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Purpose: To assess the accuracy of e-Paarvai, an artificial intelligence-based smartphone application (app) that detects and grades cataracts using images taken with a smartphone by comparing with slit lamp-based diagnoses by trained ophthalmologists. Methods: In this prospective diagnostic study conducted between January and April 2022 at a large tertiary-care eye hospital in South India, two screeners were trained to use the app. Patients aged >40 years and with a best-corrected visual acuity <20/40 were recruited for the study. The app is intended to determine whether the eye has immature cataract, mature cataract, posterior chamber intra-ocular lens, or no cataract. The diagnosis of the app was compared with that of trained ophthalmologists based on slit-lamp examinations, the gold standard, and a receiver operating characteristic (ROC) curve was estimated. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed. Results: The two screeners used the app to screen 2,619 eyes of 1,407 patients. In detecting cataracts, the app showed high sensitivity (96%) but low specificity (25%), an overall accuracy of 88%, a PPV of 92.3%, and an NPV of 57.8%. In terms of cataract grading, the accuracy of the app was high in detecting immature cataracts (1,875 eyes, 94.2%), but its accuracy was poor in detecting mature cataracts (73 eyes, 22%), posterior chamber intra-ocular lenses (55 eyes, 29.3%), and clear lenses (2 eyes, 2%). We found that the area under the curve in predicting ophthalmologists' cataract diagnosis could potentially be improved beyond the app's diagnosis based on using images only by incorporating information about patient sex and age (P < 0.0001) and best-corrected visual acuity (P < 0.0001). Conclusions: Although there is room for improvement, e-Paarvai app is a promising approach for diagnosing cataracts in difficult-to-reach populations. Integrating this with existing outreach programs can enhance the case detection rate. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate and compare the depth and percentage of sealer penetration into dentinal tubules using extracanal and intracanal heated NaOCl in the irrigation protocol using a confocal laser scanning microscope. Methods: Thirty extracted central incisors prepared till F4 ProTaper Gold were randomly distributed into three groups (n = 10 each) depending on the final irrigation protocol. Group C - nonheated 3% NaOCl, group EC - extracanal heated 3% NaOCl, and group IC - intracanal heated 3% NaOCl. Final irrigation with different warming protocols along with sonic activation was performed. Canals were obturated with standardized F4 Protaper Gold gutta-percha cone coated with AH Plus sealer labeled with Rhodamine B dye. The transverse sections of samples at different levels were examined on a confocal microscope and analyzed using IOB software. Unpaired "t" test and Mann-Whitney U test were used for intergroup comparison; P < 0.05. Results: The percentage of sealer penetration was significantly lower in group C as compared to group IC and EC at the coronal and middle third. Group C showed a lower depth of sealer penetration as compared to group EC and IC at all levels. The percentage and depth of sealer penetration were not significantly different between group EC and IC at all levels. Conclusion: Extracanal and intracanal heating of NaOCl significantly improves the percentage and depth of AH Plus sealer penetration in dentinal tubules. [ABSTRACT FROM AUTHOR]

Aim: To comparatively evaluate in vitro the cyclic fatigue resistance of different file systems based on different manufacturing technologies after exposure to NaOCl and multiple sterilization cycles. Materials and Methods: Sixty new Nickel − Titanium (NiTi) rotary files were selected and divided into five groups (n = 12) based on different manufacturing technology. These groups were: Protaper Universal (GPT) (DentsplyMaillefer, Ballaigues, Switzerland) Protaper Next (GPTN) (Dentsply, Tulsa, OK, USA), Twisted files (GTF) (Sybron Endo, Orange, CA, USA), Neoniti (GNL) (Neolix, France), and Hyflex CM (GHCM) (Coltene/whaledent inc., 235 Ascort Parkway, Cuyahoga falls, OH, USA). Files were sterilized in an autoclave at 121°C at 15 psi for 15 min and exposed to 5.0% NaOCl solution for 30 s before cyclic fatigue testing till instrument fracture using a standardized grooved block assembly with the artificial canal at 90° angle of curvature using a 16:1 reduction hand-piece powered by a torque-controlled motor. This whole procedure of autoclaving, immersion in sodium hypochlorite solution and rotating in a stainless steel assembly was repeated again and again until the file fractured. Results: The highest mean for the number of cycles before fracture was observed with Neoniti (GNL) and lowest for Hyflex CM (GHCM). The difference between GPT vs GTF, GPTvs GNL, GNLvs GHCM; GPTNvs GTF, GPTNvs GNL, GPTNvs GHCM; GTFvs GNL, GTFvs GHCM and GNL VS GHCM was statistically significant, whereas the difference between GPTvs GPTN was statistically nonsignificant. Conclusion: Neoniti and twisted file systems resisted the maximum number of cycles to fracture at 90° angle of curvature after exposure to 5% sodium hypochlorite solution and multiple autoclaving cycles. Hyflex CM showed the least resistance in the similar conditions. [ABSTRACT FROM AUTHOR]

Background: Maternal and child health implementation plan development in districts of India lacks systematic process and capacity resulting in suboptimal health improvements. There is ineffective and limited participation and lack of autonomy to effect changes in district priorities. Objectives: Primary objective was to demonstrate a systematic planning approach to develop evidence-based district implementation plans for mothers and children. Methods: A planning tool named RAASTA (RMNCH + A Action Agenda using Strategic Approach for evidence-based district work plans) adapted from WHO (World Health Organization) program review tools was used in the states of Uttarakhand and Jharkhand. The tool was implemented in the two states for the development of implementation plans in a 6-step process by prioritizing district health goals; reviewing maternal, neonatal, child, and family planning intervention coverage; and linking them with activity implementation status; assessing strengths, and weaknesses of previous implementation plans and developing solutions based on current gaps in intervention coverage's. Results: Tool was used for capacity building of 59 participants and also identification of prioritized activities based on their available data. Several newer activities were identified. The districts mainstreamed them as action plans, many of which were incorporated in the state Program Implementation Plan for budgetary provisions under state NHM (National Health Mission) funds. Conclusion: The use of a tool facilitated the systematic development of evidence-based district implementation plans. [ABSTRACT FROM AUTHOR]

Context: Extracanal and intracanal heating of sodium hypochlorite (NaOCl) improve its pulp dissolution, but limited literature is available on its effect as a combined single irrigant with etidronate. Aim: The aim of this study is to compare the effect of temperature on the effectiveness of NaOCl and continuous chelation protocol on the time required for the dissolution of vital and necrotic pulp. Materials and Methods: Dissolution time of 120 standardized bovine (buffalo) pulp fragments, divided into 12 subgroups based on tissue type (vital/necrotic), irrigant (NaOCl/continuous chelation), and temperature (extracanal, intracanal, and nonheated irrigant), was noted. Conical glass tips mimicking the root canal were considered specimen containers. About 0.2 ml of irrigant corresponding to the irrigation protocol was taken in them and then pulp samples were added to it. Samples were observed using loupes under 2.5 X magnification. Dissolution time was recorded using a stopwatch. The study was approved by the Institutional Ethical Committee (SDC/2019/591). Statistical Analysis Used: Two-way analysis of variance; statistical product and service solutions version 25. The level of significance was set at P < 0.05. Results: Time for pulp dissolution by continuous chelation mixture was significantly more as compared to NaOCl alone in all subgroups. Pulp tissue dissolution for both vital and necrotic pulp was improved by the increase in temperature of both irrigants and dissolution time was more for necrotic than vital tissue. Pulp tissue dissolution was significantly better by intracanal heating as compared to extracanal heating. Conclusion: Although intracanal heating of continuous chelation mixture improves its pulp dissolution capacity significantly as compared to extracanal heating and nonheating protocol but pulpal dissolution capacity of nonheated 5% NaOCl still remains significantly better as compared to intracanal and extracanal heated continuous chelation mixture. [ABSTRACT FROM AUTHOR]

Purpose: To develop predictive models to identify cataract surgery patients who are more likely to benefit from refraction at a four-week postoperative exam.Methods: In this retrospective study, we used data of all 86,776 cataract surgeries performed in 2015 at a large tertiary-care eye hospital in India. The outcome variable was a binary indicator of whether the difference between corrected distance visual acuity and uncorrected visual acuity at the four-week postoperative exam was at least two lines on the Snellen chart. We examined the following statistical models: logistic regression, decision tree, pruned decision tree, random forest, weighted k-nearest neighbor, and a neural network. Predictor variables included in each model were patient sex and age, source eye (left or right), preoperative visual acuity, first-day postoperative visual acuity, intraoperative and immediate postoperative complications, and combined surgeries. We compared the predictive performance of models and assessed their clinical impact in test samples.Results: All models demonstrated predictive accuracy better than chance based on area under the receiver operating characteristic curve. In a targeting exercise with a fixed intervention budget, we found that gains from predictive models in identifying patients who would benefit from refraction ranged from 7.8% (increase from 1500 to 1617 patients) to 74% (increase from 250 to 435 patients).Conclusion: The use of predictive statistical models to identify patients who are likely to benefit from refraction at follow-up can improve the economic efficiency of interventions. Simpler models like logistic regression perform almost as well as more complex machine-learning models, but are easier to implement. [ABSTRACT FROM AUTHOR]

Background: High-risk pregnancy (HRP) puts current pregnancy at an increased risk of complications. In the absence of pre-existing HRP implementation model of the country, in collaboration with the Government of Himachal Pradesh, a new digital HRP model called the 'SEWA—A System E-approach for Women at risk' was developed. The current article demonstrates a model for the early identification and line listing of high-risk pregnant women (PW) with appropriate referrals and increased engagement with the healthcare workers using a digital tool in the form of the Android App. Methods: SEWA was implemented as a pilot intervention in two community development blocks of the Chamba district. The key implementation steps included finalizing protocols for the identification of HRPs, defining processes and roles, mapping health facilities, setting up the communication loop, and developing of digital solutions. The digital app, used by the auxiliary nurse midwife (ANM) and program officers, tracked PW for a year from October 19 to October 20 and recorded the ANC visits, referrals, and birth outcomes. A qualitative assessment was conducted among the health workers to find out their level of acceptance. Results: A total of 1,340 high-risk PW were identified. The intervention year saw a rise in the identification of HRP to 27.9% from 3.5% in the previous year. A total of 2,559 conditions were tagged to the identified 1,340 women categorized into current pregnancy (81%), previous pregnancy (16%), and any existing chronic illness (3%). A majority of the women who required urgent referrals were provided referrals. The application recorded 53% of the delivered HRP with a digital birth preparedness plan, prepared and shared with the PW and Accredited Social Health Activists (ASHA), by text message for compliance. Conclusion: The SEWA application is a feasible and sustainable solution to complement the competency of the care providers for early identification of the high-risk conditions and reduce the burden of preventable unprecedented deaths around the time of birth. [ABSTRACT FROM AUTHOR]

The article focuses on GM1-gangliosidosis, a rare disorder characterized by β-galactosidase enzyme deficiency, discussing cutaneous manifestations like extensive telangiectasias and Mongolian spots. Topics include the clinical implications of these cutaneous clues in aiding diagnosis, the association of certain diseases with such cutaneous presentations, and their role as indicators of inborn errors of metabolism, particularly in lysosomal storage disorders.

Aim: To compare and evaluate the surface characteristics of different restorative materials used for restoration of cervical defects when subjected to periodontal prophylactic instrumentation techniques. Materials and Methodology: Sixty box-shaped cavities were prepared on the labial surface of decoronated permanent maxillary anterior teeth which were randomly divided into two groups (n = 30) based on the instrumentation technique Group I: Manual instrumentation using curettes and Group II: Ultrasonic instrumentation. The samples were further divided into three subgroups based on restorative material subgroups I V and II V-restored with Vitremer, subgroups I F and II F-restored with Filtek Z 250 XT and subgroups I D and II D-restored with Dyract flow, respectively. After finishing and polishing, the samples were subjected to surface profilometry analysis for determining the surface roughness values (Ra). Thereafter, the restored surfaces of all the samples in different subgroups were subjected to prophylactic instrumentation with Gracey's curettes (Group I) and ultrasonic scalers (Group II). Ra values were recorded again after prophylactic instrumentation and after polishing. The data thus obtained were subjected to the statistical analysis using the independent t-test and one-way ANOVA (p<0.05). Results: Ra values were significantly higher for both manual and ultrasonic prophylaxis compared to preprophylaxis and postpolishing in all the three restorative materials. Ultrasonic scaling produced significantly higher Ra for subgroup V as compared to subgroup F and subgroup D, whereas the difference between the materials was not significant for manual scaling. Conclusion: Manual prophylaxis resulted in significant reduction in surface roughness of all the three restorative materials while ultrasonic prophylaxis resulted in significant reduction for Vitremer only. Polishing after scaling significantly reduced the effect of both manual and ultrasonic prophylaxis on surface roughness. [ABSTRACT FROM AUTHOR]

Background: The effective implementation of evidence-based practices including the use of partograph to improve maternal and newborn outcomes is critical on account of increased institutional delivery. However, despite clear guidelines, partograph use in India is not widely practiced. Materials and Methods: Quality improvement (QI) efforts along with training and mentoring were operationalized in a total of 141 facilities across 26 high priority districts of India. Assessments were conducted across baseline, intervention period, and end line. These included reviewing the availability of partograph and staff competency in filling them at baseline and end line, as well as reviewing monthly data for use and completeness of filling. The monthly data were tabulated quarter wise to study trends. Competency scores were tabulated to show the difference across assessments. Results: An overall upward trend from 29% to 61% was seen in the practice of partograph use. Simultaneously, completeness in filling up the partograph increased from 32% to 81%. Staff competency in filling partograph improved considerably: proportion of staff scoring low decreased over the intervention period from 63% to 2.5% (P < 0.0001), and the proportion scoring high increased from 13% to 72% (P < 0.0001) from baseline to end line. Conclusion: The integrated approach of training, mentoring, and QI can be used in similar settings to strengthen partograph use. [ABSTRACT FROM AUTHOR]

Purpose: To identify factors affecting family members' decision whether to donate eye organs.Methods: A community-based case-control study based on in-home interviews with families of deceased individuals who had or had not donated eye organs, in Madurai district, Tamil Nadu, India. Data collected were knowledge and awareness of eye donations, whether the deceased individual had expressed or pledged willingness to donate, and family members' attitudes and willingness to donate their own eye organs.Results: Seventy-six families of donors and 256 families of non-donors completed the survey. Multivariable analysis showed that the following variables were significantly associated with a donation: age, whether the deceased had registered for eye donation, pre-expressed willingness of deceased to donate, whether family members personally know beneficiaries of eye donations, and higher score on a scale evaluating knowledge and awareness about eye donation. The majority of donors' families (71%) had been encouraged by someone to donate. Among non-donor families, a substantially larger fraction (52.8%) indicated they would have donated had someone reminded or encouraged them to do so, in comparison with those who indicated lack of awareness or knowledge (14.5%).Conclusion: Community programs are likely to be effective if they encourage individuals to pledge their eyes or express their willingness to donate their eyes to family members in advance of death; they increase public awareness of the value of eye donation. A friend, family member, neighbor or counselor approaching bereaved families and having a dialogue about eye donation would substantially increase the probability of a decision to donate. [ABSTRACT FROM AUTHOR]

Background: Inadequate sleep quality is a crucial problem in today's hectic lifestyle. Sleep is known to facilitate cognitive skills, aid memory, and is important for physical, emotional and intellectual health. Objectives: To determine the sleep quality of the medical undergraduate students and to explore differences in various phases of medical curriculum. Material and Methods: Sleep quality was assessed in 400 medical students in various phases of the medical course using the Pittsburgh Sleep Quality Index (PSQI). Chi square test was used for comparisons of the all seven components of PSQI and sleep quality for different study year, whereas ANOVA was used for comparison of the components and global score. Results: Of the total, 25.3% of the participants classified their sleep quality as either very or fairly bad, and 31.1% reported taking more than 30 min to fall asleep. The average hours slept per night was 7.1 ± 1.21. Of the total, 8.4% of the participants reported using sleep medication at least once a week. Subjective sleep quality and sleep duration were found to be significantly different among the four groups. Conclusion: Poor subjective sleep quality was high for students in all class years of the undergraduate medical course. The comparison across the various phases of the course showed that first years reported worse sleep quality than did those in other class years. [ABSTRACT FROM AUTHOR]

Aim: This study was conducted to evaluate the effect of mechanical alteration of enamel surface on shear bond strength in different bonding techniques. Materials and Methods: Seventy samples were fabricated and randomly divided into three groups: Group A (n = 30) – prepared enamel surfaces, Group B (n = 30) – unprepared enamel surfaces, and Group C (n = 10) – prepared enamel surfaces + etch and rinse which served as a control group. Group A and Group B were further divided into three subgroups (n = 10), sub-Group A1, B1 (nanohybrid composite + self-etch), sub-Group A2, B2 (self-adhering composite), and A3, B3 (self-adhering composite + self-etch). Teflon ring molds were used to make composite resin cylinders with the specific bonding protocol of each group. Shear bond strength testing was conducted, and data were analyzed. Results: Mean shear bond strength values were as follows: C> A1> A3>A2>B1> B3> B2. Conclusions: Prepared enamel surfaces resulted in higher shear bond strength values as compared to unprepared enamel surfaces. Prior application of self-etch agent resulted in higher shear bond strength values of self-adhering composite in prepared and unprepared enamel surfaces. [ABSTRACT FROM AUTHOR]

Aim: The aim is to compare and evaluate the different finishing and polishing systems for the change in surface roughness of resin composites and enamel. Materials and Methods: To conduct the study, 30 extracted human maxillary central incisors were selected, decoronated, and molded in self-cure acrylic molds. A box-shaped cavity of dimensions 3 mm × 3 mm × 2 mm was prepared in all the teeth. A nanohybrid composite resin (Filtek Z250) was then used to restore the prepared cavities. Thirty samples were divided into two groups, control group (Group A, n = 10) and experimental group (Group B, n = 20). The samples in Group A were cured through the Mylar matrix. The experimental group, i.e., Group B was divided into two subgroups, i.e., Subgroup BX, n = 10 in which Sof-Lex polishing system was used for polishing the tooth surface and Subgroup BF, n = 10 in which Shofu composite polishing system was used. The mean surface roughness (Ra in ìm) of the composite restoration as well as for the enamel surface of all the samples before and after polishing was measured with a contact profilometer, and the values were correlated with scanning electron microscopy. Results: The statistical analysis was carried out using paired t-test. The results exhibited a significant decrease in the surface roughness of the resin composite and enamel surface irrespective of the finishing and polishing system used. The mean surface roughness values demonstrated by Mylar matrix was the lowest followed by Sof-Lex polishing system. Shofu polishing system demonstrated the highest surface roughness values. Conclusion: Finishing and polishing of composite restoration can achieve a surface roughness similar to that of enamel. Involvement of marginal enamel in finishing and polishing procedures carried out for composite restoration results in smoother enamel surface [ABSTRACT FROM AUTHOR]

Introduction: Newborn vaccination is an integral part of routine immunization program in India, but program implementation gaps exist. The focus of this article is to identify and describe an implementation strategy which could improve the newborn vaccination at the facility level. Materials and Methods: A situation analysis was conducted through a mixed-methods approach to identify the lacunae in the health system and the same was used to develop an implementation strategy to improve newborn vaccination coverage across the six priority states. Results: Issues in stewardship and human resource, vaccine-related stock-outs, and poor service delivery were some of the reasons for low facility-level vaccination coverage. After implementation of a health system–based strategy, the new born vaccination improved from 55% to 88% across 10 quarters of program implementation. Factors such as sensitization of stakeholders, vaccination on holidays, rigorous documentation, and supportive supervision of health staff were primary reasons for improvement in service delivery. Conclusion: Importance of newborn immunization at birth is well established. The results from six states prove that "health systems approach" as an implementation strategy is a viable tool to improve newborn immunization at birth. [ABSTRACT FROM AUTHOR]

Aim: This study was conducted to evaluate and compare fluoride ion release by Cention-N (self-cure and light-cure) and conventional glass-ionomer cement (GIC) at different pH and time intervals. Methodology: Cavities of similar dimensions were prepared in mandibular molars and restored with Cention-N (by self-cure and light-cure techniques) and GIC. Samples were stored in deionized water, and the cumulative fluoride ion release and change in pH were assessed utilizing spectrophotometer and pH meter, respectively, at the end of 7 days, 14 days, and 21 days. The data thus obtained were statistically analyzed. Results: All the tested materials released fluoride ions in both acidic and neutral pH at all time intervals, and the fluoride ion release was significantly higher (<0.05) in acidic pH as compared to neutral pH except in GIC. All the groups showed a statistically significant increase in pH in acidic medium, whereas no significant increase was observed in neutral medium. Conclusions: Cention-N (self-cure) has the highest fluoride ion release and alkalizing potential in acidic pH as compared to Cention-N (light-cure) and GIC. [ABSTRACT FROM AUTHOR]

Background: India has been at the forefront of designing adolescent health (AH) policies. The National Adolescent Reproductive and Sexual Health policy (2006), the Reproductive, Maternal, Newborn Child, and AH strategy (2013), and the "Rashtriya Kishor Swasthya Karyakram (RKSK)" (2014) have been the critical milestones in this direction. However, despite policies being available, the AH outcomes need improvement through operationalization of focused and need-based AH interventions. Objectives: The objectives of this study were to improve services for RKSK interventions across select geographies of India. Materials and Methods: USAID's VRIDDHI Project has been providing technical support at the national level and in six focus states to improve uptake of evidence-based high-impact reproductive, maternal, newborn, child, and AH interventions. To improve AH services and outcomes, two approaches were implemented, namely (a) strengthen the functioning of adolescent-friendly health clinics in 95 high caseload health facilities in 26 high priority districts across six states and (b) demonstrate other operational strategies outlined in RKSK program including strengthening of district committees on AH, undertaking formative research for developing adolescent-focused communication strategy, and operationalizing weekly iron and folic acid supplementation program. Results: As a result of ongoing technical support over 2-year period (January 2016--December 2017), improvements were noted across multiple AH indicators. In addition, evidence-based 'earnings were also generated from the demonstration models for potential scale up to other geographies. Conclusion: The project was successful in improving AH services in the intervention facilities through an integrated approach which is replicable, sustainable, and scalable for driving the AH program in India. [ABSTRACT FROM AUTHOR]

Universal Health Coverage (UHC) is now the critical yardstick for countries to measure and track progress toward the "Sustainable Development Goals (SDGs)." Being a signatory, India has started taking measures to attain the targets laid out within the SDG framework and achieving the UHC. With India's National Health Policy (NHP) - 2017 in place, the policy environment for transforming country's health landscape coincides with that of the global approach toward strengthening of health systems and achieving UHC. It is imperative that for achieving the desired outcomes laid down in the SDGs and NHP-2017, coordinated actions are required including political action for making health an individual's right; effective stewardship from the National Ministry of Health and Family Welfare; reorganization of health-care service delivery implementing a "systems approach;" ensuring financial protection against health-care costs; and enhancing community participation and accountability. Undertaking these steps, imbibing the learning, and dwelling upon global experiences can help the country strongly move forward towards achieving global and national targets, thereby ensuring UHC for all its citizens. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to evaluate the marginal sealing ability of self-adhesive flowable composite resin when used as a liner in Class II composite restoration with and without aging. Materials and Methods: A total of 120 standardized Class II tooth preparations with gingival margins 1 mm coronal and apical to cementenamel junction (CEJ) were prepared on 60 extracted permanent mandibular molars and were randomly divided into eight equal Groups: Group 1: cavities coronal to CEJ and restored with Dyad flow liner + Herculite ultra, Group 2: same as Group 1 but cavities margins apical to CEJ, Group 5: cavities coronal to CEJ and restored with only Herculite ultra, and Group 6: same as Group 5 but cavities apical to CEJ. Groups 3,4,7,8 were similar to Groups 1,2,5,6, respectively, but were aged for 6 months. After thermocycling, microleakage testing was done using 0.5% basic fuchsin dye. Result: At cervical level, Group 5 exhibited statistically lower (P = 0.006) microleakage than Group 6, and Group 1 showed lesser microleakage than Group 5 (P = 0.162). Group 2 exhibited significantly less microleakage than Group 6 (P = 0.002). Increased microleakage was observed in aging Groups; however, the difference with nonaging Groups was not statistically significant (P > 0.005). Conclusion: Margins of the cavity in cementum can be better sealed by placing self-adhesive liner and is not affected by aging. [ABSTRACT FROM AUTHOR]

Background and Aims: The true incidence of penetration of the posterior wall (through-and-through puncture) of the internal jugular vein (IJV) during cannulation is unknown. This may have implications if there is hematoma formation, penetration and/or inadvertent cannulation of an underlying carotid artery. This study compared the incidence of posterior wall puncture during IJV cannulation using ultrasound guidance versus traditional landmarks-guided technique. Methods: One hundred and seventy adult patients admitted to a gastro-liver Intensive Care Unit who required central venous lines were randomly divided into Group A: IJV cannulation using anatomical landmark-guided technique and Group B: IJV cannulation using real-time ultrasound guidance. In both groups, a second investigator followed the needle path using real-time ultrasound. The incidence of posterior wall puncture, number of attempts for successful cannulation, incidence of inadvertent arterial punctures and occurrence of complications such as hematoma formation and pneumothorax were recorded. Results: Significantly more (37/80, 46%) patients in Group A had posterior wall puncture compared to 19/90 (21%) in Group B. Incidence of arterial puncture was 8/80 (10%) in Group A, 5/90 (5.5%) in Group B. The number of attempts for venous cannulation and hematoma formation was significantly less in Group B. Conclusion: Real-time ultrasound-guided IJV cannulation significantly reduces but does not wholly eliminate the incidence of posterior venous wall penetrations. It also significantly reduces the incidence of inadvertent arterial punctures and number of attempts for successful cannulation. [ABSTRACT FROM AUTHOR]

Aim: The objective of the present study is the assessment of otoacoustic emissions (OAEs) and auditory brainstem responses (ABRs) for hearing screening of high risk infants. Study Design: Prospective, hospital-based. Materials and Methods: Distortion product OAEs (DPOAEs) and brainstem evoked response audiometry (BERA) recordings were obtained for 30 controls and 100 infants with one or more high risk factors, in a sound treated room and the results were interpreted. ABR peak latencies, amplitudes, and waveform morphology in high risk infants were compared with those in control group. DPOAE as screening test was evaluated in terms of various parameters with BERA/ABR taken as gold standard. Results: Absolute latencies of Wave I and Wave V and interpeak latency of I-V were significantly prolonged in high risk group as compared to control group. The most common causes to contribute significantly for hearing impairment were found to be hyperbilirubinemia, birth asphyxia, meningitis/septicemia. DPOAE when compared with ABR taken as gold standard showed that sensitivity of the test was 87.7% (74.5%-94.9%) and specificity was 74.5% (60.0%-85.2%). Positive predictive value was 76.7% (63.2%-86.6%) and negative predictive value of the test was 86% (71.9%-94.3%). Positive likelihood ratio was 0.29 (0.18-0.46) and negative likelihood ratio was 6.08 (2.82-13.09). Conclusion: ABR/BERA, though highly reliable, is a tedious and time consuming test. DPOAE is a simple and rapid test with relatively higher acceptability but low sensitivity and specificity; therefore, limits its role as independent screening test. DPOAE-ABR test series is an effective way to screen all the high risk infants at the earliest. [ABSTRACT FROM AUTHOR]

Context: Stress is a usual and normal part of our daily lives. It is a normal physical reaction to an internal or external pressure that is placed on a person's system. Extended periods of stress can cause destructive changes in the body. Objectives: (1) To assess the prevalence of stress and its level among intensive care unit (ICU) staff (doctors and nurses) of various hospitals and (2) to correlate the level of stress with certain variables. Settings and Design: A cross-sectional study was conducted in the ICU of various hospital of Pune for a period of 1 month. Materials and Methods: Eighty-two ICU staff (doctors and nurses) were contacted and interviewed using pretested proforma containing DASS stress rating scale (for stress only). Statistical Analysis Used: Data analysis was performed using the Statistical Package for the Sciences (SPSS) version 19.0 software. To compare the level of stress with various parameters, we used Chi-square test. P value <0.05 was considered to be significant. Results: The overall prevalence of stress among ICU staff (doctors and nurses) was 52.43%. Prevalence of stress among ICU doctors was 36.58% and nurses was 68.29%. According to the DASS (for stress only), 19.51% doctors were mildly stressed, 14.63% were moderately stressed, and 2.44% were severely stressed. Among nurses, 48.78% were mildly stressed and 19.51% were moderately stressed. Conclusions: The result indicated that prevalence of stress among ICU staff (doctors and nurses) is high. [ABSTRACT FROM AUTHOR]

Eosinophilic granuloma is an uncommon granulomatous disease which can affect the temporal bone. Also known as Langerhans cell histiocytosis, the lesion is characterized by uncontrolled proliferation of Langerhans cells. Although initially silent, the disease may erode the mastoid cortex, destroy the tegmen, and extend into the cranial vault, as well as erode the semicircular canals or cochlea. These lesions almost always become infected and can be confused with chronic otomastoiditis. Equally important, temporal bone involvement may represent only one manifestation of a multifocal disease. This report describes a case of 40‑year‑old male with eosinophilic granuloma involving the right temporal bone extending into midbrain region causing focal compression and displacement of part of the temporal lobe. [ABSTRACT FROM AUTHOR]

Canine deviation from its path of eruption is usually followed by either delayed or impaction of canine. One of the important and not so noticed reasons for canine displacement is formerly impacted central incisor. The difference in age of eruption of these two teeth is 4 years; however, the absence of maxillary incisor should be perceived with utmost conviction about impending canine displacement leading to its impaction as well. This case presents similar picture where composite, compound odontoma with respect to maxillary central incisor led to its impaction resulted in deviated path of eruption for erupting canine. This canine displacement to worsen prognosis ended up getting impacted if not dealt with cautiously in the later stages of occlusal development. [ABSTRACT FROM AUTHOR]

Aim: This study compared the amount of aqueous-based and oil-based calcium hydroxide [Ca(OH)2] remaining in the canal, after removal with two different chelators 17% EDTA and 0.2% Chitosan in combination with ultrasonic agitation. Materials and Methods: Cleaning and shaping of root canals of 28 mandibular premolar was done and canals were filled either with Metapex or Ca(OH)2 mixed with distilled water. Volumetric analysis was performed utilizing cone beam-computed tomography (CBCT) after 7 days of incubation. Ca(OH)2 was removed using either 17% EDTA or 0.2% Chitosan in combination with ultrasonic agitation. Volumetric analysis was repeated and percentage difference was calculated and statistically analysed using Kruskal-Wallis and Mann-Whitney U test. Results: Both the chelators failed to remove aqueous-based as well as oil-based Ca(OH)2 completely from the root canal. Aqueous-based Ca(OH)2 was easier to be removed than oil-based Ca(OH)2. 0.2% Chitosan was significantly more effective for removal of oil-based Ca(OH)2 (P < 0.01) while both 17% EDTA and 0.2% Chitosan were equally effective in removing aqueous-based Ca(OH)2. Conclusion: Combination of 0.2% Chitosan and ultrasonic agitation results in lower amount of Ca(OH)2 remnants than 17% EDTA irrespective of type of vehicle present in the mix. [ABSTRACT FROM AUTHOR]

Dear Editor, We thank the authors[[1]] for your interest in our article.[[2]] We appreciate the suggestions for strengthening donation outcomes from counseling sessions with family members of the deceased. REFERENCES 1 Milner I, Hussain N, Imoru P, Shah H. Comments: Pendleton's Ideas, Concerns and Expectations model for improving outcomes through eye donation counseling. [Extracted from the article]

J Dermatol 2016;43:275-9. 2 Harb J, Motaparthi K. Clinicopathologic findings of guttate leukoderma in Darier disease: A helpful diagnostic feature. Thus, dermoscopic evaluation of greasy papules and guttate leukoderma may allow earlier diagnosis of this disease and may help in appropriate management. A 15-year-old boy presented with multiple itchy hyperpigmented papules over face and trunk and hypopigmented macules over limbs for the last 8 years. [Extracted from the article]

Excessive gingival display, commonly referred to as 'gummy smile' is a major hurdle in overall personality of an individual. Gummy smile, secondary to altered passive eruption and tooth mal-positioning, can be predictably treated with Surgery and orthodontic therapy. In patients with jaw deformities, orthognathic surgery can be performed. However, this requires hospitalization and entails significant discomfort. Lip repositioning is a simple surgical procedure to treat 'gummy smile'. The procedure restricts the muscle pull of the elevator lip muscles thereby reducing the gingival display while smiling. This procedure is safe and predictable with minimal risk or side effects. This case report describes the successful treatment of excessive gingival display using surgical lip repositioning procedure which can be used as an alternative treatment modality for treatment of excessive gingival display. [ABSTRACT FROM AUTHOR]

Aims: The aim of the present study was to fi nd out the hearing improvement in different types of tympanoplasties. Settings and Design: Prospective, hospital-based. Subjects and Methods: A total of 50 patients were included who were 12 years old and above, of both sexes with conductive hearing loss due chronic otitis media with or without perforation. Results: The ratio of males (28) was more as compared with females (22). Maximum number of patients belonged to the age group of 10-20 years (34%), followed by 20-30 years (30%), whereas least number of cases was found in the age group of > 50 years. Hearing loss and otorrhea were present in majority of the cases (100% and 72%, respectively). A total of 18 of the cases had cholesteatomatous chronic suppurative otitis media, while 32 ears were observed to be noncholesteatomatous chronic suppurative otitis media. The average preoperative air conduction (AC) in the present study was found to be 46.6 dB ranging from 20 dB to 112.5 dB, while the average postoperative AC was found to be 39 dB with an average gain of 7.6 dB. The four frequency average preoperative and postoperative air-bone gap (ABG) were found to be 26.48 dB and 20.17 dB respectively, with the average gain of 6.3 dB. The average ABG closure within 0-30 dB was seen in 33 (82%) of the cases. Social hearing was achieved in 86% of the cases in type I, 46% in type II, and 40% in type III tympanoplasty. Conclusions: Tympanoplasty as a procedure when indicated without compromising for the disease, can be effectively used to improve hearing in chronic suppurative otitis media, and other types of conductive hearing losses. [ABSTRACT FROM AUTHOR]

The endodontic treatment of a mandibular molar with aberrant canal configuration can be diagnostically and clinically challenging. This case report presents the treatment of a mandibular first molar with six root canals, of which three canals were located in the mesial root and three in distal root. Third canals were found between the two main root canals. This case presents a rare anatomic configuration and points to the importance of expecting and searching for additional canals. [ABSTRACT FROM AUTHOR]

Background and Aims: Alpha-2 agonists are being increasingly used as adjuncts in general anaesthesia, and the present study was carried out to investigate the ability of intravenous dexmedetomidine in decreasing the dose of opioids and anaesthetics for attenuation of haemodynamic responses during laryngoscopy and tracheal intubation. Methods: One hundred patients scheduled for elective general surgery were randomized into two groups: D and F (n=50 in each group). Group D were administered 1 &mgr;g/kg each of dexmedetomidine and fentanyl while group F received 2 &mgr;g/ kg of fentanyl pre-operatively. Thiopental was given until eyelash reflex disappeared. Anaesthesia was maintained with 33:66 oxygen: nitrous oxide. Isoflurane concentration was adjusted to maintain systolic blood pressure within 20% of the pre-operative values. Haemodynamic parameters were recorded at regular intervals during induction, intubation, surgery and extubation. Statistical analysis was carried out using analysis of variance, chi-square test, Student's t test and Mann-Whitney U test. Results: The demographic profile was comparable. The pressor response to laryngoscopy, intubation, surgery and extubation were effectively decreased by dexmedetomidine, and were highly significant on comparison (P<0.001). The mean dose of fentanyl and isoflurane were also decreased significantly (>50%) by the administration of dexmedetomidine. The mean recovery time was also shorter in group D as compared with group F (P=0.014). Conclusions: Dexmedetomidine is an excellent drug as it not only decreased the magnitude of haemodynamic response to intubation, surgery and extubation but also decreased the dose of opioids and isoflurane in achieving adequate analgesia and anaesthesia, respectively. [ABSTRACT FROM AUTHOR]

Background and Aims: Shivering is distressing to the patient and discomforting to the attending anesthesiologist, with a varying degree of success. Various drugs and regimens have been employed to abolish the occurrence of shivering. The present study aims to explore the effectiveness of dexmedetomidine in suppressing the postanesthetic shivering in patients undergoing general anesthesia. Materials and Methods: The present study was carried out on 80 patients, in American Society of Anesthesiologists I and II, aged 22-59 years, who underwent general anesthesia for laparoscopic surgical procedures. Patients were allocated randomly into two groups: group N (n = 40) and group D (n = 40). Group D were administered 1 µg/kg of dexmedetomidine intravenously, while group N received similar volume of saline during peri-op period. Cardiorespiratory parameters were observed and recorded during the preop, intraop, and postop periods. Any incidence of postop shivering was observed and recorded as per 4 point scale. Side effects were also observed, recorded, and treated symptomatically. Statistical analysis was carried out using statistical package for social sciences (SPSS) version 15.0 for windows and employing ANOVA and chi-square test with post-hoc comparisons with Bonferroni's correction. Results: The two groups were comparable regarding demographic profile (P > 0.05). Incidence of shivering in group N was 42.5%, which was statistically highly significant (P = 0.014). Heart rate and mean arterial pressure also showed significant variation clinically and statistically in group D patients during the postop period (P = 0.008 and 0.012). A high incidence of sedation (P = 0.000) and dry mouth (P = 0.000) was observed in group D, whereas the incidence of nausea and vomiting was higher in group N (P = 0.011 and 0.034). Conclusions: Dexmedetomidine seems to possess antishivering properties and was found to reduce the occurrence of shivering in patients undergoing general anesthesia. [ABSTRACT FROM AUTHOR]

Congenital lobar emphysema (CLE) is a potentially reversible, though possibly life-threatening, cause of respiratory distress in the neonate. It poses dilemma in diagnosis and management. We are presenting a 6-week-old baby who presented with a sudden onset of respiratory distress related to CLE affecting the left upper lobe. Lobectomy was performed under general anaesthesia with one lung ventilation. The details of anaesthetic challenges and management are described here. [ABSTRACT FROM AUTHOR]

Efforts to find a better adjuvant in regional anaesthesia are underway since long. Aims and objectives are to compare the efficacy and clinical profile of two α-2 adrenergic agonists, dexmedetomidine and clonidine, in epidural anaesthesia with special emphasis on their sedative properties and an ability to provide smooth intra-operative and post-operative analgesia. A prospective randomized study was carried out which included 50 adult female patients between the ages of 44 and 65 years of (American Society of Anaesthesiologists) ASAI/II grade who underwent vaginal hysterectomies. The patients were randomly allocated into two groups; ropivacaine + dexmedetomidine (RD) and ropivacaine + clonidine (RC), comprising of 25 patients each. Group RD was administered 17 ml of 0.75% epidural ropivacaine and 1.5 μg/kg of dexmedetomidine, while group RC received admixture of 17 ml of 0.75% ropivacaine and 2 μg/kg of clonidine. Onset of analgesia, sensory and motor block levels, sedation, duration of analgesia and side effects were observed. The data obtained was subjected to statistical computation with analysis of variance and chi-square test using statistical package for social science (SPSS) version 10.0 for windows and value of P < 0.05 was considered significant and P < 0.0001 as highly significant. The demographic profile, initial and post-operative block characteristics and cardio-respiratory parameters were comparable and statistically nonsignificant in both the groups. However, sedation scores with dexmedetomidine were better than clonidine and turned out to be statistically significant (P < 0.05). The side effect profile was also comparable with a little higher incidence of nausea and dry mouth in both the groups which was again a non-significant entity (P > 0.05). Dexmedetomidine is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory analgesia, adequate sedation and a prolonged post-operative analgesia. [ABSTRACT FROM AUTHOR]

Situs inversus totalis is a rare condition with a predicted incidence of one in 10,000 among the general population, the aetiologic factors for which are still not completely understood. In a patient with situs inversus totalis, not just the diagnosis of any acute abdomen pathology is difficult due to distorted anatomy and transposition of thoraco-abdominal viscera but equally challenging is the anaesthetic management during the respective surgical procedure. We are reporting a patient who had situs inversus totalis and was operated for open cholecystectomy. The present case report lays an emphasis on the potential difficulties during anaesthetic management and its various implications. [ABSTRACT FROM AUTHOR]

Noonan syndrome is a genetically transmitted autosomal dominant disorder characterized by various anatomic anomalies and pathophysiologic derangements. Anesthetic management in such cases poses a multitude of challenges, especially related to the airway management and maintenance of cardiovascular stability. We report a case of a 9-year-old male child weighing 24 kg, who was diagnosed as a case of Noonan syndrome and had undergone ligation of patent ductus arteriosus during early childhood. The child was operated on for release of bilateral neck bands under general anesthesia. The case report pertains to the successful airway and anesthetic management in the background of difficult airway and existence of various cardiac lesions. [ABSTRACT FROM AUTHOR]

A response from the author of the article "Attenuation of pressor response and dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine" is presented which discusses that the scope of the study was focused on attenuation of stress response to laryngoscopy and intubation.

A letter to the editor about a rare association and management of massive pulmonary embolism resulting in cardio-pulmonary resuscitation complicated by disseminated intravascular coagulation (DIC), is presented.

The article presents a case study of a 14-year-old patient who experience erroneous central venous pressure (CVP) measurement due to misplaced central venous catheter (CVC) tip following sub-aortic membrane resection with cardiopulmonary bypass support. It notes that placement of CVC is associated with complication associated to perforation or injury on nearby blood vessels and structures. It suggests that chest radiograph must be executed after catheter placement to confirm the position of CVC.