Background: In India, emergency obstetric care (EmOC) services were started under RCH-II program (2004) with the goal to reduce maternal mortality ratio <100/lakh live births and increase institutional deliveries to at least 80% by 2010. Implemented strategy was to enhance availability and accesses to EmOC services. Objective: This study was conducted in one of the blocks of Wardha district in Maharashtra to understand the accessibility for providing EmOC services at primary health center and rural hospital in the last 1 year. Materials and Methods: This cross-sectional qualitative study was conducted from May 2018 to October 2018. Data were collected by key informant interviews of service providers. Notes were transcribed and then translated into English. Respondents' verbatim that is significant and illustrative as per the theme of the study was used for analysis. Results: Equipment and drugs essential for EmOC were available; however, most of these were underutilized due to lack of skill in selected facilities. Basic EmOC training pattern was found inadequate in duration and practical skill. Training and recruitment of staff constantly were observed challenging for higher stakeholders. Of all EmOC signal functions, only parental antibiotics, oxytocics, and assisted vaginal delivery (episiotomy) were provided. Conclusion: Although building infrastructure, drugs, equipment, and transportation facilities were accessible, needy women may fail to receive timely and quality EmOC, due to lack of trained staff, low confidence, and lack of motivation in managing obstetric emergencies.

Background: The cases of cyanotic heart diseases are commonly admitted for medical and surgical management. Aims and Objective: The aim was to study the clinical presentation of congenital cyanotic heart diseases. Materials and Methods: For inclusion in the study, children suffering from congenital cyanotic heart diseases from age of 2 months admitted in the pediatric wards and intensive care unit were included in the this study. Results: During the study period of 1 year, 80 cases were included. This study noted that males were 55% than females. Presenting complaints in majority of patients was difficulty in breathing .They also had repeated episodes of LRTI in past. Malnutrition was seen in more than 50% of the cases of cyanotic congenital heart disease. SPO₂was low in majority of these children; SpO₂levels were above 90% among 12 patients (15%). Cyanosis was the most frequent sign. The apex beat was diffuse in 26 cases, more common in cases with increased pulmonary blood flow 18 (70%). Thrill was most common in tetralogy of fallot (TOF) physiology cases. The palpable P2 was observed in eight cases and palpable epigastric pulsations seen in three children in increased pulmonary blood flow cyanotic heart diseases. On auscultation, second heart sound findings were that the soft S2 was observed mostly in TOF and loud S2 in increased pulmonary blood flow cyanotic heart diseases. The shunt murmurs were observed in 12 cases and ventricular septal defect was seen in 8 cases and atrial septal defect in 4 cases. The most common murmur was ejection systolic murmur in the study. The most common congenital cyanotic disease was TOF 38 (47.5%), while the complication was congestive heart failure 14 (37%). On X-ray showed cardiomegaly and electrocardiogram revealed right axis deviation. Conclusion: The cyanotic heart diseases present with mostly cyanosis, difficulty in breathing, and low oxygen saturation. The general signs were more common than systemic signs.

Purpose: The aim of our study is to compare intravenous (IV) iron sucrose with ferrous sulfate for prophylactic iron therapy in pregnancy in terms of hemoglobin percent (Hb%) rise. Materials and Methods: One hundred and fifty-four pregnant women fulfilling the inclusion criteria, with Hb >10gm/dl, between 20 and 24 weeks were selected and divided into two groups, 77 each. Group A was allotted to use three doses of iron sucrose, each dose 200 mg in 100 ml normal saline as infusion over 15–20 min at 20–24, 25–28, and 29–32 weeks, respectively, and Group B was allotted to use oral ferrous sulfate 200 mg tablet once daily at bed time. All pregnant women were followed till 32 weeks. Hb% was estimated for both the groups at 20–24 weeks, 25–28 weeks, and 29–32 weeks, and statistical analysis was carried out using the Chi-square test, Student's paired, and unpaired t-test with the SPSS software version 24.0 and Graph Pad Prism 7.0 version, and P < 0.05 is considered as level of statistical significance. Results: Mean Hb% at 20–24 weeks in patients of Group A was 11.11 ± 0.89, and in Group B, it was 11.04 ± 0.80; mean Hb% at 29–32 weeks in patients of Group A was 12.39 ± 0.99, and in Group B, it was 12.23 ± 0.89. Conclusions: IV iron sucrose can be used as prophylaxis for anemia in pregnant women as it requires less follow-up and causes a rapid increase in hemoglobin.

Introduction: Preterm delivery (PTD) is a significant determinant of morbidity and neonatal mortality. Preterm babies are prone to severe neonatal illness or death. PTD is one of the unresolved problems in clinical obstetrics and one of the greatest threats to the developing fetus; predictive biomarker needs to be identified for premature delivery. Therefore, the aim of this study was to assess the serum levels of hemoglobin, iron, alkaline ferritin phosphatase and ceruloplasmin in preterm and full-term delivery. Materials and Methods: The present study includes total 60 participants that comprise thirty women presenting with preterm onset of labor followed by delivery and thirty women who delivered at term served as controls. Blood samples from the patients were obtained for Iron, Ferritin, alkaline phosphatase and ceruloplasmin estimation, when patient was in labor. Results: Serum alkaline phosphatase levels were significantly increased (P ≤ 0.05) in PTD as compared to full-term delivery. Serum ceruloplasmin levels were significantly increased in PTD as compare to the full-term delivery (P ≤ 0.05). Serum ferritin levels were significantly increased (P < 0.001) in PTD as compared to full-term delivery. Serum iron levels were nonsignificantly increased in PTD as compare to the full-term delivery.(P ≤ 0.05). Conclusion: Significant rise in serum ceruloplasmin, ferritin and alkaline phosphatase in PTD as compared to full-term delivery indicate that these biomarkers can be used as predictive biomarker for PTD. Moreover, these parameters are cost effective, simple to perform and less time-consuming and indicative of subclinical infections of pregnancy which could be one of the reasons for PTD.

Background: Eclampsia is a severe complication of preeclampsia (PE). This can create additional complications during pregnancy. It is a rare but serious condition where high blood pressure (BP) results in seizures during pregnancy and associated with risk for mother and fetus. The investigations of serum lipid profile serum uric acid are and BP with body mass index (BMI) highly suggested the feature of disease. Objective: The objective of the study is to find out the association between serum lipid profile and serum uric acid level in normotensive and preeclamptic pregnant women. Materials and Methods: A prospective case–control study was conducted in the Department of Biochemistry at Jawaharlal Nehru Medical College and Datta Meghe Institute of Medical Sciences, Sawangi (Meghe) Wardha, Maharashtra, India, with individuals suffering with severe PE to the obstetric unit of hospital. Serum lipid profile and uric acid levels were done by 159 patients suffer from PE and compare with 150 age-matched normotensive controls. Results: The average BMI in study group (preeclamptic pregnant women) was significantly higher than control group (P < 0.001). The BP was high in preeclamptic pregnant women than normal women. Statistically significant difference was observed in the levels of CH, triglycerides, high-density lipoprotein (HDL), and uric acid in the age group up to 25 and 26–32 years. There was no statically significantly difference observed in the age group of 33–39 years. HDL level was statically insignificant in both the groups. Conclusion: Serum lipid profile and serum uric acid are very useful markers for early detection, to identification of complications, and reduce the risk of occurrence in PE. Early detection is going to aid in better management which is important to improve the maternal and fetal complications.

Objective: The objective is to evaluate the role of diffusion weighted imaging (DWI) in evaluation of intracranial infections. Methods: The present study was conducted in the Department of Radiology, Jawaharlal Nehru Medical College, Sawangi, Maharashtra, India. Participants after understanding the study protocol and procedure were asked to give their written consent for the study. DWI was performed on 24 patients having ring-enhancing lesions on their post-contrast brain magnetic resonance imaging scans with infective etiology. Commonly found lesions were tuberculomas, cysticercosis, pyogenic abscess, and fungal infections. Correlation of all these findings was done with histopathology obtained in all these patients. DWI and mean apparent diffusion coefficient (ADC) value were calculated. Results: Tuberculomas showed heterogeneous areas of restricted diffusion on DWI were as pyogenic abscess showed homogenous restricted diffusion, the mean ADC values from of these lesions were 0.74 × 10⁻³ and 0.5 × 10⁻³ mm²/s, respectively. Fungal abscesses were also ring enhancing. They had restricted diffusion in the central nonenhancing portions. Mean ADC for all fungal lesions was 0.33 ± 0.06 × 10⁻³ mm²/s, with an average ADC ratio of 0.43. However, there was no significant difference between ADC values of pyogenic abscess and fungal abscess. The vesicular cysts of NCC showed ring enhancement but no significant restriction on DWI, the ADC values from the vesicular cysticercus cysts core measured (1.66 ± 0.29) ×10 ^{− 3} mm²/s, which was highest among the infective intracranial infection. Conclusion: DWI is noninvasive method with high sensitivity and specificity which can help in differentiation of infective ring-enhancing lesions. Fungal cerebral abscesses may have central restricted diffusion similar to that of bacterial abscesses but with histologic features of acute or chronic inflammation and necrosis rather than suppuration. Altered water diffusion in these lesions likely reflects highly proteinaceous fluid and cellular infiltration. The tuberculoma and NCC lesions showed heterogeneous and no restriction on DWI respectively with significant change in the ADC values which helped in differentiating these lesions. This modality should be read in conjunction with conventional imaging.

Background: General anesthesia, muscle paralysis, and increased intra-abdominal pressure are known to produce basal lung atelectasis and may contribute to the inadequate CO₂removal and increased end-tidal carbon dioxide (EtCO₂)during laparoscopic surgery. Positive end-expiratory pressure (PEEP) has been shown to prevent compression atelectasis during general anesthesia. Hence, we designed this study to test the hypothesis that the application of PEEP before capnoperitoneum will maintain EtCO₂ within the normal range without changing the ventilator parameters. Our secondary outcome measures were hemodynamic changes during PEEP and capnoperitoneum. Methods: Sixty patients were randomly allocated to receive 0 PEEP (n = 30) or 10 PEEP (n = 30) with constant minute ventilation under standardized general anesthesia. Respiratory and hemodynamic parameters were recorded every 2 min for 10 min then every 5 min till 30 min after capnoperitoneum. Results: In group PEEP-0, the mean EtCO₂increased significantly after 2 min of capnoperitoneum, plateaued at 15 min, remained at high level till 30 min (34.1 ± 3.1 to 43.3 ± 2.9 mmHg; P = 0.000). In group PEEP-10, EtCO₂dropped from the baseline (36.5 ± 3.2 to 32.0 ± 3.3 mmHg; P = 0.0003) at 5 min after the application of PEEP, and there was no net increase in EtCO₂following capnoperitoneum till 30 min (34.5 ± 3.5 mmHg). Cardiac output fell significantly after the induction in both groups but did not fall any further after the application of PEEP and capnoperitoneum. Conclusion: The application of PEEP of 10 cm H₂O before the creation of capnoperitoneum can maintain EtCO₂within the normal range without making changes in the ventilator parameters, with stable hemodynamics in patients undergoing laparoscopic cholecystectomy.

Background: The international continence society defines urinary incontinence (UI) as a situation in which involuntary urine loss is a hygienic or social issue and can be demonstrated objectively. Due to culture of silence, Indian females with urinary issues are quietly suffering from symptoms even when their symptoms trigger great discomfort and hamper regular activities. In India, there are limited research dealing with the effect of UI among rural females. Aim: The aim of the study was to determine the effect of vaginal cones and perineometer as a biofeedback device in rural females with UI. Objective: The objective of the study was to compare the effect of vaginal cones along with perineometer as a biofeedback device versus pelvic floor exercise in rural females with UI. Procedure: A comparative study included 45 participants aged 45–70 years as per the inclusion criteria which were divided into two groups: Group A was treated with vaginal cones and perineometer, whereas Group B was given Kegel exercises. Pre- and postreadings of questionnaire for female UI diagnosis and perineometer were taken. Results: The analysis of the result showed a significant improvement in Group A as compared to Group B. Conclusion: The present study concluded that a combined effect of vaginal cones and perineometer with biofeedback device showed a more significant result than pelvic floor muscle strength training (Kegel exercise).

Aim: The aim of the study was to evaluate whether epidural analgesia is more advantageous over spinal anesthesia. Material and Methods: Patients who are undergoing elective inguinal hernia repair of aged between 18 and 80 years of either sex, belonging to the American Society of Anesthesiologists Class I and II were randomly distributed and given spinal and epidural anesthesia. Results: Segmental epidural anesthesia was given with 0.5% 6 ml at L1–L2 intervertebral space to compare mainly hemodynamic parameters.

This study aims at evaluating the association between subjective well-being (SWB) and oral functions in elderly people. Materials and Methodology: A cross-sectional study was carried out in a private dental college of central part of India. A study was carried out with a structured questionnaire on 200 individuals aged above 60 years. The questionnaire consisted of demographic data, oral function, habits, and general health. The SWB scale was used to tabulate the results. Results: A total of 200 people, comprising 67% and females 33% who were in the age group of 60–80 years, were covered in this research. The demographic profiles taken in the above study were age, gender, occupation, and monthly income. It was found that there is an association of SWB with health in the previous year (0.047). Thirty-nine percent of the persons had good health and 9.5% had altered health condition. In case of smoking as a habit, 43% of the people never smoked and the remaining had the habit (P = 0.012). Dental caries was found to be associated with SWB (0.001), 48% of the people had no caries, and the rest 52% had no caries. In case of loss of taste, 71.5% had no change in taste sensations, whereas 28.5% had altered taste sensations (P = 0.005). Twenty-eight percent of the people experienced burning sensation in the mouth and the remaining 72% had no complaints (P = 0.000). Conclusion: It was found that poor oral functions such as loss of teeth and other oral conditions such as burning mouth and loss of taste caused psychological and social disturbances in elderly people.

Aim: The aim is to study the bacteriological profile of indwelling central venous catheter (CVC) among patients in intensive care unit (ICU). Settings and Design: The study was conducted on admitted patients with indwelling CVC in medical ICU, surgical ICU, and critical care unit of Krishna hospital, Karad. The study design was a prospective observational study. Materials and Methods: Two hundreded patients admitted with an indwelling, CVC. These patients were followed daily for the development of catheter related blood stream infections (CRBSIs) 48 h after insertion of CVC, in which case two sets of blood samples were drawn along with catheter tip and skin swab for culture. Statistical Methods: Incidence of CRBSIs was measured per 1000 catheter days. Results: Among 200 suspected cases with indwelling CVC, 1028 catheter days were observed, and CRBSI rate was 61.28/1000 catheter days. The incidence of CRBSIs were detected in 63 (31.5%) patients. Conclusions: This prospective study has highlighted the incidence, aerobic bacteriological profile of CVC infections, and also the changing trends in the susceptibility pattern of the isolates to routinely used antibiotics in our tertiary care centre. Combined efforts of the microbiologist, clinicians, and hospital infection control team are needed to tackle CRBSI. A proper training program of hospital staffs, maintenance of proper hand hygiene, following up of proper guidelines of catheter insertion, and maintaining aseptic precaution, prior to CVC insertion can reduce CRBSI.

Introduction: Puerperal sepsis is an infective condition in the mother following childbirth. It is the third most common cause of maternal death worldwide as a result of childbirth after hemorrhage and abortion. According to the World Health Organization estimates, puerperal sepsis accounts for 15% of the 500,000 maternal deaths annually. In low- and middle-income countries, puerperal infections are the sixth leading cause of disease burden in women during their reproductive years. Puerperal sepsis can cause long-term health problems such as chronic pelvic inflammatory disease and infertility in females. Objective: The main objective of the study was to determine the effect of demonstration on practices of Auxillary Nurse Midwives (ANMs) regarding identification and management of mothers for puerperal infection during postnatal period. Materials and Methods: A quasi-experimental design was adopted to implement live demonstration on 60 ANMs. The samples were selected by convenience sampling technique. A checklist was used to assess the practices of ANM identification and management of high-risk mothers for secondary postpartum hemorrhage during postnatal period. Results: The average pretest knowledge mean in the experimental group was 68.7, which increased to 134.1 in posttest. T-value for this test was 80 with 103 degrees of freedom. Corresponding P value was small (<0.05); null hypothesis is rejected. It is evident that the live demonstration is significantly effective in improving the knowledge of ANMs regarding identification and management of mothers for puerperal infection during postnatal period.

Context: Chronic obstructive pulmonary disease (COPD) is defined as a disease characterized by the presence of airflow obstruction that is attributed to either chronic bronchitis or emphysema. Dyspnea is one of the common symptoms of COPD where it is associated with limited physical activity and increased anxiety and depression. Anxiety and depression are frequent in patients with COPD and it increases as the severity of disease progresses. This article will serve us to know about the correlation between anxiety and depression with the Baseline Dyspnea Index in COPD Patients. Aims: The aim of this study was to study the correlation of Baseline Dyspnea Index and Hospital-associated anxiety and depression in COPD patients. Settings and Design: Settings-Bahusaheb Talegaon Rural Hospital, Pune Maharashtra, India. Design-Correlation study, Validated Hospital anxiety and depression scale was used along with Baseline Dyspnea Index to check correlation in COPD Patients. Subjects and Methods: This correlation study received institutional ethical approval. All participants according to inclusion criteria coming to the rural hospital were selected. Informed consent was obtained from each participant. Baseline Dyspnea Index and Hospital Anxiety-Depression scale. Statistical Analysis Used: Statistical analysis of data was reported, using instant application in that nonparametric test (Spearman's correlation coefficient) was used. Results: The result shows that there was a positive correlation between anxiety and the Baseline Dyspnea Index (functional impairment) in COPD Patients. Whereas there was a negative correlation of depression and the Baseline Dyspnea Index. Conclusions: The present study included COPD patients which state that the Baseline Dyspnea Index has a significant relation with anxiety in which functional impairment has greater significance. Depression does not have a significant relationship with the Baseline Dyspnea Index.

Background: The incorporation of nanotechnology in dentistry is evident, especially in the past decade. The pharmaceutical research in nanotechnology has been a most important invention while considering its application in dental materials. The evidence gathered from the various pharmacotherapeutic researches on the incorporation of chitosan nanoparticles (NPs) to improve the antimicrobial activity of various dental materials are proved, although there is very less evidence of use of functionalized materials to improve its efficacy in clinical situations. Aim: The aim of the study was to evaluate the antifungal effect of maxillofacial silicone after incorporation of chitosan NPs in patients with maxillary defect. Objectives: The objective of the study was to compare the effectiveness of antifungal activity of silicone by incorporating chitosan NPs to that of the control group at various time intervals. Materials and Methods: Chitosan NPs were incorporated in silicone material for relining of interim obturator to check its efficacy with that of conventional interim obturator. Results: Experimental group of patients in which obturator is relined with silicone material consists chitosan NPs has shown to be more effective against fungal colonization growth as compared to that of control group. Conclusion: Chitosan NP with silicone maxillofacial material proved its efficacy against candida growth in patients of maxillary defects at various time intervals.

Background: This article describes technique for coding of removable prosthesis by using rubber stamp and radiopaque marker. Material and Methods: This method involves scrapping off 1mm of polished surface of the denture. Self-cure acrylic resin in dough stage is placed in the space prepared and UID (Aadhar card number) indentations are made with rubber stamp over which barium sulphate is sprinkled and repacked with self-cure acrylic resin. Results: Finishing and polishing of denture is done and a lateral cephalogram is recorded. Lateral cephalogram shows radiopaque digitations revealing the identity of the patient. Conclusion: This method is of immense importance for identification of individuals when required for forensic investigations & in mass disaster.

Background: Probiotics are those live micro-organisms which, when administered in adequate amounts, confer a health benefit to the host. Aim: The purpose of the study was to evaluate the effectiveness of probiotics consumption on levels of salivary Streptococcus mutans in mentally retarded children. Materials and Method: The study was undertaken with 30 institutionalized healthy children and 30 institutionalized mentally retarded children of 4-14 years of age group. The children were randomly divided into two groups, each comprising 15 children; Study group I: Mentally retarded children consuming probiotics, Study group II: Mentally retarded children not consuming probiotics, Control group I: healthy children consuming probiotics, Control group II: healthy children not consuming probiotics. The children consumed probiotics for 4 weeks. Streptococcus mutans/ml of saliva was collected at baseline, after 2nd week and 4th week. Results: A statistically significant reduction (P<0.05) in streptococcus mutans counts was recorded in probiotics ingestion groups. Conclusion: A positive correlation of probiotics with mean streptococcus counts was observed with both the groups, suggestive of probiotics role in caries prevention.

Aims and Objectives: The aims and objectives of the study were to determine the efficacy of wooden spatula, cytobrush, and toothbrush in obtaining cytology smears for early detection of oral premalignant lesions and also to compare the analysis of cytology smears with the histopathological diagnosis. The smears were observed and analyzed under a compound light microscope. Materials and Method: Fifty patients of clinically diagnosed oral leukoplakia patients attending the outpatient department of oral pathology and microbiology were considered for the study. The smear samples were obtained using wooden spatula, cytobrush, and toothbrush. The samples were manually analyzed in a double-blinded fashion. Histopathological diagnosis was confirmed using scalpel biopsy and a comparison was made between cytological and histopathological diagnosis. Statistical analysis was performed using Chi-square test. Results: In our study, toothbrush cytology was comparatively better (P < 0.05) than the cytobrush and wooden spatula in terms of analyzing uniformity of cells, adequacy of abnormal cells, and higher grades of dysplasia. Conclusions: Toothbrush biopsy is a relatively quick, easy, noninvasive, and effective tool for screening suspicious premalignant lesions as compared to the invasive, painful scalpel biopsy procedure which is often impractical. Early detection, diagnosis, and management of such lesions decrease the risk for malignant changes increasing the survival rates.

Background: Probiotics and tulsi extract mouthrinses are a breakthrough approach to preventing plaque and gingivitis through their different defence mechanism. Objective: Comparison of the effectiveness of chlorhexidine (CHX), tulsi extract and probiotic mouthrinses among 12–15-year-old school children of Mysore, India. Materials and Methods: Triple-blinded randomized controlled clinical trial-concurrent parallel design. The study was done in school which was selected by the lottery method. A total of 60 children who fulfilled the eligibility criteria were randomly selected for the study. After baseline examination using computer generated table divided into three groups – Group A: 0.2%CHX mouthrinse, Group B: tulsi extract mouthrinse, and Group C: probiotic mouthrinse. Results: There was a significant reduction in plaque and gingivitis among all three study products (P < 0.05). Compared to baseline data, plaque and gingivitis reduction was more pronounced in probiotic mouthrinse compared to chlorhexidine and tulsi extract mouthrinses. Conclusions: All the study products, i.e., CHX, tulsi extract and probiotic mouthrinses showed a significant reduction in plaque and gingivitis compared to baseline scores.

Introduction: The neck-shaft angle (NSA) is the angle formed by the neck axis and the long axis of the femur. Knowledge of this angle facilitates the preoperative planning of osteotomy, arthroplasty, or fracture fixation. It also helps in designing suitable implants with more accurate angulations of the femur neck. Hence, the present study aimed at giving ready reference data to clinicians of the femoral NSA in the Central Indian population. Materials and Methods: A total of 153 dried femora, 78 of the right side and 75 of the left side of unknown sex and age were obtained from the Department of Anatomy, Pt. J. N. M Medical College, Raipur. NSAs were measures and statistically correlated with laterality using “Independent t-test,” P value was obtained. Results: Mean NSA of right-sided femora was 133.88°C ± 15.04°C (range from 103°C to 160°C) and of left-sided femora was 132.81°C ± 15.81°C (Range from 106°C to 160°C). No significant difference in values of NSA was found in the right and left-sided femora. Conclusion: The outcome of this study can be used as a ready reference data by orthopedicians, physiotherapists, and prosthesis designers for the central Indian population. Knowledge of normal value would also be helpful in making the clinical diagnosis of femur neck fractures and coxa vera.

Background: Health care delivery system is one of the most dynamic areas where the professional growth takes place on an everyday basis. In the country's present scenario, where health services is made available to the community in a variety of forms, by way of government health centers, trust hospitals, religious sponsored small and big hospitals, and private and corporate hospitals, the expectations of the patient have increased toward the quality of health services offered. Aim: The aim of the study was to assess the knowledge and attitude of the employees toward the implementation of quality management system with special reference to Six Sigma. Objectives: 1. To assess the current status of the waiting period at various departments of the selected hospitals. 2. To assess the knowledge regarding Six Sigma. 3. To assess the attitude regarding Six Sigma. 4. To compare the knowledge and attitude of private and government health care organization. Methodology: Research approach: Quantitative approach. Research design: Pre-experimental. Sampling technique: Convenience sampling. Sample size: 60 (calculated by power analysis). Sampling criteria. Inclusive criteria. 1. Those who are involved in hospital administrative work. 2. Those who are available at the time of data collection. 3. Those who can understand English. Exclusive criteria. 1. Who have already done Six Sigma citification. Results: The results showed that the maximum time spent by the patient at the outpatient department (OPD) for registration was 16–20 min. According to the reviews, this is the appropriate time taken by any health care organization to do OPD registration. Very few respond to took more than 25 min, i.e., 3%. Maximum patients spent 21–25 min at the laboratory and only 5% spent <20 min. Time taken by the individual in pharmacy indicates that maximum participants, i.e., 37%, took 16–20 min to get the drugs and 23% of participants took more than 25 min. Regarding the knowledge toward Six Sigma, 22% health care workers in private sector have good knowledge score as compared to government organization, i.e., 10%. Seven percent of health care workers have average knowledge score in private organization and 8% of participants have average knowledge score in government health sector. Regarding the attitude toward Six Sigma, private health care organization workers (53%) have a good attitude score as compared to government organization (18%). Conclusion: Six Sigma principles are well suited to the health care sector due to its zero tolerance for mistakes and Six Sigma's potential for reducing medical errors. Lean Six Sigma projects in healthcare have largely focused on direct care delivery, administrative support, and financial administration. The aim has been to improve clinical processes, to identify and eliminate waste from patient pathways, to enable staff to examine their own workplace, and to increase quality, safety, and efficiency. The concept of Six Sigma is purely corporate in nature. There is a lot of difference between the knowledge and attitude regarding Six Sigma among private and government organizations, and this study proves the same..

Introduction: Pressable all-ceramic materials are widely used in dentistry. Determining the effect of multiple firing on color stability and flexural strength will help to improve these materials so that they can remain resistant to fracture in restorative work. Aim: The aim of this study was to evaluate the change in flexural strength and color stability of pressable all ceramic material after repeated firing, which may be unavoidable when color and shape corrections are necessary for use in dental restorations. Materials and Methods: Thirty standardized bar specimens measuring 25-mm length, 10-mm width, and 2-mm thickness were fabricated from VITA PM 9 pressable all ceramic material according to the manufacturer's instructions. Each group of specimen was tested for color change using the spectrophotometer and flexural strength (three-point flexural strength test) using the universal testing machine after third (n = 10), fourth (n = 10), and fifth (n = 10) firings. The data were analyzed using a one-way analysis of variance. The Tukey honestly significant difference test was used to perform multiple comparisons. Results: L*a*b* values of the ceramic specimens were affected by the number of firings (3, 4, and 5 firings) (P < 0.05). A statistically significant difference in color change (ΔE) was found between Group 1 – Group 2 versus Group 1 – Group 3 (P < 0.05), Group 1 – Group 3 versus Group 2 – Group 3 (P < 0.05), whereas it was nonsignificant between Group 1 – Group 2 versus Group 2 – Group 3 (P > 0.05). There were statistically significant differences (P < 0.05) in the mean flexural strength values of the three groups. Conclusion: Repeated firing of leucite-based heat-pressed ceramic exhibited color changes that are clinically acceptable, but the strength of the ceramic decreases significantly. Thus, repeated firing is an important factor with respect to color and strength of definitive restoration and should be considered during shade selection and fabrication.

Introduction: The Spine Society of Europe defines low back pain (LBP) as the muscle tension or stiffness localized below the costal margin and above the inferior gluteal folds. LBP is a common musculoskeletal complain that can originate from ligaments, facet joints, vertebrae, paravertebral musculature, or spinal nerve roots. LBP lays a huge burden on the healthcare system. Aim: In this study, we analyze cases of LBP and conduct various studies within the framework of key domains of pain generators in LBP, namely (1) degenerative, (2) traumatic, (3) infectious, and (4) neoplastic etiologies. Materials and Methods: A total of 585 patients who underwent magnetic resonance imaging of lumbar spine/dorsolumbar spine with the complaints of LBP were selected for the study. The pathology was identified and grouped under one of the four entities mentioned above. Analytical tools were applied and the concerned inference was made for each case. Results and Conclusions:(1) Ligamentum flavum thickness has a positive correlation with age, severity of disc degeneration, facetal osteoarthritis, and sagittal orientation of facets at significance (P < 0.01). (2) The features of posterior element involvement, convex posterior border, and band signal are the ones with maximum differential power in differentiating benign and malignant vertebral compression fracture (P < 0001). (3) Thoracolumbar injury classification and severity score is a comprehensive and recent injury grading scale to classify spinal fractures and to provide valuable guidelines regarding diagnosis and management of spinal injuries with high accuracy. (4) Tuberculous spondylosis can mimic other infectious conditions such as spondylitis and also several other non-infectious conditions, and if some pitfalls are not considered, it might lead to wrong diagnoses.

The maintenance of a tooth with periapical lesion is more often managed by periradicular surgery when the efforts using conventional endodontic (re) treatment prove insufficient to achieve desired outcome. The most critical elements of successful bone regeneration involve the production hermetic seal of the endodontic canal after the root end resection and promotion of early uneventful wound healing using desirable biomaterials, particularly in large-sized intraosseous periapical defects. Yet even after the use of different biomaterials available, the wide varieties of such defects have shown suboptimal outcomes and also took longer healing period. The simple procurement method, ready bioavailability, cost-effectiveness, ease of handling, and remarkable healing potential of platelet-rich fibrin (PRF) in filling the large-sized periapical intrabony defects is presented in this article, with the aim of providing optimal and most elusive environment for wound healing in regenerative procedure. The entire intrabony defects were condensed with autologous PRF as the only grafting material in all four different cases for regeneration. The same surgical technique successfully applied to all four selected cases resulted in an uneventful healing post surgically and almost complete defect fill over 6 months' follow-up. The use of autologous PRF can be recommended for further research in view of its therapeutic use in large-sized intraosseous defects even in different health disciplines; to support the successful outcome identified in this case series.

Background: Docosahexaenoic acid (DHA) has diverse functions in normal metabolism and health and are widely used as a nutritional supplement. Liv. 52 is a polyherbal formulation used in hepatic dysfunction. The present study was undertaken to investigate the influence of oral supplementation of Liv. 52 and DHA alone and their combination against carbon tetrachloride (CCl₄) induced hepatic injury in Wistar rats. Materials and Methods: Hepatotoxicity was induced by administering 1:1 mixture of CCl₄and olive oil; 1 ml/kg/72 h i.p. A total of 54 adult female Wistar (150–200 g) rats were divided into nine groups of six rats each as follows-Group 1-Normal healthy control (1 ml/kg/day of 2% gum acacia), Group 2: Negative control (CCl₄ +1 ml/kg/day of 2% gum acacia), Group 3: Positive control (CCl₄+ Silymarin 50 mg/kg/day), Group 4-9: CCl₄+ Liv. 52–225 mg/kg/day, 450 mg/kg/day, DHA-300 mg/kg/day, 600 mg/kg/day alone and their combination. The treatment duration was 7 days. Hepatoprotective potential was studied by the estimation of serum alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP) in experimental rats. Results: Serum ALT, AST, and ALP were significantly increased (P < 0.05) in hepatotoxic control rats compared to normal healthy control rats. There was statistically significant change (P < 0.05) in serum levels of ALT, AST, and ALP among Silymarin, Liv. 52 and DHA treated rats in comparison to hepatotoxic control rats.Conclusions: The present study revealed that Liv. 52 and DHA alone and in combination ameliorates the hepatic injury induced by CCl₄in Wistar rats.

Objective: Inappropriate use of inhaler medications may lead to inadequate control of the disease condition. Therefore, it is important to educate the patients regarding proper inhalation technique. The objective of the study is to assess the knowledge, attitude, and practice (KAP) of patients using inhaler medications in obstructive airway diseases before and after education. Materials and Methods: A quasi-experimental pre- and post-study without a control group was conducted among sixty patients diagnosed with obstructive airway diseases who were using inhaled medications in the pulmonary medicine department. At the baseline, the patient's KAP was assessed and were educated regarding the use of inhaler medications. Then, the patient's KAP was again assessed after 1 month of baseline assessment. Results: Of sixty patients, male patients (53%) were predominant than the female (42%). The mean age of the study population was 56.7 ± 16.2 years. The pre- and post-educational KAP scores of the patients were 71.6 ± 9.9 and 82.9 ± 10.3, respectively. The KAP scores were statistically improved, and the mean change in the KAP score was 11.3 ± 6.9 (P = 0.000). Conclusion: The education provided in the small group of patients using inhaler medications leads to the betterment of KAP of the patients.

Inflammatory dental cysts of mandible are an incessant group of osteolytic lesions arising from the odontogenic epithelium having uncharacteristic appearances. The radicular cyst is, by far, the most comprehended inflammatory jaw cyst found mostly at the apices of the tooth (periapical cyst), lateral surface of the roots (lateral radicular cyst) and remains in the jaw after the removal of the offending tooth (residual cyst). They advance sluggishly and asymptomatically unless infected. Because of this, they can extent to big dimensions. Although bilateral symmetrical representation of these cysts is rare, many times, it is baffling to segregate radicular cysts from the obligatory preexisting chronic periapical periodontitis lesions or benign asymptomatic, osteolytic neoplasms radiographically, and hence, may create a challenge for the diagnosis. Herein, we describe the case of a 45-year-old female patient who presented with pain over the right and left side of the mandible. Orthopantomogram showed large, well-defined, corticated, and unilocular radiolucencies over the bilateral molar region. Fine-needle aspiration cytology was performed, and the patient was treated with beta-lactam antibiotics trailed by surgical enucleation of cystic sac, extraction of the transgressing tooth, and rehabilitation using the alloplastic graft as bone void filler. The patient responded well to prompt systemic antibiotics and local surgical measures with a complete resolution of the infection and spontaneous bone regeneration.

Ridge resorption results in loss of interdental papillae and creation of unesthetic black triangles. Root submergence technique instead maintains the natural attachment apparatus of the tooth in the pontic site, which in turn allows for complete preservation of the alveolar bone frame and assists in the creation of an esthetic result in adjacent multiple tooth replacement cases. This study reports a case of fractured nonvital tooth where root submergence procedure was carried out, which represents intact bone aiding in the esthetics and function of the prosthesis.

Injury to anterior cruciate ligament (ACL) is very common, especially seen in the athletic population. It usually occurs as a result of fall. A 33-year-old male had a history of fall from bike which lead to full-thickness tear of ACL, partial thickness tear of PCL, Grade II injury of patello-femoral ligament, and moderate knee joint effusion of the right limb and had undergone arthroscopic ACL reconstruction of the right side. After arthroscopic ACL reconstruction, the patient presented with pain (7 on numerical pain rating scale), swelling and swelling at right knee joint and referred for physiotherapy.

Angiomyolipomas (AML) are basically benign hamartomas. When associated with other autoimmune diseases such as tuberous sclerosis, it can prove to be fatal due to increased hemorrhage or malignant transformation if left untreated. High fat containing AML can be diagnosed well on computed tomography as well as ultrasonography.

Gingival enlargement is caused by gingival inflammation, fibrous overgrowth, or a combination of both, leading to adverse consequences, such as difficulty in plaque control, mastication, altered speech, and esthetic and psychological problems. A 24-year-old male reported with the chief complaint of spacing between the teeth in the front region of the jaw. This article reported a case of extreme gingival enlargement which was periodontally treated, by the removal of all gingival tissue excess using gingivectomy and gingivoplasty. After a 6-month follow-up period, the fixed orthodontic treatment is continued with monthly periodontal checkups that were scheduled to control the gingival inflammation. The collaboration between the periodontist and orthodontist is the most important key to successful treatment of hyperplasia in patients undergoing orthodontic treatment.

A 66-year-old male patient was presented to the cardiology ward with complaints of chest pain for couple of days, breathlessness, sweating, and cough. He had complaints of loss of sensation over foot. He had past medical history of type 2 diabetes mellitus with hypertension. He had a history of ulcer with right big toe gangrene and trauma to right big toe before 20 days. Following with this condition, he developed a small ulcer. He has previous history of wound debridement. His echocardiogram detected moderate left ventricular systolic function and left ventricular ejection fraction was 38% which confirmed the presence of coronary artery disease. He underwent coronary angiogram which showed the presence of calcific coronary artery disease with triple vessel disease. The patient was diagnosed with diabetic foot ulcer with coronary artery disease. He was continuously monitored for a week and prescribed with medications. The patient was found stable and he was discharged from the hospital with advise of scheduled Physician's follow-up. The patient was forwarded to a clinical pharmacist counseling services for medication usage, foot care, wound care, lifestyle modifications' advices, physical exercise, stress management strict medication adherence, dietary intake suggestions, and disease-based information to alleviate the progress of disease complications. The medications advice by clinical pharmacist services in such complex disease association management is an imperative need in clinical practice. The clinical pharmacist intervention was proved to be an implementation to effective therapeutic outcomes in the patient.

A cluster of pneumonia cases of unknown etiology were reported in Wuhan, Hubei Province, China, on December 31, 2019. China reported a novel coronavirus in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) phylogenetic group as the causative agent of this outbreak on January 9, 2020. The associated disease is now referred to as novel coronavirus disease 2019 (COVID-19). The clinical presentation of COVID-19 ranges from asymptomatic to multiorgan failure, which may result in death. Coronaviruses are believed to be transmitted through the respiratory droplets from person to person, through inhalation, or mucosal surface deposition. The transmission of coronavirus through other routes includes contact with contaminated fomites and inhalation of aerosols. Novel coronavirus has also been detected in fecal and blood samples.The lack of standard infection prevention measures leads to the risk of health-care-associated transmission, while handling COVID-19-infected patients. The current COVID-19 pandemic underlines the significance of a conscious utilization of resources (human and financial) and preserving resources. It is salient to ensure the ability of surgeons and specialized professionals to function through the pandemic. A mindful effort should be made to minimize infection in this sector. A high mortality rate within this group would be disastrous. All hospitals should develop dedicated protocols and health-care workers training as the part of the effort to face the current pandemic. Literature search was done using PubMed and Google scholar search engines, searching terms “COVID-19,” “SARS-CoV-2,” “Coronavirus,” “surgery in COVID-19” titles, abstracts and keywords. The data were reviewed, analyzed, and presented.

After being first recognized in December 2019, the latest public health threat emanating from the infection of coronavirus has taken many lives encompassing whole geographical locations. The virus named novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new infection to which humans were never exposed. There is no research, no vaccine, no drugs, and no specific treatment. This has allowed this virus to disseminate and infect the millions of people worldwide with daily increasing count. In the absence of specific treatment, and based on past experiences of SARS, Middle East respiratory syndrome and Ebola outbreaks, convalescent plasma (CP) has shown promising results in the saving lives of infected patients. There are a lot many patients who have recovered from novel coronavirus infection, and they may prove to be the source of the CP therapy, which employs passive immunity of body to neutralize the virus and improve the outcomes in infected patients. Literature search was done using the PubMed and Google Scholar search engines, searching terms “COVID-19”, “SARS-CoV-2,” “2019-Ncov,” “Corona,” “Convalescent,” “Serum,” “Plasma” “Treatment” titles, abstracts, and keywords. The data were reviewed, analyzed, and presented.

The growing spread of COVID-19 pandemic has caused unprecedented changes in how health systems and health institutes deal with patients and health care. More attention is focused on containing the outbreak and avoids further infection and transmission. Hospitals have attained a wartime atmosphere in hotspot areas and health-care workers including surgical team have been deployed to take care of this respiratory illness. Rationing of services has however affected the management of non-COVID disorders and people are suffering unduly due to restricted access to care and lack of quality care. Hospitals are overwhelmed, bed availability, and availability of health-care personnel is compromised leading to restrictions on performing routine procedures especially if they are of surgical variety. However, some emergent conditions need immediate attention, failing which the disease may get aggravated, duration of illness will get prolonged and patient may land into a life-threatening condition increasing associated morbidity and mortality. With the advantage of minimum direct contact with body tissue and rapid postoperative recovery, minimal access surgeries greatly reduce hospital stay therefore reducing the risk of infection. Endoscopic procedures can aid in settling down acute illness following which definitive surgery can be planned later. This brief addresses the issues, concerns, and recommendations for minimal access surgery and role of endoscopy in ameliorating emergent and semi-emergent surgical conditions in the present pandemic situation.