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Study Design: This study is a single-blind, parallel, three-group, and randomized controlled trial.Purpose: This study aimed to investigate the effectiveness of electrical stimulation-augmented virtual reality training in improving balance in individuals with incomplete spinal cord injury (iSCI).Overview of Literature: Individuals with iSCI often face significant balance and mobility impairments affecting their quality of life. Scientific studies focusing on standing balance training in the iSCI population are limited. Virtual reality-based balance training has shown positive results in several neurological populations. Electrical stimulation has also proved to be effective in improving voluntary muscle strength in partially paralyzed muscles after iSCI as well as promoting neuroplasticity.Methods: Forty-eight iSCI participants will be recruited based on the inclusion criteria. The participants will be randomly assigned to any of the three groups: virtual reality-based balance training along with the electrical stimulation group, virtual reality-based balance training along with sham stimulation group, or virtual reality-based balance training group. The intervention will be delivered as 60-minute sessions, thrice a week for 4 weeks.Results: The performance of the participants will be assessed using the lower extremity motor score, static and dynamic balance assessment using TechnoBody ProKin tilting platform and Berg Balance Scale, Walking Index for Spinal Cord Injury, and World Health Organization Quality of Life-BREF at pre-intervention, after 4 weeks post-intervention, and at 1-month follow-up.Conclusions: The trial will provide new knowledge about the effectiveness of electrical stimulation-augmented virtual reality training in improving balance in individuals with iSCI. The study results will contribute to the design of better rehabilitation programs for individuals with iSCI.

Introduction: Avoidable sickness, disabilities and death among under 5 children are prevented by routine immunization against some specific diseases. The percentage fully immunized children was 69.9% in Bihar, India, and was almost same in rural area. Immunization coverage is also associated with various socio-demographic factors. The aim of this study is to assess the immunization coverage among children in rural areas of Bhojpur district and identify socio-demographic factors associated with it. Methods: A cross-sectional study was conducted in rural areas of Bhojpur district during January to May 2015. 2 stage cluster sampling was done. 36 villages were selected randomly as primary selection units and within each village, 10 children of age 12-36 months were selected from the sampling frame of all eligible children in selected village. A pre-designed, pre-tested checklist was used by the trained investigators during their visits. Results: A total of 360 children of age 12-36 months were included in the study, of which 65% of children were fully immunized, 33.9% were partially immunized, and 1.1% were not immunized at all. Mother's education (AOR 2.28 (1.28-4.05), P value = 0.005), place of birth (AOR 29.04 (10.75-78.43), P value = 0.0001) and availability of immunization card (AOR 120.04 (15.82-916.47), P value = 0.001) were significantly associated with immunization status. Conclusion: Immunisation coverage in this area was lower. Socio-demographic factors like mother's literacy, place of birth and availability of immunization cards were significantly associated with full immunization of children. It is needed to focus on health related education among parents regarding immunizing services.

Antibiotic resistance has emerged as a threat to global health, food security, and development today. Antibiotic resistance can occur naturally but mainly due to misuse or overuse of antibiotics, which results in recalcitrant infections and Antimicrobial Resistance (AMR) among bacterial pathogens. These mainly include the MDR strains (multi-drug resistant) of ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species). These bacterial pathogens have the potential to “escape” antibiotics and other traditional therapies. These bacterial pathogens are responsible for the major cases of Hospital-Acquired Infections (HAI) globally. ESKAPE Pathogens have been placed in the list of 12 bacteria by World Health Organisation (WHO), against which development of new antibiotics is vital. It not only results in prolonged hospital stays but also higher medical costs and higher mortality. Therefore, new antimicrobials need to be developed to battle the rapidly evolving pathogens. Plants are known to synthesize an array of secondary metabolites referred as phytochemicals that have disease prevention properties. Potential efficacy and minimum to no side effects are the key advantages of plant-derived products, making them suitable choices for medical treatments. Hence, this review attempts to highlight and discuss the application of plant-derived compounds and extracts against ESKAPE Pathogens., Antimicrobial resistance; ESKAPE; Traditional medicine; Hospital acquired infection; Phytochemicals

Introduction: Depression is one of the under-recognized health problems in adolescents. Emotional instability resulted from childhood to adulthood transition makes adolescents vulnerable to depression. Aims: The aim of the study was to explore the prevalence of depression and its associated sociodemographic factors among school-going adolescents. Materials and Methods: This cross-sectional study was undertaken from January 2016 to June 2016 in adolescents studying in 9–12th standard from forty schools located in an urban area of Patna, Bihar. The self-administered questionnaire of Beck's Depression Inventory II was utilized to assess the prevalence of depression. Statistical analysis was done with Pearson's Chi-square test using SPSS software version 21.0. Results: Among the 1412 selected students, the prevalence of depression was found to be 49.2%, wherein the prevalence of severe depression was 7.7%. The overall prevalence of depression was significantly (P < 0.001) higher among girls (55.1%) than boys (45.8%). The prevalence of depression was found to be higher among students belonging to minorities (Buddhism, Jainism, etc.) (63.3%, P < 0.001). Elder students were found to be more depressed than younger students. Depression was found to be statistically significantly associated with gender and religion (P < 0.005). Guilty feeling (69.48%) was one of the most prominent clinical factors associated with depression followed by pessimism (58.14%), sadness (56.52%), and past failure (55.81%). Conclusions: Mental health is one of the most neglected aspects of our society. There is a need to increase awareness about depression among teachers and parents to identify and help depressed adolescents in the school.

ObjectivesThis study aimed to explore barriers to accessing care, if any, among people living with HIV/AIDS (PLHA) in two districts of Bihar. We also aimed to assess attitudes towards PLHA among healthcare providers and community members.DesignThis qualitative study used an exploratory study design through thematic analysis of semistructured, in-depth interviews.SettingTwo districts were purposively selected for the study, namely the capital Patna and a peripheral district located approximately 100 km from Patna, in order to glean insights from a diverse sample of respondents.ParticipantsOur team purposively selected 71 participants, including 35 PLHA, 10 community members and 26 healthcare providers.ResultsThe overarching theme that evolved from these data through thematic coding identified that enacted stigma and discrimination interfere with each step in the HIV care continuum for PLHA in Bihar, India, especially outside urban areas. The five themes that contributed to these results include: perception of HIV as a dirty illness at the community level; non-consensual disclosure of HIV status; reliance on identifying PLHA to guide procedures and resistance to universal precautions; refusal to treat identified PLHA and referrals to other health centres for treatment; and inadequate knowledge and fear among health providers with respect to HIV transmission.ConclusionsThe continued presence of discriminatory and stigmatising attitudes towards PLHA negatively impacts both disclosure of HIV status as well as access to care and treatment. We recognise a pressing need to improve the knowledge of HIV transmission, and implement universal precautions across all health facilities in the state, not just to reduce stigma and discrimination but also to ensure proper infection control. In order to improve treatment adherence and encourage optimal utilisation of services, it is imperative that the health system invest more in stigma reduction in Bihar and move beyond more ineffective, punitive approaches.

Background Co-infection with Visceral Leishmaniasis (commonly known as Kala Azar, KA) and Human Immunodeficiency Virus (HIV) is increasingly being diagnosed among patients in Bihar. This qualitative study is the first assessment of self-reported quality of life among patients co-infected with KA-HIV in the Asian context. Methods We conducted semi-structured, in-depth interviews and adopted an inductive thematic analysis to generate evidence on the quality of life of patients co-infected with KA and HIV. Patients were purposively sampled until saturation was attained. Results We found that patients highly valued income or livelihood potential and health as indicators of a good quality life, and routinely went into debt accessing care in the private setup. This was due to perceptions of poor quality of care in the government setup and a lack of knowledge regarding available government services at the district level. KA symptoms were often misdiagnosed in the private sector as seasonal fever, while care providers found it difficult to disentangle the clinical symptoms of KA and HIV; hence, patients presented late to district hospitals. Patients perceived a high level of stigma, largely due to their HIV status, and routinely reported that HIV had "destroyed" their life. Conclusions Inadequate social support and referral pathways that were not conducive to patient needs negatively impacted patients' quality of life. The dual burden of poverty interacting with the severity and chronicity of KA-HIV co-infection means financial support, increased community engagement, and collaborative decision making are crucial for co-infected patients. Increased provider awareness of co-infection and effective stigma-reduction interventions should be integrated to ensure that appropriate and effective access to care is possible for this vulnerable population. A sustainable long-term strategy requires a people-centered approach wherein the perceptions and life circumstances of patients are taken into account in the medical decision making process.

Background Muzaffarpur district in Bihar, India has witnessed several outbreaks of Acute Encephalitis Syndrome in the past decade with reportedly high case fatality in children under the age of 15 years. No study has documented the mode of transmission and nature of causative agent. Methods A case–control study was conducted to assess the risk factors associated with AES. All cases reported from two hospitals in the district were selected with four controls per case selected randomly. Questionnaires were administered using geographical positioning system (GPS) enabled Tablets. Results The median age was 4 years (IQR: 3–6.5) in both cases and controls. Case-fatality rate was 274 per 1000 AES cases. Logistic regression analysis showed significant association (p Conclusions Outbreaks of acute encephalitis of unknown origin coinciding with the harvesting season of lychee strengthens hypothesis of oral-faecal transmission.

Introduction Hypertension (HT) has its origin in childhood and adolescent period but it goes undetected due to absence of sign and symptoms, unless specifically looked for during this period. It has been seen that one with raised blood pressure level in this period will also have raised Blood Pressure (BP) level in their adulthood and elderly period. Aim The present study was conducted to estimate the prevalence of HT and its risk factor among apparently healthy school going adolescents of Patna district. Materials and methods A cross-sectional study among 2913 school going adolescents of eighth to 10th standard was conducted from April 2014 to August 2015 by adopting a two stage cluster sampling technique. The questions pertaining to risk behavior in relation to cardiovascular diseases from WHO's Global School based Student Health Survey were used for this study. Results The mean systolic and diastolic blood pressure of study population was 107.4 mm of Hg (95% C.I. 106.93-107.77) and 67.4 mm of Hg (95% C.I. 67.26-67.54), respectively. Prevalence of pre-HT and HT was 10.9% and 4.6% in school going adolescents while prevalence of overweight/obesity was 1.5%. Both systolic and diastolic blood pressures had positive and significant correlation with age, height and body mass index. The proportion of children who had ever taken tobacco was 5.3%, cigarette smoking 4.3%, alcohol consumption 2.1%, and excess salt intake 22.3%. Only 49.1% children were doing physical activity at least one hour a day in past seven days for maintenance of good health. Conclusion The present study recommends that regular screening of blood pressure level must be initiated in adolescents so that remedial measure can be initiated as early as possible.

Background: Population mobility and migration are important processes of human life. It affects broad range of sociocultural parameters. Mobility increases personal interaction and exposure to sexual partners from high-risk group. Although traditional Indian value prohibits premarital or extramarital sexual activities, but this aspect has not been explored in migrant workers. Methods: It was a qualitative study based on indepth interview of participants. The participants were wives of migrant workers. Indepth interviews were conducted by two female field interviewers recruited for the study. A total of 24 study subjects were recruited for the study. An indepth interview guide was prepared which mainly focused on sexual behavior, including premarital, marital, and extramarital, quality of marital relationship, gender roles, peer networks, substance abuse, work-related activities, etc., The transcripts were analyzed in NVIVO and themes were generated. Results: The premarital sex was more common in boys than girls. It is more common in the same age group and has increased in the recent years. Various reasons were cited in relation to premarital sex in rural areas like love affair, delayed marriage, watching bad movies, bad company, allurement for gifts money, etc., Some women had opinion that males belonging to affluent and powerful families had tendency to enjoy sex with other women within and outside village. The major themes which emerged from the study were the sexual activity, type of sexual partners, reasons for multiple sexual partner, and risky and nonrisky sexual activity. Conclusion: The findings of the study provided insights to design and conduct a larger and more representative quantitative study among the wives of migrant workers to understand the dynamic combination of biomedical, behavioral, and sociocultural factors that may influence transmission of infection within marriage.

Aim: This study aims to evaluate the effect of type of cement, and their thickness on stress distribution at dentin-cement interface of computer-aided designed glass fiber post using three-dimensional finite element analysis. Materials and Methods: Nine 3D models of endodontically treated maxillary second premolar were divided into three groups according to the adhesive cement used PermaCem (Group I), Variolink II (Group II), and ParaCore (Group III). Each group was further divided into subgroup a, b, and c on the basis of the thickness of the adhesive cement 50 μm, 200 μm, and 300 μm, respectively. All the models were simulated to be cemented with computer-aided designed glass fiber post and core followed by zirconia crown. The core was modeled with incomplete ferrule. The load of 200N at 45° at lingual and central fossa was applied. Maximum von Mises stresses distribution was calculated. Results: Maximum and minimum stresses in dentin were seen in the Ic and IIIa, respectively. Maximum and minimum stresses in cement were seen in IIIc and Ia, respectively. Conclusion: The von Mises stresses in dentin can be minimized by keeping the cement thickness minimum and selecting the cement whose modulus of elasticity is closest to that of dentin.

Aim: The aim of this study was to evaluate the microtensile bond strength (μTBS) of bulk fill and low shrinkage composite for different depths of Class II cavities with the cervical margin in cementum. Materials and Methods: Standardized conservative box-shaped Class II cavities were prepared on sixty sound-impacted human third molars. The samples were randomly divided into two groups: Group I (n = 30) - horizontal incremental technique and Group II (n = 30) - bulk fill technique (SonicFill). They were further subdivided into three subgroups of (n = 10) samples each according to the different occluso-gingival height: subgroup (A - 4 mm, B - 5 mm, and C - 6 mm). The gingival margins for all the samples were located 1 mm below the cementoenamel junction. The restored samples were subjected to thermocycling (500 cycles) followed by μTBS testing. The scores were statistically analyzed using ANOVA and post hoc test using SPSS software version 16. Results: Subgroups IA and IB showed lower μTBS than subgroups IIA and IIB (P < 0.05) whereas subgroup IC showed higher μTBS than subgroup IIC (P < 0.05). SonicFill showed a significant reduction in μTBS as the depth increased. Conclusion: SonicFill should be used in two increments for cavities with a depth of more than 5 mm.

Background: India is regarded as the “Diabetes Capital” of the world owing to the existence of the largest number of people with diabetes in this country. Diabetes is a serious public health problem that has a strong negative impact on the health-related quality of life (HRQoL). Objective: To know the quality of life (QoL) of diabetic persons and compare them with normal subjects. Materials and Methods: This cross-sectional study was done among 85 diabetic patients and 85 age- and sex-matched normal comparison group. We used the World Health Organization Quality of Life Questionnaire—short version (WHOQoL-BREF) to assess QoL. Result: The mean QOL-BREF instrument score, indicating the QoL of the patients, was 57.80. Domain-wise, 55% of the patients revealed good physical QoL, 47% good psychological QoL, 55% good social QoL, and 45% good environmental QoL. The mean score of physical domain of diabetic patients was significantly lower than nondiabetic subjects. Conclusion: This study has shown that the physical domain of QoL was significantly affected in diabetic persons. So, apart from taking regular medications and health checkup, there is a need to address other components of physical domain so that their QoL will improve. While it might not be easy to modify clinical outcomes with good services and support, it might be much more effective in bringing a change in QoL.