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Mango (Mangifera indica L.) is a salt sensitive crop and its cultivation in salt affected area is declining day by day. There is a need to find out the rootstocks to sustain under saline conditions which can be used for commercial cultivation of superior cultivars through grafting. To achieve this, the present study was carried out to understand the salt tolerance and sensitive nature of fifteen polyembryonic mango rootstock seedlings (EC-95862, Bappakkai, Vellaikolamban, Nekkare, Turpentine, Muvandan, Kurukkan, Kensington, Olour, Manipur, Deorakhio, Vattam, Mylepelian, Sabre and Kitchener) which were exposed to 0 mM, 25 mM, 50 mM and 100 mM concentration of NaCl+CaCl2 (1:1) salt. The outcome of this study revealed that there was reduction in K+, Ca++, Mg++, Fe++ and Zn++ while the content of Cu++ and Mn++ in both leaf and root tissues were found to increase with gradual increase in salt concentration from 0 to 100 mM. The overall results of this study revealed that the salinity stress caused the alterations in mineral nutrient composition of polyembryonic mango genotypes. Among the fifteen genotypes the seedlings of Turpentine, Deorakhio, Olour and Bappakkai respond better in maintaining the mineral nutrient status in leaf and root tissues under higher level of salinity.

A study was conducted at the ICAR-Indian Institute of Horticultural Research, Hesaraghatta, Bengaluru for three consecutive seasons during 2019-20, to standardize the container type, substrate combination and nutrition for potted plant production of China aster var. Arka Archana. The treatments comprised of two type of containers (plastic and coir), three substrates {Red soil + FYM + Sand (1:1:1 v/v), Arka Fermented cocopeat (AFC), AFC + Vermicompost (1:1 v/v)} and four nutrition concentration (160:30:180 ppm N:P: K, 128:24:144 ppm N:P: K, 96:18:108 ppm N:P: K and Jeevamrutha @ 3%) laid out in factorial completely randomized design with three replications. Plant height at flowering (33.12 cm), number of primary branches (12.4), plant spread (536.64 cm2), number of flowers/plant (26.47), flower size (5.26 cm) and uptake of major, secondary and minor nutrients were maximum in the plants grown in 6" plastic pots using the substrate combination of soil +sand +FYM (1:1:1 v/v/v) along with the weekly application of nutrient solution of 96:18:108 ppm NPK/plant. This production protocol resulted in a dense canopy and highly floriferous potted plants. The benefit cost ratio of potted China aster production was 1.70. This technology can be adopted by the nurserymen for large-scale commercial potted plant production.

Response of gerbera var. Arka Nesara was studied under different soil-less production systems with the aim to improve quality, productivity and water use efficiency, in completely randomized design with eight treatments viz., deep flow technique (DFT), nutrient film technique (NFT), aggregate wick system (AWS) with pots on NFT bench, AWS with pots on ground, AWS with grow bags on ground, AWS on soil bed, aeroponics and conventional soil-based drip system, which were replicated five times. Results revealed that AWS with pots on ground recorded maximum plant height (31.66 cm), leaf length (21.31 cm), leaf breadth (9.96 cm) and stalk diameter near neck (4.75 mm), minimum stem deviation (1.27 cm) and stem deflection (2.2o), prolonged vase life (9.2 days), greater water use efficiency (92 mL/plant/day) and water saving (83.46%). Hence, cultivation of gerbera var. Arka Nesara under aggregate wick system with pots on ground could be the superior alternative for traditional soil cultivation.

Gladiolus is a popular commercial flower crop among top ten cut flowers of international trade. In order to improve the rate of multiplication, eleven gladiolus varieties with three nutrient regimes (N1- 96:18:108, N2-128:24:144 and N3-160:30:180 ppm of NPK) were evaluated under aeroponics system. The results revealed that different varieties and nutrient regimes had significant influence on plant growth, corm and cormel production. Among the genotypes, Arka Naveen recorded maximum plant height (109.44 cm), on par with Arka Amar (104.77 cm). The genotype Arka Amar (1.89) recorded highest number of corms per plant, on par with Arka Ranjini (1.78), Arka Aayush (1.44), Arka Naveen (1.44) and Arka Shobha (1.67). However, number of cormels were recorded highest in Arka Aayush (1.67), on par with Arka Amar (1.67) and Arka Ranjini (1.44). Among the nutrient regimes, N2 (128:24:144 ppm NPK) registered maximum plant height (85.44 cm), on par with N3 (160:30:180 ppm NPK) (77.42 cm). The number of corms (1.39) and cormels (3.56) per plant were recorded highest in N2 (128:24:144 ppm of NPK). The genotype Arka Manorama did not produce cormels under aeroponics system. Gladiolus varieties Arka Amar, Arka Aayush and Arka Naveen were found as best suited under aeroponic system for better corm multiplication under the nutrient regime of N2 (128:24:144 ppm of NPK).

The present study was conducted to determine the effect of osmotic stress on the plant growth hormone production by six osmotolerant plant growth promoting bacterial strains. These strains originated from the phytomicrobiome of chilli cultivated in the drought prone areas of Andhra Pradesh. They possessed multiple plant growth promotion traits including the ability to produce a variety of plant growth hormones. The effect of osmotic stress on the plant growth hormone production was determined by High Performance Liquid Chromatography (HPLC) under normal and in vitro osmotic stress conditions using 25% Poly Ethylene Glycol (PEG) 8000. In general, it was observed that osmotic stress impacted the plant growth hormone production of the isolates, but nevertheless plant hormones were detected in all the bacterial strains. An exception to this was the cytokinin molecule zeatin riboside, which was produced at higher levels by five of the six bacterial isolates under osmotic stressed conditions.

Mutation breeding is a key method of generating a large number of heritable variations. Effective dose (LD50) needs to be standardized for inducing sufficient variation in a crop. In the present study, seeds were irradiated with different doses of Gamma rays and found that 66.94 Gy could suppress germination close to 50 percent (LD50) in pummelo. This 60 Gy gamma dose can effectively be used for raising the mutant populations to identify a desirable mutation in pummelo.

An experiment was conducted to study the effect of integrated nutrient management practices on the microbial community dynamics of soils under sweet basil (Ocimum basilicum L.) at ICAR - Indian Institute of Horticultural Research, Bengaluru during the Kharif season of 2015 and 2016. There were nine treatments replicated thrice in randomized complete block design. The results indicated that integrated application of FYM (10 t/ha) + 100% recommended N through FYM + bio-fertilizer i.e., T2 recorded the highest population of heterotrophic free-living N2 fixers (40.66 and 63.33 CFU ×103/ g), phosphate solubilizing bacteria (5.6 and 6.6 CFU ×103/ g) and fungal (6.4 and 5.33 CFU ×103/ g) while T9 with the application of NPK (160:80:80 kg /ha) + FYM (10 t/ha) recorded the highest population of actinomycetes (29.93 and 44.56 CFU ×103/ g) in the soil during 2015 and 2016, respectively. Application of recommended dose of FYM (10 t/ha) in T7 resulted in a reduction in the population of heterotrophic free-living N2 fixers (26.13 and 34 CFU ×103/ g) and actinomycetes (20 and 30.5 CFU ×103/ g) whereas, the application of a recommended dose of chemical fertilizer in T8 recorded the lowest population of phosphate solubilizing bacteria (3.9 CFU ×103/ g) and fungal (3.6 and 2.5 CFU ×103/ g) during 2015 and 2016, respectively. The highest organic carbon (0.63 and 0.66 %) content in the post-harvest soil samples was recorded with the application of NPK (160:80:80 kg /ha) + FYM (10 t/ha) while, the lowest organic carbon value (0.52 and 0.53%) was recorded in T8 during 2015 and 2016, respectively. Application of recommended FYM (10 t/ha) along with recommended NPK (160:80:80 kg/ha) in T9 recorded maximum herbage yield in the main crop (41.59 and 38.31 t/ha) and ratoon (20.97 and 17.77 t/ha) during 2015 and 2016, respectively. The results obtained from this study clearly demonstrated that integrated nutrient management can maximize soil microbial community dynamics which is considered as the driving force behind regulating soil processes that support sustainable sweet basil cultivation.

Perennial horticulture in India has undergone a change from rainfed system to drip fertigation systems and from isolated hedge and bund trees to high intensity orchard systems with enhanced number of trees per unit area. In several parts, particularly in the Deccan plateau, the system has now become completely dependent on water pumped from tube wells. Severe competition for water from tube wells makes farmers to devote more water for cash rich annual crops and even sell water for city dwellers nearby. As a consequence, the groundwater level in the past three decades has fallen from few feet to above thousand feet. At several places it has crossed the “peak water”. Frequent and prolonged exposure of fruit trees and nuts to drought coupled with ground water depletion has led to soil profile drying leading to reduced vigour and enhanced vulnerability to diseases and pests. This has led to withering of fruit and nut trees. Perennial crops are likely to become increasingly maladapted to their environment, particularly in the earlier period of climate change they are more likely to be attacked by diseases and insects. Coconuts, areca nuts and mango trees have died in several places and the government constituted committees have recommended compensation to the farmers. As a country, we have dramatically increased our reliance on groundwater. 175 million Indians are now fed with food produced with the unsustainable use of groundwater. This increase has dried up rivers and lakes, because there is a hydrologic connection between groundwater and surface water. Yet the legal rules governing water use usually ignore the link between law and science. The issue needs thorough examination and needs policy interventions to come out of this vicious circle.

Cashew (Anacardium occidentale L.) is an important tropical nut crop of social and economic importance worldwide. However, the crop is threatened with the low yield. In the present study, an attempt was made to test the effects of plant growth hormones as well as micronutrients on nut and apple quality of cashew var. Bhaskara. Significant differences in kernel weight, shelling percentage, carbohydrates and starch content of cashew kernel and juice content of cashew apple were observed with the foliar application of growth hormones and micronutrients. The foliar application of ethrel @ 50 ppm increased shelling percentage (35.8%), carbohydrate content (21.63%), sugar content (6.26%), protein content (32.4%), starch content (31.42%), juice content (78.3%) and total soluble solids (120 Brix). Further, the foliar spray of zinc sulphate (0.5%) + borax (0.1%) increased shelling (36.13%), protein content (32.15%), starch content (32.03%) among all the treatments tested. Furthermore, higher cashew apple juice content (78%) and total soluble solids (120Brix) was also recorded with the foliar spray of zinc sulphate (0.5%) + borax (0.1%). [ABSTRACT FROM AUTHOR]

A study was conducted to determine the mineral nutrients concentration in the index leaf of pummelo accessions. Index leaf samples from 25 pummelo accessions grafted on pummelo and 12 pummelo clones grafted on Rangpur lime rootstocks were collected for assessing leaf mineral nutrient status. The results revealed that pummelo plants grafted on pummelo, the concentration of leaf N (1.43-2.49 %), P (0.17-0.22 %), K (0.75-4.45 %), Ca (2.37-6.29 %), Mg (0.60-1.04 %), S (0.06-0.22 %), Fe (124-245.45 mg kg-1), Mn (9.85-50.05 mg kg-1), Zn (17-69 mg kg-1) and Cu (8.8-25.15 mg kg-1) showed significant variation with different accessions. Out of 25 pummelo accessions, twenty-four accessions were deficient in N and S, fourteen were deficient in K, four were deficient in Mn and five were deficient in Zn and all accessions were sufficient in P, Ca, Mg, Fe and Cu. The observed trends in the leaf nutrient concentration of pummelo accessions clearly indicated the significance of the genotypic variation when chemical analysis is used for diagnosing the leaf nutrient status of pummelo trees. Similarly, leaf N, P, K, Ca, Mn, Cu and Zn varied significantly among twelve pummelo clones grafted on Rangpur lime. Among the clones grafted on Rangpur lime, 18-3 and 18-5 found to have higher and lower leaf nutrient content in most of the mineral nutrients, respectively. The leaf nutrient content of pummelo varies among genotypes, but there is no genotype that stands out in all macro and micronutrients evaluated. The N, P, K, Ca, S, Fe, Mn and Cu leaf contents in pummelo were always higher in plants grafted on Rangpur lime. However, the foliar Mg and Zn contents were continually higher in plants grafted on ‘pummelo’ compared to Rangpur lime which eventually reduces leaf yellowing/chlorosis in pummelo. Pummelo rootstocks were found to respond well in terms of Mg and Zn nutrient uptake and tolerance to Phytophthora as compared to Rangpur lime. Therefore, it is concluded that pummelo can be an ideal rootstock for commercial pummelo cultivation. [ABSTRACT FROM AUTHOR]

Production of potted plants is influenced by factors viz., type of container, potting medium, nutrient dose. A study was conducted to standardize these factors for potted French marigold var. Arka Pari. The treatments comprised of two type of containers (plastic and coir), three potting media [red soil + FYM + sand (1:1:1 v/v), Arka fermented cocopeat (AFC), AFC + vermicompost (1:1 v/v)] and four nutrition concentrations (160:30:180 ppm N:P: K, 128:24:144 ppm N:P: K, 96:18:108 ppm N:P:K and 3% Jeevamrutha) laid out in factorial completely randomized design replicated thrice. Plants grown in potting media combination of Arka fermented cocopeat (AFC) + vermicompost (1:1 v/v) along with weekly application of nutrient solution (128:24:144 ppm NPK) produced maximum number of flowers plant-1 (147.61) and registered highest uptake of nitrogen (2.87 g plant-1), phosphorus (0.53 g plant-1), potassium (3.24 g plant-1), magnesium (0.85 g plant1 ) and sulphur (0.21 g plant-1). Based on the attributes of the potted plants, this treatment combination also registered the highest score (81.2 on a scale of 100), willingness of the consumers to purchase (4.5 on a scale of 5), overall acceptability (2.7 on a scale of 3) and the benefit cost ratio of 1.18. [ABSTRACT FROM AUTHOR]

Tuberose (Agave amica, family Asparagaceae) is an important commercial flower crop valued for its spectacular fragrant flowers. An experiment was conducted to evaluate the single petalled tuberose genotypes for growth, flowering, flower yield, concrete yield and response to biotic stress for two consecutive years from 2020 to 2022. Tuberose genotype IIHR 17-23SP-08 was found to be superior with highest plant height (55.53 cm), early flowering (94.93 days), highest number of spikes/plant (8.47), longest spikes (114.61cm) and rachis (32.11 cm) and maximum number of florets/spike (54.87). The matured bud weight of IIHR 17-23SP-08 was 1.29 g, which is preferable in the medium segment range with higher number of flower buds (725 buds per kg). It is a high yielder producing the highest number of spikes/m2 (76.20) and loose flower yield 18.88 t/ha/year among the genotypes evaluated. The genotype IIHR 17-23SP-08 was also found to be a good multiplier with the maximum bulb production of 8.94 bulbs per clump. It was found to be resistant to root knot nematode (Meloidogyne incognita) and tolerant to leaf burn disease (Alternaria polianthi) under field conditions. It was found suitable as loose flower for garland preparation with the shelf life of 2 days under ambient conditions and for concrete extraction with the concrete yield of 0.095%. It produces white buds (RHS colour: NNI55D, white group, Fan 4) with green tinge on the tip. Thus, the genotype IIHR 17 23SP 08 was found promising and novel among the single types with better flower and bulb yield parameters [ABSTRACT FROM AUTHOR]

A study was conducted at the ICAR-Indian Institute of Horticultural Research, Hesaraghatta, Bengaluru for three consecutive seasons during 2019-20, to standardize the container type, substrate combination and nutrition for potted plant production of China aster var. Arka Archana. The treatments comprised of two type of containers (plastic and coir), three substrates {Red soil + FYM + Sand (1:1:1 v/v), Arka Fermented cocopeat (AFC), AFC + Vermicompost (1:1 v/v)} and four nutrition concentration (160:30:180 ppm N:P: K, 128:24:144 ppm N:P: K, 96:18:108 ppm N:P: K and Jeevamrutha @ 3%) laid out in factorial completely randomized design with three replications. Plant height at flowering (33.12 cm), number of primary branches (12.4), plant spread (536.64 cm2), number of flowers/plant (26.47), flower size (5.26 cm) and uptake of major, secondary and minor nutrients were maximum in the plants grown in 6" plastic pots using the substrate combination of soil +sand +FYM (1:1:1 v/v/v) along with the weekly application of nutrient solution of 96:18:108 ppm NPK/plant. This production protocol resulted in a dense canopy and highly floriferous potted plants. The benefit cost ratio of potted China aster production was 1.70. This technology can be adopted by the nurserymen for large-scale commercial potted plant production. [ABSTRACT FROM AUTHOR]

Field experiments were conducted at Acharya N.G. Ranga Agricultural University, Hyderabad, Andhra Pradesh, India, during rabi and kharif seasons of 2010 and 2011 to study direct, cumulative, or residual effect of organic manures (Farmyard Manure, Vermicompost, Poultry Manure, Neem Cake, and combinations thereof) along with the recommended dose of fertilizers (RDF) and absolute Control, on nutrient uptake, yield and quality in cabbage-baby corn cropping sequence system. Results showed that application of recommended dose of fertilizers [N, P and K (100:50:50 kg ha-1)] recorded highest yield in cabbage (38.91t ha-1), which was comparable to combined application (2.89t ha-1) of poultry manure and neem cake (37.9t ha-1). In baby corn, maximum yield (6.12t ha-1) was recorded with recommended dose of fertilizers, followed by the combined use of poultry manure and neem cake (5.80t ha-1). Among various treatments, residual effect and combined application of poultry manure and neem cake to a preceding cabbage crop, recorded maximum yield in baby corn (4.71t ha-1) over other treatments. Similar trend was seen in nutrient uptake by cabbage and baby corn (cumulative and residual). Highest protein and ascorbic acid content in cabbage, residual and cumulative baby corn was recorded with application of poultry manure + neem cake (2.89t ha-1), and poultry manure + FYM (6.11t ha-1) respectively.

The vegetative performance of chrysanthemum var. Marigold with respect to phenophase based irrigation and fertigation schedule was evaluated. In the vegetative phase, the maximum plant height (62.44 cm), number of secondary branches per plant (42.65), number of primary branches per plant (10.85), leaf area (3793.81 cm2) was recorded in the treatment combination. Whereas, the maximum average plant spread (47.98 cm) was in I1F4, number of leaves per plant (217.76) was in I3F1. Scheduling irrigation regime I3-(0.8 ER each at vegetative, bud and flowering phases) in combination with weekly application of (F4) 75:112.5:75 kg NPK/ha in three splits 40:20:20 % NPK (vegetative phase), 30:40:40 % NPK (bud phase) 30:40:40% NPK (flowering phase) through fertigation recorded maximum loose flower yield (26.27 t/ha) and this can be correlated with increased values for most of the vegetative parameters that directly influence the yield of the crop. Hence the above was observed best treatment over other treatment combinations with respect to vegetative parameters of chrysanthemum var. Marigold. [ABSTRACT FROM AUTHOR]

An experiment was conducted to study the effect of integrated nutrient management practices on the microbial community dynamics of soils under sweet basil (Ocimum basilicum L.) at ICAR - Indian Institute of Horticultural Research, Bengaluru during Kharif season of 2015 and 2016. There were nine treatments replicated thrice in randomized complete block design. The results indicated that integrated application of FYM (10 t/ha) + 100% recommended N through FYM + bio-fertilizer i.e., T2 recorded the highest population of heterotrophic free-living N2 fixers (40.66 and 63.33 CFU ×10³/g), phosphate solubilizing bacteria (5.6 and 6.6 CFU ×10³/g) and fungal (6.4 and 5.33 CFU ×10³/g) while T9 with application of NPK (160:80:80 kg/ha) + FYM (10 t/ha) recorded the highest population of actinomycetes (29.93 and 44.56 CFU ×10³/g) in soil during 2015 and 2016, respectively. Application of recommended dose of FYM (10 t/ha) in T7 resulted in reduction in population of heterotrophic free-living N2 fixers (26.13 and 34 CFU ×10³/g) and actinomycetes (20 and 30.5 CFU ×10³/g) whereas, the application of recommended dose of chemical fertilizer in T8 recorded the lowest population of phosphate solubilizing bacteria (3.9 CFU ×10³/g) and fungal (3.6 and 2.5 CFU ×10³/g) during 2015 and 2016, respectively. Highest organic carbon (0.63 and 0.66 %) content in the post-harvest soil samples was recorded with application of NPK (160:80:80 kg/ha) + FYM (10 t/ha) while, the lowest organic carbon value (0.52 and 0.53%) was recorded in T8 during 2015 and 2016, respectively. Application of recommended FYM (10 t/ha) along with recommended NPK (160:80:80 kg/ha) in T9 recorded maximum herbage yield in the main crop (41.59 and 38.31 t/ha) and ratoon (20.97 and 17.77 t/ha) during 2015 and 2016, respectively. The results obtained from this study clearly demonstrated that integrated nutrient management can maximize soil microbial community dynamics which is considered as driving force behind regulating soil processes that support sustainable sweet basil cultivation. [ABSTRACT FROM AUTHOR]

Cashew (Anacardium occidentale L.) is an important tropical nut crop of social and economic importance worldwide. However, the crop is threatened with the low yield. In the present study, an attempt was made to test the effects of plant growth hormones as well as micronutrients on nut and apple quality of cashew var. Bhaskara. Significant differences in kernel weight, shelling percentage, carbohydrates and starch content of cashew kernel and juice content of cashew apple were observed with the foliar application of growth hormones and micronutrients. The foliar application of ethrel @ 50 ppm increased shelling percentage (35.8%), carbohydrate content (21.63%), sugar content (6.26%), protein content (32.4%), starch content (31.42%), juice content (78.3%) and total soluble solids (120 Brix). Further, the foliar spray of zinc sulphate (0.5%) + borax (0.1%) increased shelling (36.13%), protein content (32.15%), starch content (32.03%) among all the treatments tested. Furthermore, higher cashew apple juice content (78%) and total soluble solids (120Brix) was also recorded with the foliar spray of zinc sulphate (0.5%) + borax (0.1%).

The prognosis of luxation injuries of primary teeth is often unpredictable. A two-year-old girl presented with a displaced left primary maxillary anterior tooth diagnosed as severe intrusive luxation. On radiographic examination, it was noticed to be impinging on the underlying permanent tooth bud. The tooth was extracted, and periodic follow-ups were emphasized until the successor tooth erupted. However, after eight years, the patient followed up with a chief complaint of an unerupted permanent maxillary anterior tooth. Cone-beam computed tomography (CBCT) revealed a combination of anomalies in the crown and root of the maxillary anterior tooth. After a wait-and-observe regime for six months, the incisal third of the crown erupted. At eight years and eight months, the tooth developed a periapical abscess which was treated endodontically and restored. At nine years and three months, the tooth is asymptomatic till date. The present case report highlights the consequences of intrusive luxation injuries to the primary teeth and the need for a multidisciplinary team approach in the management of complications of dental trauma along with meticulous long-term follow-ups., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Tamil Nadu Government Dental College issued approval Ref No: 5/IERB/2021. Ethical approval was obtained from the Institutional Ethics Committee of Tamil Nadu Government Dental College, Chennai in full accordance with the ethical principles. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Revathy et al.)

Background and Objective: Frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, gingiva, and the underlying periosteum. The frena may jeopardize the gingival health when they are attached too closely to the gingival margin, either due to interference in the plaque control or due to muscle pull. Identifying labial frenum attachment and its association with oral hygiene helps in primary prevention of gingival health. The purpose of this study was to examine the prevalence of the various types of maxillary labial frenum attachment and its association with oral hygiene status in adolescent population., Methodology: A total of 300 adolescents between 13 and 18 years were selected randomly. They were clinically examined for maxillary frenum attachment. Placek's classification of the labial frenum attachments was used to check the origin of frenum. Oral hygiene index (simplified) was recorded and results were subjected to statistical analysis., Results: Among 300 examined children 53% were males and 47% were females. The prevalence of the maxillary labial frenum was gingival type (39%) followed by mucosal (28.3%), papillary (23.7%), and papillary penetrating type (9.0%). The gingival type of frenal attachment was statistically significant among different age of children and also between different types of frenal attachment and oral hygiene status ( p value < 0.001). There was no significance between frenum attachment and gender., Conclusion: The type of frenal attachment is strongly associated with oral hygiene status. as the age progresses the frenum tends to migrate apically. However, our study did not reveal any relationship between the gender and type of frenal attachment., Competing Interests: There is no conflict of interest., (Copyright: © 2019 Journal of Family Medicine and Primary Care.)