Self-reported preparedness of final year undergraduate dental students and interns in Saudi Arabia: a multi-institutional study.

BACKGROUND: Contemporary undergraduate dental education aims to equip the dental students with clinical competence, empathy, and professionalism to enable them to deliver safe and effective dental care to the communities. The purpose of this study was to assess the self-reported preparedness of final year dental students and interns at three Saudi dental institutions, using the pre-validated Dental Undergraduates Preparedness Assessment Scale (DU-PAS). METHODS: A cross-sectional study design was employed to assess the self-reported preparedness of the participants using the DU-PAS. Following ethics approval, a probability sampling technique was used to recruit undergraduate dental students and interns from three dental institutions in Saudi Arabia. The data was collected online on Google Forms and all participants provided their consent to participate in the study prior to providing their responses to DU-PAS. RESULTS: Responses were received from 397 participants including 171 males and 226 females yielding a response rate of 60.3%. The total mean score of the participants was 81.85 ± 13.11. Although higher scores were reported in males, the interaction between gender and DU-PAS scores were not significant. Interaction between DU-PAS scores and stage of education showed significant effect of the stage of education with interns reporting higher overall scores. The participants reported that they were able to perform most clinical procedures independently. However, low confidence was reported in performing multi-rooted endodontics, fabrication of removable dentures and orthodontic assessment. The participants also expressed their confidence in a wide range of behavioural attributes related to communication, teamworking and professionalism. However, lack of experience was noted in referral for oral cancer, interpreting research, and evaluation of new dental products using an evidence-based approach. CONCLUSION: The study provides useful insights into the self-reported preparedness of undergraduate dental students and interns in three dental institutions. While the overall preparedness of the participants was comparable to their international peers, the findings underscore the need for further enhancements to the teaching and training of undergraduate students particularly in multirooted endodontics, removable prosthodontics and orthodontics.

Co-occurrence of Guillain-Barre syndrome and rheumatoid arthritis in a young female: A case report from a low middle-income country.

Key Clinical Message: We present the case of an adult female who had rheumatoid arthritis at first but later tested positive for Guillain-Barré syndrome (GBS). In symptomatic GBS patients (related to large joints), physicians (and therapists) should consider rheumatoid arthritis when risk factors are present. Abstract: The co-existence of GBS and other autoimmune disorders is uncommon. We present the case of an adult female who had rheumatoid arthritis at first but later tested positive for GBS. Further details are provided regarding the interdisciplinary diagnostic and therapy strategy that led to the patient's complete recovery. An adult female patient with rheumatoid arthritis presented with progressive weakness in her lower limbs, affecting her arm and causing numbness in her left hand and bilateral lower limbs. She has not passed stool for the last 2 days and has experienced gastroenteritis with watery, profuse diarrhea. On admission, the patient was awake, alert, and able to communicate. She had a thorough history of vital signs, with no signs of dehydration, jaundice, pallor, or edema. The patient's lower limbs were hypotonic and her upper limbs were normal. She experienced loss of sensation in her lower limbs, vibration, and proprioception. The patient's EMG-NCS report indicated sensory and motor axonal neuropathy (AMSAN variant). Plasmapheresis sessions were finished in our patient, and a very good result was achieved. In symptomatic GBS patients (related to large joints), physicians (and therapists) should consider rheumatoid arthritis when risk factors are present. Appropriate clinical treatment, which includes prompt evaluation of alternate diagnoses in the case of therapeutic failure, can improve patient outcomes.

Pyrolysis of exhausted biochar sorbent: Fates of cadmium and generation of products.

Biochar is a promising sorbent for Cd removal from water, while the disposal of the exhausted Cd-enriched biochar remains a challenge. In this study, pyrolysis was employed to treat the exhausted biochar under N2 and CO2 atmospheres at 600-900 °C, and the fate of Cd during pyrolysis and characteristics of high-valued products were determined. The results indicated that higher temperature and CO2 atmosphere favored the volatilization of Cd. Based on the toxicity characteristic leaching procedure (TCLP) results, the pyrolysis treatment under both atmospheres enhanced the stability of Cd, and the leached Cd concentration of regenerated biochar obtained at high temperatures (>800 °C) was lower than 1 mg/L. Compared with the pristine biochar, the regenerated biochar demonstrated higher carbon content and pH, whereas the contents of oxygen and hydrogen declined, and exhibited promising sorption properties (35.79 mg/g). The atmosphere played an important role in modifying biochar properties and syngas composition. The N2 atmosphere facilitated CH4 production, whereas the CO2 atmosphere increased the proportion of CO. These results implied that pyrolysis can be a valuable and environmental-friendly strategy for the treatment and reuse of exhausted biochar sorbent.

The toxicological effect on pak choi of co-exposure to degradable and non-degradable microplastics with oxytetracycline in the soil.

Microplastics and antibiotics are emerging as ubiquitous contaminants in farmland soil, harming crop quality and yield, and thus threatening global food security and human health. However, few studies have examined the individual and joint effects of degradable and/or non-degradable microplastics and antibiotics on crop plants. This study examined the individual and joint effects of polyethylene (PE) and polylactic acid (PLA) microplastics and the antibiotic oxytetracycline (OTC) on pak choi by measuring its growth, photosynthesis, antioxidant enzyme activity, and metabolite levels. Microplastics and/or oxytetracycline adversely affected root weight, photosynthesis, and antioxidant enzyme (superoxide dismutase, catalase, and ascorbate peroxidase) activities. The levels of leaf metabolites were significantly altered, causing physiological changes. Biosynthesis of plant secondary metabolites and amino acids was altered, and plant hormones pathways were disrupted. Separately and together, OTC, PE, and PLA exerted phytotoxic and antagonistic effects on pak choi. Separately and together with OTC, degradable microplastics altered the soil properties, thus causing more severe impacts on plant performance than non-degradable microplastics. This study elucidates the effects on crop plants of toxicity caused by co-exposure to degradable or non-degradable microplastic and antibiotics contamination and suggests mechanisms.

Single and combined effect of tetracycline and polyethylene microplastics on two drought contrasting cultivars of Oryza sativa L. (Rice) under drought stress.

Co-exposure of tetracycline (TC) and polyethylene microplastic (MP-PE) pollution might result in more intricate effects on rice growth and grain quality. In present study, two different rice cultivars of contrasting drought tolerance, Hanyou73 (H73, drought-resistant) and Quanyou280 (Q280, drought-sensitive) were grown on MP-PE and TC-contaminated soils under drought. It was found that drought stress had different influence on TC accumulation in the two rice cultivars. H73 accumulated more TC in leaves and grains without drought stress while Q280 accumulated more TC under drought stress. Furthermore, metabolomics results demonstrated that under drought stress, about 80 % of metabolites in H73 and 95 % in Q280 were down-regulated as compared to non-drought treatments. These findings provide insights into the effects of TC and MP-PE with and without drought stress on potential risks to rice growth and grain quality, which has implications on rice production and cultivar election under multiple-stress conditions.

Endodontic infection control practices among Pakistani general dental practitioners: A national cross-sectional questionnaire survey.

Objective: This study was aimed at evaluating the self-reported endodontic infection control practices of general dental practitioners in Pakistan. Methods: An e-questionnaire was sent to 619 general dental practitioners in several WhatsApp groups. Sixteen questions associated with various infection control measures recommended by the ESE were asked, including the use of various isolation methods/rubber dams, the selection of canal irrigants and anti-bacterial solutions, and practices regarding hand hygiene and use of examination gloves. The e-questionnaire also included questions associated with demographics. Data analysis was conducted in SPSS-24. Descriptive statistics were documented as percentages and frequencies. Results: Of 619 GDPs, 350 responded (56.5% response rate), of whom 43.7% worked in private dental practices. The majority were women (64%), had graduated after 2010 (81.1%), and were 24-34 years of age (78.9%). A total of 72.3% of GDPs used cotton rolls, and 17.4% routinely used rubber dams for endodontic isolation; 89% did not disinfect the operative field; 80% reported using different concentrations of NaOCl during root canal instrumentation; and 0.9% reported not using any irrigant during endodontic procedures. A total of 61.7% reported always using intra-canal medication during multi visit endodontic treatment, among whom 82.5% reported using Ca(OH)2. Finally, 100% of respondents reported using gloves during endodontic treatment. Conclusion: The results indicated that the GDPs tended to follow some of the endodontics quality standards recommended by the ESE, but the overall implementation of all guidelines requires improvement.

Root Canal Configuration and Its Relationship with Endodontic Technical Errors and Periapical Status in Premolar Teeth of a Saudi Sub-Population: A Cross-Sectional Observational CBCT Study.

Endodontic technical errors are the foremost cause of treatment failure. A thorough understanding of root canal configuration (RCC) is essential to prevent these iatrogenic errors. This study used CBCT images to determine the association between root canal configuration, endodontic technical errors, and periapical status. CBCT images of 101 patients, including total of 212 obturated premolars (256 canals) were assessed. RCCs were classified according to the Vertucci system. The presence of endodontic errors and periapical lesions associated with each RCC was noted. Presence or absence of coronal restoration and its association with periapical radiolucency was recorded. The most frequent RCC was Type I (199 cases; 77.73%), followed by Type II (26 cases; 10.15%), Type IV (22 cases; 8.59%), Type V (4 cases; 1.56%), Type III (4 cases; 1.56%), and Type VI (1 case; 0.39%). Under-filling and non-homogeneous filling were the most common technical errors. Prevalence of periapical radiolucency was 81% in the presence of technical errors. The absence of coronal restoration caused apical lesions in 93% of cases. The frequency of endodontic technical errors increased as the root canal configurations became more complex. Periapical lesions occurred more often in teeth with endodontic errors and/or absent coronal restoration.

Impact of polystyrene microplastics with combined contamination of norfloxacin and sulfadiazine on Chrysanthemum coronarium L.

Antibiotics and microplastics including nanoplastics are emerging contaminants which have become global environmental issues. The application of antibiotics along with microplastics in soil and their entrance in food chain may pose a major threat to human health. The single and combined exposure of polystyrene microplastic (MPS), norfloxacin (NF) and sulfadiazine (SFD) on Chrysanthemum coronarium L. a medicinal food crop, were investigated. Accumulation of nutrient element contents (Fe, Mn, Mg, Zn, K) differentially responded to the single or combined treatments compared to the control. Scanning electron microscopy and transmission electron microscopy analysis indicated that MPS, NF and SFD accumulated in roots, shoots, and leaves and affected their ultrastructure. Compared with that of the single contamination, the co-contamination of microplastics and antibiotics had a greater effect on leaf metabolites due to combination of multiple abiotic stresses. MPS, NF and SFD accumulated from roots and transported to shoots and leaves which ultimately impacts plant metabolites and, nutritional value. They subsequently impact agricultural sustainability and food safety of medicinal food plants. This investigation suggests the possible ecological risks of microplastics to medicinal food plants, especially in co-exposure with organic pollutants like antibiotics and help to reveal potential mechanisms of phytotoxicity of different antibiotics with polyethylene microplastic.

Comparison of cadmium adsorption by hydrochar and pyrochar derived from Napier grass.

Biochar (e.g. pyrochar and hydrochar) is considered a promising adsorbent for Cd removal from aqueous solution. Considering the vastly different physicochemical properties between pyrochar and hydrochar, the Cd2+ sorption capacity and mechanisms of pyrochars and hydrochars should be comparatively determined to guide the production and application of biochar. In this study, the hydrochars and pyrochars were prepared from Napier grass by hydrothermal carbonization (200 and 240 °C) and pyrolysis (300 and 500 °C), respectively, and the physicochemical properties and Cd2+ sorption performances of biochars were systematically determined. The pyrochars had higher pH and ash content as well as better stability, while the hydrochars showed more oxygen-containing functional groups (OFGs) and greater energy density. The pseudo second order kinetic model best fitted the Cd2+ sorption kinetics data of biochars, and the isotherm data of pyrochar and hydrochar were well described by Langmuir and Freundlich models, respectively. In comparison with hydrochar, the pyrochar exhibited better Cd2+ sorption capacity (up to 71.47 mg/g). With increasing production temperature, the Cd2+ sorption capacity of pyrochar elevated, while the reduction was found for hydrochar. The mineral interaction, complexation with surface OFGs, and coordination with π electron were considered the main mechanisms of Cd2+ removal by biochars. The minerals interaction and the complexation with OFGs was the dominant mechanism of Cd2+ removal by pyrochars and hydrochars, respectively. Therefore, the preparation technique and temperature have significant impacts on the sorption capacity and mechanisms of biochar, and pyrochar has better potential for Cd2+ removal than the congenetic hydrochar.

Pyrolysis of exhausted hydrochar sorbent for cadmium separation and biochar regeneration.

Sorption is considered a cost-effective technique for cadmium (Cd) removal from water, while the exhausted Cd-enriched sorbent should be properly disposed of. In this study, pyrolysis of exhausted hydrochar sorbent was conducted at 300-900 °C, and the behavior of Cd and the physicochemical properties and environmental applications of the regenerated biochar were investigated. The vaporization of adsorbed Cd in hydrochar was greatly enhanced by elevating pyrolysis temperature, and almost no Cd was observed in the regenerated biochars obtained at 700-900 °C. In comparison with the raw hydrochar, the regenerated biochars showed higher pH, ash content, and carbon content, while the contents of hydrogen and oxygen decreased. According to the toxicity characteristic leaching procedure result, the toxicity and mobility of Cd in hydrochar were greatly reduced after pyrolysis. Notably, the regenerated biochar showed much higher Cd sorption capacity (26.05-30.24 mg/g) than the raw hydrochar (6.70 mg/g). Surface complexation with oxygen-containing functional groups was the dominant Cd sorption mechanism for hydrochar, and precipitation between Cd2+ and carbonates dominated the Cd removal by the regenerated biochars. These results illuminated that pyrolysis can be an effective technique for the harmless disposal of exhausted hydrochar sorbent and the regeneration of valuable biochar.

Joubert syndrome a rare entity and role of radiology: A case report.

Introduction and importance: Joubert syndrome (JS) is defined by the characteristic set of cerebellum and midbrain abnormalities that communally result in the indicative "molar tooth sign" on the axial MRI report. The incidence of estimated to be from 1:80,000 to 1:100,000. Case presentation: Clinical features can be noticed shortly after birth that includes hypotonia episodic tachypnea and apnea that may be followed by developmental delays and speech apraxia. Polydactyly, cleft lip or palate, tongue abnormalities, hypotonia, encephalocele, meningocele, hydrocephalus, kidney problems, pituitary abnormality, and autistic-like behavior are the other deformities that can be seen with JS. Seizures may also occur. Motor disability and mental health range from mild to severe forms. Clinical discussion: Treatment for JS is symptomatic and supportive. The prognosis depends on cerebellar vermis development. Conclusion: JS can be missed if special attention were not given to radiological findings.

A case of McKusick-Kaufman syndrome with perinatal diagnosis: Case report and literature review.

Introduction: and importance: McKusick-Kaufman syndrome (MKS) is a rarely reported autosomal recessive syndrome characterized by hydrometrocolpos (HMC), polydactyly and various gastrointestinal and renal manifestations. Case presentation: We present a case of suspected MKS in a prenatal ultrasound with dilated lateral ventricles of the brain and HMC. Clinical discussion: Main differential diagnosis includes Bardet-Beidel syndrome (BBS) which can present with HMC and polydactyly but retinal manifestations are a differentiating feature from MKS. Conclusion: Both of the disease syndromes are diagnosed clinically after birth.Keywords: McKusick Syndrome, Bardet-beidel syndrome, hydrometrocolpos, case report.

Depression and anxiety among Pakistani healthcare workers amid COVID-19 pandemic: A qualitative study.

Objectives: The sudden COVID-19 crisis required a determined effort on the part of the healthcare workers (HCWs) and excessive workload increased the risk of depressive and anxious symptoms in frontliners. The aim of the study was to assess anxiety and depression levels among HCWs during times of pandemic and its potential aggravating factors. Materials and methods: A web-based survey was conducted to assess the mental health outcomes of healthcare workers and related factors during the COVID-19 pandemic. For assessing depression and anxiety, the Hospital Anxiety and Depression Scale (HADS) comprised of 14 items with seven items for depression and seven for anxiety were used. Results: Of all 436 participants, 158 (36.2%) showed noticeable symptoms of depression and 220 (50.4%) showed substantial anxiety symptoms. The majority of them were females. It has been observed in the study that female gender, young, and unmarried marital status are associated with higher scores. HCWs working in urban regions show more depressive symptoms. Mild depression and anxiety ratio are very common among participants (21.3%). Factors found to be associated with higher anxiety and depression are the increased number of deceased patients with lower family support. Conclusions: Altogether, the present study findings present concerns about the psychological well-being of all HCWs during the acute COVID-19 outbreak. Therefore, steps should be taken to protect them from mental exhaustion, so they may fight with more zeal against the infectious pandemic that has caused significant impacts worldwide.

Phytotoxic effects on chloroplast and UHPLC-HRMS based untargeted metabolomic responses in Allium tuberosum Rottler ex Sprengel (Chinese leek) exposed to antibiotics.

Introduction of antibiotics into agricultural fields poses serious health risks to humans. This study investigated the uptake of antibiotics, their effects on metabolic pathways, and chloroplast structure changes of Allium tuberosum exposed to norfloxacin (NFL), oxytetracycline (OTC), and tetracycline (TC). Among all the antibiotic treatments, the highest accumulation of antibiotics in roots (4.15 mg/kg) and leaves (0.29 mg/kg) was TC, while in bulbs it was NFL (5.94 mg/kg). OTC was with the lowest accumulation in roots: 0.19 mg/kg, bulbs: 0.18 mg/kg, and leaves: 0.11 mg/kg. The number of mitochondira and the number of plastoglobulli increased. The chloroplast structure was disturbed under the stress of NFL, OTC, and TC. Disturbance in the chloroplast ultrastructure leads to altered chlorophyll fluorescence variables. Simultaneously, metabolomic profiling of leaves demonstrated that NFL stress regulated more of metabolic pathways than OTC and TC. Differences in metabolic pathways among the antibiotic treatments showed that each antibiotic has different impact even under the same experimental conditions. TC and NFL have more toxic effects than OTC antibiotic. Metabolic variations induced by antibiotics stress highlighted pools of metabolites that affect the metabolic activities, chlorophyll fluorescence, ultrastructural adjustments, and stimulate defensive impact in A. tubersoum. These findings provide an insight of metabolic destabilization as well as metabolic changes in defensive mechanism and stress response of A. tuberosum to different antibiotics.

A scientometric analysis of agricultural pollution by using bibliometric software VoSViewer and Histcite™.

While modern agriculture brings more food to people, it causes environmental pollution as well. Agricultural pollution has attracted extensive public attention. A lot of reviews on agricultural research were conducted from different research aspects, but there is a lack of work on analyzing the research trend from large volumes of publications in the field of agricultural pollution. In the present work, a scientometric analysis of agricultural pollution was conducted to fill the gap by using the software of VoSviewer and HistCite™. The datasets are collected from the core database of Web of Science from 1991 to 2019, totally 1338 records on the topic of agricultural pollutions. In most years (1996, 1999, 2002, 2006, 2009, 2011, and 2013), the total local citation score (TLCS) and total global citation score (TGCS) have coincident peaks. Zhang, Ju, and Zhu have the highest TLCS and TGCS. In terms of institutes, Chinese Acad Sci and China Agr Univ are the leading institutes in this field. The Univ Calif Davis, INRA, and USDA ARS have very high global impacts. From the research hot topics, the representative words include "soil," "agriculture," "contamination," "environment," "lead," and "balance." Representative words like "heavy-metals," "groundwater," "land-use," and "water" are emerging in the latter time period. Five leading research co-cited reference clusters are identified, including environment management, underground water, monitoring and alarming for the agriculture-environment standards, intrinsic mechanism to the circulatory system, and ecology system and land use. The recent trend is revealed from the bibliographical-coupling network, focusing on classical and old-fashion research, like pollution chemicals including N management, pesticides, and heavy metal. This work provides a holistic picture on the research in the field of agriculture pollution.

Large lumbosacral schwannoma in a young female- a case report from Afghanistan.

INTRODUCTION: Mobile Schwannoma is a rare soft tissue tumor that commonly involves the elderly population. It has no cellular material and grows as solitary, firm, oval, encapsulated benign tumors from the sensory (dorsal) nerve root. If multiple, they are usually associated with Neurofibromatosis type 2 (NF-2). The initial sign and symptoms include segmental pain and paresthesia. It may lead to myelopathy if the tumor expands. CASE PRESENTATION: We present a twenty-year-old female with chronic lower backache radiating to the ipsilateral thigh with no urinary or fecal incontinence. On physical examination, the ankle reflex was hypoactive on the left side, and the straight leg raise test was positive. A large 32 × 15 × 14 mm heterogeneous enhancing focal lesion was found on the posterior side of L5 and S1 vertebrae with severe central canal stenosis. A diagnosis of nerve sheath tumor was made based on contrast MRI pre-operatively. The underlying cause was a nerve sheath tumor. A total bilateral laminectomy at the L1-S5 level and mass excision was performed, preserving nerve roots. The postoperative period was uneventful, and no tumor re-growth was noticed. CLINICAL DISCUSSION: Schwannoma is a slow-growing tumor; benign; usually, less than 8 cm in diameter tumor, commonly found in the head and neck region. It is the 3rd most common soft tissue tumor and the 2nd most common intradural extramedullary tumor. In our report, a young, non-Caucasian female patient is diagnosed with schwannoma, which is quite rare. In our case, a larger tumor of size 32 × 15 × 14 mm was noted, affecting the posterior body of L5 and S1 vertebrae in the left lateral recess with impingement of the left S1 traversing nerve root. Around 29% of spinal root nerve tumors are schwannomas. As the tumor grows slowly, the diagnosis may be delayed. CONCLUSION: Schwannoma is a slow-growing solitary, firm, oval, encapsulated benign tumor arising from the sensory (dorsal) nerve root. Histopathology plays a vital role in diagnosis, and overall, the disease has a favorable prognosis. Therefore, an appropriate approach is necessary to rule out the disease.

Biochar from constructed wetland biomass waste: A review of its potential and challenges.

Constructed wetland is considered a promising approach for water remediation due to its high efficiency, low operation costs, and ecological benefits, but the large amounts of wetland plant biomass need to be properly harvested and utilized. Recently, wetland plant derived biochar has drawn extensive attention owing to its application potential. This paper provides an updated review on the production and characteristics of wetland plant derived biochar, and its utilization in soil improvement, carbon sequestration, environmental remediation, and energy production. In comparison to hydrothermal carbonization and gasification, pyrolysis is a more common technique to convert wetland plant to biochar. Characteristics of wetland plant biochars varied with plant species, growth environment of plant, and preparation conditions. Wetland plant biochar could be a qualified soil amendment owing to its abundant nutrients. Notably, wetland plant biochar exhibited considerable sorption capacity for various inorganic and organic contaminants. However, the potentially toxic substances (e.g. heavy metal and polycyclic aromatic hydrocarbons) retained in wetland plant biochar should be noticed before large-scale application. To overcome the drawbacks from the scattered distribution, limited productivity, and seasonal operation of constructed wetlands, the economic feasibility of wetland plant biochar production system could be improved via using mobile pyrolysis unit, utilizing local waste heat, and exploiting all the byproducts. Future challenges in the production and application of wetland plant derived biochar include the continuous supply of feedstock and proper handling of potentially hazardous components in the biochar.

Comparison of the Efficacy of Tap Water Iontophoresis Versus Aluminum Chloride Hexahydrate in the Treatment of Palmoplantar Hyperhidrosis.

OBJECTIVE: To compare the efficacy of tap water iontophoresis (TWI) versus aluminum chloride (AC) hexahydrate in the treatment of palmoplantar hyperhidrosis. METHODS: The study was a randomized control trial performed at the dermatology department of Pakistan Navy Station (PNS) Shifa Hospital, Karachi from March 2022 to September 2022. A total of 70 palmoplantar hyperhidrosis patients were included in the study after getting approval from the ethical committee. Patients were divided into two groups. Group A patients were treated with TWI three times a week for four weeks. Group B patients were treated with a 20% AC topical solution applied at night to the affected areas for four weeks. The Hyperhidrosis Disease Severity Scale (HDSS) score for both groups was calculated at baseline, one, two, three, and four weeks. The final response was labeled at four weeks by comparing mean HDSS reduction in both groups. SPSS version 28 (IBM Corp., Armonk, NY) was used for data analysis. RESULTS: Mean HDSS was compared for both groups at the end of the study, which showed a significant reduction in the mean score from 3.40 ± 0.65 to 1.48 ± 0.78 in group A, as compared to a decline in scores in group B from 3.28 ± 0.67 to 2.14 ± 0.94 (p = 0.002). In group A, zero, one, two, and three points HDSS improvement was 2.9%, 25.7%, 48.6%, and 22.9%, respectively. Whereas in group B, it was 34.3%, 22.9%, 34.3%, and 8.6%, respectively (p = 0.001). CONCLUSION: As compared to AC topical solution, TWI is an effective, safe, and inexpensive management option for palmoplantar hyperhidrosis. It causes more improvement in HDSS scores and has lesser side effects.