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The ‘’capability approach’’, developed by the Indian economist Amartya Sen, has been widely used in the field of development and has contributed a perception of development that is different from the traditional understanding of it. Despite this, the theory has received a great amount of feminist critique and it has been concluded that the field lacks empirical data on how women in developing countries can be fully understood from the approach of Sen. This field study aims at filling this gap of empirical data as well as to examine how well Sen’s approach can contribute to the understanding of women in a developing context. Responses such as the one of Martha Nussbaum and other feminist critique of Sen is examined using a field study on poor women conducted in the state of Karnataka, India. The collection of data has been conducted through interviews with urban poor women as well as with women working with women empowerment at a local organization. Participant observation in the field has been complementary to the interviews. This study reveals that Sen’s capability approach is incomplete to some extent in order to understand the situation of women in a developing context. This lack of understanding is further completed with Nussbaum’s work. Finally, the modern feminist critique against both Sen and Nussbaum shows a lack of analysis in them both in terms of intersectionality and power.

Background: Influenza is a disease caused by four types of viruses and causes annual outbreaks. An outbreak of a new type of Influenza virus (A/H1N1) was declared as a pandemic by the World Health Organization (WHO) in 2009. Recently, there has been a lot of focus on the development of the COVID-19 vaccine but the Influenza vaccine, which has been available for a long time and has proven efficacy, is not being optimally utilized in India. Objective: The study aimed at assessing the awareness and attitude about Influenza and its vaccine amongst Indian doctors so as to analyze reasons for Influenza vaccine hesitancy in India. Method: An online questionnaire-based survey was undertaken between September 2020 and December 2020. 1000 doctors with valid Indian medical graduation (Bachelor of Medicine and Bachelor of Surgery, MBBS) or above were invited to participate. Results: The survey revealed that most doctors believed in Influenza vaccination as the best strategy to prevent infection, but lacked adequate awareness about the common facts regarding the appropriate season, diseases covered and the requirement of the influenza vaccine during pregnancy. Doctors opined that lack of patient awareness, casual counseling, few prescriptions by physicians, misconceptions about safety, and high cost of Influenza vaccine were the key reasons for vaccine hesitancy in patients. Conclusion: There is incomplete awareness amongst doctors regarding Influenza vaccination which might be a roadblock in the widespread acceptance of Influenza vaccines in India. Moreover, there is a need for patient-to-patient education through social media and the deployment of digital tools to address vaccine hesitancy in the country.

Background: Oral hygiene maintenance is crucial for prevention of various oral diseases. Oral hygiene practices across the country vary largely and people in peri-urban and rural areas use traditional methods of oral hygiene like powders, bark, oil and salt etc. Their effect on oral soft and hard tissues need to be studied to understand their beneficial and/ or harmful effects on maintenance of oral hygiene and prevention or causation of oral diseases. Objectives: This study aimed to assess the plaque-cleaning efficacy, gingival bleeding, recession and tooth wear with different traditional oral hygiene methods as compared to use of toothpaste-toothbrush, the most accepted method of oral hygiene practice. Study Design: Hospital based cross sectional analytical study. Results: Total 1062 traditional oral hygiene method users were compared with same number of toothpaste-brush users. The maximum number in the former group used tooth powder (76%) as compared to other indigenous methods, such as use of bark of trees etc and out of tooth powder users; almost 75% reported using red toothpowder. The plaque scores and gingival bleeding & recession were found to be more in traditional oral hygiene method users. The toothwear was also more severe among the toothpowder users. Conclusions: Traditional methods were found to be inferior in plaque control as was documented by increased bleeding and gingival recession. Its effect on hard tissues of teeth was very damaging with higher tooth wear scores on all surfaces.

Background: Age estimation in living individuals is imperative to amicably settle civil and criminal disputes. A biochemical method based on amino acid racemization was evaluated for age estimation of living Indian individuals. Design: Caries-free maxillary/mandibular premolar teeth (n = 90) were collected from participants with age proof documents and divided into predefined nine age groups. Materials and Methods: Dentine biopsy from the labial aspect of the tooth crown was taken with an indigenously developed microtrephine. The samples were processed and subjected to gas chromatography. Dextrorotatory:levorotatory ratios were calculated, and a regression equation was formulated. Results: Across all age groups, an error of 0 ± 4 years between protein racemization age and chronological age was observed. Conclusion: Aspartic acid racemization from dentine biopsy samples could be a viable and accurate technique for age estimation of living individuals who have attained a state of skeletal maturity.

Aims and Objectives: The study aims at determining pulp response of two high fluoride releasing materials silver diamine fluoride (SDF) and Type VII glass ionomer cement (GIC) when used as indirect pulp treatment (IPT) materials. Materials and Methods: Deep Class V cavities were made on four first premolars indicated for extraction for orthodontic reasons. SDF, Type VII GIC, and calcium hydroxide base are given in three premolars, and one is kept control. Premolars were extracted 6 weeks after the procedure and subjected to histopathological examination to determine the pulp response. The results were analyzed using Chi-square test. Results: No inflammatory changes were observed in any of the groups. Significantly more number of specimens in SDF and Type VII GIC groups showed tertiary dentin deposition (TDD) when compared to control group. No significant difference was seen in TDD when intergroup comparison was made. Odontoblasts were seen as short cuboidal cells with dense basophilic nucleus in SDF and Type VII GIC group. Conclusion: The study demonstrated TDD inducing ability of SDF and Type VII GIC and also established the biocompatibility when used as IPT materials.

Prosthetic rehabilitation of grossly decayed teeth is a challenge. The treatment options range from nonsurgical endodontic therapy to extraction and subsequent placement of dental implants. Tooth transplantation involves placement of an impacted, embedded or erupted autogenous tooth from one site into an extraction site. It is a time tested, predictable maneuver with high success rate for replacement of severely compromised natural teeth. This paper documents a successful autotransplantation of an immature mandibular third molar into the socket of a grossly decayed adjacent second molar. Autotransplantation should be considered as a viable treatment option in comparison to dental implants.

FAKTOR RISIKO TERJADINYA GAGAL GINJAL KRONIK DI RSUP PROF. DR. R. D. KANDOU MANADOIntan Logani1), Heedy Tjitrosantoso1), Adithya Yudistira1)1)Program studi farmasi FMIPA UNSRAT Manado, 95115 ABSTRACT Risk factors are factor which can increase the incidence of a disease. Chronic Kidney Disease (CKD) is a progressive development of kidney disease and usually lasts for one year. Increased chronic renal disease can be caused by several risk factors. This study aims to find out what are the risk factors of Chronic Kidney Disease (CKD) in the Prof. Dr. R. D. Kandou Hospital, Manado. This type of research is included in the type of observational research with prospective data retrieval. This research was conducted prospectively during December 2016 - February 2017 at the inpatient installation of Prof. Dr. R. D. Kandou Hospital, Manado. This study was conducted on 50 records of patient medical records and through interviews of respondents with chronic kidney disease. The results showed that the risk factors of Chronic Kidney Disease in inpatients at Prof. Dr. R. D. Kandou Hospital, Manado was the patient with a history of hypertension, uric acid, diabetes mellitus, with a long history of ≥10 years of illness, irregular use of medication during previous history, and the use of painkillers. Other risk factors lie in the patient's lifestyle which includes smoking habits, meat consumption, coffee consumption, high salt content consumption, excessive sugar consumption, lack of sleep and lack of exercise. Keywords: Risk factor, Chronic Kidney Disease (CKD) ABSTRAKFaktor risiko adalah suatu faktor yang dapat meningkatkan timbulnya suatu penyakit. Gagal Ginjal Kronik (GGK) merupakan perkembangan gagal ginjal yang bersifat progresif dan biasanya berlangsung selama satu tahun. Meningkatnya penyakit gagal ginjal kronik dapat disebabkan oleh beberapa faktor risiko. Penelitian ini bertujuan untuk mengetahui apa saja faktor risiko terjadinya Gagal Ginjal Kronik (GGK) di RSUP Prof. Dr. R. D. Kandou Manado. Jenis penelitian ini termasuk dalam jenis penelitian observaional dengan pengambilan data secara prospektif. Penelitian ini dilakukan secara prospektif selama bulan Desember 2016 – Februari 2017 di instalasi rawat inap RSUP Prof. Dr. R. D. Kandou Manado. Penelitian ini dilakukan terhadap 50 catatan rekam medik pasien dan melalui wawancara terhadap responden dengan penyakit gagal ginjal kronik. Hasil penelitian menunjukan bahwa faktor risiko terjadinya Gagal Ginjal Kronik pada pasien rawat inap di RSUP Prof. Dr. R. D. Kandou Manado ialah pasien dengan riwayat hipertensi, riwayat asam urat, riwayat diabetes melitus, dengan lama menderita riwayat penyakit ≥10 tahun, penggunaan obat yang tidak teratur selama menderita riwayat penyakit dahulu, serta penggunaan obat penghilang nyeri. Faktor risiko lain terdapat pada pola hidup pasien yang meliputi kebiasaan merokok, konsumsi daging, konsumsi kopi, konsumsi kandungan garam tinggi, konsumsi gula berlebihan, kurang tidur dan kurang olahraga.Kata Kunci : faktor risiko, gagal ginjal kronik (GGK)

Loss of pulp vitality in an immature permanent tooth arrests root development. This leads to tooth with open apex and weak lateral dentinal walls. Management of such necrotic teeth with immature roots poses several treatment challenges. The documented study was performed to evaluate and compare apexogenesis induced by revascularization, with and without platelet rich plasma (PRP) in non-vital, immature anterior teeth. Three patients having bilateral, non-vital, immature maxillary central incisors with apical periodontitis were recruited after institutional ethical clearance. Subsequent to chemo-mechanical preparation, revascularization with and without PRP was randomly induced in either of the tooth. The cases were followed-up clinically and radiographically at 6 and 12 months. There was a marked difference in periapical healing, apical closure and dentinal wall thickening of teeth treated by revascularization with PRP.

Introduction This study was conducted to evaluate and compare maturogenesis induced by revascularization with and without platelet-rich plasma (PRP). Methods Twenty patients with nonvital, immature anterior teeth were randomly categorized into 2 groups. Subsequent to chemomechanical preparation, revascularization with and without PRP carried on a collagen sponge was induced in groups 1 and 2, respectively. The cases were followed up clinically and radiographically at 6- and 12-month intervals. Results Clinically, all cases were asymptomatic with complete resolution of signs and symptoms. Radiographically, there was a marked difference in periapical healing, apical closure, and dentinal wall thickening in group 2 in comparison with group 1. However, root lengthening was comparable for both of the procedures. Conclusions Revascularization is a conservative and an effective method for inducing maturogenesis in nonvital, immature teeth. Supplementations with PRP can potentially improve the desired biological outcome of this regenerative technique.

Aim: This study aims to compare the periapical healing of teeth with asymptomatic apical periodontitis treated either by conventional apical preparation (CAP) or apical clearing technique (ACT). Materials and Methods: Twenty subjects with bilateral nonvital similar teeth exhibiting comparable periapical index (PAI) score were enrolled and randomly allocated. Group I (CAP, n = 20): Apical preparation three sizes greater (master apical file [MAF]) than the first binding file at the established working length. Group II (ACT, n = 20): Apical preparation three sizes greater than the MAF that was followed by dry reaming. Root canal therapy was accomplished in single-visit for all the teeth. They were pursued radiographically at 3, 6, 9 and 12 months. Pre- and post-treatment PAI scores were compared. To ascertain the proportion of healed teeth between the two groups, McNemar Chi-square test was applied. Results: At 3, 6, and 9 months’ time interval the proportion of healed teeth for Group II (ACT) was greater in comparison to Group I (CAP) (P < 0.05). However, at 12 months follow-up period this difference was not significant (P = 0.08). Conclusion: ACT enhanced the healing kinetics. However, the long-term (12 months) radiographic outcome was similar for either technique.

Modern medicine benefits from technological advances that both extend life and also improve the quality of life. Cardiovascular implantable electronic devices (CIEDs), including implantable cardioverter defibrillators (ICDs) and per manent pacemakers (PPMs), are commonly used to treat cardiac rhythm disorders. An aging population in the USA, combined with expanding indications, promises an exponential increase in the utilization of these devices. However, challenging ethical dilemmas arise. Mortality rates among CEID recipients remain high due to worsening underlying cardiac disorders, as well as the development of other terminal illnesses [1,2]. Appropriate end-of-life management of these devices can be difficult, as clinicians attempt to balance autonomy with the wellbeing of the patient and the obligation to avoid harm. Furthermore, how these devices should be handled after a patient’s death poses other challenges, as well as opportunities.

We have reported previously that millimeter waves (MMWs) protect T-cell functions from the toxic side effects of cyclophosphamide (CPA), an anticancer drug. Since the effect of MMWs has been reported to be mediated by endogenous opioids, the present study was undertaken to investigate the role of endogenous opioids in protection of T-cell functions by MMWs. The effect of MMWs (42.2 GHz, incident power density = 38 mW/cm²) was studied on CPA-induced suppression of cytokine release by T cells in the presence of selective opioid receptor antagonists (ORA). Production of cytokines was measured in CD4 T cells isolated from splenocytes. Treatment of mice with CPA suppressed the formation of Th1 cytokines (TNF-α, IFN-γ, and IL-2), shifting the overall balance toward Th2 (IL-4 and IL-5). MMW irradiation of CPA-treated groups up-regulated the production of Th1 cytokines suppressed by CPA. Treatment of the CPA+MMW group with selective kappa (κ) ORA further potentiated this effect of MMWs on Th1 cytokine production, whereas treatment with μ or δ ORA increased the imbalance of cytokine production in the Th2 direction. These results provide further evidence that endogenous opioids are involved in immunomodulation by MMWs.

Background: Recent emphasis on the judicious use of imaging prompted the publication of the 2007 ACC/ASE Appropriateness Use Criteria (AUC) for Echocardiography. However, the intersection of the AUC with the safety and clinical use of transesophageal echocardiography (TEE) is not well established. Methods: We reviewed 490 consecutive orders for TEEs for appropriateness, significant findings, and reasons for cancellation. Results: We found that 79% (389/490) of ordered studies were performed and 21% (101/490) were not. The number of TEEs cancelled for safety reasons (n = 29) was similar to that cancelled for inappropriateness (n = 36). Only 2% (6/389) of those performed were inappropriate vs. 16% of those that were cancelled. New or unsuspected findings were obtained in half of all performed TEEs; the majority of which were ordered to detect cardiac source of embolism (CSE). Conclusions: The AUC should specifically consider the utility of clinician-based prescreening of TEEs to encourage appropriate use and safety. Furthermore, given the incremental value of TEE over transthoracic echocardiography in detection of CSE, in some cases, TEE may be considered an appropriate initial test for this indication. (Echocardiography 2011;28:767-773)

Background: Following high-profile device failures, the Heart Rhythm Society emphasized the need for postmarketing surveillance by recommending that physicians return all explanted devices to the manufacturer for analysis. Methods: We conducted a national survey of electrophysiologists (EPs) regarding recovery for analysis of explanted pacemakers and implantable cardioverter defibrillators (devices), and attitudes toward device-specific advance directives to facilitate return of devices. Online survey invitations were sent in four waves from December 2008 to June 2009 to 300 e-mail addresses from the Heart Rhythm Society member database. Results: From 250 invitations, there were 95 responses (38%). Demographics included average age 50 years (range, 31–87); 95% male; 81% Caucasian. Only 23% reported returning all explanted devices to the manufacturers. Of all the respondents, 32% discarded >10 devices/year as medical waste, 42% stored devices in a box in the electrophysiology lab, and 10% donated at least 1 device/year to charity for reuse overseas. Sixty-seven percent felt that it would not be helpful to have an advance directive specifying what the patient would want done with their device postmortem. Conclusions: Few EPs return all explanted devices or send interrogation reports to the manufacturers, though nearly all said it was easy to do so. A majority either dispose of explanted devices as medical waste or store them in laboratories or offices, and a small percentage donate for reuse in underserved nations or to veterinary hospitals. This study suggests a need for initiatives such as educational campaigns to increase the retrieval and return of devices, either for analysis or reuse. (PACE 2011; 659–665)

Aim : Indirect pulp capping (IPC) preserves the pulp vitality by disinfecting and remineralizing remaining carious dentin. In the present study, glass ionomer (GC, FUJI VII) and silver diamine fluoride (SDF) were tested and compared to calcium hydroxide for their antimicrobial efficacy and remineralizing potential. Materials and Methods : Dentin disks prepared from 45 freshly extracted first premolars were divided into three groups (n = 15). Each disk was cut into two equal parts, in which one half formed the control. Thirty dentin samples were used for ion estimation and the other 15 for microhardness testing. Atomic absorption spectrophotometry, colorimetric and potentiometric titration analyses were performed for calcium, phosphate and fluoride ion detection, respectively. The antimicrobial efficacy was analyzed using pure culture of Streptococcus mutans and mixed flora. Results : Increase in the levels of calcium and phosphate ions was the highest in calcium hydroxide group. Both SDF and GC VII groups showed significant increase in fluoride ion levels. Samples treated with GC VII showed maximum increase in micro hardness. The highest zone of bacterial inhibition was found with SDF group. Conclusions : This in vitro study documented the remineralizing, re-hardening and antimicrobial efficacy of both SDF and GC VII and hence can act as effective IPC materials.

The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU) are associated with cost savings and improved outcomes. We evaluate the literature investigating the cost-effectiveness and clinical outcomes of high-intensity ICU physician staffing as recommended by The Leapfrog Group (a consortium of companies that purchase health care for their employees) and identify ways to overcome barriers to nationwide implementation of these standards. Hospitals that have implemented the Leapfrog initiative have demonstrated reductions in mortality and length of stay and increased cost savings. High-intensity staffing models appear to be an immediate cost-effective way for hospitals to meet the challenges of health care reform.

It is important for the clinician not only to gather as much information about a case as possible, but also to be able to correctly interpret the data to arrive at an accurate diagnosis. Occasionally, a case presents with symptoms that might be suggestive of a condition; however, the final diagnosis may be totally different. This paper reports on an interesting case of a true vertical root fracture, in an intact maxillary molar in a 55-year-old man. The case was misdiagnosed and treated as a periodontal defect for over two months. The paper discusses the various causes and diagnostic dilemmas of root fractures.

Coronary artery vasculopathy (CAV) is one of the major factors that limit the long-term survival of heart transplant recipients. It is difficult to diagnose CAV, especially in the early stages. Traditional coronary angiography has been used for the diagnosis of CAV, but this method has limitations. Current literature suggests that intravascular ultrasound (IVUS) is a safe imaging technique that is beneficial for the early diagnosis of CAV; in comparison, IVUS with virtual histology (IVUS-VH) is an even more promising diagnostic utility. Despite its advantages, IVUS is currently not routinely utilized as the primary diagnostic modality for CAV in heart transplant recipients. In this review, we evaluate and summarize the clinical utility of IVUS in the early diagnosis of CAV, including its utility for assessing vessel remodeling, plaque composition, and prognostic value; morphometric analysis; and guiding therapy. After reviewing the relevant published literature, it is our recommendation that the use of IVUS be considered in all post-transplant CAV screening. (J Interven Cardiol 2011;24:9–14)

The aim of this study was to investigate the ability of transthoracic echocardiography (TTE) to detect vegetations and the relationship between blood cultures and transesophageal echocardiography (TEE).Five hundred eleven TTE and TEE pairs performed to evaluate endocarditis were retrospectively analyzed. Vegetation on TTE, prosthetic valve, change in regurgitation, and blood cultures were correlated with vegetation on TEE.TTE detected 45% of vegetations seen on TEE. There was no difference for prosthetic valves. Prosthetic valves (odds ratio, 1.7; P = .03) and increased regurgitation (odds ratio, 1.7; P = .01) were associated with vegetations on TEE; staphylococcal bacteremia and fungemia were not. Negative blood cultures were associated with negative results on TEE (P.0001), but 27% of patients with prosthetic valves had culture-negative endocarditis or nonbacterial thrombotic endocarditis, and 6% had abscesses missed by TTE.This study demonstrates a limited capacity of TTE to detect vegetations. TEE may be an appropriate initial study to evaluate prosthetic valves. TEE for culture-negative endocarditis deserves further study.

Objective The purpose of this in vitro study was to evaluate the effect of various root canal instrumentation techniques with different instrument tapers on cleaning efficacy and resultant vertical root fracture (VRF) strength of the roots. Study design Fifty human mandibular first premolar roots were enlarged to ISO size 20, inoculated with Enterococcus faecalis [ATCC2912] for 72 hours and divided into 5 groups: group I: prepared with .02 taper hand instruments ISO size 40; group II: Profile .04 taper size 40; group III: Profile .06 taper size 40; group IV: ProTaper size F4; and group V (control group) further divided into: Va: with bacterial inoculation and no mechanical instrumentation; and Group Vb: neither bacterial inoculation nor mechanical instrumentation. Cleaning efficacy was evaluated in terms of reduction of colony forming units (CFUs). The VRF strength was evaluated using D11 spreader as wedge in an Instron testing machine. Results Root canals instrumented with ProTaper and 6% Profile instruments showed maximum reduction in CFUs, with statistically insignificant difference between them. The VRF resistance decreased in all instrumented groups. The difference of VRF between 2% and 4% taper Profile groups was statistically insignificant ( P = .195). One-way analysis of variance showed that canals instrumented with ProTaper F4 showed maximum reduction in VRF resistance compared with control uninstrumented group. Conclusions Profile 6% taper instruments offer the advantage of maximum debridement without significant reduction in root fracture resistance.