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Purpose: To analyze the imaging characteristics and the clinical course of patients showing concomitant paracentral acute middle maculopathy (PAMM) and acute macular neuroretinopathy (AMN) post?blunt trauma. Methods: PAMM and AMN lesions post?blunt trauma diagnosed on enhanced depth imaging optical coherence tomography (EDI?OCT) were recruited for the study. Results: Thirteen eyes of 13 individuals with a history of blunt trauma were included in the study, of whom 11 (85%) were males. Mean age of the patients was 33.62 (range 16–67) years. Mean visual acuity at presentation and the last visit was 1.67 log of minimum angle of resolution (logMAR) and 0.82 logMAR, respectively. Mean interval between trauma and imaging was 5.08 (range 1–15) days. All patients had unilateral involvement, with the right eye being involved in 10 patients (77%). All patients had concomitant PAMM and AMN lesions. Conclusion: Presence of coincident PAMM and AMN suggests a common pathophysiologic etiology, but the description of concomitant PAMM and AMN in the setting of blunt trauma to eye is hitherto unreported. Identifying AMN in a setting of PAMM requires meticulous examination of the OCT and OCTA images. It can be a cause of suboptimal visual recovery in such eyes.
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Background: The lack of specialized geriatric healthcare in India, coupled with an aging population, has resulted in longer wait times, communication barriers, and a potential increase in unmet needs in a demographic that is already financially and socially vulnerable. This raises the need for exploring the perspectives and needs of the geriatric patient population to improve the quality and accessibility of the healthcare they receive. Objectives: This study was conducted to assess the perceptions and perceived needs of geriatric patients regarding current healthcare and their attitudes toward specialized geriatric healthcare. Materials and methods: Following the Institutional Ethics Committee (IEC), a cross-sectional study was carried out among 262 geriatric patients (age >60) from seven outpatient departments (OPD). A structured 10-item questionnaire was administered to assess the perceptions and perceived needs of the study population. Results: A total of 165 (63%) patients were not satisfied with the healthcare being provided to them. Around 96.1% of patients felt the need for a separate geriatric OPD/department. A total of 98% of patients had optimistic attitudes toward the possibility of specialized geriatric healthcare. A total of >80% of the patients were willing to spend more time for checkups and follow-ups regularly if that would improve their quality of life. Conclusion: This study showed a low satisfaction rate of geriatric patients with the current healthcare and a high felt need for specialized geriatric facilities. There was an overall positive attitude of patients toward the implementation of various facilities of specialized geriatric healthcare.
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Background & objectives: A combination of resistant and susceptible Mycobacterium tuberculosis (MTB) isolated from clinical specimens is referred to as heteroresistance. Heteroresistance leads to difficulties in drug resistance testing and may adversely affect treatment outcomes. The present study estimated the proportion of heteroresistance among MTB in clinical samples of presumptive drug-resistant tuberculosis (TB) patients in Central India. Methods: A retrospective analysis of data generated from line probe assay (LPA) at a tertiary care hospital in Central India between January 2013 and December 2018 was carried out. A heteroresistant MTB in a sample was indicated by the presence of both wild-type and mutant-type patterns on an LPA strip. Results: Data analysis was carried out on interpretable 11,788 LPA results. Heteroresistance in MTB was detected in 637 (5.4%) samples. Of these, heteroresistance in MTB was detected in 413 (64.8%), 163 (25.5%) and 61 (9.5%) samples with respect to rpoB, katG and inhA genes, respectively. Interpretation & conclusions: Heteroresistance is considered a preliminary step in the development of drug resistance. Delayed or suboptimal anti-tubercular therapy in patients with heteroresistance of MTB may elicit full clinical resistance and negatively impact the National TB Elimination Programme. Further studies are, however, needed to determine the impact of heteroresistance on treatment outcomes in individual patients.
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Purpose: The primary objective of the study was to assess the macular retinal vessel density, subfoveal choroidal thickness, and retinal layer metrics by optical coherence tomography angiography (OCTA), enhanced?depth imaging optical coherence tomography (EDI?OCT), and spectral domain optical coherence tomography (SD?OCT), respectively, in recovered COVID?19 patients and its comparison with the same in control subjects. The secondary objective was to evaluate differences in OCTA parameters in relation with the severity of COVID?19 disease and administration of corticosteroids. Methods: A case–control study was performed that included patients who had recovered from COVID?19 and age?matched healthy controls. Complete ocular examination including OCTA, SD?OCT, and EDI?OCT were performed three months following the diagnosis. Results: Three hundred sixty eyes of 180 subjects were enrolled between the two groups. A decreased mean foveal avascular zone area in both superficial capillary plexuses (P = 0.03) and deep capillary plexuses (P < 0.01), reduced average ganglion cell layer?inner plexiform layer thickness (P = 0.04), and increased subfoveal choroidal thickness (P < 0.001) were observed among cases in comparison to the control group. A significant correlation was found between sectoral macular vessel density in relation to disease severity and a decrease in vessel density with greater severity of the disease. Conclusion: OCTA detected retinal microvascular alterations following SARS?CoV?2 infection in subjects with the absence of any clinical ocular manifestation or systemic thrombotic events. These parameters could be used to help identify patients with a higher incidence of systemic thromboembolism on longer follow?ups and identify the impact of corticosteroids on retinal architecture.
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Objective:To investigate the relationship between serum fibroblast growth factor 21 (FGF21) and sarcopenia in hemodialysis (HD) patients, and to explore the relationship between FGF21 and signal pathways related to skeletal muscle metabolism in uremic state at the cellular level.Methods:The data of the HD patients from the blood purification center of the Third Affiliated Hospital of Soochow University were collected in this prospective observational study between January 2018 and December 2019. Serum FGF21 concentration was detected by enzyme-linked immunosorbent assay (ELISA). Meanwhile, the skeletal muscle indexes (SMI) at the fourth thoracic vertebra (T4) and the first lumbar vertebra (L1) were assessed by chest CT. According to the T4 SMI and L1 SMI, the patients were divided into sarcopenia group and non-sarcopenia group. The relationship between serum FGF21 and sarcopenia was analyzed. The C2C12 mouse myoblasts were cultured in vitro, which were intervened with healthy human serum, healthy human serum+different concentrations of FGF21, uremic serum, uremic serum+different concentrations of FGF21. The expressions of muscle ring finger protein-1 (MURF1), muscle atrophy F-box (Atrogin-1), myogenic differentiation (MyoD) and myogenin (MyoG) were detected by Western blotting. Results:A total of 118 HD patients with age of (52.64±15.29) years were enrolled in the study, including 64 males (54.2%) and 54 females (45.8%). The images at T4 and L1 level assessed by chest CT could be acquired from 118 patients and 82 patients, respectively. According to the lowest sex-specific quartile ( P25) of T4 SMI (male < 59.92 cm 2/m 2, female < 46.75 cm 2/m 2) and the lowest sex-specific quartile ( P25) of L1 SMI (male < 29.02 cm 2/m 2, female < 24.50 cm 2/m 2), patients were divided into sarcopenia group and non-sarcopenia group, and there were 29(24.58%) and 20(24.39%) patients in the sarcopenia group, respectively. When the patients were divided into two groups according to the sex-specific lowest quartile of T4 SMI, although the serum FGF21 level in the sarcopenia group was higher than that in the non-sarcopenia group, there was no statistical significance between the two groups [448.52(183.96, 1 684.08) ng/L vs. 273.65 (152.83, 535.54) ng/L, Z=-1.741, P=0.082]. When the patients were divided into two groups according to the sex-specific lowest quartile of L1 SMI, the serum FGF21 level in the sarcopenia group was significantly higher than that in the non-sarcopenia group [460.95(188.91, 1 276.38) ng/L vs. 239.10(133.25, 466.36) ng/L, Z=-2.170, P=0.030]. Binary logistic regression analysis showed that higher serum FGF21 was an independent influencing factor for sarcopenia in HD patients regardless of whether the patients were divided into two groups according to the sex-specific lowest quartile of T4 SMI or the sex-specific lowest quartile of L1 SMI (T4 SMI grouping: OR=4.085, 95% CI 1.778-9.388, P=0.001; L1 SMI grouping: OR=7.327, 95% CI 1.841-29.160, P=0.005). At T4 and L1 levels, the area under the receiver operating characteristic curve of FGF21 in predicting sarcopenia in HD patients was 0.636(95% CI 0.494-0.779, P=0.036) and 0.684(95% CI 0.535-0.833, P=0.018), respectively. Cell experiment showed that compared with the uremic serum group, the expressions of MURF1 and Atrogin-1 in myotube cells were increased, while the expressions of MyoD and MyoG were significantly decreased in uremic serum+FGF21 group (both P < 0.05). Conclusions:Higher serum FGF21 is associated with an increased risk of sarcopenia in HD patients. FGF21 may increase the expression of ubiquitin proteasome system, reduce the synthesis and differentiation of skeletal muscle protein, and promote the occurrence of muscle atrophy in uremic patients
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Background@#Patients with prostate cancer tend to be at heightened risk for fracture due to bone metastases and treatment with androgen-deprivation therapy. Bone mineral density (BMD) derived from dual energy X-ray absorptiometry (DXA) is the standard for determining fracture risk in this population. However, BMD often fails to predict many osteoporotic fractures. Patients with prostate cancer also undergo 18F-sodium fluoride (18F-NaF)-positron emission tomography/computed tomography (PET/CT) to monitor metastases. The purpose of this study was to assess whether bone deposition, assessed by 18F-NaF uptake in 18F-NaF PET/CT, could predict incident fractures better than DXA- or CT-derived BMD in patients with prostate cancer. @*Methods@#This study included 105 males with prostate cancer who had undergone full body 18F-NaF PET/CT. Standardized uptake value (SUVmean and SUVmax) and CT-derived Hounsfield units (HU), a correlate of BMD, were recorded for each vertebral body. The average SUVmean, SUVmax, and HU were calculated for cervical, thoracic, lumbar, and sacral areas. The t-test was used to assess significant differences between fracture and no-fracture groups. @*Results@#The SUVmean and SUVmax values for the thoracic area were lower in the fracture group than in the no-fracture group. There was no significant difference in cervical, thoracic, lumbar or sacral HU between the 2 groups. @*Conclusions@#Our study reports that lower PET-derived non-metastatic bone deposition in the thoracic spine is correlated with incidence of fractures in patients with prostate cancer. CT-derived HU, a correlate of DXA-derived BMD, was not predictive of fracture risk. 18F-NaF PET/CT may provide important insight into bone quality and fracture risk.
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ABSTRACT Objective: The aim of this in-vivo study was to assess the salivary dehydroepiandrosterone sulphate (DHEAS) and cortisol levels, and their correlation to the Cervical Vertebrae Maturation method (CVM) in males and females at pre-pubertal, pubertal and post-pubertal growth stages. Methods: 48 patients (24 males, 24 females) who were to undergo routine orthodontic treatment were screened according to the inclusion and exclusion criteria. Then subjects were grouped according to CVM stages, using lateral cephalogram, in pre-pubertal, pubertal and post-pubertal groups. Unstimulated saliva from the selected subjects was collected. DHEAS and cortisol levels in the salivary samples were estimated by Enzyme-Linked Immunosorbent assay (ELISA). Then they were compared to Cervical Vertebrae Maturation Method stages. One-way ANOVA test followed by Tukey's post-hoc test was used to compare the salivary DHEAS and cortisol levels between different CVM stages in males and females. Independent Student t-test was used to compare the mean salivary DHEAS and cortisol levels between different males and females in each CVM stage. Result: There was a progressive increase in salivary DHEAS and cortisol concentration as skeletal maturation progressed from CVM stages 1 and 2, CVM stages 3 and 4, reaching the highest value at CVM stages 5 and 6. Their levels were higher in males than females. Conclusion: The salivary DHEAS and cortisol levels can be useful as a potential indicator of skeletal maturation, to aid in the assessment of pubertal status.
RESUMO Objetivo: O objetivo deste estudo in vivo foi avaliar os níveis salivares de sulfato de dehidroepiandrosterona (DHEAS) e de cortisol, e sua correlação com o método de maturação das vértebras cervicais (CVM) em homens e mulheres nas fases de crescimento pré-puberal, puberal e pós-puberal. Métodos: 48 pacientes (24 homens, 24 mulheres) que se submeteriam a tratamento ortodôntico de rotina foram selecionados de acordo com os critérios de inclusão e exclusão. Em seguida, usando telerradiografia lateral, os indivíduos foram agrupados de acordo com os estágios CVM, em grupos pré-puberal, puberal e pós-puberal. Foi feita coleta de saliva não estimulada nos indivíduos selecionados. Os níveis de DHEAS e cortisol nas amostras salivares foram avaliados pelo teste ELISA (Enzyme-Linked Immunosorbent assay). Em seguida, foram comparados aos estágios do método CVM. O teste ANOVA de uma via seguido pelo teste post-hoc de Tukey foi usado para comparar o DHEAS salivar e os níveis de cortisol entre os diferentes estágios de CVM em homens e mulheres. O teste t de Student independente foi usado para comparar a média de DHEAS salivar e os níveis de cortisol entre diferentes homens e mulheres em cada estágio de CVM. Resultados: Houve um aumento progressivo no DHEAS salivar e na concentração de cortisol à medida que a maturação esquelética progrediu dos estágios CVM 1 e 2, para os estágios CVM 3 e 4, atingindo o valor mais alto nos estágios CVM 5 e 6. Seus níveis foram maiores nos homens do que nas mulheres. Conclusões: Os níveis salivares de DHEAS e cortisol podem ser úteis como um potencial indicador de maturação esquelética, para auxiliar na avaliação do estado puberal.
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Purpose: This study was conducted to assess the outcomes of bleb needling for the treatment of failure of filtration surgeries in primary glaucoma with a follow?up of six months. Methods: This prospective interventional study included patients with primary glaucoma who underwent trabeculectomy or combined glaucoma and cataract surgery with failed or failing bleb after six weeks of surgery and less than two years. A comprehensive examination including best?corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, gonioscopy, slit?lamp examination, and bleb morphology grading was done. Selected patients underwent a subconjunctival bleb needling with mitomycin C (MMC) (dose 0.2 mg/ml). Postoperatively, patients were followed up on the first, third, and sixth months and were assessed with respect to IOP, need for antiglaucoma medication (AGM), and complications. Results: Sixty eyes of 59 patients were included. Preoperatively, 33.3% of patients were on one AGM, whereas postoperatively at the third month 51.7% and at the sixth month 50% of patients were on no AGM. There was a statistically significant decrease in IOP (P < 0.001) from preoperative (mean: 23.8 ± 7.86 mmHg) to postoperative first month (mean: 19.8 ± 9.08 mmHg), third month (mean: 17.4 ± 5.4 mmHg) and sixth month (mean 16.6 ± 4.39). According to the defined criteria in the current study, we achieved 22 (37.9%) successes, 31 qualified successes (53.4%), and 5 (8.6%) failures. Univariate regression analysis showed a higher failure rate among younger age groups. Gender, laterality, and intraoperative complications were not significant statistically. Conclusion: Bleb needling is a safe and effective procedure for the treatment of failed filtration surgeries
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Background: Coronary artery diseases (CADs) contribute to the majority of deaths and disabilities worldwide. People who have suffered an acute myocardial infarction (AMI) are at a higher risk of having a further attack. Hence, prolonged secondary prevention is necessary following index myocardial infarction (MI) for long-term cardiovascular protection as it reduces the morbidity and mortality associated with reinfarction, improves the quality of life, and is cost-effective. Methods: An observational, ambidirectional study was carried out in a tertiary care hospital for 6 months. A total of 200 patients above 18 years of age with a confirmed diagnosis of acute coronary syndrome (ACS) or chronic coronary syndrome (CCS) were included in the study. Prospective data were collected using a self-designed patient profile form and by interviewing patients in the cardiac outpatient department while retrospective data were collected from the medical records department of the hospital. Results and conclusion: Sex-wise distribution showed that males and females constituted 79 and 21% of the study participants, respectively, while the age-wise distribution revealed that the majority of patients were in the age-group of 60 years and above (63.5%). Hypertension and diabetes mellitus were the most common comorbid conditions, while dyslipidemia was the least observed comorbidity. Prescription adherence to secondary prevention guideline recommendations was studied, which revealed that 26.5% of the prescriptions were adherent to all four guideline recommendations. On evaluating adherence to pharmacotherapy, the maximum proportion of patients demonstrated moderate adherence (45%).
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A new series of cold brand reactive dyes (D1 to D12) were synthesized by the coupling of diazotized 4-Amino-N-(5- methylisoxazol-3-yl)-benzenesulfonamide with various cyanurated coupling components in good yield. These reactive dyes were confirmed by 1H NMR analysis and FTIR. The synthesized dyes have been applied to cotton, silk, and wool fibres. They exhibited a variety of color shades with good dept and informality on the fibres. % Exhaustion and % fixation of dyes were determined by using Glauber salt as a fixing agent at various temperature conditions.
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Objectives: Observation and analysis of the risk factors associated with preeclampsia and eclampsia and its effect on maternal and fetal outcome. It is a prospective study where 500 diagnosed Methods: cases of preeclampsia and eclampsia were recruited after taking informed consent. Data collected on the basis of detailed history and clinical evaluation. The maximum number of preeclampsia and eclampsia in the present series occurred Result: between the age group 21 to 25 years (46%). Majority of cases (71.4%) in our study presented between 35.1 to 40 weeks of gestational age. 24.4% cases had BMI in range of 25-29.9. 51.4% women were primipara and 53.2% cases were unbooked. Majority of the cases (45.2%) belonged to the upper lower socio-economic class. Out of 500 cases, 23.2% had anaemia, followed by hypothyroidism in 14.8% cases, GDM in 3.8% cases, obesity 2.8% cases, chronic hypertension in 2.2% cases, diabetes mellitus in 2% cases, and PCOD in 0.4 % cases. Risk factors found in our study that affected maternal and perinatal outcome severely were: primiparity, unbooked status, lower middle class III and upper lower class IV, BMI>24.9, gestational age < 34 weeks, anaemia, hypothyroidism and chronic hypertension and gestational diabetes mellitus. Our study reveals Conclusion: that if patients present with multiple risk factors (three and more), maternal morbidity and mortality increased signi?cantly.
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Blockchain technology is a core, underlying technology with promising application prospects in the banking industry. As such, blockchains could revolutionize the underlying technology of the payment clearing and credit information systems in banks, thus upgrading and transforming them. Blockchain applications also promote the formation of “multi- center, weakly intermediated” scenarios, which will enhance the efficiency of the banking industry.
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Purpose: To study clinical efficacy of valganciclovir in cytomegalovirus retinitis (CMVR) in human immunodeficiency virus (HIV)?positive?positive patients in a tertiary care clinic in a developing nation. Methods: In a retrospective study, systemic and ocular records of HIV patients suffering from CMVR and treated with valganciclovir, were analyzed. Primary outcome measures were involvement of the other eye, incidence of retinal detachment, systemic involvement, and mortality encountered. Secondary outcome measures included change in BCVA. Results: Out of nine patients who were included, two patients developed CMVR in the other eye and only one patient (11.11%) developed retinal detachment during the course of the study. No patient developed any systemic manifestations or had mortality during the course of the study. The change in BCVA was not statistically significant. Conclusion: Use of oral valganciclovir showed good outcome and was found to be a better alternative compared to the use of intravitreal ganciclovir in the literature. Introduction of valganciclovir at an affordable price in developing nations can decrease disease burden
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Background: The OSA is commonly found in ILD with overall incidence varying from 17 to 88 %. The morbidity and mortality of OSA are high when it occurs with chronic respiratory diseases like ILD. There is lack of data on sleep breathing disorder in ILD patients from India. The present study aims is to assess the occurrence of OSA in ILD patients and its correlation with other parameters. Method: Prospective observational study of 41 ILD patients of one year duration. All patients underwent detailed clinical examination, radiological, laboratory investigations and Type 1 diagnostic polysomnography according to AASM guideline. The severity of OSA was defined as per AHI and the correlation of OSA with other parameters were assessed.
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Background: Dental caries being the leading health issue worldwide has no specific cure due to its multifactorial etiology and genetic susceptibility. Hence, this paper attempted to correlate the clinical and hereditary factors between mother and child, to predict the caries occurrence in child in future, and thereby implement early preventive measures. Aim: The aim of the study was to look for an association between maternal and child's human leukocyte antigen (HLA)-DR4 levels and relate it with other physiochemical factors to assess caries susceptibility in children. Methodology: Saliva samples were collected from children who were in the age group of 0–6 years and their mothers by spitting method and swab method. The clinical indicators such as Decayed, Missing, and Filled Teeth, decayed, extraction needed, and filled teeth, salivary flow rate, and pH were recorded by clinical evaluation. The Streptococcus mutans count was measured by culture plate followed by colony count method, and the HLA-DR4 factor was assessed using ELISA. Results: The results revealed a statistically significant correlation between the physiochemical factors of the mother and the child. The genetic factor in which the HLA-DR4 caries indicator was checked also has a strong association between the mother and the offspring. Thus, a strong caries prediction formula was derived through which probability of caries occurrence in the child could be determined prematurely. Conclusion: Thus, it can be concluded that using the clinical and genetic factors, the caries prediction can be done for the child and preventive protocol can be started before disease occurrence.
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Background: Direct pulp treatment is carried out when a healthy pulp gets mechanically/accidentally exposed during the operative procedures or trauma. Aim: To determine the effects of various direct pulp capping materials as measured by the clinical and radiographic analysis. Design: Two reviewers performed a database search of the studies published between January 2005 and November 2020. The inclusion criteria were papers published in the English language; children aged 3–12 years having deep carious lesions in primary teeth. All potential studies were acknowledged by their title and abstract. The full-text analysis of potentially relevant studies, the selected studies were included in the systematic review. A meta-analysis calculation was performed for the overall data and the subgroup data. Results: The database searching led to 57 articles, which were of direct pulp treatment in primary teeth, after the removal of duplicates, 55 records remained but did not meet all inclusion criteria. A high variability was observed among the papers. Further filtering with criteria led to nine articles, which met all inclusion criteria. Meta-analysis demonstrated the success rates of DPT in primary teeth (95% confidence interval −0.799–0.898); P < 0.001. Clinical assessments of various direct pulp capping materials suggested 84.9% of success irrespective of the material used. The nine studies were heterogeneous according to the random effect model (P < 0.001, I2 = 84.08%). Conclusions: Direct pulp treatment has the advantage of being a conservative vital pulp therapy reducing the need for a more invasive treatment.
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Abstract Introduction Flow cytometric immunophenotyping (FCI) plays a major role in diagnosing hematologic malignancies. In patients diagnosed with precursor B-lineage acute lymphoblastic leukemia (B-ALL), expression of certain non-lineage/cross lineage antigens is of prognostic and cytogenetic relevance. There is a paucity of studies that have comprehensively analyzed the clinical and laboratory profiles of B-ALL patients showing aberrant T/natural killer (NK) cell antigen expression. Materials and methods This is a prospective study where 152 consecutive B-ALL patients were analyzed for aberrant expression of T/NK cell antigens (CD1a, CD5, CD4, CD7, CD8 and CD56) by FCI. The clinical and laboratory profile of these T/NK-cell antigen-expressing B-ALL patients was statistically analyzed against conventional B-ALL patients. Results In our B-ALL cohort, CD5, CD7 and CD56 expression were observed in one, six and nine patients, respectively. CD56-expressing B-ALL patients were predominantly children (89%) and presented as standard clinical risk (p = 0.010) disease with frequent ETV6-RUNX1 fusion (p = 0.021) positivity. On the contrary, CD7-expressing B-ALL patients were adolescent-young adult/adult-age skewed (83%) and had an adverse cytogenetic profile (p = 0.001), especially for the frequent presence of BCR-ABL1 fusion (p = 0.004) and KMT2A rearrangement (p = 0.045). CD7-expressing B-ALL patients had inferior event-free survival (p = 0.040) than their CD56-expressing counterparts, but there was no significant difference in the overall survival (p = 0.317). Conclusion In comparison to conventional B-ALL patients, there are significant differences in the age, cytogenetic profile and event-free survival of T/NK-cell antigen-expressing B-ALL patients.
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Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Young Adult , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma , Flow Cytometry , Immunophenotyping , Antigens, CD7 , CD56 AntigenABSTRACT
Purpose: The aim of this study is to evaluate and compare the effectiveness of five pre?treatment behaviour modification techniques in 4–7?year olds in reducing dental anxiety by evaluating pulse rate, partial pressure of oxygen, systolic blood pressure, diastolic blood pressure, salivary flow rate, salivary pH, and through modified facial anxiety scale. Material and Methods: Using simple random sampling technique (drawing of lots), 125 children were equally distributed into 5 groups of 25 each: Group 1: tell?show?do (control); Group 2: tell?show?play?doh; Group 3: Playmobil Dentist; Group 4: mobile dentist games; Group 5: role play as dentist. Samples in each group were treated in a single appointment after using the behaviour modification techniques. Class I or Class II cavities were prepared on carious primary molar and restored using glass ionomer cement. Patient’s anxiety level was assessed by recording blood pressure, pulse rate, oxygen saturation, salivary pH, salivary flow rate, and facial anxiety scale at different time intervals, that is before the treatment, during the treatment, and after the treatment. Results: All the intervention Groups (Groups 2–5) showed reduced anxiety scores in both physiological and facial anxiety compared to the control group, that is tell, show do. The modified distraction techniques aid in better modification. Conclusion: Tell?show?play?doh, Playmobil dentist games, mobile dentist games and role play as dentist are effective distraction techniques as compared to conventional tell?show?do techniques which can be incorporated in day?to?day clinical practice to reduce dental anxiety in paediatric patients