Aim: Comparison of the effect of QMix, 7% maleic acid and 2.5% sodium hypochlorite on the accuracy of Root ZX II and Root ZX Mini apex locator. Methodology: 45 single rooted teeth were decoronated. Patency was checked and coronal flaring was done. They were then divided into 3 groups: i) QMix, ii) 7% Maleic acid and iii) 2.5% Sodium hypochlorite. The actual length of each tooth was determined before embedding them in an alginate model. 5ml of the respective irrigant was introduced into the canal. Working length was measured with Root ZX and Root ZX Mini apex locators. For each sample, an average of a total of three readings was considered. Statistical analysis was performed using Anova, Two Way, Post hoc, Paired t-tests. Results: Group I (QMix) showed no statistically significant results. Group II (7% Maleic acid), showed statistically significant difference from the actual length with Root ZX Mini (p=0.002). Group III (2.5% sodium hypochlorite) showed statistically significant difference from the actual length with Root ZX II (p=0.04) and Root ZX Mini (p=0.0002). A statistically significant difference was seen in the readings by both the apex locators (p=0.005). Conclusion: QMix does not affect the accuracy of apex locators. Root ZX II is more accurate than Root ZX Mini in the presence of 7% maleic acid and 2.5% sodium hypochlorite.

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The health care industry is currently undergoing a massive and irreversible transformation and change. Time is approaching when telemedicine/e-health initially shall be visibly practiced in majority of the Indian hospitals as a separate department before eventually fusing into respective medical specialties in spite its slow growth in India. This review appraises current scenario of telemedicine and telehealth in India. Official documents belonging to the Health ministry and finally related literature were examined. Telemedicine can enhance basic/specialty healthcare for India’s population which is predominantly rural. Indian Medical Personals, by large are not computer savvy’s, virtually lack awareness and exposure with regard to the application of information and communication technology in Medicine. These are foremost bottlenecks to the growth of Telemedicine in India. The present study outlines telemedicine strong and weak points. Undoubtedly, the advantages outweigh its disadvantages, but just like any other innovations, it has some drawbacks.

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Background: Muscular flexibility is an essential aspect of normal human function. Flexibility can be gained by a variety of stretching techniques and other techniques, yet little work has been performed to compare these techniques. The objective of this study was to compare the effectiveness of muscle energy technique (MET) and positional release technique (PRT) on hamstring flexibility in healthy individual participants. Methods: Twenty-four healthy participants who met the inclusion criteria were randomly divided into two equal groups. Two groups following a home-based 2 weeks' (five 10 min sessions per week) hamstring stretching protocol (stretching performed by MET or by PRT). The range of motion (ROM) of knee extension was measured before and after stretching program by means of active knee extension test and active straight leg raise using universal goniometer. Results: There was a significant improvement in hamstring flexibility following the application of MET and PRT. However, increase in knee extension ROM was higher in MET compared to PRT. The change in the flexibility from the value at initial evaluation to after 2 weeks' intervention was also higher in the MET. Conclusion: The findings suggest that the MET is more effective than PRT for healthy individuals with normal and limited hamstring flexibility.

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Surgical resection of mandible has to be done to treat various odontogenic epithelial tumours. Prosthodontic rehabilitation of the hemimandibulectomy patients with functional & aesthetic acceptance by the patient is the most difficult task. Guide flange appliance is given to correct deviation as well as permitting function of mastication & speech. Thus here two different case reports are discussed with removable & fixed guide flange appliances.

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Introduction: Assisted body mechanics is used to describe the movement we make each day during normal activities, including lying in bed, sitting, standing, lifting, pulling, pushing and walking. Body mechanics can be both good and bad and can have direct effects on back. Good body mechanics will help remedy and prevent future back problem, while bad body mechanics contribute to back problem and other muscle and bone problems. Nursing is a job that needs a lot of bending our back, arms and legs and pushing, pulling patients, because of which many nurses are at risk for developing physical strains and back injuries or even fractures. Aim: The main aim of the study was to assess the knowledge and practice of internship students regarding assisted body mechanics to reduce the musculoskeletal disorders with a view to develop safety guideline on manual handling technique. Methodology: A descriptive approach was used to collect data from 100 internship nursing students using self administered knowledge questionnaire and practice checklist at Sumandeep Nursing College. Result: The study result shows that 85% of internship students had average knowledge regarding assisted body mechanics, 84 % were practicing good body mechanics technique, 14% had fair practice, and 2% had poor practice of body mechanics.

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Introduction: Synthetic indicators had continuously been the first choice for all types of acid-base titrations since long time. However, due to certain disadvantages like high cost, availability problems and environmental pollution, an attempt is required to replace synthetic indicators with natural indicators. Methods: Methanolic extract of Euphorbia milii flowers from family Euphorbiaceae were evaluated in different types of titrations like strong acid (SA) v/s strong base (SB), weak base (WB) v/s strong acid (SA), and weak acid (WA) v/s strong base (SB). Results: Natural indicators gives sharp and intense colour change at the neutralization point and shows promising results when tested against available synthetic acid-base indicators such as methyl orange and phenolphthalein. Conclusion: This natural indicators could be an excellent replacement for synthetic indicators since they are economical, easily available, non-toxic, easy to extract, ecofriendly and accurate in all types of acid-base titrations.

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Background: Dermatophytosis is a type of superficial fungal infection which is a cause of significant morbidity especially in the Indian subcontinent. One of the major causes of the rising trend in the incidence of dermatophytosis is the unwarranted use of steroids in the management of fungal infection. Methods: A cross sectional study of dermatophytic fungal infections was carried out with research question of ‘Is steroid formulation abused in dermatophytic infections? What are their effects and side effects?’ All patients of dermatophytic infection were primarily selected over period of six months of which patients who had history or findings of some form of steroid use were further analyzed. Quantitative and qualitative data were collected in regards to steroid formulations about type, duration of use, route of administration and their availability by prescription or “over the counter”. Dermatological signs of steroid use were noted. Results: Of total 180 patients of dermatophytosis, 72 patients (40%) had used steroid formulations either topical (52), intralesional (9) or injectable (11) and 108 did not. Most patients (50 of 72) (69%) were from rural background and had long mean duration of illness (24 ± 3 weeks). Multiple site infection of dermatophytosis was present in 60 of 72 (83%) and in 51of 108 (47.22%) in steroid misuse and in non-steroid use patient group respectively. Cutaneous adverse effects were common in steroid modified dermatophysis patients. Unauthorized use of steroid was in form of self application, over the counter availability, use of steroid preparation of relatives and others. Conclusions: Misuse of steroid formulations in dermatophytic infections may lead to adverse effect as well as chronicity. Awareness of this problem is needed for prevention of steroid modified dermatophytosis, which is a rising menace.

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Sexual and reproductive health is important component of well-being of human health. It has close relationship with responsible, safe, and satisfying reproductive life. Unaccountable sexual health results in sexual and reproductive ill-health. HIV/AIDS is recently found pandemic disease, but sexually transmitted infections (STIs) are present since ancient time. The history of reproductive tract infection (RTI)/STIs is interesting from name change to treatment change strategy. It is very important to know the historical changes of disease and pattern of disease in country. The present review article is trying to evaluate various aspects of RTI/STIs including historical studies and SWOT analysis for the future challenges.

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Mesial migration of primary 2nd molar and 1st permanent molar occurs due to early exfoliation of primary first molar. Early exfoliation of deciduous teeth may lead to destruction in the integrity of normal occlusion. Early orthodontic procedures are often used to facilitate favorable developmental modifications in the developing occlusion. There are different space regaining methods described in literature. This case report presents a space regaining accomplished with distal movement of tooth by Gerber Space Regainer.

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Background: Periodontitis is a multifactorial chronic inflammatory disease. It occurs due to inflammation and tooth-supporting tissues destruction by subgingival microbiota. Anti-infective therapy has been accepted as the cornerstone of periodontal treatment. Aim: The aim of the study was to evaluate the efficacy of doxycycline as adjunct to scaling and root planing in treatment of chronic periodontitis. Materials and Methods: A total of 52 participants having moderate to severe chronic periodontitis were included and divided into 2 groups: Group A (Test group-SRP+Doxycycline) and Group B (Control group-SRP alone). Plaque Index (PI), Gingival Index (GI), Probing Depth (PD) and Clinical Attachment Level (CAL) were assessed at baseline and 3 months interval. Result: Significant differences were seen from baseline to 3 months in both test and control groups in terms of reduction in PI, GI, PD and gain in CAL (P<0.001). Inter-group analysis showed significant differences between the two groups after 3 months, with GI, PD and CAL with P-value <0.001. Conclusion: At the end of 3 months, Doxycycline showed better results after mechanical therapy in the treatment of patients with chronic periodontitis because it has an anticollagenase effect that can inhibit tissue destruction and aid bone regeneration.

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Appropriate and rational use of antibiotics in common infection syndrome such as urinary tract infection (UTI) is the need of the day to prevent bacterial resistance and side effects. Various protocols and guidelines are available for its use; however, perception as well as practices of clinicians may play an important role in their implementations. Methodology: To find problems as well as dilemma in regard to “when,” “what,” and “how long” to use antibiotics in UTI, a questionnaire and opinion-based study was conducted. Sixty clinicians engaged in adult internal medicine practice in Gujarat participated in the study. Many of the participants were resident doctors engaged in serving patients in the outpatient department, teaching hospitals, and medical intensive care units. Results: UTI was the second most common condition where the use of antibiotics is warranted in their practice. All of them had dilemma in the use of antibiotics because of various reasons. Majority did not ask for urine culture examination before giving antibiotics in uncomplicated UTI, but they demanded it in cases of recurrent UTIs, hospitalized patients, and pregnant patients. Their practice was akin to guidelines as far as treatment for asymptomatic bacteriuria was concerned. Fluoroquinolones and beta-lactam antibiotics were the choice of antibiotics in uncomplicated UTIs when urine culture was not ordered and was satisfied with clinical cure. Beta-lactam antibiotics were the choice in pregnant women having UTIs. Fifty-six percent responses favored 5–7-day treatment, whereas 17.86% favored 3-day treatment with fluoroquinolones or beta-lactam antibiotics. Although they were conscious and vigilant about antibiotic resistance problems, limitations did exit in their management plan which bothered them. Conclusions: Gaining insight from perceptions, knowledge, and practices of clinicians regarding the use of antibiotics in common situations such as UTI may be necessary to formulate a plan for local protocol and strategy. Antibiotic stewardship is an essential step. Shortening duration of antibiotics and use of appropriate antibiotics in different clinical situations of UTI may help to prevent antibiotic resistance. This topic needs priority in medical and paramedical education curriculum.

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Vitamin B12 (Vit. B12) is an important cofactor for the cellular metabolism and myelination. Vit. B12 deficiency can manifest as hematological, neurological, or gastrointestinal (GI) abnormalities. The following case had a unique manifestation of Vit. B12 deficiency in the form of dysarthria without any evidence of hematological involvement. From this case, we can infer that, in young patients with isolated neurological manifestation, Vit. B12 deficiency can always be a differential diagnosis. A 26-year-old female presented with complaints of fever, odynophagia, and dysarthria. She was vitally stable and had no neurological deficits. Her blood investigations showed leukopenia and thrombocytopenia. She was positive for dengue immunoglobulin M, her Vit. B12 levels were low, and her hemoglobin electrophoresis was suggestive of sickle-cell trait. She was subjected to an upper GI endoscopy which was suggestive of antral gastritis. Her magnetic resonance imaging findings were within normal limits. Upon intravenous supplementation of Vit. B12, her dysarthria resolved. From the clinical course and investigation, we consider that dysarthria is an isolated neurological manifestation of Vit. B12 deficiency.

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Introduction: Organophosphates (OP) are irreversible cholinesterase inhibitors, producing nicotinic and muscarinic effects. Cardiac complications with these compounds are often fatal. Early recognition of abnormal rhythm protects the patients against acquiring life-threatening arrhythmias. Hence, this study was done to determine the ECG findings in patients with OP poisoning. Aims & Objectives: To determine the various electrocardiographic changes & its importance in acute Organophosphate poisoning. Materials and methods: This prospective observational study of 50 cases was conducted for 2 years in a tertiary care institute. All adults with history of OP poisoning, admitted within 12 hours were enrolled. Patients with cardiac disease or treated from outside were excluded. Diagnosis was made by history, clinical features and confirmed by serum cholinesterase level. ECG analysis of each case was done for rate, rhythm, ST-T changes, PR and QTc intervals, and conduction defects etc. Results: Mean age in the study group was 30.66 ± 11.70(SD). Male:Female ratio was 1.94:1. 78% were suicidal, 22% were accidental and 6(12%) cases expired. Most common mode of poisoning was ingestion 45 cases (90%). Most common ECG abnormality was Sinus Tachycardia in 12(24%) followed by ST-T changes 8(16%), QTc prolongation in 6(12%), Sinus Bradycardia 4(8%), Extrasystole 2(4%), PR Prolongation 1(2%), AF 1(2%) and VT 1(2%). Conclusion: Poisoning with OP compounds can produce significant ECG abnormalities especially sinus tachycardia, non specific ST-T changes and QTc interval prolongation. Since these abnormalities can cause lethal arrhythmia and cardiac damage, careful observation of the electrocardiogram of the patients exposed to OP compound is necessary, parallel to the appropriate medical management.

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Background: Emerging concepts of interventions in diabetic diets should have been targeted to preserve health and nutritional status for the “living with disease philosophy.” Objective: In search of holistic dietary practice guidelines, the authors emphasized conceptual and contextual module for all levels of health-care providers for the optimum care of diabetics. Materials and Methods: Twenty-four research studies were identified from 45 potentially relevant databases and published literature to collate an updated idea of diabetic diet. Studies were selected on; first, all emerging nutritional plans and corresponding diets in diabetes mellitus among published literature were sketchily searched; second, “Diabetic diets” impacting disease control, retain health, and nutritional status affecting prognosis in downstream morbidities were identified; third, published reports from apex bodies of global importance such as American Diabetes Association, World Health Organization, Centre for Disease Control, Atlanta, USA, and others were given due weightage for their conceptual and contextual framework. Results: We have assembled diversity and novel concepts in diabetic diets, keeping tailor-made nutritional requirements as the mainstay in the philosophy of all-inclusive regimes for this chronic disease. There is a paucity of qualitative translational researches on diabetic diets and often limited to on paper suggestions and devoid of feedback on compliance from stakeholders. Conclusions: In a holistic approach, we require more research about diabetic diet; these are very useful in daily family medicine practices for the improvement in clinical approach and treatment in patients with diverse downstream morbidities of this complex entity.

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Incorporation of soft tissue consideration, retention, changing trend in appliance design and treatment biomechanics has led to a lot of controversy in decision of extraction in orthodontics. Hence an attempt was made to review the orthodontic considerations for the choice of extraction in an orthodontic treatment. The literature was refined with the advanced search option for case reports, meta-analysis, and randomized control trial, retrospective and prospective studies. We observed that extraction of second premolar was more advantageous in orthodontic treatment.

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Background: Knee Osteoarthritis is the most prevalent degenerative joint disease. The treatments of patient with knee osteoarthritis focused on pain reduction, improve joint motion, enhancement of muscle strength and endurance. However, little attention was given to hamstring flexibility training. It is believed that hamstring flexibility plays an important role in functional performance of patient with knee osteoarthritis. Aim: The present study was aimed to find out the correlation between hamstring flexibility and functional performance in patient with knee Osteoarthritis. Materials and Methods: Thirty-five patients with knee osteoarthritis matched with the inclusion criteria were included in the study. Active Knee Extension Test (AKET) was used to evaluate the hamstring tightness. Functional performance of participants was assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Pearson's product moment correlation was used to determine the relationship between hamstring flexibility and functional performance of patients with knee osteoarthritis. Results: A statistically significant positive correlation between hamstring flexibility and total WOMAC score (+0.467, p = 0.005). The component of WOMAC was also analysed separately pain (+0.369, p = 0.029), physical function (+0.418, p = 0.012) and (+0.273, p = 0.113). The results of the present study shows that decreased in hamstring flexibility in patient with knee osteoarthritis causes significant reduction in physical functional and pain. Conclusion: The results states that decreased in hamstring flexibility in patient with osteoarthritis causes functional limitation. Therefore, it is essential to suggest flexibility exercises for knee osteoarthritis patients during physical therapy.

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Prolactinoma is classified as microprolactinoma when it measures <10 mm and macroprolactinoma when it measures ≥10 mm. Prolactinoma is an important cause of amenorrhea and infertility in premenopausal female. With early diagnosis and treatment with dopamine agonist, many patients have restoration of fertility within few months of treatment. In presence of estrogenic environment of pregnancy there is a tendency for prolactinoma to increase in size during pregnancy. This may be associated with visual field compromise and rarely pituitary apoplexy. This review discusses some key points in management of prolactinoma during pregnancy and postpartum. In case of microprolactinoma, the risk of complications are low hence it is recommended to keep a close follow up of patient without any need for intervention. In case of macroprolactinoma it is recommended to use barrier contraception to prevent pregnancy for at least 6-12 months after detection and starting treatment to allow proper shrinkage of the tumor with dopamine agonist. Once pregnancy is confirmed -In those with low risk features, dopamine agonist is stopped and a close follow up is advised. In those with high risk features, it is recommended to continue the dopamine agonist therapy with a close follow up. Postpartum period generally doesn’t pose much threat to prolactinoma and treatment may be discontinued if patient wishes to breast feed her infant.

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Xanthogranuloma (XG), a condition of obscure pathogenesis and varied terminology, can occur in choroid plexus. We present here xanthogranuloma of the choroid plexus of lateral ventricle, who presented with headache, mild cognitive impairment and hemiplegia. It was difficult to determine whether bilateral small xanthogranuloma found on MRI was responsible for patient’s presenting symptoms or not. Appraisal of clinical and pathological findings related to intracranial and intraventricular choroid plexus XG, is done from the available literature. Furthermore, review in topic of “relation of XG with arthrosclerosis” as well as “Dyslipidemia” is also done.

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Introduction : PAD is an atherosclerotic occlusive condition in which plaque builds up in the distal arteries. Until 10 years ago, conventional angiography and digital subtraction angiography were the only angiographic techniques used in peripheral vascular disease and are considered gold standard. However, the complications and patient discomfort associated with these techniques have prompted the need of less invasive means of assessing the peripheral arterial system. Aim of the study was to compare efficacy of USG and MDCT angiography for investigating the lower limb arterial disease. Method: 40 patients suspected of lower limb PAD were included. Patients with previous amputation surgery were excluded. In all patients color Doppler sonography and multi-detector CT angiography was done. A comparative study of multi-detector CT angiography and color Doppler sonography was undertaken. Result: 50% patients had complaints in left lower limb and 25% in right lower limb. 22% had bilateral lower limb pain which was more on the left side (12%). Three patients examined by angiography showed irregularity of arterial wall on both sides, which appeared as calcifications on CT angiography (sensitivity 100%) while only 2 of them appeared on color coded Doppler examination (sensitivity 75%). Conclusions: Color Doppler USG is the initial modality of choice in PAD. CT Angiography is a better for segmental length assessment, collateral circulation along with a road map reproduction of the arterial system. USG is better than CT angiography in diagnosis of Grade 1 &2 cases, with better assessment of soft plaques, segmental flow and recanalization in PAD.

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Background: Time is a nonrenewable resource and effective time management is the key to better academic performance. Objective: To assess the time management skills of undergraduate medical students of a tertiary care health instituMethodology: This cross-sectional study was conducted among 243 undergraduate medical students of a tertiary healthcare institution in Puducherry. The time management skill was assessed using a time management questionnaire (TMQ) which has 18 items in 5-point Likert scales. A score of ≥58 on TMQ was considered as good time management skill. Results: The mean (standard deviation) of the TMQ score was 52.7 (9.8) overall, and 18.2 (5.8), 19.4, (3.5) and 15.1 (3.4), respectively in short-range planning, time attitude, and long-range planning domains. More than two-third of the students were found to have poor to average time management skills. Students with high readiness for self-directed learning were found to have significantly higher TMQ score [55.7(9.9) Vs 50.1 (8.9), P=0.000]. Conclusion: Majority of the students possess poor to average time management skills. Further study relating time management with academic performance may be conducted and counseling/workshops should be organized for students to improve their time management skills.

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Background: The pharmacists can contribute to positive therapeutic outcomes by educating patients for rational use of medications. A chronic obstructive pulmonary disease (COPD) is one the most prevalent chronic respiratory diseases which requires continuous medication therapy. The clinical pharmacist can play an effective role through providing patient counselling to improve medication adherence and therapeutic outcomes. Aims and Objectives: The present study aims to assess the baseline levels of knowledge, attitude and practice of COPD patients and to study the impact of patient counselling on level of knowledge, attitude and practice with COPD patients. Materials and Methods: A total 90 patients (45 in the test group and 45 in control group) were enrolled in the study. A validated Knowledge, Attitude and Practice (KAP) Questionnaire was administered to both test and control group of patients at base line and at follow up (after 15 days) to assess the awareness regarding disease management. Patients in test group received counselling at visit and information leaflets were given. The control group of patients did not receive such counselling and information leaflets. Results: At the end of study the KAP scores of test group patients improved significantly (P<0.05), whereas no significant changes were observed in control group patients. We did not observed significant improvement in practice outcomes. However, patients counselling by a pharmacist improved overall KAP score. Conclusion: We conclude that pharmacist counselling may have an impact in improving the perception about disease and lifestyle change and thereby improving the Quality of life (QOL) of COPD patients.

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Objectives: To assess the incidence rate of OSMF and its etiology in patients attending OPD at GDCH, Jamnagar. Material and Methods: The diagnosis of OSMF was based on clinical examination and evaluating patients “signs and symptoms. Results: The total number of patients affected by OSMF in this time duration was 268. Out of these, 230 (85.82%) were male, while 38 were female (14.18%). Therefore, male: female (M:F) ratio was 6:1. 104 males in the age group of 21-30 years constituted a single majority. Conclusion: This study reveals that the incidence rate of OSMF in patients visiting GDCH, Jamnagar was 1%. Males were more affected than females. It was seen that the major etiological factors in the development of OSMF was areca nut and gutkha usage by the patients.

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