systematic disorder such as diabetes mellitus, rheumatoid arthritis, osteoporosis, hypertension, chest disorder such as COPD, pneumonia, asthma, carcinoma, myocardial infarction, coronary artery diseases, valvular diseases, anaemia, gastrointestinal problems, hypertension, arthritis, visual defects, hearing impairment, functional limitation. The risk of fall is more among the age group of 65 years and above. 3-6&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Gait is known as a translator progression of the body as a whole, produced by coordinated, rotatory movements of body segments. The gait cycle consists of two phases, the Stance phase which includes heel strike, foot flat, mid stance, heel off and toe-off. Swing phase which includes early swing phase/acceleration phase, mid-swing and late swing /deceleration phase&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Gait analysis by the journal of forensic biomechanics is rated as one among the journals that publish the advanced and top article. Gait analysis according to it, the animal locomotion, in particular the human motion, through observation. Gait analysis can be done in several methods. Observational gait analysis is a kinematic qualitative gait analysis in which the patterns of movement, joint angle, type of gait is analysed. On performing task especially with mild cognitive impairment (MCI) there will be an increased risk of fall. Hence this analysis can help in identifying the normative value of gait in elderly individuals.&#xD;
&#xD;
Clinicians require simple and cost-effective outcome measures to analyze the kinematic parameters of gait in their day&#x2013;to&#x2013;day practice. Visual diagnosis of a patient&#x2019;s gait in real-time is subjective, lack accuracy and relies on the clinician&#x2019;s training and experience. Visual gait analysis using a structured Performa has been suggested as an alternative to the IGA. 7 Observations gait tools are commonly used as an essential tool for an assessment gait of children with CP. 8-15&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The Edinburgh Visual Gait Score (EVGS) is a comprehensive video assessment tool to assess the gait. EVGS provides 17 gait parameters in the foot, knee, pelvis and trunk in both the stance and swing phase. The EVGS consists of a 5-point scoring system ranging from 2, 1, 0, 1, and 2. Zero is normal, 1 is the moderate deviation in one/either direction, and 2 is the marked deviation in either direction. The higher the score is, the greater the deviation. The total possible score of EVGS per limb is 34. In clinical practice, the scale EVGS has more responsiveness and reliability. The EVGS is simple and easy to apply. It depends on the clinical experience of the examiner. 14&#xD;
&#xD;
NEED OF THE STUDY:&#xD;
&#xD;
Many studies are they are regarding 3D-GA prevalent, as the most gold standard method of assessing gait. But it is not always accessible, practical, or feasible. To date there is less published evidence for inter-rater reliability of observational gait analysis (videos) in cerebral palsy but not in elderly peoples. So need of the study is to analyze the interrater reliability of observational gait analysis (EVGS) among elderly people.&#xD;
&#xD;
METHODOLOGY:&#xD;
&#xD;
120 subjects using a Cross-sectional study design (Convenient Sampling were included from Saveetha Geriatric outpatient department, Saveetha Medical College and Hospital, SIMATIC Chennai. They were included with inclusion criteria of Aged from 65 years to 75 years, Male and female participants, medically stable and without the support of walking aids. The exclusion Criteria was recent fractures of lower limbs, neurological defect, trunk and Lower limb deformity, mental illness, limb length discrepancy; amputate patients, vertigo and audiovisual disturbances.&#xD;
&#xD;
PROCEDURE:&#xD;
&#xD;
Participants were taken from Saveetha medical college and hospital geriatric outpatients, based on inclusion criteria and exclusion criteria, after the inclusion of participants they were assessed for gait parameters such as stance phase and swing phase. In this study, the videos were recorded and collected for all 120 participants. These recorded videos were graded using Kinovea software according to the Edinburg visual gait score format. Rater 1 and Rater 2 was graded the same videos. All the scores were analyzed using INTRA CLASS CORRELATION value. &#xD;
&#xD;
STATISTICAL ANALYSIS:&#xD;
&#xD;
&#xA0;The collected data were tabulated in TABLE &#x2013; 1 and analyzed using intraclass correlation.&#xD;
&#xD;
ETHICAL CLEARANCE: The present study was approved by Institutional Ethics Committee (IEC), Saveetha Medical College and Hospital (IEC No. 041/07/2020/IRB-HS/SIMATIC ON 02-03-2020). The procedure was informed to all the members and higher authorities. The procedure and benefits of the study were well explained to the participants before enrolling on the study. The details from the participants were collected after getting informed consent and the information was maintained confidential throughout the study.&#xD;
&#xD;
RESULTS:&#xD;
&#xD;
From the statistical analysis made with the inter class correlation values. The intraclass correlation values inter-rater of foot component single measures of intraclass correlation were 0.9103 and single measure 95 % confidence interval was 0.8738 &#x2013; 0.9366. The average measure of intraclass correlation was 0.9530 and the average measure of 95% confidence interval was 0.9326 - 0.9673. Knee component single measures of intra class correlation were 0.7824 and single measure 95 % confidence interval was 0.7019 &#x2013; 0.8432. The average measure of intraclass correlation was 0.8779 and the average measure of 95% confidence interval was 0.8249 - 0.9149. Hip component single measures of intraclass correlation were 0.8920 and single measure 95 % confidence interval was 0.8486 &#x2013; 0.9235. The average measure of intraclass correlation was 0. 949 and the average measure of 95% confidence interval was 0.9181 - 0.9602. Pelvis component single measures of intraclass correlation were 0.525 and single measure 95 % confidence interval was 0.4148 &#x2013; 0.6654. The average measure of intraclass correlation was 0.7117 and the average measure of 95% confidence interval was 0.5864 - 0.7991. Trunk component single measures of intraclass correlation were 0.5387 and single measure 95 % confidence interval was 0.3984 &#x2013; 0.6543. The average measure of intraclass correlation was 0.7002 and the average measure of 95% confidence interval was 0.5698 - 0.7911.&#xD;
&#xD;
DISCUSSION:&#xD;
&#xD;
In general, this EVGS scale is very easy to administer for those with or without gait analysis experience. This tool is also valuable to determine the effect of the clinical intervention on cerebral palsy children gait. 15,16,17 In addition the tool gait score is also a reliable indicator of gait deviation severity. All of our studies showed good inter-rater reliability, foot component is 0.9103, the knee component is 0.7824, the hip component is 0.8920, the pelvis component is 0.525, trunk component is 0.5387.&#xD;
&#xD;
This is a low cost-effective, advanced technology that is currently emerging. This includes video gait assessment software and also a mobile phone application that can measure joint angles. This hypothesis needs to be done on different patient groups.&#xD;
&#xD;
The best part of this EVGS was we can assess the all components gait cycle on only one scale and easy to administer at any setup&#xD;
&#xD;
Heather et al. read the complex gait analysis system is not generally available everyone was and no simple system of assessing gait by observation has been validated specifically for use in patients with Cerebral palsy. All 17 items in the score had positive kappa values. the score demonstrated good intraobserver and inter-observer reliability. 14&#xD;
&#xD;
Among et al. investigated the reliability and validity of EVGS for observers inexperienced in gait analysis, they aimed to study the investigation of intra and inter-observer reliability and validity of EVGS when used by the observer who was not specifically experienced in clinical gait analysis. the hypothesis was first that the inexperienced observer would be less reliable than the experienced observer and secondly that there would be a discernible learning effect and improvement of score between the 1st and 2ndviewings. The observations of gait events by the inexperienced observers using the EVGS were reasonably reliable not very accurate when compared to the experienced observer and 3D gait analysis. A positive learning effect for the inexperienced observers, reflected by improved scores, occurring between the 2 sessions that not been confirmed in this study. 15&#xD;
&#xD;
E.Viehwega et al. said that there was good reliability were observed in the foot and knee than in the proximal segments with significant differences between stance and swing phase of gait. Significantly very good results in gait analysis trained observers underlines the importance to either be used to clinical gait analysis (or) to benefit of video analysis training before observational studies. Good clinical practice in CP associated with knowledge of clinical gait analysis allows better reliability. 16&#xD;
&#xD;
Garza P Bella et al. compared the EVGS, VGAS and OGS to verify whether there is an agreement among the final score of the scales with regards to the degree of deviation from normal gait and to analyze the inter-rater reliability concerning the total score of the scale and to analyze the time and difficulty degree of use of each scale. The VGAS and EVGS seem to be more appropriate for evaluation of subject with diplegic CP as its increase the classification accuracy of gait in their children. 17&#xD;
&#xD;
Chandrasekar Rathinam et al. reviewed and identified the variety of pediatric gait analysis tools that have been reported EVGS includes gait data in all three planes and has good reliability and concurrent validity. EVGS is better than other tools which can be used by examiners who possess a variable range of experience but none of the tools is nearly equal to IGA. We suggest that the EVGS is the best scale currently available and it should be considered to assess the gait pattern of children with cerebral palsy. 18&#xD;
&#xD;
All the previous studies showed good reliability and validity for EVGS among the cerebral palsy subject. But our study aimed and showed good inter-rater reliability and also intra rater reliability.&#xD;
&#xD;
CONCLUSION:&#xD;
&#xD;
Our study showed the intraclass correlation excellent reliability for foot component, intraclass correlation good reliability for knee and hip component and intraclass correlation moderate reliability for pelvis and trunk component of EVGS. Of course, EVGS is good to scale in assessing the gait of the pediatric population has proved in various studies.11-18 It has excellent reliability and validity in the pediatric population. So we have taken the challenge of using this scale in geriatric normal individuals and seen reliability. This study has shown that this scale can also use in the elderly population.&#xD;
&#xD;
RECOMMENDATIONS AND LIMITATIONS:&#xD;
&#xD;
This EVGS can be used in any age group for gait analysis and any condition not only specific to cerebral palsy.&#xD;
&#xD;
Further studies may include more sample size to see the better reliability and validity.&#xD;
&#xD;
FUNDING SOURCES: &#xA0;This was a self-funded project.&#xD;
&#xD;
ACKNOWLEDGEMENTS: The authors acknowledge the support received from the staff at the department of physiotherapy, Saveetha University, Chennai. The authors also acknowledge the colleagues for their assistance in recruiting participants for the study and finally the authors acknowledge all the participants who took part in the study.&#xD;
&#xD;
CONFLICT OF INTEREST: All the contributing authors declare no conflict of interest.&#xD;
&#xD;
AUTHOR CONTRIBUTION: &#xD;
&#xD;
&#xA0;Senthil Kumar and Sathish Kumar conceive and presented the idea. Kotteeswaran K and&#xA0; Saravan Kumar helped in developing the idea. The first and second authors collected the data and analyzed the data. All the authors discussed the results and contributed to the final manuscript. &#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3934</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3934</Fulltext></URLs><References>&#xD;
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	&#xA0;Orimo H, Ito H, Suzuki T, Araki A, Hosoi T, Sawabe M. Reviewing the definition of &#x201C;elderly&#x201D;. Geri Geront Int. 2006 Sep;6(3):149-58.&#xD;
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	Verghese J, Lipton RB, Hall CB, Kuslansky G, Katz MJ, Buschke H. Abnormality of gait as a predictor of non-Alzheimer&amp;#39;s dementia. New Eng J Med. 2002 Nov 28;347(22):1761-8.&#xD;
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	Corradin M, Schiavon R, Borgo A, Deslandes J, Cersosimo A, Canavese F. The effects of uninvolved side epiphysiodesis for limb length equalization in children with unilateral cerebral palsy: clinical evaluation with the Edinburgh visual gait score. Eur J Orthop Surg Traum. 2018 Jul;28(5):977-84.&#xD;
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	Carpenter MG, Cleworth TW. Letter to the Editor: On" Advantages and disadvantages of stiffness instructions when studying postural control" by CT Bonnet: Comments on" Advantages and disadvantages of stiffness instructions when studying postural control". Gait Posture. 2016 May;46:214-5.&#xD;
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	Robinson LW, Clement N, Fullarton M, Richardson A, Herman J, Henderson G, Robb JE, Gaston MS. The relationship between the Edinburgh visual gait score, the gait profile score and gmfcs levels i&#x2013;iii. Gait posture. 2015 Feb 1;41(2):741-3.&#xD;
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	Gupta S, Raja K. Responsiveness of Edinburgh Visual Gait Score to the orthopaedic surgical intervention of the lower limbs in children with cerebral palsy. Am J Phys Med Rehab. 2012 Sep 1;91(9):761-7.&#xD;
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	van Schie PE, Vermeulen RJ, van Ouwerkerk WJ, Kwakkel G, Becher JG. Selective dorsal rhizotomy in cerebral palsy to improve functional abilities: evaluation of criteria for selection. Child&amp;#39;s Nerv Syst. 2005 Jun 1;21(6):451-7.&#xD;
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	Daribayev Z, Bulekbayeva S, Saltychev M, Lysovskyy Y, Lisovska N, Kussainova K. Measuring the change in the functional level of children rehabilitates with cerebral palsy: a brief report. J Ped Orthop 2018 May 7;1(1):4-6.&#xD;
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	Read HS, Hazlewood ME, Hillman SJ, Prescott RJ, Robb JE. Edinburgh visual gait score for use in cerebral palsy. J Ped Orthop. 2003 May 1;23(3):296-301.&#xD;
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	Ong AM, Hillman SJ, Robb JE. Reliability and validity of the Edinburgh Visual Gait Score for cerebral palsy when used by inexperienced observers. Gait posture. 2008 Aug 1;28(2):323-6.&#xD;
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	Viehweger E, Pfund LZ, H&#xE9;lix M, Rohon MA, Jacquemier M, Scavarda D, Jouve JL, Bollini G, Loundou A, Simeoni MC. Influence of clinical and gait analysis experience on the reliability of observational gait analysis (Edinburgh Gait Score Reliability). Ann Phys Rehab Med. 2010 Nov 1;53(9):535-46.&#xD;
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	Bella GP, Rodrigues NB, Valenciano PJ, Silva LM, Souza RC. Correlation among the visual gait assessment scale, Edinburgh visual gait scale and observational gait scale in children with spastic diplegic cerebral palsy. Rev Bras de Fisioterapia. 2012;16(2):134-40.&#xD;
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	Rathinam C, Bateman A, Peirson J, Skinner J. Observational gait assessment tools in paediatrics&#x2013;a systematic review. Gait&#xA0; Posture. 2014 Jun 1;40(2):279-85.&#xA0;&#xD;
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&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effect of Microcurrent Electrical Stimulation on Two Acupoints to Control Anxiety in Patients Receiving Prosthodontics Treatment&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>218</FirstPage><LastPage>223</LastPage><AuthorList><Author>Tanvi R. Balwani</Author><AuthorLanguage>English</AuthorLanguage><Author> Surekha Godbole Dubey</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Dental fear is the most common issue which is present in patients. Therefore managing anxiety has become a task to achieve successful treatment. Therefore, dental anxiety is linked with an undesirable effect on oral health. Objective: To evaluate the effect of microcurrent electrical stimulation on two Acupoints i.e yintang and shenmen points to control the level of anxiety amongst the patients. Material and Methods: A total number of 30 patients who scored more than 10 in the MDAS questionnaire were enrolled in the study. Before commencing prosthodontic treatment procedures pulse oximeter and MDAS was used to assess anxiety levels. After which acupuncture and acupressure therapy was performed on acupoints using the acupuncture meridian pen. Treatment procedures were carried out after the therapy. The pre-treatment and post-treatment values were compared. Results: Acupuncture and acupressure performed at yintang acupoint 8.62 &#xB1; 2.32 (mean&#xB1;SD) proved to be more effective compared to shenmen point 9.62&#xB1; 2.26 (mean&#xB1;SD). But when compared with the control group both the acupoints were effective in controlling anxiety levels. The decrease in anxiety levels was statistically significant(p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Acupuncture, Anxiety, Novel Technique, Acupressure</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Dental fear is the most common issue which is present in patients. Therefore managing anxiety has become a task to achieve successful treatment. Therefore, dental anxiety is linked with an undesirable effect on oral health.1,2 Here are the numerous treatment options that have come across for the treatment of dental anxiety. There is two treatment option which includes pharmacological and non-pharmacological methods. The use of Pharmacological methods although is effective but it also has its side effects. Due to which there is high demand for non-pharmacological techniques.1One of the recent technique for the management of anxiety disorders is the use of acupuncture and acupressure.&#xD;
&#xD;
In the dental field, a study on adult populations reported a reduction in anxiety after acupuncture; another study proved this procedure to be as in effect as intranasal midazolam in decreasing anxiety in dental patients.2, 3The constant need to incorporate alternative techniques into clinical dental practice led to the introduction of acupuncture, which is apart of ancient Chinese medicine. The technique is created upon the conception of Qi (whose pronunciation is &#x201C;chee&#x201D; meaning &#x201C;life force, energy flow&#x201D;), which states that most of the physical and emotional issues begin at a level of functions that is subtler than the chemistry of the brain and organ function. The specific locations where this Qi gathers are termed acupoints, into which needles are put in to achieve numerous effects.4 This procedure has proven its effectiveness in the management of insomnia, asthma, general anxiety, and anxiety disorders.5-9&#xD;
&#xD;
Acupuncture done by the traditional method using needles can be traumatic for the patients. So by using microcurrent electrical stimulation, acupressure and acupuncture&#xA0; works by stimulating (tonify or sedate) specific reflex points which are present along the lines of energy that run through the body, called Meridians.10,11,12&#xD;
&#xD;
This original research study aims to &#x201C;Evaluate the effect of microcurrent electrical stimulation on two Acupoints that is yintang and shenmen points to control the level of anxiety amongst the patients&#x201D;. In this original research study, a novel technique was used to control anxiety levels in patients receiving Prosthodontic treatment.&#xD;
&#xD;
METHODOLOGY&#xD;
&#xD;
Ethical clearance was obtained from the Ethics Committee of the university and performed at the Department of Prosthodontics And Crown &amp; Bridge Sawangi Meghe Wardha.(DMIMS(DU)/IEC/2018-19/7633) A total of 30 patients were selected from the age group (18-45years). They were planned for Prosthodontic treatment were performed. Patients were enrolled only after they gave written informed consent.&#xD;
&#xD;
The inclusion and exclusion criteria were as follows:&#xD;
&#xD;
&#xD;
	&#xD;
	Exclusion criteria included dental emergencies, &#x2018;those who have experienced acupuncture, &#x2018;language difficulties&#x2019;, &#x2018;history of drug abuse, &#x2018;chronic pain therapy&#x2019;, &#x2018;neurological or psychiatric disorders, &#x2018;malignomas&#x2019;, &#x2018;lesions at the external ear&#x2019;, &#x2018;immunosuppression&#x2019;, &#x2018;pregnancy&#x2019;, &#x2018;asthma and &#x2018;coagulation disorders&#x2019;.&#xD;
	&#xD;
	&#xD;
	Inclusion criteria were patients who fall under 10 to 25 score of modified dental anxiety scale, Patients who will give informed consent for the therapy, patients coming for prosthodontic treatment procedures, patients above the age of 18 years.&#xD;
	&#xD;
&#xD;
&#xD;
The patient was randomly divided into three groups 1, 2 and 3.Ten patients were present in each group. In all three groups, prosthodontics treatment procedures were done. Before and after which Patient was selected based on anxiety measuring scale and using a pulse oximeter, pulse rate, as well as oxygen saturation level, were evaluated before the patient underwent the therapy which was evaluated again after the therapy was done.&#xD;
&#xD;
Modified Dental Anxiety Scale (MDAS) was used to assess the anxiety levels. It has a score of 0-25(not anxious to extremely anxious). In which Patient&#x2019;s under fairly anxious to extremely anxious that is from score (10 to 25) anxiety scale were selected for the study. &#xD;
&#xD;
Group 1 received electrical pulses at yintang anxiolytic point as shown in figure 1 (located midway between the medial ends of the two eyebrows) using a laser acupuncture pen. This pen automatically searches the site, no piercing of the skin is done, it is safe and effective with no side effects. It has 9 intensity levels so a mild range level that is up to 3 intensity level was used in the patients.&#xD;
&#xD;
After this using Pulse oximeter, pulse rate and oxygen saturation levels were checked pre-treatment and post-treatment. Levels of pulse rate and oxygen saturation helped to evaluate whether there is a reduction in anxiety level amongst the patients.&#xD;
&#xD;
Group 2received microcurrent electrical pulses to stimulate anxiolytic points the auricular Shen Men point as shown in figure 2(located at lateral third of the triangular fossa, in the bifurcating point between superior and inferior crura of antihelix)&#xD;
&#xD;
Group 3 was the placebo group, received microcurrent electrical pulses on point not documented to reduce anxiety (located on the forehead above the eyebrows 3 cuns aways from yintang point). The placebo point was selected different from yintang point and Shenzen points to check the efficacy of microcurrent stimulation using a laser acupuncture pen on a point that is different from an acupuncture point which does not have any anti-anxiety effect.&#xD;
&#xD;
For all the patients in treatment groups, a self-report measure of anxiety (MDAS) was recorded 40 minutes before starting the treatment.1&#xD;
&#xD;
Those receiving microcurrent electrical stimulation at the selected acupoints were held passively every 3 minutes for approximately 10 minutes.1&#xD;
&#xD;
After completion of the intended treatment, Modified Dental Anxiety Scale (MDAS) scores were recorded again.&#xD;
&#xD;
All the variations in the pulse rate, beginning with 40 minutes before starting the treatment to 15 minutes post-treatment, were recorded.1&#xD;
&#xD;
With the help of an anxiety measuring scale before and after values were compared. Based on which it was concluded that microcurrent electrical stimulation is effective in reducing Anxiety.&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0;&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Statistical analysis was done by using descriptive and inferential statistics using one way ANOVA and Multiple comparisons: Tukey test and software used in the analysis was SPSS 22.0 version and p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3935</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3935</Fulltext></URLs><References>&#xD;
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	Avisa P, Kamatham R, Vanjari K, Nuvvula S. Effectiveness of acupressure on dental anxiety in children. Pediatric Dent. 2018 May 15;40(3):177-83.&#xD;
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	Gondivkar SM, Bhowate RR, Gadbail AR, Gondivkar RS, Sarode SC, Sarode GS, Patil S. Impact of oral submucous fibrosis on oral health?related quality of life: A condition?specific OHRQ oL?OSF instrument analysis. Oral Dis. 2018 Nov;24(8):1442-8.&#xD;
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	Karst M, Winterhalter M, M&#xFC;nte S, Francki B, Hondronikos A, Eckardt A, Hoy L, Buhck H, Bernateck M, Fink M. Auricular acupuncture for dental anxiety: a randomized controlled trial. Anesth Analg. 2007 Feb 1;104(2):295-300.&#xD;
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	Rosted P, Bundgaard M, Gordon S, Pedersen AM. Acupuncture in the management of anxiety related to dental treatment: a case series. Acupunc&#xA0; Med. 2010 Mar;28(1):3-5.&#xD;
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	Ramey D, Buell PD. A true history of acupuncture: Focus on Alternative and Complementary Therapies. Acupunc&#xA0; Med. 2004 Dec;9(4):269-73.&#xD;
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	Spence DW, Kayumov L, Chen A, Lowe A, Jain U, Katzman MA, Shen J, Perelman B, Shapiro CM. Acupuncture increases nocturnal melatonin secretion and reduces insomnia and anxiety: a preliminary report.&#xA0; J Neuropsy Clin Neurosci. 2004 Feb;16(1):19-28.&#xD;
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	Liu CF, Chien LW. Efficacy of acupuncture in children with asthma: a systematic review. Ital J Ped. 2015 Dec 1;41(1):48.&#xD;
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	Pilkington K, Kirkwood G, Rampes H, Cummings M, Richardson J. Acupuncture for anxiety and anxiety disorders&#x2013;a systematic literature review. Acup Med.. 2007 Jun;25(1-2):1-0.&#xD;
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	Wang SM, Kain ZN. Auricular acupuncture: a potential treatment for anxiety. Anesth Analg. 2001 Feb 1;92(2):548-53.&#xD;
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	Bussell J. Acupuncture and anxiety 2013: the year in (literature) review. OA Altern Med. 2014;2(1):3.&#xD;
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	Errington?Evans N. Acupuncture for anxiety. CNS Neurosci Therap. 2012 Apr;18(4):277-84.&#xD;
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	Raghavan R, Sathish S. Acupuncture in prosthodontics: Review. J Guid. 2016 Feb 1;9(3).&#xD;
	&#xD;
	&#xD;
	Carvalho F, Weires K, Ebling M, de Souza Rabbo Padilha M, Ferr&#xE3;o YA, Vercelino R. Effects of acupuncture on the symptoms of anxiety and depression caused by the premenstrual dysphoric disorder. Acup Med. 2013 Dec;31(4):358-63.&#xD;
	&#xD;
	&#xD;
	Singla D, Anand A, Dharma P, Sharma A.Evaluation Of Pulse Rate And Arterial Oxygen Saturation (Sa02) Levels In Children During Routine Dental Procedures. J Den Spe. 2013 Sept;1(2):27-34&#xD;
	&#xD;
	&#xD;
	Khanam N, Wagh V, Gaidhane AM, Quazi SZ. Assessment of work-related musculoskeletal morbidity, perceived causes and preventive activities practised reducing morbidity among brickfield workers. Ind J Comm Health. 2019 Apr 1;31(2).&#xD;
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	&#xD;
	Khandelwal V, Gupta N, Nayak UA, Kulshreshtha N, Baliga S. Knowledge of hepatitis B virus infection and its control practices among dental students in an Indian city. Int J Adolesc Med Hea. 2017 Aug 18;30(5).&#xD;
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	&#xD;
	Tripathi A, Avasthi A, Grover S, Sharma E, Lakdawala B.M, Thirunavukarasu M, Dan A. Gender Differences in Obsessive-Compulsive Disorder: Findings from a Multicentric Study from Northern India. Asi J Psych.2018:37:3&#x2013;9. &#xD;
	&#xD;
&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Evaluate the Effect of Tapered Canal Preparation on the Retention of Posts Cemented with Resin Cement - An in vitro Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>224</FirstPage><LastPage>229</LastPage><AuthorList><Author>Tarun Kumar Singh</Author><AuthorLanguage>English</AuthorLanguage><Author> Govind Lal Meena</Author><AuthorLanguage>English</AuthorLanguage><Author> Amit Chhaparwal</Author><AuthorLanguage>English</AuthorLanguage><Author> Manish Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author>  Prashant Jadhav</Author><AuthorLanguage>English</AuthorLanguage><Author> Ranjan Mani Tripathi</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: In endodontically treated teeth with less remaining tooth structure posts are inserted to provide stability and retention for a core. The posts retention is dependent on various factors related to post like- cement post and cement dentine interaction, type of luting cement, and taper of the post. Aim: This in-vitro study aimed to evaluate the effect of endodontic taper on post retention using parallel-sided prefabricated posts luted with dual-cure resin cement. Methodology: Sixty freshly extracted human maxillary central incisors of approximately the same sizes were selected for this study. The Crown of these teeth was separated at the cementoenamel junction and divided randomly into six groups of ten teeth each. Biomechanical preparation was carried out using different tapered Ni-Ti file systems ranged as 0.02, 004, 0.06, 0.08, 0.10, and0.12 taper. Root canal obturation was done with gutta-percha using the lateral condensation method. Results: Taper 0.02 represents the taper size where a smaller average force was required to remove the post from the root canal. The average force required to remove the post from the root in taper group 0.02 was statistically different from all other taper sizes. Taper size 0.04 required highest average force to remove the post. Average force for size 0.04 was statistically different from the taper size 0.02, 0.06, 0.08, 0.10, 0.12 tapers. Conclusion: The result of the present study indicates that increasing taper of root canal adversely affect the post retention. The findings of this study indicate that instrument taper size preparation of the canal makes a difference to resistance to post dislodgement.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Post Retention, Prefabricated Post, Polymerization shrinkage, Resin Cement, Fracture, C-Factor</Keywords><Fulltext>&#xD;
Introduction:&#xD;
&#xD;
Endodontics has become an increasingly routine facet of patient care in general dental practice. Success in endodontic treatment depends almost completely on how well the root canal is shaped and cleaned. Principles of root canal preparation are to remove all organic debris and microorganism from the root canal system and shape the walls of the root canal to facilitate cleaning and subsequent obturation of entire root canalsystem.1&#xD;
&#xD;
Parallel sided posts are more retentive than tapered post and serrated or grooved posts are more retentive than smooth posts. Cement thickness is a very important factor as parallel sided post relies on even thickness of cement throughout the length of the post to overcome the inherent weaknesses of the cementing medium. With greater taper file systems root canal walls are prepared to divergent. Parallel sided post placement in a highly divergent canals lead to uneven thickness of luting cement throughout the post length. Thus highly tapered root canal preparation may have an adverse effect on postretention.2&#xD;
&#xD;
The purpose of this study was to evaluate the effect of tapered canal preparation on the retention of posts cemented with resin cement. Retention of post in canal prepared using 0.04 to 0.12 taper instruments were compared for retention against canal preparation using the traditional 0.02 taper instrument as a positive control. Sixty human maxillary central incisors were used and divided into six groups with different tapered root canal preparation. Prefabricated parallel sided grooved posts were cemented in prepared post channels with resin cement. Retention of these posts was checked using tensile testing machine. Hypothesis was that an increase in the taper of root canal results in a lowering of post retention.&#xD;
&#xD;
&#xD;
Material and Methods:&#xD;
&#xD;
Sixty Caries free, unrestored human maxillary central incisors recently extracted for periodontal reason were used for this study. Storage, handling, and Sterilization of extracted teeth were used in this study followed the occupational safety and health administration and the Centre for the Disease Control guidelines.&#xD;
&#xD;
Selection, preparation and storage of specimens-&#xD;
&#xD;
All teeth were approximately of similar size and free of caries. Care was taken to select teeth to obtain 12 to 13 mm root length after crown removal at Cemento- Enamel Junction (CEJ). All teeth were free of open apices, fracture lines, resorptive areas.&#xD;
&#xD;
Clinical crowns of teeth were removed at CEJ using high speed air- rotor hand piece and diamond taper fissure burs. Teeth were observed at cross sectional view of root canal at CEJ and selected according to the internal diameter of uninstrumented root canal so that the intracanal variation can be minimized.&#xD;
&#xD;
Now total 60 teeth were selected and randomly divided into six groups consisted 10 teeth in each group.&#xD;
&#xD;
Instrumentation of root canal-&#xD;
&#xD;
After removal of the pulp tissue remnants by barbed broach, # 10 K-file was inserted into each root canal until it could be seen through the apical foramen. The working length was established by reducing this length by 0.5mm.&#xD;
&#xD;
Group I- (Taper 0.02 Group) /control group&#xD;
&#xD;
10 teeth in this group were prepared with hand Ni-Ti files (Dentsply/ Tulsa Dental), using RC Help (EDTA Gel) for lubrication and 2.5% NaOCl for irrigation. Teeth were instrumented using step back technique upto apical size # 30 and upto # 60 coronally according to the technique proposed by Walton.&#xD;
&#xD;
Group II- (Taper 0.04 Group)&#xD;
&#xD;
10 teeth in this group were prepared using 0.04 taper rotary Profile Ni- Ti files (Dentsply/ Tulsa dental)by using Crown down preparation using RC Help and 2.5% NaOCl solution. Files were used in contra angle Gear Reduction handpiece (Tecnika, Dentsply/Maillefer) and torque control motor.&#xD;
&#xD;
Group III- (Taper 0.06 Group) &#xD;
&#xD;
10 teeth were prepared using 0.06 taper rotary Profile Ni-Ti files (Dentsply/ Tulsa Dental), in crown down manner in gear reduction handpiece with RC Help and 2.5% NaOCl solution.&#xD;
&#xD;
Group IV- (Taper 0.08 Group) &#xD;
&#xD;
10 teeth were prepared using 0.08 taper rotary NRT files (Mani/Prime dental products), in crown down manner in gear reduction handpiece with RC Help and 2.5% NaOCl solution.&#xD;
&#xD;
Group V- (Taper 0.10 Group) &#xD;
&#xD;
10 teeth were prepared using 0.10 taper rotary NRT files (Mani/ Prime dental products), in crown down manner in gear reduction handpiece with RC Help and 2.5% NaOCl solution.&#xD;
&#xD;
Group VI- (Taper 0.12 Group) &#xD;
&#xD;
10 teeth were prepared using 0.12 taper rotary NRT files (Mani/ Prime dental products), in crown down manner in gear reduction handpiece with RC Help and 2.5% NaOCl solution.&#xD;
&#xD;
All teeth were thoroughly irrigated with 10 ml of 2.5% NaOCl solution and dried with paper points.&#xD;
&#xD;
Obturation of teeth&#xD;
&#xD;
The root canals were dried thoroughly with appropriately sized paper points. All root canals were obturated with suitable gutta percha points and AH Plus Sealer. Sealer was mixed according to the manufacturer&#x2019;s directions and applied into the root canals with lentulospiral attached to a slow speed Micromotor handpiece. Roots were left undisturbed for 48 hours for thorough setting of sealer.&#xD;
&#xD;
Preparation of the post space&#xD;
&#xD;
All roots were marked at 8mm downward from the CEJ to produce a constant depth of post space preparation. It allowed about 3-5 mm gutta percha seal apically after post space preparation in the root canals. Gutta percha was removed by using heated pluggers. Then post channels were prepared using Peesoreamers. Size of final Peesoreamers was selected after evaluation of prepared root canal size. After post space preparation corresponding sized EG posts (Effective Groove post) were checked inside the prepared post space for closest fit and to assure 8 mm embedment depth and passivity of fit in to the post space.&#xD;
&#xD;
Cementation of posts-&#xD;
&#xD;
Step I- Etching&#xD;
&#xD;
&#xD;
	&#xD;
	37% phosphoric acid gel was applied to root canal for 30 seconds.&#xD;
	&#xD;
	&#xD;
	Canals were rinsed for 10 seconds with distilled water.&#xD;
	&#xD;
	&#xD;
	Root canals were dried with paper points.&#xD;
	&#xD;
&#xD;
&#xD;
Step II- Bonding&#xD;
&#xD;
&#xD;
	&#xD;
	Bonding agent was applied to the canals.&#xD;
	&#xD;
	&#xD;
	Excess was removed with dry paper points.&#xD;
	&#xD;
	&#xD;
	Dried for 5 seconds.&#xD;
	&#xD;
	&#xD;
	Light curing was carried out for 10 seconds.&#xD;
	&#xD;
&#xD;
&#xD;
Step III- Cementation&#xD;
&#xD;
&#xD;
	&#xD;
	3M RelyX ARC was dispensed on the mixing pad, mixed for 10 seconds and applied to root canal walls with lentulospiral.&#xD;
	&#xD;
	&#xD;
	A thin layer of cement was placed on the posts and posts were seated slowly in the prepared post channels and held vertically by exerting slight pressure at the post head.&#xD;
	&#xD;
	&#xD;
	Excess cement was removed and light curing of cement was carried out for 40 seconds from occlusal direction.&#xD;
	&#xD;
&#xD;
&#xD;
Preparation for testing-&#xD;
&#xD;
Roots of all teeth were embedded in acrylic resin blocks, parallel to the long axis of the root. Then they were stored in saline solution until tensile testing. All the specimens of six groups were subjected to Scientific Tensile Testing Machine at the crosshead speed of 2 inch/min. the load was gradually increased and the tensile force required to initially break the cement bond and partially or totally remove the post was recorded.&#xD;
&#xD;
Observations:&#xD;
&#xD;
In this study, influence of tapered canal preparations on post retention was evaluated using Scientific tensile testing machine.This study was conducted in vitro using 60 extracted human maxillary central incisors. Six groups were created and ranged as 0.02, 0.04, 0.06, 0.08, 0.10, and 0.12. Each group comprises of ten teeth.&#xD;
&#xD;
The required force to dislodge posts from the specimens were recorded in kilograms and summarized in (Table-1) (Graph1&amp;2). Following observation was made with each experimental group-&#xD;
&#xD;
GROUP I (Control group)/ 0.02 taper Group-&#xD;
&#xD;
Mean force required to dislodge posts was 8.53 Kg. Minimum value of force required was 7.23 Kg and maximum value of force was 9.58 Kg.&#xD;
&#xD;
GROUP II / 0.04 taper Group-&#xD;
&#xD;
Mean force required to dislodge posts was 23.25 Kg. Minimum value of force required was 21.91 Kg and maximum value of force was 24.97 Kg.&#xD;
&#xD;
GROUP III /0.06 taper Group-&#xD;
&#xD;
Mean force required to dislodge posts was 19.21 Kg. Minimum value of force required was 18.24 Kg and maximum value of force was 20.89 Kg.&#xD;
&#xD;
GROUP IV /0.08 Taper Group-&#xD;
&#xD;
Mean force required to dislodge posts was 19.10 Kg. Minimum value of force required was 17.84 Kg and maximum value of force was 20.59 Kg.&#xD;
&#xD;
GROUP V / 0.10 Taper Group-&#xD;
&#xD;
Mean force required to dislodge posts was 16.38 Kg. Minimum value of force required was 15.18 Kg and maximum value of force was 17.33 Kg.&#xD;
&#xD;
GROUP VI / 0.12 Taper Group-&#xD;
&#xD;
Mean force required to dislodge posts was 14.76 Kg. Minimum value of force required was 14.07 Kg and maximum value of force was 15.59 Kg.&#xD;
&#xD;
Dislodged posts were observed after tensile testing for failure mode. In all groups failure was noted at the resin cement-dentin interface i.e. adhesive failure. Most of the resin was adhered to the post with little remaining on root canal. No root fracture was noted in any group. Thus failure noted was due to the loosening of posts in all groups with increasing tensile forces.&#xD;
&#xD;
Statistical analysis-&#xD;
&#xD;
Statistical analysis was conducted by using one-way ANOVA test. Results are summarized in table. One-way ANOVA indicated very highly significant difference between means of all groups, i.e. p = 0.0000 (p &lt; 0.0001). (Table 2) (Graph 3)&#xD;
&#xD;
Tukey HSD (Honestly significant test) test was conducted to find out homogeneity between groups. Only 0.06 and 0.08 taper groups were found homogenous. (Table 3) (Graph 4)&#xD;
&#xD;
Results-&#xD;
&#xD;
Taper 0.02 represents the taper size where smaller average force was required to remove the post from the root canal. Average force required to remove the post from the root in taper group 0.02 was statistically different from all other taper sizes.&#xD;
&#xD;
Taper size 0.04 required highest average force to remove the post. Average force for size 0.04 was statistically different from the taper size 0.02, 0.06, 0.08, 0.10, 0.12 tapers. All taper sizes were different from each other except 0.06 and 0.08 taper sizes were found homogenous as per Tukey HSD test.&#xD;
&#xD;
Discussion:&#xD;
&#xD;
In this study six groups of ten teeth each were prepared with tapers of 0.02, 0.04, 0.06, 0.08, 0.10, 0.12 and parallel sided grooved posts were cemented in prepared post space with the help of dual cure resin cement.3,4,5,6 Resin based AH plus sealer is used as eugenol based sealers are reported to inhibit polymerization of the composite resin.&#xD;
&#xD;
Depth of the post preparation was 8 mm in all teeth to produce a constant post embedment depth. Dentin smear layer produced during endodontic procedure is removed during etch and rinse process. Infiltration of exposed collagen fibrils network with resin permits the formation of resin dentin interdiffusion zone with resin tags and adhesive lateral branches, thus creating the micromechanical retention of the resin to the demineralized substrates. Post cementation was carried out using dual cure resin luting cement (Rely X ARC, 3M, ESPE). Composite material is suggested as a luting agent for endodontic posts because it allows latitude of 500&#xB5; during the adaptation of root canal.7 Advantage of dual cure cement is in areas deep inside the post space which are not accessible to light curing, thus requiring chemical cure.8,16&#xD;
&#xD;
All specimens were subjected to tensile force using Scientific Tensile testing Machine after embedding in acrylic blocks. Increasing tensile force was applied at constant speed until post dislodgement occurs. Forces are recorded in kilograms.&#xD;
&#xD;
All failures were noted at the cement-dentin interface which is usually noted with post luted with resin luting cement. Bonding of resin cements is mainly impaired by unfavorable root canal configuration, related to a high C- factor (cavity configuration factor), which may be up to 40 times higher compared to direct intracoronal restorations with similar cement thickness.9 The C-factor indicate the ratio between the bonded and non-bonded surface areas. It allows resin flow with consequent reduction in polymerization shrinkage stress.10,11,12 With the reduced non-bonded area inside the root canals, reduces stress is not enough and polymerization shrinkage is higher than the bond strength, give rise to the formation of voids at the cement-dentin interface.13, 14,15.&#xD;
&#xD;
This in-vitro study has limitations as the tests were carried out in uniradicular teeth with specific dimensions and post preparations, under static tensile loading. Diverse retention values in the present study may be attributed.&#xD;
&#xD;
- Various quantities of dentin particles in the prepared canal after cleaning and in smeared layers.&#xD;
&#xD;
&#xD;
	&#xD;
	&#xD;
		&#xD;
		Absence of control to ensure the identical position of all posts in the channel center for uniform width of the cement layer surrounding the posts.&#xD;
		&#xD;
		&#xD;
		Differences in the dentin of teeth resulting from moisture content, pulpal condition at the time of extraction, age of patient, and direction of dentin tubules.&#xD;
		&#xD;
		&#xD;
		Inconsistent and unpredictable cementing pressure during the setting process.&#xD;
		&#xD;
		&#xD;
		Another factor of importance to consider is the shape of the root canal. Since root canals are seldom entirely conical, there will likely be uneven film thickness and possible voids.&#xD;
		&#xD;
	&#xD;
	&#xD;
&#xD;
&#xD;
Conclusion:&#xD;
&#xD;
The result of the present study indicates that increasing taper of root canal adversely affect the post retention. The findings of this study indicate that instrument taper size preparation of the canal makes a difference to resistance to post dislodgement. Therefore it seems that the taper size is important in restoration of endodontically treated teeth. More studies are needed to see how taper preparation size affects the strength of the remaining root structure.&#xD;
&#xD;
Acknowledgement: Authors acknowledge the enormous help received from the authors whose articles are cited and included in references to the manuscript.&#xD;
&#xD;
Conflict of interest: Nil&#xD;
&#xD;
Financial support: Nil&#xD;
&#xD;
Ethical Clearance: Not required (In-Vitro study)&#xD;
&#xD;
Patient consent: Not required (In-Vitro study)&#xD;
&#xD;
Individual Author&#x2019;s contribution: All authors have equally contributed in the writing and formatting of manuscript of this article.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3936</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3936</Fulltext></URLs><References>1. Hunter A.J, Feiglin, Williums. J. F. Effects of post placement on endodontically treated teeth. J&#xA0;Prosthet Dent. 3013 Aug; 62(2):166-72.&#xA0;&#xD;
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2. Buchanan LS. The standardized taper root canal preparation &#x2013; Part-1. Concepts for variably tapered shaping instruments. Int Endod J. 2000 Nov; 33(6):516-29.&#xD;
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3. Fernandes A., Rodrigues S., Sardesai G &amp; Mehta. Retention of endodontic post- A Review. Endodontology 2001; 13:11-18.&#xD;
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4. Bonfante G, Kaizer OB, Luiz Fernando Pegoraro Acc&#xE1;cio Lins do Valle. Tensile bond strength of glass fiber posts luted with different cements. Braz Oral Res 2007;21(2):159-64.&#xD;
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5. Ferrari M, Vichi, Grandini, Goracci. Efficacy of a self-curing adhesive resin cement system on luting glass fiber posts into root canals: an SEM investigation. Int J Prosthodont 2001;14:543&#x2013;549.&#xD;
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6. Purton DG, Love RM. Rigidity and retention of carbon fiber versus stainless steel root canal posts. Int. Endod. J. 1996; 29: 262-5.&#xD;
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7. Mark S. Hagge, Ralan D. M. Wong, James S.&#xA0; Lindemuth. Composite cement thickness on retention of a prefabricated dowel. J&#xA0;Prosthodont. 2002 Mar; 11(1):19-24.&#xA0;&#xD;
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8. Schwartz RS, Robbins JW. Post placement and restoration of endodontically treated teeth: A literature review. J Endod 2004; 30:289?301.&#xD;
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9. Zandbiglari T, David H, Schafer E. Influence of instrument taper on the resistance to fracture of endodontically treated roots, Oral Surg Oral Med Oral Pathol Oral Radiol, Endod 2006; 101:126-31).&#xD;
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10. Richard S. Schwartz, James W. Robbins- Post placement and restoration of endodontically treated teeth: A Literature Review. J&#xA0;Endod.&#xA0;2004&#xA0;May; 30(5):289-301.&#xD;
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11. Stegaroiu, Yamada. Retention and failure mode after cyclic loading in two post &amp; core system. J Prosthodont. 2006 May-Jun;15(3):172-9.&#xD;
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12. Dominici JT, Eleazer PD, Clark SJ, Staat RH, Scheetz JP. Disinfection/ sterilization of extracted teeth for dental student use. J Dent Educ 2001; 65:1278?80.&#xD;
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13. Anderson GC, Perdigao J, Hodges JS, Bowles WS, Effeciency and effectiveness of fiberpost removal using three techniques. Quintessence Int. 2007; 38: 663-70.&#xD;
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14. Rundquist BD, Versluis A. How does canal taper affect root stresses? Int Endod J. 2006;39(4):226&#x2013;237&#xD;
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15. Thompson SA. An overview of Nickel Titanium alloys used in dentistry. Int Endod J.&#xA0;2000 Jul;33(4):297-310.&#xD;
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16. Ashok NG, Sangeetha S. Evaluation of post-operative complaints in fixed partial denture wearers and thoses with crowns: A questionnaire based study. Int J Cur Res Rev. 2016; 16(8):30-34.&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>&#xD;
	A Comparative Analysis of the Study Patterns of Day Scholar Versus Hostler Nursing Students&#xD;
&#xD;
&#xD;
&#xD;
	&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
	&#xA0;&#xD;
&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>230</FirstPage><LastPage>235</LastPage><AuthorList><Author>Manda Jaywant Phuke</Author><AuthorLanguage>English</AuthorLanguage><Author> Vaishali Mohite</Author><AuthorLanguage>English</AuthorLanguage><Author> Mahadeo Shinde</Author><AuthorLanguage>English</AuthorLanguage><Author> Rajashree Karale</Author><AuthorLanguage>English</AuthorLanguage><Author> Anagha Katti</Author><AuthorLanguage>English</AuthorLanguage><Author> Afsana Mulani</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>&#xD;
	Introduction: &#x201D;Education is the greatest treasure&#x201D; Education leads to success. Students must acquire effective study habits to improve their academic success. Step-by-step, study habits can be modified. This is why researchers want to compare hostler and day scholar study patterns. Aims: (1) To assess study habits of hostler and day scholar students, (2) To compare the study habits, time Budgeting, Concentration, Memory, Note Taking ability, factors in learning Motivation, Achievement in the examinations, Test Preparation And Test Taking, Test Anxiety Management as a dimension of study habit between hostler and day scholar students. Methods: A descriptive survey of 418 undergraduate and postgraduate students, including 205 hostler and 213-day scholars. Result: Delmar .edu/student life/tutoring uses the SHI. Out of 418 respondents, more B.Sc. nursing students responded than P.B. and M.Sc. nursing students. 64.6% of respondents have fair study habits, 28.95% have good, 5.98% have poor, and 0.48% have exceptional. Conclusion: Hostler and day scholar students had different study habits in every other areas except test preparation, test taking, and note taking. Study habit is a student&#x2019;s predisposition to study, whether it&#x2019;s systematic or unsystematic, efficient or inefficient, and suggests a persistent method of learning. Various students have different study habits, but student success depends on appropriate study habits. To improve study habits, be conscious of your own.&#xD;
&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Education, Students, Hostler, Nursing, Predisposition, Learners</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4636</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4636</Fulltext></URLs><References>&#xD;
	1. Angelica Mae V, Alcantara Allen Nicole P, Angat Ralph Anthony I, Angeles., Assessment Of The Study Skills Of 1st Year And 2nd Year Computer Engineering Students Of Polytechnic University Of The Philippines Institute Of Technology(march 2014 ) &#xD;
&#xD;
&#xD;
&#xD;
	2. Khurshid F, Relationship between Study Habits and Academic Achievement among Hostel Living and Day Scholars&#x2019; University Students. Int J Humanit Soc. Sci..2012, Vol. 3 (2) &#xD;
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&#xD;
&#xD;
	3. Bhat Y. I, Khandai H, Academic Achievements and Study Habits of College Students of District Pulwama, J Educ Pract Vol.6, No.31, 2015, pp-1-6. &#xD;
&#xD;
&#xD;
&#xD;
	4. Meyers&#x2019;, &#x201C;Learning Styles and Study Habits: Teaching Students to Take Control of their Own Learning&#x201D;. 5. Kumar S, &#x201C;Study Habits Of Undergraduate Students&#x201D; Int. J. Educ. Inf. Stud. ISSN 2277-3169 Volume &#xD;
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&#xD;
	5, Number 1 (2015), pp. 17-24 &#xA9; Research India Publications http://www.publication.com &#xD;
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&#xD;
&#xD;
	6. Pathak R,&#x201D; Study Habits of Hostler and Day Scholar Students: A Comparative Study&#x201D; Indian J. Appl. Res. volume : 6 | Issue : 1 | January 2016 | ISSN - 2249-555 p- 400-402.&#xD;
&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>14</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>&#xD;
	Self-Information Module on Psychotropic Drug Management Among Mentally Ill Patients Attending Psychiatric OPD&#xD;
&#xD;
&#xD;
&#xD;
	&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
	&#xA0;&#xD;
&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>236</FirstPage><LastPage>241</LastPage><AuthorList><Author>Prabhuswami Hiremath</Author><AuthorLanguage>English</AuthorLanguage><Author> Sangeeta Patil</Author><AuthorLanguage>English</AuthorLanguage><Author> Mahadeo Shinde</Author><AuthorLanguage>English</AuthorLanguage><Author> Dhananjay Kamble</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>&#xD;
	Introduction: Psychiatric drugs, which are also used to treat mental problems, are given to a significant number of patients in today&#x2019;s society. Many persons who have been diagnosed with psychiatric problems are now able to lead happy lives as a direct result of the use of psychiatric drugs. Aims: The purpose of this study was to evaluate the effectiveness of a self-information module on the management of psychotropic medicines for carers of mentally ill patients who were attending the psychiatric outpatient department at Krishna Hospital. evaluation of the knowledge of psychotropic drug use among caretakers of psychiatric patients is the purpose of this study, in order to determine the usefulness of the information module. to establish a connection between the findings and a range of relevant demographic data. Methodology: Consisted of using an evaluating strategy in conjunction with a one-group pre-test post-test pre experimental design. The mental outpatient department of Krishna Hospital in Karad served as the site of the study. The population of this study is comprised of all of the carers of psychiatric patients who visited the psychiatric outpatient department (OPD). The sample included sixty caretakers of patients who were being treated with antipsychotic medications. A technique known as non probability sampling is one in which the sample is collected by the use of a method that does not provide every individual in the population with an equal chance of being selected. The goals of the study served as the foundation for the development of the instrument. Result: The findings showed that 50 (83.33%) of the samples had an average level of expertise regarding the administration of psychotropic medicines. The results show that the 10 (16.66%) samples had inadequate understanding on the administration of psychiatric drugs. The table reveals that not a single sample achieved a perfect score of 0 (100%) on the pre-test. In the post-test, 54 (90%) of the samples have good knowledge regarding the management of psychotropic drugs, 5 (8.33%) of the samples have average knowledge regarding the management of psychotropic drugs, and only 1 (1.66%) of the samples have poor knowledge regarding the management of psychotropic drugs. The knowledge scores regarding the management of psychotropic medicines prior to and after undergoing the self-information module of 60 observations had a mean of 13.15 before the test and 23.45 after the test. Before the test, the standard deviation was 2.7558, and after the test, it was 2.9968. The null hypothesis is rejected since the computed result for the t-test statistical test is 57.592, and the p-value for the test is less than 0.05, hence the test rejects the null hypothesis. Conclusion: It has been demonstrated that the self-information module is an effective way for increasing the level of knowledge that carers have on the administration of psychiatric drugs.&#xD;
&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords></Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4637</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4637</Fulltext></URLs><References>&#xD;
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	2. Townsend MC. Essentials of psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis; 2013 Aug 16. &#xD;
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	3. Backus VP. Practical Management of the Side Effects of Psychotropic Drugs&#x2022; Managing Side Effects of Psychotropic Drugs: A Clinical Handbook for Health Care Professionals. Psychiatric Services. 2000 Jan;51(1):124-5. &#xD;
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	6. Sharma DK, Vyas H, Doss K. A Study to Assess the Effectiveness of Informational Booklet (IB) for Caregivers Regarding the Care of Patients Receiving Antipsychotic Drugs at Selected Hospital of Gwalior. Int. J. Nurs. Educ. 2016;4(1):79-80. &#xD;
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	9. Rani VU, Heema MB, Kiranmayi K. Knowledge of caregivers of mentally ill patients on psychotropic drugs and various therapies in selected hospitals with a view to develop self instructional module. Indian J Psychiatry. 2018 Feb 1;15(2):24.&#xD;
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	10. Rani VU, Heema MB, Kiranmayi K. Knowledge of caregivers of mentally ill patients on psychotropic drugs and various therapies in selected hospitals with a view to develop self-instructional module.Indian J Psychiatry.&#xD;
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