Comparison of intraocular lens power prediction accuracy of formulas in American Society of Cataract and Refractive Surgery post-refractive surgery calculator in eyes with prior radial keratotomy

Purpose: To evaluate the accuracy of intraocular lens (IOL) power prediction of the formulas available on the American Society of Cataract and Refractive Surgery (ASCRS) post?refractive calculator in eyes with prior radial keratotomy (RK) for myopia. Methods: This retrospective study included 25 eyes of 18 patients whose status was post?RK for treatment of myopia, which had undergone cataract extraction with IOL implantation. Prediction error was calculated as the difference between implanted IOL power and predicted power by various formulae available on ASCRS post?refractive calculator. The formulas compared were Humphrey Atlas method, IOLMaster/Lenstar method, Barrett True?K no?history formula, ASCRS Average power, and ASCRS Maximum power on ASCRS post?refractive calculator. Results: Median absolute errors were the least for Barrett True?K and ASCRS Maximum power, that is, 0.56 (0.25, 1.04) and 0.56 (0.25, 1.06) D, respectively, and that of Atlas method was 1.60 (0.85, 2.28) D. Median arithmetic errors were positive for Atlas, Barrett True?K, ASCRS Average (0.86 [?0.17, 1.61], 0.14 [?0.22 to 0.54], and 0.23 [?0.054, 0.76] D, respectively) and negative for IOLMaster/Lenstar method and ASCRS Maximum power (?0.02 [?0.46 to 0.38] and ? 0.48 [?1.06 to ? 0.22] D, respectively). Multiple comparison analysis of Friedman抯 test revealed that Atlas formula was significantly different from IOLMaster/ Lenstar, Barrett True?K, and ASCRS Maximum power; ASCRS Maximum power was significantly different from all others (P < 0.00001). Conclusion: In post?RK eyes, Barrett True?K no?history formula and ASCRS Maximum power given by the ASCRS calculator were more accurate than other available formulas, with ASCRS Maximum leading to more myopic outcomes when compared to others

Clinical utility, feasibility of home tonometry using iCare HOME by glaucoma patients

Purpose: To determine agreement between diurnal variation testing (DVT) of intraocular pressure (IOP) with Goldmann applanation tonometer (GAT) and iCare HOME (IH) by an optometrist (OP) and home monitoring by participants (PT). Methods: Patients (18–80 years) with glaucoma and suspects were enrolled. IH IOP and GAT were taken by an OP at 2 h intervals from 8 AM to 4 PM on Day 1 and PT between 6 AM and 9 PM, for the next 2 days. IOP, date, and time were viewed via iCare LINK software. Results: In total, 72.9% (51/70) PT trained were able to take reliable readings. One hundred two eyes (51 patients, age 53 ± 16 yrs) were analyzed. Correlation between optometrist (OP) and participants (PT) was strong and positive {IH OP?IH PT? r = 0.90, p?0.0001;IH PT?GAT? r = 0.79, p?0.0001}. Agreement by Bland Altman plots was limited {IH OP?IH PT mean 0.1 mmHg (95% LOA ?5.3 to 5.5), IH PT?GAT 2.2 mmHg (?5.7 to 10.1)}. Intraclass correlation coefficient for IH OP?IH PT was 1.18 (95% CI 1.37?1.09). Intradevice {0.95 (95% CI 0.94?0.97)} and interrater repeatability {0.91 (0.79–0.96)} were good. 37% of eyes had a synchronous peak on GAT and IH during the day DVT. Conclusion: Home tonometry by iCare HOME is easy, feasible, but due to limited agreement cannot substitute GAT DVT.

Anthropometry of deep-set eyes with respect to difficulty in docking during femtosecond laser procedures

Purpose: To identify the facial anthropometric parameters that predict the difficulty during femtosecond (FS) laser. Methods: This was a single?center observational study was conducted on participants between the ages 18 and 30 years who were planned for FS?LASIK (femtosecond laser?assisted laser in situ keratomileusis) or SMILE (small incision lenticule extraction) at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India. The front and side?facing images of the participants were analyzed using Image J software to measure different anthropometric parameters. The nasal bridge index, facial convexity, and other parameters were measured. The difficulty faced by the surgeon during docking was recorded for each subject. The data were analyzed on Stata 14. Results: A total of 97 subjects were included. The mean age was 24 (±7) years. Twenty?three (23.71%) subjects were females while the rest were males. Difficulty in docking was seen in 1 (4.34%) female and 14 (19%) males. The mean nasal bridge index was 92.58 (±4.01) in subjects with deep?set eyes and 89.72 (±4.30) in normal subjects. The mean total facial convexity was 129.28 (±4.24) in deep?set eyes, and 140.23 (±4.74) in normal subjects. Conclusion: Total facial convexity appeared as the most important feature, with the value being less than 133° in most subjects with unfavorable facial anthropometry

Optic nerve sheath fenestration: A second lease at sight

Purpose: To study the safety and efficacy of optic nerve sheath fenestration surgery in patients with optic disc edema due to different etiologies. Methods: Records of 18 eyes of 15 patients who underwent optic nerve sheath fenestration for vision threatening optic disc edema were reviewed retrospectively, and results were analyzed. Improvement of visual acuity was the main measure of outcome. Improved visual fields, resolution of optic disc edema, diplopia, and headache were other benefits that were observed. Results: Fifteen patients between 13 and 54 years of age were included in the study. Three patients underwent successive bilateral surgery. Idiopathic intracranial hypertension was the most common cause for optic disc edema and was found in 80% of the patients. Mean preoperative logMAR acuity was ?1.9789 ± 1.46270, which improved to ?0.9022 ± 1.23181 (p < 0.005) in the operated eye, and mean logMAR acuity of contralateral eye improved from ?1.3378 ± 1.50107 to ?1.0667 ± 1.33813 (p < 0.05). Conclusion: Early optic nerve sheath fenestration is an effective modality for treating optic disc edema due to a wide myriad of causes and helps resolve the associated symptoms.

Virological and cytological changes in tears and conjunctiva of patients with COVID-19

Purpose: To analyze the presence of severe acute respiratory syndrome coronavirus 2 (SARS?CoV?2) in tears/conjunctival epithelium and assess the cytomorphological changes in the conjunctival epithelium of coronavirus disease 2019 (COVID?19) patients. Methods: In this pilot study, patients with moderate to severe COVID?19 were recruited from the COVID ward/intensive care unit of the institute. Tears and conjunctival swabs were collected from COVID?19 patients and sent to the virology laboratory for reverse transcription polymerase chain reaction (RT?PCR) testing. Conjunctival swabs were used to prepare smears, which underwent cytological evaluation and immunocytochemistry for SARS?CoV?2 nucleocapsid protein. Results: Forty?two patients were included. The mean age of participants was 48.61 (range: 5–75) years. Seven (16.6%) patients tested positive for SARS?CoV?2 ribonucleic acid in tears samples, four (9.5%) of which were positive on conjunctival swab by RT?PCR in the first test. Cytomorphological changes were observed significantly more in smears from patients with positive RT?PCR on tear samples, including bi?/multi?nucleation (p = 0.01), chromatin clearing (p = 0.02), and intra?nuclear inclusions (p < 0.001). One case (3.2%) showed immunopositivity for SARS?CoV?2; this patient had severe disease and the lowest Ct values for tear and conjunctival samples among all positive cases. Conclusion: Conjunctival smears from patients with COVID?19 revealed cytomorphological alterations, even in the absence of clinically significant ocular infection. However, viral proteins were demonstrated within epithelial cells only rarely, suggesting that although the conjunctival epithelium may serve as a portal for entry, viral replication is possibly rare or short?lived.

Comparison of Short-Term Hearing Outcome in Stapedotomy Using either Vein or Fat (Adipose Tissue) as Sealing Material

Abstract Introduction Otosclerosis is a common cause of conductive hearing loss in the adult population that is caused by fixation of the stapes footplate. Cochlear otosclerosis may also present with sensorineural or mixed hearing loss. Surgery is the definitive treatment of choice and, during the procedure, sealing of the oval window with autologous tissue graft around the stapes prosthesis has been routinely done to improve hearing outcome and to mitigate postoperative complications. Objectives To evaluate the efficacy of two different types of autologous tissue (vein or fat) grafts as oval window sealing materials in stapedotomy in improving short-term hearing outcomes. Methods In our study, 70 patients with otosclerosis who underwent primary stapedotomy were included. They were divided into group 1 (vein graft) and group 2 (fat graft) based on the type of sealing material used. All patients were followed-up at the end of 3 months, undergoing an audiometric examination to assess the hearing outcome. Results A total of 80% (n = 28) of the patients in group1 had an air-bone gap (ABG) closure < 10dB, and, in group 2, 85.7% had an ABG closure < 10 dB; this difference was found to be statistically insignificant. A total of 42.9% (n = 15) of the patients in group 1 and of 31.4% (n = 11) in group 2 had a significant improvement in bone conduction, while 14.3% (n = 5) of the patients in group 1 and 17.1% (n = 6) in group 2 had worsening of average bone conduction postoperatively, which was found to be statistically insignificant. Conclusions Both vein and fat grafts had comparable effects on hearing outcomes when used as sealing materials in stapedotomy.

Role of polymerase chain reaction–based viral detection in pterygia

Purpose: Pterygium is a fibrovascular disease that originates in the conjunctiva and commonly spreads to the corneal surface, thereby posing a threat to eyesight. Despite intensive research, the pathophysiology of this disease remains unclear. Recent research suggests that oncogenic viruses, such as human papillomavirus (HPV), cytomegalovirus, and Epstein–Barr virus (EBV), may play a role in pterygia development. Although there are questions concerning the function of oncogenic viruses in pterygium pathogenesis, existing research shows a lack of consensus on the subject, demonstrating the heterogeneity of pterygium pathophysiology. Therefore, we aimed to simultaneously detect the three common viral pathogens that have been reported in pterygium tissue obtained after excision. Methods: Thirty?five tissue specimens of pterygium from patients undergoing pterygium surgery (as cases) were analyzed for evidence of viral infection with multiplex polymerase chain reaction (PCR), and virus?specific real?time quantitative PCR was used for the samples that were detected positive by multiplex PCR. Results: Of the 35 patients, one sample was positive for EBV and two samples were positive for HPV. Further PCR?based DNA sequencing of the HPV PCR?positive product showed identity with HPV?16. Real?time quantitative PCR on samples that showed EBV or HPV positivity did not yield any detectable copy number. Conclusion: Our study results confirmed that PCR positivity could be due to transient flora, but it was not quantitatively significant to conclude as the causative factor of pterygium pathogenesis. However, additional studies with larger sample populations are warranted to fully determine the role of the virus in pterygium.

Simulation-based training in ear, nose and throat skills and emergencies

Abstract Objectives: The aim of the study was to compare lecture-based teaching and simulation-based hybrid training for ENT induction and objectively assess the performance of trainees in a simulated environment. Methods: This is a prospective interventional study that included 60 interns in their rotatory internship with no prior exposure to ENT emergencies. The interns came in batches of 5-6 for their 15-days ENT postings. On the first day, a pre-test questionnaire, lecture-based teaching on three scenarios and then allocation into one of the three simulation groups- Group A (Tracheostomy group), Group B (Nasogastric tube group), and Group C (Epistaxis group) was done. Hands-on simulation training was given only to the assigned group. At the end of 15-days, post-test questionnaire and an objective assessment of the three scenarios in a simulated environment was conducted. The same training was repeated for each batch of participants who attended the posting. Results: The participants had significant improvement in the post-test scores in all three scenarios (p < 0.05), and these improvements were marked in those who had received simulated training. On comparing simulation scores, the participants who received hands-on training on a particular scenario outperformed other (p < 0.05). Conclusion: Simulation-based training improves cognition and overall confidence in managing ENT skills and emergencies. In simulation training, objective and standardized assessment is the key to achieve specific learning objectives to improve the psychomotor and cognitive skill. Level of evidence: II.

Predicting recurrence in oral cavity cancers: a review of 116 patients with buccal mucosa carcinoma in northwestern India

Background@#Oral cavity cancers, the second most common type in India, are responsible for 10% of the overall cancer burden. With a recurrence rate of 30% to 40% and a 5-year survival rate of 50%, these malignancies account for substantial morbidity and mortality. Despite advances in treatment modalities, survival rates following treatment completion have not improved significantly. The present study aimed to establish specific epidemiological and pathological factors responsible for recurrence after treatment completion in buccal mucosa cancers. @*Methods@#A retrospective analysis of the data of 116 patients treated for biopsy-proven cancers of the buccal mucosa was undertaken 1 year after treatment completion. Factors such as age, sex, education, lymphovascular invasion, extranodal extension (ENE), perineural invasion, depth of invasion, and pathological margin status were compared between patients who presented with recurrence and those who did not. Statistical significance was set at p 10 mm did not show statistically significant associations. @*Conclusion@#Neck node metastasis, ENE, and margins of resection < 5 mm were the histopathological factors associated with recurrence in cancers of the buccal mucosa.

Benign Retrovesical Pelvic Mass in Men : Diagnostic and Management Dilemma

Aim : To identify the diagnostic difficulties and management issues of benign pelvic masses in males and high light the diagnostic protocol for these rare pelvic masses. Methods : A prospective single center study over a period of six years and three months. History, physical examination, operative findings and histopathological (HPE) diagnosis were recorded. Results : A total of 20 male patients presented with retrovesical mass, aged 17 to 65 years old (mean age 36.7 years) were evaluated. masses were found to be of prostatic origin in seven cases (5 prostatic utricle cyst and 2 prostatic abscess), connective tissue in seven, seminal vesicle origin in four, mullerian duct remnant in one case, and embryonic urogenital vestigial remnants in one case. Of these 20 patients, 19 presented with acute or chronic lower urinary tract symptoms and in one case, the mass was asymptomatic and found incidentally. Ultrasound showed cystic lesions in 17 patients and solid masses in three. Nine cases underwent exploratory laparotomy. Further biopsies of specimen demonstrated tissue of origin in all cases (8/9) except one. HPE report confirmed the same clinical and operative diagnosis in six cases. Conclusion : Benign retrovesical mass presents with lower tract obstructive symptoms, palpable pelvic mass and retention of urine. Needle or open biopsy is required in most cases to establish a histopathological diagnosis. Benign retrovesical mass is rare, we faces difficulty in diagnosis and management. Hence, diagnostic protocols can be helpful to manage retrovesical pelvic masses.

Knowledge of Chronic Kidney Disease among MD Medicine Postgraduates and Residents

Introduction : Physicians in India are frequently the first point of contact for patients with chronic kidney disease. Hence, awareness of clinical practice guidelines for Chronic Kidney Disease (CKD) among the Postgraduates/ residents of MD Medicine is of paramount importance. The aim of this study is to assess MD Medicine Postgraduates’ and Residents’ awareness and knowledge of clinical practice guidelines for Chronic Kidney Disease (CKD). Materials and methods : The present study is a cross-sectional observation study. A questionnaire of clinical vignettes on CKD with multiple choices was prepared. A one-time survey of MD Medicine postgraduates and residents from various medical colleges in three states of southern India has been collected. Results : A total of 228 Postgraduates or Residents of MD Medicine participated in the study. The awareness of clinical practice guidelines for CKD was low across all postgraduate years (PGYs) of MD Medicine. We measured the CKD awareness in postgraduates and residents of MD Medicine based on the Postgraduate year, Medical college and institute, type of institution (either Government funded or capitation fee), the presence of a nephrology fellowship in the institution, and the consultation given to the Nephrology patients in the Medicine OPD. Conclusions : The modest awareness of clinical practice guidelines for CKD across all PGYs has suggested that incorporation of these guidelines into the medicine postgraduate training curriculum is not robust at present. We also discussed the means to improve the understanding of nephrology by the postgraduates/residents of MD Medicine

TO FIND CORRELATION OF CORE STRENGTH AND THORACIC ROTATION WITH SPEED OF THROWING IN CRICKETERS

Cricket is one of the most popular games which is played all over the world and its popularity has ever been increasing in the last decade. Fielding is an important dimension of the game as is batting and bowling. With the game being so fast with the introduction of 20 overs game fielding has had an increased demand in the sport. Throwing is considered one of the major and main activities of fielding. Throwing motions involve moving objects spatially using body segments, in particular, hand and arm segments, which can be classified into overarm throws, sidearm throws and underarm throws and divided into throwing objects quickly, accurately and far away. Aim of this study was to find The Correlation of Core Strength and Thoracic Rotation with Speed of Throwing in Cricketers. 31 Cricketers were assessed for their core strength with side rotational medicine ball throws and distance measured, Thoracic rotation in lumbar locked sitting position and measuring with universal goniometer and speed of throws with a BUSHNELL Speed gun. Results of this study showed that Core Strength and Speed of Throws showed a positive, strong and significant correlation whereas Thoracic Rotation and Speed of Throws also showed a positive and significant correlation. Core Strength showed greater clinical and statistical correlation with Speed of Throws than Thoracic Rotation. This study will not only help in preventing throwing injuries but also will help to train and enhance throwing abilities and overall performance

Comparison of gingival inflammatory parameters and pain perception on periodontal probing - a cross sectional study, part II / Comparación de parámetros inflamatorios gingivales y percepción del dolor en el sondaje periodontal - un estudio transversal, parte II

Background: Probing of the periodontal pocket is an essential part of the diagnosis of periodontal disease and 15-77% of untreated periodontal patients experience pain during probing. Therefore, the objective of this study is to evaluate the pain perceived by patients with dental plaque-induced gingivitis and chronic periodontitis during periodontal probing and the main objective includes the evaluation of the relationship between pain perceived during periodontal probing and gingival inflammatory parameters. Material and Methods: A total of 475 participants were recruited into the study. The patients were divided into two groups: Group-A (Gingivitis Group - 275 patients) and Group-B (Chronic Periodontitis Group - 200 patients). Clinical parameters included analysis of bleeding on probing, simplified gingival index, pocket depth on probing, and clinical attachment level. Pain score was recorded using the HP VAS scale and all patients participated in the study after a detailed explanation of the study protocol. Results: A significant difference in pain perception was noted between groups, highlighting the role of the degree of inflammation in the examination of periodontal parameters. Conclusion: Within the limitations of the present study, we can conclude that pain perception is directly correlated with the degree of inflammation in periodontitis rather than plaque-induced gingivitis during periodontal probing. Therefore, some form of adjuvant topical anesthesia may be considered in order to reduce pain levels in severely inflamed patients, to encourage continued acceptance of supportive periodontal therapy.

Antecedentes: El sondaje de la bolsa periodontal es una parte esencial en el diagnóstico de la enfermedad periodontal. 15-77% de los pacientes periodontales no tratados experimentan dolor durante el sondaje. Por lo tanto, el objetivo de este estudio es evaluar el dolor percibido por pacientes con gingivitis inducida por placa dental y periodontitis crónica durante el sondaje periodontal y el objetivo principal incluye la evaluación de la relación entre el dolor percibido durante el sondaje periodontal con parámetros inflamatorios gingivales. Material y Métodos: Un total de 475 sujetos fueron reclutados en el estudio. Los sujetos se dividieron en 2 grupos: Grupo - A (Grupo de gingivitis - 275 pacientes) y Grupo - B (Grupo de periodontitis crónica - 200 pacientes). Los parámetros clínicos incluyeron el análisis del sangrado al sondaje, el índice gingival simplificado, la profundidad de la bolsa al sondaje y el nivel de inserción clínica. La puntuación del dolor se registró utilizando la escala HP VAS y todos los pacientes participaron en el estudio después de una explicación detallada del protocolo del estudio. Resultados: Se notó una diferencia significativa en la percepción del dolor en el grupo B que en el grupo A, lo que significa el papel del grado de inflamación en el examen de los parámetros periodontales. Conclusión: Dentro de las limitaciones del presente estudio, podemos concluir que la percepción del dolor se correlaciona directamente con el grado de inflamación que se observa en la periodontitis más que con la gingivitis inducida por la placa dental durante el sondaje periodontal. Por lo tanto, se puede considerar alguna forma de anestesia tópica adyuvante para reducir los niveles de dolor en pacientes gravemente inflamados para fomentar la aceptación continua de la terapia periodontal de apoyo.

Significance of Siddha Thirithoda Balancing Food Stuffs

The Siddha system of medicine is an ancient medical system, which provides ‘Holistic Health’. The word ‘Siddha’ originated from the word ‘Siddhi’ meaning achievement of perfection, eternal bliss and accomplishment. The Siddha system evolved based on ninety-six tools (96 Thattuvam) which include physical, physiological, psychological and intellectual aspects of every human being. Among the 96 tools, the five elements i.e. Pancha bootham namely Earth, Water, Fire, Air and Space are the fundamental units of everything in the human body and the cosmos. There are three vital life factors (Vaatham, Pittam, Kabham) responsible for good health. There is a relationship between these to maintain the body’s healthy. Any increase or decrease in humour causes diseases. Thirthoda sama porutkal (TSP) maintains these humour when we are using our regular diet. This article details the TSP to maintain the body healthy.

Relative Risk Analysis of Patient Return Within 72 Hours to Emergency Department.

Introduction: Transparency in patient care in an emergency department can be projected by capturing data from the medical records of patients. Policy makers envision that transparency in this data will allow the patient to choose the right hospital of his choice. Relative risk is a ratio of the probability of an event occurring in the exposed group versus the probability of the event occurring in the non-exposed group. It is usually used in the scenario of clinical events. In this study we have used it to analyse one of the key performance indicators used in Emergency Department, as per Emerald standards. The problem statement identified in the study is the returning of patients to the Emergency department of a private, tertiary care hospital within 72 hours after the initial visit. A revisit in this study is assumed as an unplanned visit done by the patient within 72 hours with similar presenting complaints. Methodology: A retrospective cohort study for all emergency visits between January to June 2021. People who returned to EMD within 72 hours were compared to other non-re attending patients based on medical diagnosis, patient demographics, mode of arrival, triage category and qualification of doctors in charge. Multivariate analysis using the generalized linear model was conducted on variables associated with 72-hour ED re-attendance. Result: Among 18,355 patients, 128 (0.69%) were in the 72-hour re-attendees’ group. Multivariate analysis showed female gender as more, above 60 years of age, arrival by ambulance, triaged as yellow. Among the ICD-10 diagnosis for the patients who returned, it was not possible to identify one specific condition. But abdominal pain was one reason for the re-visit of a few patients. There was also a significant difference in the seniority ranking of the doctor-in-charge between both groups. Conclusion: Identification of characteristics of patients lead to improved care by surgeons and gastroenterology.

North India Childhood Cataract Study - The real scenario and causes of surgical delay of pediatric cataract

Purpose: The study sought to describe the clinical presentation pattern of pediatric cataracts and factors leading to delay in surgery at a tertiary care center in North India. Methods: A cross?sectional, interview?based study was conducted from January 2020 to October 2020, that included pediatric patients <12 years, with unilateral or bilateral congenital or developmental cataract. A pre?validated questionnaire was used to record data. The parameters recorded were age at first symptoms, age at diagnosis of cataract, age at surgery, laterality of cataract, first symptom, first family member noticing the abnormality, the morphology of cataract, association of perinatal complications, family history, systemic diseases, and cause (s) of delay in surgery. Results: A total of 89 patients were included. The mean age of subjects was 4.75(±3.51) years. A white pupil was the most common symptom (64.04%) and appeared in infancy in 30.3% of cases. Parents first detected the problem in 60.67%, and the pediatrician was the first medical contact in 11.23% of cases. The median (IQR) delay period between diagnosis of cataract and cataract surgery was 4 (3–6) months, the major causes were long GA waiting (30.33%), and delay due to systemic ill health (14.61%). Conclusion: Parental education on cataract detection is recommended to help in the timely detection and hence, improved outcomes of pediatric cataract surgery. Pediatricians, consulted for any systemic illness, have the role of the second most important contact in the detection of pediatric cataract.

Effectiveness of self-designed dental storybook as behavior modification technique in 5 – 7 year-old children A randomized controlled study

Background: Dental anxiety is one of the key factors that prevent children from obtaining dental treatment and raises anxiety levels in children. The first dental visit is usually fearful for the child and contributes to managing the child patient in a dental operatory. A pediatric dentist's role is to perform effective treatment using various nonpharmacological behavior management techniques. Aims: The aim of the study was to evaluate and compare the effect of self-designed dental storybook on behavior and pulse rate before and after dental procedures in 57-year-old children. Settings and Design: The study was a prospective, randomized, controlled trial. Materials and Methods: The study was conducted on 380 aged 57 years. Children were randomly allocated into two groups, namely, Group A ? Behavior modification using a self-designed dental storybook and Group B – Behavior modification without storybook. Research was carried out in two dental visits (screening, examination, and preventive and restorative treatment) wherein, before and after intervention, pulse rate, Facial Image Scale (FIS), and Venham Scale (VS) were recorded. Descriptive statistical analyses followed by the paired t-test and Wilcoxon signed-rank test were applied and tabulated using the SPSS software version 23.0. Results: There was a significant difference observed in the interventional group as compared to the control group for pulse rate, FIS, and VS. Conclusion: Self-designed dental storybook as an adjuvant was found to be promising behavior modification technique for 57-year-old children.

Evaluation of pain perception on periodontal probing in patients with dental plaque induced gingivitis and chronic periodontitis - a cross sectional study, part I / Evaluación de la percepción del dolor al sondaje periodontal en pacientes con gingivitis inducida por placa dental y periodontitis crónica: un estudio transversal, parte I

Background: Probing of periodontal pockets is an essential part in the diagnosis of periodontal disease. Fifteen to seventy seven percent of untreated periodontal patients experience pain during probing. Hence the aim of this study is to evaluate the pain perceived by patients with gingivitis and periodontitis during periodontal probing. The goals of this study were to compare the patients' pain perception when using a conventional UNC15 probe and a manual pressure sensitive periodontal probe, and to relate the clinical features of gingivitis and periodontitis to the discomfort associated with periodontal probing. Material and Methods: A total of 475 subjects were recruited into the study. The subjects were initially divided into two groups ­ Group ­ A (Gingivitis group - 275 patients) and Group ­ B (Chronic Periodontitis group -200 patients) according to the AAP 1999 Classification. These two groups were further subdivided into two groups each (Gingivitis ­ Conventional Probe ­ GCP, Gingivitis ­ Manual Pressure Sensitive Probe ­ GMPS, Periodontitis - Conventional Probe ­ PCP, Periodontitis ­ Manual Pressure Sensitive Probe ­ PMPS) using a computer generated program of random numbers. Results: A significant difference was noted in pain perception when pressure sensitive probe was used compared to conventional UNC-15 probe. Reduced Bleeding on Probing and Pain scores were noted in Chronic periodontitis subjects with use of pressure sensitive probe, which was statistically significant (p<0.001). Conclusion: Dentistry has changed its focus towards painless dentistry. In this context, the present study presents data towards use of manual pressure sensitive probes, which offers an advantage of low cost when compared to more advanced computerized systems with reduced pain during periodontal examination. It could result in a positive attitude of the patients towards continuous supportive periodontal therapy thereby monitoring periodontal health.

Antecedentes: El sondaje de los sacos periodontales es una parte esencial en el diagnóstico de la enfermedad periodontal. Del quince al setenta y siete por ciento de los pacientes periodontales no tratados experimentan dolor durante el sondaje. De ahí que el objetivo de este estudio fué evaluar el dolor percibido por pacientes con gingivitis y periodontitis durante el sondaje periodontal. Los objetivos de este estudio fueron comparar la percepción del dolor de los pacientes al usar una sonda UNC15 convencional y una sonda periodontal sensible a la presión manual, y relacionar las características clínicas de la gingivitis y la periodontitis con la incomodidad asociada con el sondaje periodontal. Material y Métodos: Un total de 475 sujetos fueron reclutados en el estudio. Los sujetos se dividieron inicialmente en dos grupos - Grupo - A (grupo de Gingivitis - 275 pacientes) y Grupo - B (grupo de Periodontitis Crónica - 200 pacientes) de acuerdo con la Clasificación AAP 1999. Estos dos grupos se subdividieron en dos grupos cada uno (Gingivitis - Sonda convencional - GCP, Gingivitis - Sonda manual sensible a la presión - GMPS, Periodontitis - Sonda convencional - PCP, Periodontitis - Sonda manual sensible a la presión - PMPS) usando un programa generado por computadora de datos aleatorios. números. Resultados: Se notó una diferencia significativa en la percepción del dolor cuando se usó una sonda sensible a la presión en comparación con la sonda UNC-15 convencional (p<0,001). Conclusion: La odontología ha cambiado su enfoque hacia una odontología sin dolor. En este contexto, el presente estudio presenta datos hacia el uso de sondas manuales sensibles a la presión, que ofrece una ventaja de bajo costo en comparación con sistemas computarizados más avanzados con reducción del dolor durante el examen periodontal. Podría resultar en una actitud positiva de los pacientes hacia la terapia periodontal de apoyo continuo, monitoreando así la salud periodontal.

An interesting case of anemia with jaundice

Hemoglobinopathies are haematalogical disorders that afflict millions of individuals worldwide. HbE is a hemoglobinvariation caused by a mutation in the ? globin gene that results in the substitution of glutamic acid for lysine at position 26 of the ? globin gene. Hemoglobin (Hb) synthesis abnormalities are among the most prevalent inherited disorders. They can be quantitative (thalassemia syndrome) or qualitative (variant HbS). Hemoglobin E (HbE) is the second most common hemoglobin variation after hemoglobin S (HbS).

Development of an interview-based warfarin nomogram predicting the time spent in the therapeutic INR range: A cost-effective, and non-invasive strategy building from a cross sectional study in a low resource setting

A cross-sectional study was conducted to predict time in therapeutic range (TTR) using clinical history, examination, and socioeconomic data. Study included warfarin-receiving patients from outpatient-clinic. In 203 patients studied, mean warfarin start-dose was 2.55 mg/day and maintenance-dose/week was 30.79 mg. Body mass index (BMI) (p ¼ 0.03), warfarin maintenance dose/day (p ¼ 0.02), and comorbidity presence (p ¼ 0.04) were significantly associated with TTR. Occupation (p ¼ 0.53), income (p ¼ 0.83), education (p ¼ 0.55), and socioeconomic score (p ¼ 0.73) showed non-significant association with TTR. A TTR predicting nomogram was built from clinical history and examination findings.