"Cancer Education on Wheels," a Novel Cost-Effective Method in Creating Awareness in the Community: a Pilot Study.

Cancer education raises disease awareness, the value of early identification and importantly the need for prompt screening and treatment when diagnosed. In this study, an effort was made to understand how well a unique cancer education program, "Cancer Education on Wheels," transfers knowledge in general public in society. The community was shown prerecorded cancer awareness videos using a TV monitor, CD player, and speaker system mounted on an eight-seat Toyota Innova. Before and after seeing the video presentation, consenting volunteers filled out questionnaires asking about demographics and understanding of cancer. Frequency and percentage calculations were done on the demographic information and a Wilcoxon signed-rank test was run on the overall subject score. Data was stratified based on demographic information and compared by applying Kruskal-Wallis test and Mann-Whitney test. p values under 0.05 were regarded as significant. A total of 584 people completed the pre-test and post-test questionnaires. The Wilcoxon signed-rank test revealed a difference between the pre-test and post-test (3.29 ± 2.48 vs. 6.78 ± 3.52; P = 0.0001). The pre-test results showed that volunteers between the ages of 18 and 30; men; students; urban residents; single volunteers; graduates; people who had known a person/or family member with cancer; and people who were aware of the suffering cancer causes had a high baseline knowledge of cancer (p = 0.015 to 0.001). The post-test results show that participants who had less baseline scores like housewives and unemployed people performed better (p = 0.006 to 0.0001). The findings unambiguously demonstrated that "Cancer Education on Wheels" was successful in raising participants' awareness of cancer signs and screening. Additionally, the findings showed that volunteers who were aged, married, housewives, and unemployed had higher scores. Most importantly, this approach to cancer education is simple to organize and carry out in a local setting. It is also affordable and simple to execute using readily available technological equipment and manageable logistics. According to the authors' knowledge, this is the first study to use "Cancer Education on Wheels" to spread awareness of cancer throughout the neighborhood especially in budget constrained areas.

Clinical and genetic spectrum of 104 Indian families with central nervous system white matter abnormalities.

Genetic disorders with predominant central nervous system white matter abnormalities (CNS WMAs), also called leukodystrophies, are heterogeneous entities. We ascertained 117 individuals with CNS WMAs from 104 unrelated families. Targeted genetic testing was carried out in 16 families and 13 of them received a diagnosis. Chromosomal microarray (CMA) was performed for three families and one received a diagnosis. Mendeliome sequencing was used for testing 11 families and all received a diagnosis. Whole exome sequencing (WES) was performed in 80 families and was diagnostic in 52 (65%). Singleton WES was diagnostic for 50/75 (66.67%) families. Overall, genetic diagnoses were obtained in 77 families (74.03%). Twenty-two of 47 distinct disorders observed in this cohort have not been reported in Indian individuals previously. Notably, disorders of nuclear mitochondrial pathology were most frequent (9 disorders in 20 families). Thirty-seven of 75 (49.33%) disease-causing variants are novel. To sum up, the present cohort describes the phenotypic and genotypic spectrum of genetic disorders with CNS WMAs in our population. It demonstrates WES, especially singleton WES, as an efficient tool in the diagnosis of these heterogeneous entities. It also highlights possible founder events and recurrent disease-causing variants in our population and their implications on the testing strategy.

Comparative Evaluation of Antibacterial Efficacy of Silver and Cadmium Nanoparticles and Calcium Hydroxide against Enterococcus faecalis Biofilm.

AIM: The purpose of this study was to evaluate and compare the antibacterial efficacy of calcium hydroxide medicament, silver (AgNPs) and cadmium nanoparticles (CdSNPs) as medicament against the biofilms of Enterococcus faecalis on dentin sections. E. faecalis is commonly detected in asymptomatic and persistent endodontic infections. METHODS: Twenty standard size dentin sections were prepared. E. faecalis was inoculated on these dentin sections for four weeks to form the bacterial biofilm. Twenty dentin sections were segregated into four different groups with five specimens in each group. Group I was kept as control group, and antibacterial efficacy was tested by treating biofilms with Ca(OH) 2 medicament, 0.02% AgNP and CdSNP gels for 7 days. The ultrastructure of biofilms from each group was examined under scanning electron microscope and was visually evaluated and compared for different groups. RESULTS: Ca(OH)2 exhibited a slight disruption of E. faecalis biofilm. Both AgNP and CdSNP medicaments disrupted E. faecalis biofilm effectively after 7 days of inoculation. AgNPs disrupted the biofilm more effectively than CdSNPs. Biofilms in control group, which was irrigated with saline, did not show any disruption of biofilm, which could be seen as homogenous layer over most of dentin sections. CONCLUSIONS: This study suggests that both AgNP and CdNP gels are effective against E. faecalis and can be used as a medicament to eliminate residual bacterial biofilms during root canal disinfection. AgNP medicament is more effective than CdNP, whereas Ca(OH) 2 is not effective against E. faecalis biofilms. CLINICAL SIGNIFICANCE: Incomplete clearance and the development of antibiotic resistance in E. faecalis are the important factors for failure of root canal treatment. When cationic nanoparticles are introduced for the treatment of biofilms, it can interact with both extracellular polymeric substances and bacterial cells. The initial electrostatic attraction between positively charged nanoparticles and negatively charged bacterial surface leads to bacterial killing via the production of reactive oxygen species. Metal nanoparticles that are effective against E. faecalis have a significant potential role in the prevention and treatment of such cases, as bacteria do not develop resistance against metal nanoparticles.

Evidence for Chloroquine/Hydroxychloroquine in the Treatment of COVID-19.

INTRODUCTION: Given the current lack of an approved and effective treatment or vaccine for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), repositioning old drugs for use as an antiviral treatment is an interesting strategy because knowledge about these drugs' safety profile, posology, and drug interactions is already known. Chloroquine and hydroxychloroquine, widely used as antimalarial and autoimmune disease drugs, have recently been reported as a potential broad-spectrum antiviral drug. BACKGROUND: The in vitro antiviral activity of chloroquine has been identified since the late 1960s. However, antiviral mechanisms of chloroquine remain speculative. Several clinical trials have been conducted to test the efficacy and safety of chloroquine or hydroxychloroquine in the treatment of COVID-19-associated pneumonia. The quality of the studies and the outcomes are evaluated in this systematic review and meta-analysis. REVIEW RESULTS: Literature review revealed 23 clinical studies. Only 9 of 23 studies were randomized controlled trials. Of nine randomized controlled trials, only study by Skipper et al. was deemed to be at low risk of bias. All studies evaluated variedwith different outcomes. Mechanical ventilation and virological clearance were the only common outcomes evaluated in more than two studies. Virological clearance odds ratio (OR) was 1.25 (95% confidence interval [CI] of 0.57-2.73; Chi2 = 0.83; I2 = 0%). GRADE quality of evidence was downgraded by three levels to very low due to concerns about the risk of bias, inconsistency, and imprecision. For mechanical ventilation, OR was 1.09 (95% CI 0.80-1.50; Chi2 = 0; I2 = 0). GRADE quality of evidence was downgraded by two levels to low due to concerns about the risk of bias and imprecision. There was no statistically significant difference between the groups for these two outcomes. CONCLUSION: As per the available evidence, based on our review, we conclude that hydroxychloroquine/chloroquine has not shown to be beneficial when used for the treatment of patients with COVID-19 pneumonia. HOW TO CITE THIS ARTICLE: Shetty RM, Namachivayam A. Evidence for Chloroquine/Hydroxychloroquine in the Treatment of COVID-19. Indian J Crit Care Med 2021;25(4):441-452.

Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19.

INTRODUCTION: There is strong evidence for the use of corticosteroid in the management of severe coronavirus disease-2019 (COVID-19). However, there is still uncertainty about the timing of corticosteroids. We undertook a modified Delphi study to develop expert consensus statements on the early identification of a subset of patients from non-severe COVID-19 who may benefit from using corticosteroids. METHODS: A modified Delphi was conducted with two anonymous surveys between April 30, 2021, and May 3, 2021. An expert panel of 35 experts was selected and invited to participate through e-mail. The consensus was defined as >70% votes in multiple-choice questions (MCQ) on Likert-scale type statements, while strong consensus as >90% votes in MCQ or >50% votes for "very important" on Likert-scale questions in the final round. RESULTS: Twenty experts completed two rounds of the survey. There was strong consensus for the increased work of breathing (95%), a positive six-minute walk test (90%), thorax computed tomography severity score of >14/25 (85%), new-onset organ dysfunction (using clinical or biochemical criteria) (80%), and C-reactive protein >5 times the upper limit of normal (70%) as the criteria for patients' selection. The experts recommended using oral or intravenous (IV) low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5-10 days and monitoring of oxygen saturation, body temperature, clinical scoring system, blood sugar, and inflammatory markers for any "red-flag" signs. CONCLUSION: The experts recommended against indiscriminate use of corticosteroids in mild to moderate COVID-19 without the signs of clinical worsening. Oral or IV low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5-10 days are recommended for patients with features of disease progression based on clinical, biochemical, or radiological criteria after 5 days from symptom onset under close monitoring. HOW TO CITE THIS ARTICLE: How to cite this article: Nasa P, Chaudhry D, Govil D, Daga MK, Jain R, Chhallani AA, et al. Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19. Indian J Crit Care Med 2021;25(11):1280-1285.

Transverse Ridge of Premolars and Oblique Ridge of Maxillary Molars are in Divine Golden Ratio.

AIMS: In premolars and molars, transverse ridge (TR) and oblique ridge (OR) play major roles in providing strength and stability to the cusps in particular and tooth as a whole. Hence, they could be divided at the central groove or the transverse groove in a divine golden ratio. MATERIALS AND METHODS: Twenty pairs of maxillary and mandibular casts were retrieved from the Department of Orthodontics. The lengths of buccal triangular ridge (BTR), lingual triangular ridge (LTR) and TR of maxillary and mandibular first and second premolars were measured. Similarly, lengths of distal cuspal ridge of mesiopalatal cusp, triangular ridge of distobuccal cusp (DBTR) and OR of the maxillary first and second molars were measured using a brass wire and a Vernier caliper. The TR:BTR, BTR:LTR, OR:distal ridge of mesiopalatal cusp (MPDR), and MPDR:DBTR ratios were calculated to find out the possibility of golden ratio. RESULTS: Transverse ridges of the premolars and OR of the maxillary first and second molars were divided at the central groove in a divine golden ratio. The mean TR/BTR ratio for maxillary first premolar was 1.61 ± 0.007, whereas the mean BTR/LTR ratio was 1.63 ± 0.02. The mean TR/BTR ratio for maxillary second premolar was 1.61 ± 0.01, whereas the mean BTR/LTR ratio was 1.62 ± 0.04. The TR/BTR and BTR/LTR ratios for mandibular first premolar were 1.6 ± 0.008 and 1.64 ± 0.02, respectively. Similarly, the mean TR/BTR ratio for mandibular second premolar was 1.61 ± 0.01, whereas the mean BTR/LTR ratio was 1.63 ± 0.02. CONCLUSION: The ORs of maxillary first molar ridge and TR of maxillary and mandibular premolars are divided into two parts at transverse and central grooves, respectively, in a divine ratio. CLINICAL RELEVANCE: The ORs of maxillary first molar ridge and TR of maxillary and mandibular premolars are divided into two parts at transverse and central grooves, respectively, in a divine ratio. This signifies the strength and stability of the occlusal table in the posterior teeth, as the golden ratio is the mark of functional excellence. Golden ratio should be taken into consideration while restoration or fabrication of the posterior teeth.

R0 and Re of COVID-19: Can We Predict When the Pandemic Outbreak will be Contained?

R0 (R naught) is the basic reproduction number, also known as basic reproduction ratio or rate which is an epidemiological metric used to measure the transmissibility of infectious agents. R0 is a derivative of the following variables-the duration of infectivity after the patient gets infected, the likelihood of transmission of infection per contact between a susceptible person and an infectious individual, and the contact rate. R0 is usually estimated retrospectively from serial epidemiological data or using theoretical mathematical models. Epidemiologists can calculate R0 using contact-tracing data, the most common method is to use cumulative incidence data. When mathematical models are used, R0 values are estimated using ordinary differential equations. R0 of COVID-19 as initially estimated by the World Health Organization (WHO) was between 1.4 and 2.4. The forecast is of critical importance as it will help the governments to have an estimate as well as strategize quickly to avoid any unfavorable condition. HOW TO CITE THIS ARTICLE: Achaiah NC, Subbarajasetty SB, Shetty RM. R0 and Re of COVID-19: Can We Predict When the Pandemic Outbreak will be Contained? Indian J Crit Care Med 2020;24(11):1125-1127.

A Unique Case of Arterial Thrombosis and Recurrent CVA in ICU: Unfathomable Presentation of an Occult Malignancy.

INTRODUCTION: Critically ill patients may present with prothrombotic manifestations. Carcinoma cervix with prothrombotic manifestations are not common. Arterial thrombosis in such cases is very rare. We present a case of carcinoma cervix which posed a diagnostic dilemma and difficulty in localizing primary. This patient also had recurrent strokes and cardiac metastasis with metastatic arterial thrombosis. CASE DESCRIPTION: A 34-year-old lady presented with a history of acute lower limb ischemia and recurrent strokes. Transthoracic echocardiography showed valvular vegetations. Prothrombotic and infective endocarditis workup were negative. Histopathological examination (HPE) of clot showed metastatic squamous cells. Contrast CT of chest and abdomen only showed mediastinal lymphadenopathy. Endobronchial ultrasound (EBUS) with mediastinal lymph node biopsy showed metastatic squamous cells. As the patient gave a history of hysterectomy, Pap smear from the vault was sent, which was suggestive of high grade squamous intraepithelial neoplasia. Palliative chemotherapy was started. The patient made a good recovery and was discharged home in a stable condition. CONCLUSION: Arterial thrombosis is an uncommon manifestation of occult malignancy. Carcinoma cervix usually does not metastasize to heart, brain, and arteries, which was the case in our patient. A high index of suspicion and systematic evaluation can clinch the diagnosis even when rare complications of malignancy are presented by critically ill patients. CLINICAL SIGNIFICANCE: Any unprovoked thrombotic episodes should be extensively worked up for occult malignancies. We present a case demonstrating challenges faced by critical care physicians and benefits of methodical evaluation when confronted with unusual presentation of a malignancy. HOW TO CITE THIS ARTICLE: Rangappa R, Shetty RM, Denzil M, Haranahalli PE, Susmita S, Chaurasia S. A Unique Case of Arterial Thrombosis and Recurrent CVA in ICU: Unfathomable Presentation of an Occult Malignancy. Indian J Crit Care Med 2020;24(7):585-588.

BIS monitoring versus clinical assessment for sedation in mechanically ventilated adults in the intensive care unit and its impact on clinical outcomes and resource utilization.

BACKGROUND: Patients admitted to intensive care and on mechanical ventilation, are administered sedative and analgesic drugs to improve both their comfort and interaction with the ventilator. Optimizing sedation practice may reduce mortality, improve patient comfort and reduce cost. Current practice is to use scales or scores to assess depth of sedation based on clinical criteria such as consciousness, understanding and response to commands. However these are perceived as subjective assessment tools. Bispectral index (BIS) monitors, which are based on the processing of electroencephalographic signals, may overcome the restraints of the sedation scales and provide a more reliable and consistent guidance for the titration of sedation depth.The benefits of BIS monitoring of patients under general anaesthesia for surgical procedures have already been confirmed by another Cochrane review. By undertaking a well-conducted systematic review our aim was to find out if BIS monitoring improves outcomes in mechanically ventilated adult intensive care unit (ICU) patients. OBJECTIVES: To assess the effects of BIS monitoring compared with clinical sedation assessment on ICU length of stay (LOS), duration of mechanical ventilation, any cause mortality, risk of ventilator-associated pneumonia (VAP), risk of adverse events (e.g. self-extubation, unplanned disconnection of indwelling catheters), hospital LOS, amount of sedative agents used, cost, longer-term functional outcomes and quality of life as reported by authors for mechanically ventilated adults in the ICU. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, ProQuest, OpenGrey and SciSearch up to May 2017 and checked references citation searching and contacted study authors to identify additional studies. We searched trial registries, which included clinicaltrials.gov and controlled-trials.com. SELECTION CRITERIA: We included all randomized controlled trials comparing BIS versus clinical assessment (CA) for the management of sedation in mechanically ventilated critically ill adults. DATA COLLECTION AND ANALYSIS: We used Cochrane's standard methodological procedures. We undertook analysis using Revman 5.3 software. MAIN RESULTS: We identified 4245 possible studies from the initial search. Of those studies, four studies (256 participants) met the inclusion criteria. One more study is awaiting classification. Studies were, conducted in single-centre surgical and mixed medical-surgical ICUs. BIS monitor was used to assess the level of sedation in the intervention arm in all the studies. In the control arm, the sedation assessment tools for CA included the Sedation-Agitation Scale (SAS), Ramsay Sedation Scale (RSS) or subjective CA utilizing traditional clinical signs (heart rate, blood pressure, conscious level and pupillary size). Only one study was classified as low risk of bias, the other three studies were classified as high risk.There was no evidence of a difference in one study (N = 50) that measured ICU LOS (Median (Interquartile Range IQR) 8 (4 to 14) in the CA group; 12 (6 to 18) in the BIS group; low-quality evidence).There was little or no effect on the duration of mechanical ventilation (MD -0.02 days (95% CI -0.13 to 0.09; 2 studies; N = 155; I2 = 0%; low-quality evidence)). Adverse events were reported in one study (N = 105) and the effects on restlessness after suction, endotracheal tube resistance, pain tolerance during sedation or delirium after extubation were uncertain due to very low-quality evidence. Clinically relevant adverse events such as self-extubation were not reported in any study. Three studies reported the amount of sedative agents used. We could not measure combined difference in the amount of sedative agents used because of different sedation protocols and sedative agents used in the studies. GRADE quality of evidence was very low. No study reported other secondary outcomes of interest for the review. AUTHORS' CONCLUSIONS: We found insufficient evidence about the effects of BIS monitoring for sedation in critically ill mechanically ventilated adults on clinical outcomes or resource utilization. The findings are uncertain due to the low- and very low-quality evidence derived from a limited number of studies.

Comparative Evaluation of Cytotoxicity of Root Canal Sealers on Cultured Human Periodontal Fibroblasts: In vitro Study.

AIM: To evaluate and compare the cytotoxic effects of different types of root canal. MATERIALS AND METHODS: The sealers were eluted with culture medium for 1 hour, 7 days, and 14 days. Cell viability was estimated by 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) assay and trypan blue exclusion method on human periodontal ligament (PDL) fibroblast cells. Sealers used are mineral trioxide aggregate (MTA)-based sealer (MTA Fillapex, Angelus), calcium hydroxide-based sealer (Apexit Plus, Ivoclar Vivadent), resin-based sealer (AH Plus, Dentsply), and zinc oxide eugenol-based sealer (Tubli Seal, SybronEndo). RESULTS: The order of cytotoxicity through MTT assay, at the end of the second week, was observed as MTA Fillapex> Tubli Seal> Apexit Plus > AH Plus. The percentage cell viability obtained after trypan blue exclusion method decreased in the order of Apexit Plus> Tubli Seal> AH Plus> MTA Fillapex, which was similar to the reported cytotoxicity from the MTT assay after 1 hour. CONCLUSION: Each type of sealer showed moderate-to-severe cytotoxic response when compared with the control. The MTA Fillapex was found to be the most cytotoxic sealer. Use of resin-based material as a root canal sealer may result in a more favorable response to PDL fibroblasts. CLINICAL SIGNIFICANCE: Having knowledge of the cytotoxicity of various sealers will help in increasing patient's comfort.

Prosthetic rehabilitation of an orbital defect for a patient with hemifacial atrophy.

Removal of an eye may be indicated in cases of congenital abnormality, severe trauma, or disease such as an infection, tumor, or malignancy. The disfigurement associated with a loss of an eye is often accompanied with physical problems, psychological trauma, and a poor quality of life. A prosthetic replacement is the treatment of choice to return the individual to his normal vocation by producing an acceptable and life-like appearance. This article describes prosthetic rehabilitation of a 19-year-old male suffering from facial hemiatrophy with the loss of his left eye due to retinoblastoma when he was 2-year-old using medically graded silicone material. The technique used is simple, cost effective, and easy way for fabrication and rehabilitation of an orbital defect using silicone prosthesis where retention is achieved by a combination of silicone adhesives and tapes, and to a very small extent by bony and soft tissue undercut, hence providing better esthetic and psychological outcome. The acrylic part of the prosthesis was adhered to the socket with the help of a two-way silicon adhesive tape. Since the patient had lost his eye when he was 2-year-old, the development of eye and periorbital tissue on the defect side lead to hemiatrophy; in our approach, we have attempted to build the prosthesis in par with the normal side so that the fullness on the defect side was restored to that of the contralateral side. The fabricated facial prosthesis was durable, esthetic, and had good retention.

Association of vitamin D and multiple sclerosis in India.

BACKGROUND: Vitamin D deficiency is widely prevalent in India. The association between vitamin D status and multiple sclerosis (MS) has not been previously studied in Indians. OBJECTIVE: The objective of this paper is to determine whether vitamin D status is associated with MS in India. METHODS: In this study 110 MS patients and 108 matched controls were included. Serum 25-hydroxyvitamin D (25(OH)D) was measured in 63 patients in relapse, 77 patients in remission and all controls. Quantity of sun exposure in childhood and body mass index (BMI) were calculated. Patients and controls were genotyped for HLA-DRB1*1501. RESULTS: Patients had significantly lower 25(OH)D levels than matched controls (p = 0.003), and patients in relapse had a significantly lower vitamin D level as compared to those in remission (p = 0.001). Vitamin D deficiency (< 50 nmol/l) was seen in a higher proportion of cases (71.8%) than controls (53.7%) (p = 0.01). Higher quartiles of vitamin D (> 58 nmol/l) showed an inverse relationship with MS (OR = 0.28, CI = 0.11-0.68, p= 0.005). This effect persisted after adjusting for sun exposure. CONCLUSION: The results of our study indicated that serum 25(OH)D shows an inverse relationship with MS in the Indian population. Reverse causality cannot be excluded.

Fluoride releasing and uptake capacities of esthetic restorations.

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate and compare in vitro the fuoride release and uptake from 5 different esthetic restorative materials. MATERIALS AND METHODS: Materials tested were conventional GIC - Fuji 7, GC (group1), resin modifed GIC - Vitremer, 3M ESPE (group 2), polyacid modifed composite - Dyract, Dentsply (group 3), fuoride releasing composite - Tetric ceram, Ivoclar Vivadent (group 4), Giomer-Beautifl, Shofu (group 5). Fluoride release was estimated at 6th, 24th, 48th hour and weekly interval for 5 weeks. For fuoride recharge, each specimen was exposed to 2 ml of 1.23% APF gel for 4 minutes and fuoride release measured at 1st, 2nd, 3rd day and 7th day. The fuoride release and recharge was measured using fuoride ion specifc electrode. RESULTS: ANOVA and Tukey HSD test were used for statistical analysis. During tested period all materials showed statistically different capability to release and uptake fuoride. Groups 1 and 2 results were comparable in fuoride release. Similarly groups 3 and 5. Groups 1 and 2 vs 3, 4, 5 were statistically very highly signifcant. Only conventional GIC showed initial 'burst effect'. INTERPRETATION AND CONCLUSION: Materials tested showed potential for fuoride release and recharge. Different esthetic materials had variable fuoride release hence selection of materials should be guided by specifc clinical situations.

Cephalometric: evaluation of influence of edentulousness on mandibular morphology: a comparative study.

Mandible undergoes several dimensional changes due to aging accompanied with gradual loss of teeth. There is marked alterations in shape and dimensions of the parts of the mandible associated with complete or nearly complete loss of dentition. The purpose of this study was to analyze the effect of loss of dentition on the dimensions of mandible using lateral cephalogram. The study group comprised of 35 dentulous subjects (age range 25-30 years) and 35 edentulous subjects (age range 45-65 years), with a period of edentulousness of 1-5 years. Subjects were selected based on certain selection criteria and lateral cephalograms were taken. Lateral cephalograms were traced and the values obtained were statistically analyzed using T test. On statistical analysis it was found that the thickness of condylar process and corpus were reduced in edentulous subjects. Length of mandible, ramus and corpus were reduced in edentulous subjects when compared to dentulous subjects. Gonial angle was more obtuse in edentulous subjects. Reduction in thickness of condylar length and length of mandible were negatively correlated to duration of edentulousness. It can be concluded that mandible undergoes significant dimensional changes as a result of loss of teeth.

Correlation of "K" plane to occlusal plane and three different ala-tragal lines in dentulous subjects with different skeletal forms: A cephalometric study.

Aim: Orientation of the occlusal plane is an important clinical procedure for complete denture fabrication. An attempt had been made to reconstruct the occlusal plane using a different reference plane. The aim of this study was to find the correlation of the "K" plane to the occlusal plane and to assess the angular deviation between the K-plane to the occlusal plane (KO) with different skeletal forms. Settings and Design: An in vivo observational study was conducted on dentulous subjects having Class I dental occlusion with different skeletal forms undergoing orthodontic treatment. Materials and Methods: The study was conducted on 54 subjects aged 18-30 years. Metallic balls (3 mm in diameter) were attached to the desired landmarks, and a lateral cephalogram was taken for each subject. Cephalometric analysis was done using the Dolphin Imaging software, and the values obtained were recorded and subjected to statistical analysis. Statistical Analysis Used: The values obtained were recorded and subjected to statistical analysis using simple descriptive analysis, Shapiro-Wilk test, Mann-Whitney U-test, and Pearson's correlation. Results: A positive correlation was found between KO with a mean angular deviation of 8.59° ± 3.05°. The angle was found to be steeper in skeletal Class II subjects. Conclusions: Clinical application of the K-plane to use as a reference plane to orient the posterior occlusal plane can enhance the treatment outcome for a removable prosthesis. The results of this study provide a theoretical foundation for the practical restoration of the occlusal plane in different skeletal forms.

Usefulness of structured teaching module in improving knowledge about cancer in Accredited Social Health Activist: A pilot study.

AIM: In India, the Accredited Social Health Activists (abbreviated as ASHA) are an important group of community health workers and are involved in initiating and maintaining health care programs in the rural communities they live. This study was conducted with a purpose to evaluate the effectiveness of a structured teaching module in improving knowledge on cancer cause, diagnosis, and treatment in the ASHA workers. MATERIALS AND METHODS: This was a cross-sectional pretest posttest study and was conducted from April 2017 to February 2020 with ASHA workers working in the various Primary Health Centers in Udupi and South Kanara districts of Karnataka and Kasargod district of Kerala in India after obtaining the permission from the medical officer in charge of the respective primary health centers. The participants were briefed about the study objective and also that confidentiality will be maintained. A validated investigator developed questionnaire consisting of 20 questions categorized into four domains (general, subject, diagnosis, and treatment aspects) was distributed to the willing volunteers before the start of the program. They were instructed to fill the pretest form before and posttest after the teaching program. Informed content was taken in a separate sheet and volunteers were informed not to write any personal or identification details. Resource persons with experience in cancer cause, diagnosis and treatment delivered the structured talk in the local language Kannada. The data collected from the filled questionnaires were subjected to frequency, percentage, mean, and standard deviation and appropriately subjected to Chi-square test or paired t-test. A P < 0.05 was considered statistically significant. RESULTS: The demographic detail suggest that majority of the women were Hindus (79.3%), married (93.7%), between the age of 31-40 (46.7%) and had only matriculation as the highest education (68%). The analysis of the pretest administration collected before the start of teaching program indicates that most participants were aware of self-breast examination (79.74%) and that cancer is a disease as old as human civilization (70.26%), while only 8.82% were unaware of which is the leading type of cancer in rural women. The results analyzed from posttest indicate that the highest percentage change (323.96%) was observed for domain on treatment aspects followed by for general (64.03%), diagnosis (56.70%), and subject (36.42%) aspect and was significant (P < 0.001). The total mean values changed from 6.48 ± 2.01 in pretest to 11.81 ± 2.15 in posttest indicating an increase of 5.33 ± 1.91 and percentage change of 82.25% (P < 0.001). The results also showed that 60.8% had average, while 39.2% had good increment in the knowledge at the end of the program. CONCLUSIONS: The observations of the current study indicate the usefulness of the structured teaching module in improving knowledge on cancer cause, diagnosis and treatment in the ASHA workers. It is proposed that with further training ASHA workers can be very useful in the propagation of cancer awareness and screening in the community they serve.

Usefulness of walkathon in improving knowledge on cancer: A cross-sectional study with the participants.

AIM: Globally, walkathon, a type of community event involving walking a determined distance to raise awareness and/or collect donations for a social cause is gaining a lot of public attention. This study was conducted to understand the usefulness of walkathon in creating cancer awareness among the participants. MATERIALS AND METHODS: This was a pre- and post-test study and was carried out on World Cancer Day on February 4, 2019 in Mangalore, Karnataka, India. The study subjects were the walkathon participants willing to be volunteers for the study. Differences in the answers were calculated by ascertaining the difference between the pretest and posttest using McNemar, Chi-square, or Fisher's exact test. A P < 0.05 was considered statistically significant. RESULTS: Pretest scores indicated most volunteers were aware of the role of tobacco and alcohol in cancer, while most were unaware of the importance of fruits and consumption of vegetables and sedentary lifestyle in the development of cancer. Posttest showed a significant increase in knowledge gain (P = 0.003 to <0.001). CONCLUSIONS: For the first time, this study shows Walkathon to be helpful in improving cancer knowledge in the participants. Walkathon is an inexpensive and joyful way to educate people and warrants further study on a range of medical and social themes affecting society to establish its usefulness in public health education.