Symptoms and psychosocial effects following hospitalization for Covid-19: A sequential, mixed-methods study from northern India

BACKGROUND It is reported that patients who have recovered from Covid-19 continue to experience various symptoms and adverse outcomes. However, this aspect has not been studied well. We aimed to evaluate these variables and the perceived impact of Covid-19 among patients discharged from a Covid hospital in northern India. METHODS We conducted this study among patients discharged from a Covid-19 hospital in northern India in June 2020. As per the official policy at that time, patients detected to have Covid-19 (symptomatically or via contact tracing) were mandatorily admitted. A sequential, mixed-methods design was followed. Patients discharged from the hospital were contacted telephonically, and the cross-sectional prevalence of symptoms, the prevalence of depression and anxiety and the social consequences of admission were assessed. A subgroup of patients was interviewed for qualitative assessment of their experience. RESULTS A total of 274 patients provided consent and were assessed, of which 8 patients underwent detailed interviews. The prevalence of somatic symptoms was 3.4%; 36.2% of the patients had depressive and 12% of the patients had anxiety symptoms. A majority of patients experienced adverse social and economic consequences of hospitalization for Covid-19. These themes were reinforced by a qualitative analysis of in-depth interviews. CONCLUSIONS Our study population experienced a high prevalence of adverse psychosocial consequences of Covid-19. These included depression and anxiety symptoms, stigma and economic and occupational consequences. These deserve more recognition and study.

Development and Validation of Perceived Oral Health Benefits on Yoga Scale (POBYS) / Desenvolvimento e validação da Escala de Benefícios da Saúde Oral Percebidos no Yoga (POHBYS)

Objective: Sustained practice of Yoga leads to self-awareness, physical strength and high sense of energy. Yoga stimulates antioxidant levels in the body and reduces likelihood of dental disorders. No research has been undertaken connecting perception on yoga and oral health behaviors. The present study is an attempt to develop a psychometric scale entitled Perceived Benefits on Yoga Scale (PBYS) to measure individuals' perception on Yoga in relation to oral health behaviors. Material and methods: The psychometric tool was developed based on the concepts of Health Benefit Model (HBM). Among the four components of the model, the present study considered "perceived benefits" component. A total of 206 individuals participated in the study. To analyze the scale theoretically, face and content validity were assessed. Reliability of the scale was tested using Cronbach's alpha and Spearman-Brown coefficient. Using exploratory and confirmatory factor analysis, construct validity was tested. Cronbach alpha and Spearman- Brown coefficient were applied to test the reliability of scale. Results: There were six items in the final scale, with a Spearman- Brown coefficient of 0.92 and Cronbach's alpha of 0.91. Statistically significant (p < 0.001) positive correlation was found between POBYS scores and Yoga Self-Efficacy Scale (YSES). Validity of scale is within accepted range as indicated by Goodness of Fit indices. Conclusion: POBYS is a reliable and valid measure of perception on yoga outcomes with specific reference to oral health behavior. (AU)

Objetivo: A prática continua de Yoga leva ao autoconhecimento, força física e a sensação de energia elevada. O yoga estimula os níveis de antioxidantes no corpo e reduz a probabilidade de desordens dentais. Nenhuma pesquisa foi realizada conectando a percepção sobre o yoga e os comportamentos da saúde bucal. O presente estudo é uma tentativa de desenvolver uma escala psicométrica intitulada Escala de Benefícios Percebidos no Yoga (PBYS) para medir a percepção dos indivíduos sobre o Yoga em relação aos comportamentos da saúde bucal. Material e Métodos: A ferramenta psicométrica foi desenvolvida com base nos conceitos do Modelo de Benefícios à Saúde (HBM). Dentre os quatro componentes do modelo, o presente estudo considerou o componente "benefícios percebidos". Participaram do estudo 206 indivíduos. Para analisar teoricamente a escala, foram avaliadas a validade de face e de conteúdo. A confiabilidade da escala foi testada usando o alfa de Cronbach e o coeficiente de Spearman-Brown. Usando análise fatorial exploratória e confirmatória, a validade do construto foi testada. O alfa de Cronbach e o coeficiente de Spearman-Brown foram aplicados para testar a confiabilidade da escala. Resultados: Havia seis itens na escala final, com coeficiente de Spearman-Brown de 0,92 e alfa de Cronbach de 0,91. Estatisticamente significativo (p <0,001) foi encontrada correlação positiva entre os escores do PBYS e a Escala de Autoeficácia do Yoga (YSES). A validade da escala está dentro da faixa de aceitabilidade conforme indicado pelos índices de Goodness of Fit. Conclusão: PBYS é uma medida confiável e válida de percepção sobre os resultados do yoga com referência específica ao comportamento de saúde bucal. (AU)

Calvarial metastasis from adenocarcinoma of lung: An uncommon initial presentation diagnosed by cytology

Bone metastasis from lung primary is not uncommon and about one-third of bone metastases originate from lung. However, skull bone metastasis is uncommon from lung carcinoma. Metastasis to skull bone and scalp as an initial presentation of lung carcinoma is a very rare phenomenon. We have diagnosed a case of calvarial metastasis with scalp swelling as an initial presentation of adenocarcinoma of lung by fine-needle aspiration cytology in an aged female. Radiologically, it was suggested as tuberculous lesion but cytology gave the correct diagnosis. Here, we present a rare case of calvarial metastasis as a presentation of adenocarcinoma of lung in an elderly female

Biomarkers: An Important Tool for Diagnosing and Treating Breast Cancer

Breast cancer is a type of tumor in which individual cases deviate from each other in morphology, protein expression, molecular phenotype, genetic characteristics, and prognosis. Worldwide, breast cancer is the most-common invasive cancer in women. A patient with breast cancer may have the following symptoms:-lumps, skin dimples, nipple discharge, nipple height, nipple withdrawal, pain and burning sensation. There are many causes and risks of breast cancer, including family history (heriditary), obesity, active smoking, early and late childbearing, breastfeeding for less than two weeks, exposure to estrogen and oral contraceptive pills. Most breast cancers are diagnosed through estrogen receptor (ER) -positive determination and rely on estrogen for cell growth and survival. Breast cancer treatment has encountered a few progressions in the previous decades with the revelation of explicit prescient prognostic biomarkers that make conceivable the use of individualized treatments.Blocking estrogen biosynthesis by aromatase inhibitors (AI) has, subsequently, become a first-line endocrine treatment for menopausal ladies with ER-positive breast disease. Various conventional diagnosing and treating methods of breast cancer is available but there have limitation of accuracy and treating. For that reason now a day’s various biomarkers like Molecule or Biochemical biomarkers like Estrogen receptor, Progesterone receptor, human epidermal growth factor receptor 2 (HER2), human Mammaglobin(H-MAM), Osteopontin, Fibroblast Growth Factor Receptor 2 (FGFR2), Phosphatase and tensin homolog (PTEN), Physiologic Biomarkers like Carcinoma Antigen 15-3(CA 15–3), Cancer Antigen 125 (CA 125), Prostate specific antigen (PSA) and Anatomic Biomarkers Oncotype Dx, and Cystic fibrosis Trans-membrane conductance regulator(CFTR). These biomarkers are of great importance in the evaluation and diagnosis process, which leads to better patient’s care and protection of the patients. Due to its various advantages, biomarkers are considered as an innovative tool in the progression of breast cancer diagnosis and treatment.

Computational search for potential COVID-19 drugs from FDAapproved drugs and small molecules of natural origin identifies several anti-virals and plant products

The world is currently facing the COVID-19 pandemic, for which mild symptoms include fever and dry cough.In severe cases, it could lead to pneumonia and ultimately death in some instances. Moreover, the causativepathogen is highly contagious and there are no drugs or vaccines for it yet. The pathogen, SARS-CoV-2, is oneof the human coronaviruses which was identified to infect humans first in December 2019. SARS-CoV-2shares evolutionary relationship to other highly pathogenic viruses such as Severe Acute Respiratory Syndrome (SARS) and Middle East respiratory syndrome (MERS). We have exploited this similarity to model atarget non-structural protein, NSP1, since it is implicated in the regulation of host gene expression by the virusand hijacking of host machinery. We next interrogated the capacity to repurpose around 2300 FDA-approveddrugs and more than 3,00,000 small molecules of natural origin towards drug identification through virtualscreening and molecular dynamics. Interestingly, we observed simple molecules like lactose, previously knownanti-virals and few secondary metabolites of plants as promising hits. These herbal plants are already practicedin Ayurveda over centuries to treat respiratory problems and inflammation. Disclaimer: we would not like torecommend uptake of these small molecules for suspect COVID patients until it is approved by competentnational or international authorities.

A study on clinical profile and etiological agents of empyema in hospitalised children in Jaipur, India

Background: Objective is to study the clinical profile and etiological agents of empyema in hospitalised children in Jaipur.Methods: This hospital based prospective study was carried out in the Department of Pediatrics, SMS Medical College, Jaipur between April 2016 to March 2017. Children between 1 month to 18 year of age having empyema thoracis (pleural tap showing pus cells under microscopy or on gross examination purulent exudates) were included in the study. Children with Empyema secondary to post-surgical or post-traumatic cause and with tubercular effusion were excluded from the study. Relevant history, clinical examination and investigation were done. Pleural fluid studies were done for cytology, biochemical analysis , culture and antibiotic sensitivity pattern.Results: Total 100 patients were included in study. Out of total 100 patients 62 (62%) were between 1 month to 5 years. Most common symptoms were fever (94%), breathlessness (87%) and cough (85%). 27% patients were severely malnourished as per IAP classification of PEM. Pleural fluid culture was positive in 29 (29%) patients. Most common organism isolated was Staphylococcus aureus (27%), 87.5% isolates of Staphylococcus aureus had sensitivity to vancomycin and linezolid.Conclusions: Empyema thoracis is frequently encountered complication of bacterial pneumonia. Fever, cough, and respiratory distress were the most common presenting complaints and severe acute malnutrition was an important risk factor. Staphylococcus aureus was found to be the most common organism for childhood empyema.

Incidence of culture proven neonatal sepsis, pattern of antibiotic sensitivity and clinical course in neonatal intensive care unit in tertiary care center in North India

Background: Neonatal sepsis is a major cause of neonatal mortality, accounts for nearly half of all the neonatal deaths in our country. The incidence of neonatal septicemia ranges from 1 to 10 per 1000 live births. In our country the incidence of culture proven neonatal sepsis is 8.6 per 1000 live births, intramural data. Antibiotics are rapidly losing their effectiveness, with some early reports going so far to suggest that we are approaching a post-antibiotic era. Aims of this study was to find out the incidence of culture proven neonatal sepsis and to analyze data collected for mortality and morbidity in culture proven neonatal sepsis and antibiotic sensitivity pattern in culture proven neonatal sepsis at Neonatal Intensive Care Unit of Santokba Durlabhji Memorial Hospital (SDMH), Jaipur.Methods: The study included 129 newborn fulfilling the inclusion criteria, admitted into NICU of SDMH, Jaipur from 01st January 2013 to 31st December 2013, were investigated using various hematological and biochemical test e.g. CBC, Serum CRP, Blood culture and sensitivity, CSF examination includes cell counts, gram staining, biochemistry, culture and sensitivity etc.Results: Overall 722 cases admitted in NICU during the period of one-year 2013. Out of which 129 cases had blood culture proven neonatal sepsis (17.87%). 14.88% cases in P.C.U. and 21.79% cases in I.P.U. had positive blood culture sepsis with statistically significant difference (p value 0.016, <0.05).Conclusions: Antibiotic resistance is an emerging problem requires justified use of antibiotics.

Analysis of Demographic Profiles among Cases of Isolates of Enterococci at a Tertiary Care Teaching Hospital

Introduction: Therapy for infections due to Vancomycinresistant Enterococci presents real challenge for the clinician.Despite increasing reports of VRE from different countries,there is a paucity of information on this issue from our country.Hence, the present study aims to study of demographic profileamong cases of isolates of Enterococci from various clinicalsamples of PBM and associated group of hospital SPMC,Bikaner up to the species level.Materials and Methods: The present descriptive study wascarried out in the Department of Microbiology, S.P.M.C.Bikaner over a period of one year. 194 isolates of Enterococcalwere obtained from various clinical samples of patientsattending P.B.M. Hospital, Bikaner.Results: The maximum number of samples (30.41%) wasisolated from patients in the 0-10 year age group. It should benoted that out of the 59 patients in this group, 21 (35.59%)were <1year old. The mean age of incidence of enterococcalinfections was 31.53 years. 21 babies included in the 0-10 yearage group were <1 year old. Out of the 194 enterococcalisolates, 79 (40.72%) were from female patients, and 115(59.28%) were from male patients.Conclusion: Majority of the isolates were from the pediatricage group as the maximum number of samples was isolatedfrom patients in the 0-10 year age group The E.faecium strainsshowed a higher percentage of resistance to all the antibioticstested, as compared to the E.faecalis strains.

Characterization of Bacteria from Blood Cultures of Cancer Patients Admitted to Cancer Institute at a Tertiary Care Hospital

Background: Infection is a continuous and significant problemin patients with cancer. Bloodstream infection remains a majorcause of morbidity and mortality in patients undergoingtreatment for cancer. Bloodstream infection (BSI) is a leadinginfectious complication among cancer patients and has anegative impact on patients' outcome. Hence; the presentstudy was undertaken for characterizing bacteria from bloodcultures of cancer patients admitted to cancer institute.Materials & Methods: A total of 344 blood samples werecollected for culture from the suspected cases blood streaminfection from cancer patients. Blood samples were collectedbefore starting the antimicrobial therapy. Regardless of visualappearance every blood culture bottle was sub cultured afterovernight incubation and on the fourth and seventh days. Theinoculated pates of solid media were incubated overnight at37°C. Organism identification was done. All the results weresummarized in Microsoft excel sheet.Results: Out of 344 blood culture samples, 86 blood streaminfections were recovered from blood culture samples from allages and both sexes. Out of total 61 blood culture samples forneutropenic patients, Gram positive cocci, CONS was isolatedin 7(11.5%) while 2(3.3%) COPS were isolated. In GramNegative bacilli enterobacteriaceae members, E. coli wasisolated in 3(4.9%) and klebsiella was isolated in 6(9.8%). andin gram negative bacilli non fermenter, pseudomonas wasisolated in 8(13.1%) and acinetobacter was isolated in7(11.5%) of blood stream infection.Conclusion: The study highlighted the variations observed inthe pattern of aerobic bacterial profile from suspected cases ofBSIs and also the changing trends in the susceptibility patternsof the isolates to routinely used antibiotics.

Determine the Antimicrobial Susceptibility Pattern of Different Antimicrobials Used for Treating Infections in Cancer Patients: An Institutional Based Study

Background: Malignancy is a leading cause of deathworldwide, and accounted for 7.6 million deaths (around 13%of all deaths) in 2008. Broad spectrum antibiotics arecommonly used as empirical therapy in febrile cancer patients.Hence; the present study was undertaken for determiningantimicrobial susceptibility pattern of different antimicrobialsused for treating infections in cancer patients.Materials & Methods: From the suspected cases of bloodstream infection from cancer patients, a total of 344 bloodsamples were collected for culture. Blood samples werecollected before starting the antimicrobial therapy. Theantibiotic susceptibility testing of the isolates were done byKirby- Bauer disk diffusion method on Mueller Hinton agar.Isolates were grown in peptone water by incubating at 37°Cand turbidity was matched with 0.5 MacFarland standards.Then lawn culture was done on Mueller Hinton agar plate andcommercial antibiotic disks were placed. The plates wereincubated at 37°C overnight and on the next day the zones ofinhibition were measured and susceptibility/ resistanceinterpreted.Results: Out of total 30 CONS cases, sensitivity was found inVancomycin (100%), Linezolid (93.3%), Amoxy-clav (80%),Cefoxitin (80%), Amikacin (73.3%), Ceftriaxone (73.3%),Ciprofloxacin (53.3%), Cotrimaxazole (33.3%), Erythromycin(26.7%), and Tetracycline (20%). Out of total 12 COPS cases,sensitivity was found in Vancomycin (100%), Linezolid (91.7%),Amoxy-clav (83.3%), Ceftriaxone (83.3%), Amikacin (66.7%)Ciprofloxacin (41.7%), Erythromycin (41.7%), Tetracycline(41.7%), Cotrimaxazole (25%) and Cefoxitin (25%). Out of total12 isolates of Staph aureus (COPS) 3(25%) cases were foundto be MRSA. Above table shows sensitivity pattern of gramnegative bacilli enterobactericae (E coli and klebsiella).Conclusion: The clinicians should have thorough knowledgefor appreciating empirical therapy as well switch over to thebest regime based on antibiotic susceptibility pattern toimprove the overall outcome of the patient’s health.

Adenocarcinoma in a tailgut cyst: A rare case report

Tailgut cysts (TGCs) are rare congenital lesions derived from the remnants of primitive hindgut and are usually lined by squamous, transitional, or glandular epithelium. Malignant transformation in TGC may occur which is still rarer. Most common malignancies that arise from these cysts are adenocarcinomas. Preoperative diagnosis is difficult as high degree of suspicion is required for the diagnosis. We report here a case of adenocarcinoma arising in a tale gut cyst diagnosed preoperatively and till date very few cases have been reported in literature

Assessment Of Knowledge And Awareness About Leprosy Among Medical College Students In Mewat Region Of Haryana

Introduction-Leprosy is a chronic infectious disease which still remains a serious public health problem due to its ability to cause disability. The prevention of leprosy ultimately lies in the early diagnosis and treatment of the individ-uals having leprosy. Changing leprosy scenario has led to requirement of leprosy education. However the knowledge of medical college students on leprosy remains unknown. Aim: To assess the post-sensitization knowledge and awareness of medical students after state leprosy sensitization program. Materials and methods: A questionnaire based, cross sectional study was conducted among 107 medical students of different years starting from 2ndyear and onwards in the month of July 2017 after state leprosy sensitization program. Results: Among the medical students 70 (75%) were male students and 37(25%) were female students coming from different years of their admission in med-icalcollege.Regardingthebasicknowledgeofleprosy100%of3ndyear and final year students were having knowledge about the cause of leprosy and 100% of final year and 3rdyear medical students know about other name of Leprosy (Hansen,s disease) respectively.100% of final year ,3rdyear and 2ndyear medical students had knowledge about multidrug therapy (MDT) in in-depth knowledge of leprosy respectively. Regarding the virulence of bacilli 87%, 60% and 63% of final, 3rd and 2nd year medical students had apt knowledge respectively. Conclusion-These observa-tions suggest that the basic and in-depth knowledge of medical students about cause, types, prevention and treat-ment etc. of leprosy shows increasing trend owing to the part of their curriculum. However there is still a need to organize sensitization programs at regular intervals to impart basic and in-depth knowledge to new medical stu-dents, as well as to update the knowledge of those who already had such sensitization programs.

Comparison of the Erosive Potential of Commercially Available Beverages on Human Enamel: An in vitro Study

Objective: To assess and compare the erosive potential of commercially available beverages and to evaluate the relationship between mineral loss and physiochemical properties (pH and titratable acidity) of different beverages. Material and Methods: Seven commercially available beverages [4 soft drinks, 1 chlorhexidine mouthwash and 2 controls (Amul milk and human saliva)] were tested. The pH and tritratable acidity of the beverages was determined. Fifty-six human premolars were sectioned into enamel and root surface (total 112 specimens) by using diamond-cutting machine. The specimens were immersed in each beverage for 24-hour intervals at 370C. The weight loss of the specimens and mineral loss (calcium, phosphorus and fluoride) was determined at pre and post immersion and was subjected to statistical analysis at p<0.05 level of significance. Results: All beverages included in this were acidic. Nimbooz exhibited significant (p<0.05) weight loss compared to all other beverages. Fanta shows significantly (p<0.05) high loss of phosphorus and calcium for enamel and root surface respectively. There was a week correlation with pH and tritratable acidity and loss of minerals. Conclusion: The erosive potential of Fanta and Nimbooz was significant compared to other beverages. However, it must be considered that there are numerous factors, which may influence the erosion rate in the intra oral environment; hence the result of this in vitro study should be applied with caution.

Histological Changes in the Cerebellum of Albino Rats after Inhalational Exposure to Pyrethroid Based Mosquito Repellent

Background: There has been an ever increasing use of liquid vaporizers as residential insecticides to get rid of the problem of mosquito and as a concern shown towards prevention of  increasing cases of vector borne diseases. Adverse impact of these chemicals are many  including giddiness, nausea, headache, body ache,  lethargy and dizziness but the current research on the safety of these chemical compounds is market driven and proper histological studies that can establish their toxic effects on cerebellar cortex which acts as higher  centre of coordination, balance and learning are  rare. Accordingly the present  study was planned  to look into the claim of safety of these inhalational compounds and to establish  the correlation, if any between pyrethroid based mosquito repellent inhalational use and the histological insult to the  cerebellum of  Albino rats. Methods: Total of twenty albino rats were marked  into groups marked as control and experimental. The exposure of experimental group was carried out  to 3.2% w/v prallethrin vapours for total of 12 hours in a day and continued for 180 days. The Albino rats in control group were put in similar surroundings but without exposure to any mosquito repellent. The albino rats  were killed after completing exposure of 180 days. The rats brain was dissected and  Cerebellum was taken out. Tissue processing and sectioning done and finally  stained wusing  haematoxylin, eosin and thionin stains. Results: Outer molecular and inner granular layer of cerebellum showed areas of degeneration with disruption and decreased density of cells in Purkinje cell layer. Conclusions: The findings of the  study do confirms that mosquito repellents  given  by inhalational route leads to toxic insult  as evident in this study on Albino rats  on long term  exposure of 180 days as shown by histological alterations  in the sections of cerebellar cortex of rat CNS.

Aetiology, outcomes & predictors of mortality in acute respiratory distress syndrome from a tertiary care centre in north India.

Background & objectives: Acute respiratory distress syndrome (ARDS) is a common disorder in critically ill patients and is associated with high mortality. There is a paucity of literature on this condition from developing countries. This prospective observational study was designed to find out the aetiology, outcomes and predictors of mortality in ARDS. Methods: Sixty four consecutive patients who satisfied American-European Consensus Conference (AECC) definition of ARDS from medical Intensive Care Unit (ICU) of a tertiary care centre in New Delhi, India, were enrolled in the study. Demographic, biochemical and ventilatory variables were recorded for each patient. Baseline measurements of serum interleukin (IL)-1β, IL-6, tumour necrosis factor-alpha (TNF-α), procalcitonin (PCT) and high sensitivity C-reactive protein (hsCRP) were performed. Results: Common causes of ARDS included pneumonia [44/64 (68.7%)], malaria [9/64 (14.1%)] and sepsis [8/64 (12.5%]. Eight of the 64 (12.5%) patients had ARDS due to viral pneumonia. The 28-day mortality was 36/64 (56.2%).Independent predictors of mortality included non-pulmonary organ failure, [Hazard ratio (HR) 7.65; 95% CI 0.98-59.7, P=0.05], Simplified Acute Physiology Score (SAPS-II) [HR 2.36; 95% CI 1.14-4.85, P=0.02] and peak pressure (Ppeak) [HR 1.13; 95% CI 1.00-1.30, P = 0.04] at admission. Interpretation & conclusions: Bacterial and viral pneumonia, malaria and tuberculosis resulted in ARDS in a considerable number of patients. Independent predictors of mortality included non-pulmonary organ failure, SAPS II score and Ppeak at baseline. Elevated levels of biomarkers such as TNF-α, PCT and hsCRP at admission might help in identifying patients at a higher risk of mortality.

The prevalence of malocclusion and orthodontic treatment needs in school going children of Nalagarh, Himachal Pradesh, India.

Objective: The aim of this study was to determine the prevalence of malocclusion and orthodontic treatment need in 13–18‑year‑old schoolchildren of Nalagarh, Himachal Pradesh, India using the Index of Orthodontic Treatment need (IOTN) and to analyze the treatment needs between males and females and correlation between the esthetic component (AC) and dental health component (DHC) of IOTN. Subjects and Methods: The sample comprised 2000 school children (1125 females and 875 males) who had not undergone orthodontic treatment. No radiographs, study casts, were used; IOTN was calculated from clinical examination. Results: DHC results showed that little need for orthodontic treatment was found in 31.6% and moderate need in 30.85%. A great need was estimated at 37.55%. Severe contact point displacement of more than 4 mm was the most common occlusal feature in the definite treatment need group, followed by increased overjet, impeded eruption of teeth, and anterior or posterior cross bite. AC results showed that little need for orthodontic treatment was in 86.15%, moderate need in 8.90%, and great need in 4.95%. Limitations: Index does not consider midline discrepancy, soft tissue abnormalities, and AC does not include Class III and Class II div 2 malocclusion photographs. Conclusions: There seems a discrepancy in the proportion of children needing orthodontic treatment on esthetic and dental health grounds. This study provides baseline data on the need and demand for orthodontic treatment among the sample which is important for planning public orthodontic and dental services.

Computer Aided Designing-Computer Aided Milling in Prosthodontics: A Promising Technology for Future.

Computer aided designing-computer aided milling (CAD-CAM) technology was introduced to dentistry way back in 1971. Over the years there has been a constant upgradation in the quality and popularity of its application to dentistry. CAD-CAM fabricated prosthesis though initially were considered costly and technique sensitive, nowadays they are being extensively used because of advancements in various CAD-CAM systems that have gained popularity. Th e ease of work and reduced chair side time makes them a boon while providing prosthodontics treatment. Dental CAD-CAM systems are being used not only for crowns and bridges, inlays and onlays but also for fabrication of removable prosthesis, stents, and implant components. Th is article reviews the evolution of the CAD-CAM system and its applications in the fi eld of dentistry over the past two and a half decades.