Perspective of medical undergraduates in India towards the LGBTQIA+ population: a short insight into changes in the medical curriculum.

BACKGROUND: Understanding the attitudes of medical students towards individuals from the lesbian, gay, bisexual, transgender, queer, questioning, intersex and asexual (LGBTQIA+) community is a prerequisite for informing competencies-based medical education (CBME) guidelines to make them LGBTQIA+ inclusive. The present study was conducted to assess the attitudes of medical undergraduate students from Indian medical colleges towards the LGBTQIA+ community. METHODS: An online cross-sectional survey was conducted in medical undergraduate students across India, which measured the opinions, beliefs, and acceptance of LGBTQIA+ people using a structured questionnaire uploaded on Google Forms. After data collection, the datasheet was downloaded, cleaned, and anonymised before being imported into RStudio for analysis. RESULTS: A total of 273 valid entries were assessed from the online survey. There was significant gender-based differences on most traditional opinions and beliefs regarding the LGBTQIA+ population (P <0.05). The female participants appeared to be more accepting of and comfortable with all denominations of LGBTQIA+. Many of the participants believed that members of the LGBTQIA+ community are more prone to sexually transmitted diseases, especially HIV/AIDS. However, a few participants also opined that the increased susceptibility to HIV/AIDS may be due to increased prevalence of intravenous drug abuse in the LGBTQIA+ community. CONCLUSIONS: There are some misconceptions about the LGBTQIA+ community among medical students. Therefore, in order to ensure LGBTQIA+ sensitive healthcare provision, there needs to be a concerted, informed effort to incorporate necessary changes in the CBME curriculum.

Ankle and Hindfoot Alignment Changes in Advanced OA Varus Knees After Cruciate Retaining Total Knee Arthroplasty: A Prospective Cohort Study.

Background: Correct alignment of the knee is considered to be one of the most influential factors in determining the long-term outcomes after Total Knee Arthroplasty (TKA), and is believed to decrease both the mechanical and shear stresses placed on the bearing surfaces, as well as the bone/prosthesis interfaces. Compensatory malalignment of ankle and hindfoot is a recognized cause for ankle disability and deformity in long-standing osteoarthritic patients with varus deformity. This study aims to assess changes in ipsilateral ankle and hindfoot if any, pre- and post-operative TKA. Methods: 65 knees of 54 patients of osteoarthritis knee were evaluated for alignment in knee, ankle and hindfoot pre- and post-TKA. Pre- and post-operative scanogram were evaluated for knee and ankle alignment. Hindfoot alignment view was used to calculate hindfoot alignment angle. All parameters were compared before TKA and after 10 weeks TKA and Wilcoxon signed rank test was used to test the significance of the values. Results: Mean age of the patients was 62.9 years (49-80 years). Mean varus before surgery was 14.49 which changed to 4.01 and mean hindfoot angle valgus reduced from 9.23 to 6.62, both of which was found significant. Significant changes were also observed between pre- and post-op measurements of knee society scores, AOFAS, with improved functional outcomes both in knee and ankle. Conclusion: This study reveals the radiological and functional changes occurring in the ankle and hindfoot after acute correction of long-standing varus deformity of the knee using total knee arthroplasty. Hindfoot valgus alignment in varus knees decreased significantly post-TKA without any intervention at ankle level. In cases undergoing knee arthroplasty, effect of the acute change in the alignment of the knee on the ankle and hindfoot should be taken into consideration and the amount of correction of knee alignment can be a predictor of correction of ankle and hindfoot malalignment too. The lateral benefit of improvement in ankle pain after TKA is a significant gain in this study.

Comparison of cognition and alexithymia in patients of schizophrenia with and without comorbid alcohol use: A cross-sectional exploratory study.

Background: Cognitive impairment and alexithymia are commonly associated with schizophrenia and alcohol use disorder independently. Both can lead to poor prognosis and recovery. In patients with dual diagnosis, this association can be more prevalent and severe. Materials and Methods: A total of 75 participants were grouped into two (35 each): Group A, a Schizophrenia group and Group B with comorbid alcohol use. Sociodemographic factors, clinical profile, cognitive functions, and alexithymia were compared between the two groups using semi-structured pro forma, Positive and Negative Syndrome Scale, Alcohol Use Disorders Identification Test (AUDIT), Montreal Cognitive Assessment (MoCA) Scale, Toronto Alexithymia Scale (TAS-20) (subcategorized into three subscales (1) "Difficulty describing feelings" (DDF), (2) "Difficulty identifying feeling" (DIF), and (3) "Externally-Oriented Thinking" and Brief Psychiatric Rating Scale. Statistical analysis was performed using the Chi-square tests and t-tests as applicable. P < 0.05 was considered statistically significant. Results: The mean age of the participants was 33.61 (standard deviation [SD]-8.11), mean duration of schizophrenia was 70.8 months (SD-47.5) and mean duration of alcohol consumption was 9.10 years (SD-7.7). MoCA score was significantly lower (mean-21.80, SD-2.98) and TAS total score was significantly higher in Group B (Mean-67.31, SD-8.10). DDF (Mean-19.28, SD-4.02) and DIF scores (Mean-22.86, SD-4.66) were significantly higher in alcohol group compared to nonalcohol group. Furthermore, MoCA score was significantly impaired and TAS total, DDF and DIF scores were significantly higher in participants with AUDIT score >8 (P < 0.05). Lower score on MoCA correlated with the higher score of alexithymia. Conclusion: Cognitive dysfunction and alexithymia were significantly more in patients of schizophrenia with comorbid alcohol use and positively correlated with the severity of alcohol use disorder.

ISP Good Clinical Practice Recommendations for the management of Dentin Hypersensitivity.

Dentin hypersensitivity (DH) is a rising concern in clinical dentistry that causes pain and discomfort and negatively affects the quality of life of patients. Indian Society of Periodontology conducted a nationwide survey, involving 3000 dentists in December 2020, which revealed significant knowledge gaps regarding DH, viz., under-diagnosis, incorrect differential diagnosis, and treatment strategies/recommendations for the management of DH patients in daily clinical practice. The current paper has been envisioned and conceptualized to update the practicing Indian dentists regarding the so-called enigma of dentistry "Dentin Hypersensitivity," based on the best available contemporary evidence. An expert panel was constituted comprising 30 subject experts from across the country, which after extensive literature review and group discussions formulated these recommendations. The panel advocated routine screening of all dentate patients for exposed dentin areas and DH to avoid under-diagnosis of the condition and suggested an early preventive management. Consensus guidelines/recommendations for the use of desensitizing agents (DAs) at home, including the use of herbal agents, are also provided within the backdrop of the Indian context. The guidelines recommend that active management of DH shall be accomplished by a combination of at home and in-office therapies, starting with the simplest and cost-effective home use of desensitizing toothpastes. A diagnostic decision tree and a flowchart for application in daily practice are designed to manage the patients suffering from DH or presenting with exposed dentin areas in dentition. Various treatment methods to manage DH have been discussed in the paper, including the insights from previously published treatment guidelines. Further, a novel system of classification of DH patients based on specific case definitions has been developed for the first time. Explicit charts regarding the available treatment options and the chronology of institution of the agent, for the management in different case categories of DH, have been provided for quick reference. The management strategy takes into account a decision algorithm based on hierarchy of complexity of treatment options and intends to improve the quality of life of the patient by long-term maintenance with an innovatively defined triple C's or 3Cs approach.

A pilot multicentre cluster randomised trial to compare the effect of trauma life support training programmes on patient and provider outcomes.

INTRODUCTION: Trauma accounts for nearly 10% of the global burden of disease. Several trauma life support programmes aim to improve trauma outcomes. There is no evidence from controlled trials to show the effect of these programmes on patient outcomes. We describe the protocol of a pilot study that aims to assess the feasibility of conducting a cluster randomised controlled trial comparing advanced trauma life support (ATLS) and primary trauma care (PTC) with standard care. METHODS AND ANALYSIS: We will pilot a pragmatic three-armed parallel, cluster randomised controlled trial in India, where neither of these programmes are routinely taught. We will recruit tertiary hospitals and include trauma patients and residents managing these patients. Two hospitals will be randomised to ATLS, two to PTC and two to standard care. The primary outcome will be all-cause mortality at 30 days from the time of arrival to the emergency department. Our secondary outcomes will include patient, provider and process measures. All outcomes except time-to-event outcomes will be measured both as final values as well as change from baseline. We will compare outcomes in three combinations of trial arms: ATLS versus PTC, ATLS versus standard care and PTC versus standard care using absolute and relative differences along with associated CIs. We will conduct subgroup analyses across the clinical subgroups men, women, blunt multisystem trauma, penetrating trauma, shock, severe traumatic brain injury and elderly. In parallel to the pilot study, we will conduct community consultations to inform the planning of the full-scale trial. ETHICS AND DISSEMINATION: We will apply for ethics approvals to the local institutional review board in each hospital. The protocol will be published to Clinical Trials Registry-India and ClinicalTrials.gov. The results will be published and the anonymised data and code for analysis will be released publicly.

How to make services adolescent friendly? A cross-sectional study on awareness of adolescent friendly health clinics in Central India.

Background: India's flagship program on adolescent health - Rashtriya Kishor Swasthya Karyakram (RKSK) emphasises the importance of strengthening Adolescent Friendly Health Clinics (AFHCs) under its facility-based approach for improving the health of adolescents. AFHCs are intended to provide targeted intervention in six domains - nutrition, injuries & violence (including gender-based violence), mental health, sexual & reproductive health, substance abuse and noncommunicable diseases. Objective: The current study was conducted to assess the determinants of awareness and utilisation of AFHC services in districts with RKSK services in Madhya Pradesh. Subjects: In total, 1605 adolescents (both males and females) within the age group of 10-19 years were included in the study. Methods: Multistage stratified random sampling was employed to enrol participants from three districts of Madhya Pradesh, where AFHC services have been launched. Results: The mean age of the participants was 15.07 ± 2.32 years. Only 153 (9.5%) adolescents were aware of AFHC services. On multivariate logistic regression, awareness of AFHC was seen to be associated with being aware of RKSK, being a part of the peer educator-led peer group, having had adolescent health days organised in the village and belonging from one of the financially better off districts. Utilisation rate of AFHC services was lower still - at 2.74%. Conclusion: Both awareness and utilisation of AFHC services remain very low among adolescents. There is a pressing need to focus on awareness generation campaigns - via mass media, but more importantly, through community health workers and peer educators - in order to sensitise target beneficiaries about the available services.

Outdoor activity and myopia progression in children: A follow-up study using mixed-effects model.

PURPOSE: The purpose of this study was to determine the influence of outdoor activity on myopia progression. METHODS: It was a hospital-based longitudinal prospective observational study. Children between 7 and 14 years of age with a myopia of - 0.5 D or worse were included. Myopia progression was evaluated by cycloplegic refraction, every 6 months for 18 months. Parents were asked to record the daily outdoor activity of the child in hours per day at school and at home during weekdays and at weekends separately, based on which the daily outdoor activity score was calculated. The independent variables measured included age and gender of the participant, degree of myopia, and the daily outdoor activity score. Progression of myopia was defined as an increase in the spherical equivalent (SE) over 18 months. The magnitude of the association was determined by two mixed-effects models. RESULTS: A total of 495 participants (250 males and 245 females) completed three visits during the study period. On taking age groups and paired observations as a random effect and adding SE at the last visit as the random slope in Model 1, each unit increase in outdoor activity had a negative effect on change in SE of - 0.01 (-0.02 to 0.00; P = 0.045). The same inverse relationship between outdoor activity and absolute SE as - 0.06 (-0.07 to - 0.03; P < 0.001) is estimated in Model 2. CONCLUSION: The study demonstrates a statistically significant inverse relationship between outdoor activity and myopia.

The Role of Visfatin (Adipocytokine) Biomarker in Oral Health and Diseases among Nonobese Indian Population: A Proteomic Assay.

Visfatin is an adipocytokine and a potential biomarker encoded by the nicotinamide phosphoribosyltransferase gene. It belongs to the nicotinic acid phosphoribosyltransferase family and involved in various metabolic processes and aging. The aim of this study was to evaluate the role of visfatin biomarker in oral diseases like periodontitis. A total of 60 patients (20-50 years) were included in this study, and they were divided into three groups. Group I consisted of 20 subjects with healthy periodontium, group II consisted of 20 subjects with generalized moderate gingivitis, and group III consisted of 20 subjects with generalized periodontitis. The clinical periodontal parameters, including plaque index, gingival index, probing pocket depth, and clinical attachment levels, were recorded, and saliva samples were collected. Salivary visfatin concentrations were assessed using standard enzyme-linked immunosorbent assay. The results of the study showed that the visfatin concentrations were higher in patients with gingivitis and periodontitis compared with those of healthy individuals. Visfatin was found highest in group III (38.22 ± 3.38 ng/mL) followed by group II (26.66 ± 2.24 ng/mL) and the group I (25.60 ± 2.19 ng/mL). Thus, salivary visfatin is a potential inflammatory biomarker and acts as a mediator in the pathogenesis of periodontal disease and, might serve as a diagnostic and therapeutic biomarker in oral diseases like periodontitis.

Heterogeneous patterns of COVID-19 transmission in an Urban set up - sero-epidemiological survey data from Ujjain, Madhya Pradesh (a central Indian city).

In the wake of rising number of SARS-CoV-2 cases, the Government of India had placed mass-quarantine measures, termed as "lockdown" measures from end-March 2020. The subsequent phase-wise relaxation from July 2020 led to a surge in the number of cases. This necessitated an understanding of the true burden of SARS-CoV-2 in the community. Consequently, a sero-epidemiological survey was carried out in the central Indian city of Ujjain, Madhya Pradesh. This article details the processes of data acquisition, compilation, handling, and information derivation from the survey. Information on socio-demographic and serological variables were collected from 4,883 participants using a multi-stage stratified random sampling method. Appropriate weightage was calculated for each participant as sampling fraction derived from Primary Sampling Unit (PSU), Secondary Sampling Unit (SSU) and Tertiary Sampling Unit (TSU). The weightage was then applied to the data to adjust the findings at population level. The comprehensive and robust methodology employed here may act as a model for similar future endeavours. At the same time, the dataset can also be relevant for researchers in fields such as data science, epidemiology, virology and earth modelling.

Efficacy of Reduced-Intensity Chemotherapy With Oxaliplatin and Capecitabine on Quality of Life and Cancer Control Among Older and Frail Patients With Advanced Gastroesophageal Cancer: The GO2 Phase 3 Randomized Clinical Trial.

Importance: Older and/or frail patients are underrepresented in landmark cancer trials. Tailored research is needed to address this evidence gap. Objective: The GO2 randomized clinical trial sought to optimize chemotherapy dosing in older and/or frail patients with advanced gastroesophageal cancer, and explored baseline geriatric assessment (GA) as a tool for treatment decision-making. Design, Setting, and Participants: This multicenter, noninferiority, open-label randomized trial took place at oncology clinics in the United Kingdom with nurse-led geriatric health assessment. Patients were recruited for whom full-dose combination chemotherapy was considered unsuitable because of advanced age and/or frailty. Interventions: There were 2 randomizations that were performed: CHEMO-INTENSITY compared oxaliplatin/capecitabine at Level A (oxaliplatin 130 mg/m2 on day 1, capecitabine 625 mg/m2 twice daily on days 1-21, on a 21-day cycle), Level B (doses 0.8 times A), or Level C (doses 0.6 times A). Alternatively, if the patient and clinician agreed the indication for chemotherapy was uncertain, the patient could instead enter CHEMO-BSC, comparing Level C vs best supportive care. Main Outcomes and Measures: First, broad noninferiority of the lower doses vs reference (Level A) was assessed using a permissive boundary of 34 days reduction in progression-free survival (PFS) (hazard ratio, HR = 1.34), selected as acceptable by a forum of patients and clinicians. Then, the patient experience was compared using Overall Treatment Utility (OTU), which combines efficacy, toxic effects, quality of life, and patient value/acceptability. For CHEMO-BSC, the main outcome measure was overall survival. Results: A total of 514 patients entered CHEMO-INTENSITY, of whom 385 (75%) were men and 299 (58%) were severely frail, with median age 76 years. Noninferior PFS was confirmed for Levels B vs A (HR = 1.09 [95% CI, 0.89-1.32]) and C vs A (HR = 1.10 [95% CI, 0.90-1.33]). Level C produced less toxic effects and better OTU than A or B. No subgroup benefited from higher doses: Level C produced better OTU even in younger or less frail patients. A total of 45 patients entered the CHEMO-BSC randomization: overall survival was nonsignificantly longer with chemotherapy: median 6.1 vs 3.0 months (HR = 0.69 [95% CI, 0.32-1.48], P = .34). In multivariate analysis in 522 patients with all variables available, baseline frailty, quality of life, and neutrophil to lymphocyte ratio were independently associated with OTU, and can be combined in a model to estimate the probability of different outcomes. Conclusions and Relevance: This phase 3 randomized clinical trial found that reduced-intensity chemotherapy provided a better patient experience without significantly compromising cancer control and should be considered for older and/or frail patients. Baseline geriatric assessment can help predict the utility of chemotherapy but did not identify a group benefiting from higher-dose treatment. Trial Registration: isrctn.org Identifier: ISRCTN44687907.

Current Surgical Antibiotic Prophylaxis Practices: A Survey of Orthopaedic Surgeons in India.

BACKGROUND: Surgical antibiotic prophylaxis (SAP) has become the standard of care in orthopaedic surgery. Inappropriate usage of antibiotics (dosage, strength, and/or administration time and duration) can inadvertently result in superadded infections and antimicrobial resistance. The purpose of this study was to document and analyse the prescription patterns for SAP, and to investigate the factors associated with divergence from standard guidelines. METHODS: We conducted an online cross-sectional questionnaire-based study to collect information about the SAP practices of the members of the Indian Orthopaedic Association (IOA) using Google forms. A link to the questionnaire was sent by e-mails. RESULTS: The overall response rate was 5.73%. While 97.3% respondents practised SAP routinely, the practice was not aligned with standard guidelines' recommendations. There was heterogeneity in the use of SAP in terms of choice of antibiotic(s), number of co-prescribed drugs, single- versus multiple-dose regimens, and the duration of therapy. The prescription practice patterns showed that orthopaedic surgeons almost always used broad-spectrum antibiotics for long durations, regardless of the type of surgery. CONCLUSION: While Orthopaedic surgeons in India are practicing SAP, the pattern of antibiotic usage is heterogeneous. Variations were noted in the choice of antibiotics for different types of surgeries, time of administration, duration of usage in the postoperative period as well as co-prescriptions. This study highlights the urgent need for a comprehensive, rational, and robust national SAP policy for orthopaedic surgeries.

Primary healthcare and child and maternal health in the Middle East and North Africa (MENA): A retrospective analysis of 29 national survey data from 13 countries.

The objective of this paper is three-fold: (i) to analyse the coverage and equity of access to selected maternal and child healthcare interventions, particularly those delivered in Primary Healthcare (PHC) setting; (ii) to analyse the main drivers of inequitable access to selected interventions; and (iii) to synthesise and compare the results across the Middle East and North Africa (MENA) region as well as over time. We analysed data for five key maternal and child healthcare interventions from 29 national surveys (DHS and MICS) covering 13 MENA countries and spanning a period of almost 20 years (2000-2018). We calculated coverage indicators, concentration indices (CI) and decomposition of CIs according to standard definitions. We synthetized the results by country groups based on their human development index (HDI). Over time and among countries that started from a lower base, there has been an improvement in coverage and equity of selected interventions (four ante-natal care visits and skilled birth assistance). When considering the place of skilled delivery, there is a clear rich-poor divide, with women from richer wealth quintiles gravitating toward private healthcare facilities and those from poorer wealth quintiles toward public ones. While most of the care-seeking for common child illnesses occurs in PHC facilities, a fraction (20-30 percent) of care-seeking takes place in secondary healthcare facilities. PHC has played a role in improving coverage and equity of access in key maternal and child health interventions in the wider MENA region. Better integration of care, strengthening and improving the PHC network could increase the use of cost-effective interventions, which are key to improving maternal and child health.

Determinants of behavioural and biological risk factors for cardiovascular diseases from state level STEPS survey (2017-19) in Madhya Pradesh.

BACKGROUND: National and statewide assessment of cardiovascular risk factors needs to be conducted periodically in order to inform public health policy and prioritise allocation of funds, especially in LMICs. Although there have been studies from India which have explored the determinants of cardiovascular risk factors, they have mostly been from high epidemiological transition states. The present study assessed the determinants of cardiovascular (CVD) risk factors in a low epidemiological transition state (Madhya Pradesh) using the WHO STEPwise approach to surveillance (STEPS). METHODS: A total of 5,680 persons aged 18-69 years were selected from the state of Madhya Pradesh through multi-stage cluster random sampling. Key CVD risk factors we sought to evaluate were from behavioural (tobacco, alcohol, physical activity, diet) and biological domains (overweight or obese, Hypertension, Diabetes, and Raised serum cholesterol). Key socio-demographic factors of interest were the caste and tribe groups, and rural vs urban location, in addition to known influencers of CVD risk such as age, gender and education level. RESULTS: Those belonging to the scheduled tribes were more at risk of consuming tobacco (OR 2.13 (95% CI [1.52-2.98]), and a diet with less than five servings of fruits and vegetables (OR 2.78 (95% CI [1.06-7.24]), but had had the least risk of physical inactivity (OR 0.31 (95% CI [0.02-0.54]). Residence in a rural area also reduced the odds of physical inactivity (OR 0.65 (95% CI [0.46-0.92])). Lack of formal education was a risk factor for both tobacco consumption and alcohol intake (OR 1.40 (95% CI [1.08-1.82]) for tobacco use; 1.68 (95% CI [1.14-2.49]) for alcohol intake). Those belonging to schedules tribes had much lower risk of being obese (OR 0.25; 95% CI [0.17-0.37]), but were at similar risk of all other clinical CVD risk factors as compared to other caste groups. CONCLUSION: In the current study we explored socio-demographic determinants of behavioural and biological CVD risks, and found that in Madhya Pradesh, belonging to a scheduled tribe or living in a rural location, protects against being physically inactive or being overweight or obese. Increasing age confers a greater CVD-risk in all domains. Being a male, and lack of formal education confers a greater risk for behavioural domains, but not for most clinical risk domains. Future efforts at curbing CVDs should be therefore two pronged -a population-based strategy targeting biological risk factors, and a more focussed approach directed at those displaying risky behaviour.

Descriptive profile of risk factors for cardiovascular diseases using WHO STEP wise approach in Madhya Pradesh.

BACKGROUND: Periodic information on risk factor distribution is critical for public health response for reduction in non-communicable disease (NCDs). For this purpose, the WHO has developed STEPs wise approach. State representative population-based STEPS survey was last conducted in 2007-08 in seven states of In India. Since then no such work has been reported from low ETL states. This survey was carried out to assess the prevalence of risk factors associated with NCDs and the prevalence of NCDs in the low ETL state of Madhya Pradesh using the WHO STEPs approach. METHODS: A total of 5680 persons aged 18-69 years were selected from the state of Madhya Pradesh using multi-stage cluster random sampling. Using the WHO STEPs approach, details were collected on demographics, STEP 1 variables (tobacco consumption, alcohol consumption, physical activity, diet), STEP 2 variables (weight, height, waist circumference, blood pressure) and STEP 3 variables (fasting blood glucose, blood cholesterol). RESULTS: We found that 9.4% individuals smoked tobacco, 15.3% were overweight/obese, 22.3% had hypertension, and 6.8% have diabetes mellitus. As compared to women, men were less likely to be overweight or obese, but more likely to smoke tobacco, and have diabetes mellitus. Hypertension was also more common in men. Overall, about a fourth of all adults had three or more risk factors for cardiovascular disease. CONCLUSION: The survey shows that a large section of the population from Madhya Pradesh is either suffering from NCDs or have risk factors which predispose them to acquire NCDs. This state representative survey provides benchmarking information for behavioural and biological risk factor distribution for recently scaled up National Programme for the Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS).

Evaluation of diode laser along with 1.23% acidulated phosphate fluoride gel on dentinal tubule occlusion: An in vitro study.

CONTEXT: Several studies have recommended the use of lasers in treatment of dentinal hypersensitivity. These materials have been used alone or in combination with an active desensitizing agent. AIMS: The present study aimed to evaluate the use of 1.23% acidulated phosphate fluoride (APF) gel and 810 nm diode laser when used alone and when used together on exposed dentinal tubules. SETTINGS AND DESIGN: Sixty-one extracted teeth were sectioned with a diamond saw and dentin slices were prepared. They were then treated with 37% orthophosphoric acid to remove the smear layer. MATERIALS AND METHODS: One of the 61 sections was left as an untreated control, whereas the remaining sixty sections were divided into three groups of twenty sections each. The first set of sections (Group 1) was treated with laser alone, whereas the second set (Group 2) was treated with APF alone. A third set of sections (Group 3) was treated with a combination of laser and APF. The sectioned teeth were then evaluated using field emission scanning electron microscopy, and the percentage of dentinal tubule occlusion was observed. STATISTICAL ANALYSIS: The Shapiro-Wilk normality test was performed to check for the normal distribution of data, whereas the Kruskal-Wallis test was used to compare the mean percentage of dentinal tubule occlusion between the three groups. The Chi-square test was used to compare the number of images with complete tubular occlusion between the three groups. RESULTS: A total of 96 images were processed from the sixty sectioned samples. It was seen that the sections in Group 3 showed the highest percentage of dentinal tubule occlusion. Group 3 also showed the highest number of samples with complete dentinal tubule occlusion. Significantly lesser levels of dentinal tubule occlusion were seen in Groups 1 and 2. CONCLUSIONS: Diode lasers were effective in occluding dentinal tubules. The addition of 1.23% APF significantly increased the efficacy and thoroughness of dentinal tubule occlusion. Significantly lesser levels of dentinal tubule occlusion were seen in the sections treated with laser alone and APF alone.

Recurrent black stains and periodontal disease.

OBJECTIVES: The objective of this study was to identify the anaerobic pigment-forming bacteria present in black stain and correlate its occurrence with dental caries incidence and periodontal destruction. MATERIALS AND METHODS: A total of 50 healthy subjects with the chief complaint of recurrent black stains were selected based on the inclusion and exclusion criteria. decayed/missing/filled surfaces score, community periodontal index, Gingival Crevicular Fluid (GCF), black stain score, and microbial analysis were done. RESULTS: The data presented indicate that black stain has a constant microflora, dominated by various gram-negative rods, gram-positive cocci and rods (P ≤ 0.1). However, the incidence of gram-positive rods decreased with the increase in plaque score and probing depths and decrease in black stain score. CONCLUSIONS: Presence of black stains is predominated by various gram-positive and negative rods, and gram-positive cocci. Increase in the plaque score decreases the severity of black stains, thereby increasing the probability of periodontal destruction and dental caries incidence in adult subjects. Further studies are required to corroborate the results.

On the existence of a perennial river in the Harappan heartland.

The legendary river Saraswati of Indian mythology has often been hypothesized to be an ancient perennial channel of the seasonal river Ghaggar that flowed through the heartland of the Bronze Age Harappan civilization in north-western India. Despite the discovery of abundant settlements along a major paleo-channel of the Ghaggar, many believed that the Harappans depended solely on monsoonal rains, because no proof existed for the river's uninterrupted flow during the zenith of the civilization. Here, we present unequivocal evidence for the Ghaggar's perennial past by studying temporal changes of sediment provenance along a 300 km stretch of the river basin. This is achieved using 40Ar/39Ar ages of detrital muscovite and Sr-Nd isotopic ratios of siliciclastic sediment in fluvial sequences, dated by radiocarbon and luminescence methods. We establish that during 80-20 ka and 9-4.5 ka the river was perennial and was receiving sediments from the Higher and Lesser Himalayas. The latter phase can be attributed to the reactivation of the river by the distributaries of the Sutlej. This revived perennial condition of the Ghaggar, which can be correlated with the Saraswati, likely facilitated development of the early Harappan settlements along its banks. The timing of the eventual decline of the river, which led to the collapse of the civilization, approximately coincides with the commencement of the Meghalayan Stage.

Comparative evaluation of growth factors from platelet concentrates: An in vitro study.

AIM: The aim of the study was to compare and evaluate the various growth factors released for a period of 23 days from platelet rich fibrin (PRF) and platelet rich fibrin matrix (PRFM). MATERIALS AND METHODS: A total of 15 systemically healthy controls were recruited and 10 ml of blood sample was withdrawn from the individual. Following the standard centrifugation protocol, PRF and PRFM were prepared. The platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), fibroblast growth factor (FGF), transforming growth factor (TGF), and insulin growth factor (IGF) were evaluated for 23 days. RESULTS: The PDGF released from PRFM was statistically significant from PRF till the 15th day of release. The VEGF too had an increased release up till the 15th day from PRFM group as compared to PRF, but no statistically significant difference could be obtained. EGF from the 15th day to 23rd day had a greater release from PRFM group as compared to PRF group. FGF from 7th day to 23rd day had statistically significant difference in the PRFM group as compared to PRF group. TGF and IGF had statistically significant difference in PRFM group as compared to PRF group from 11th day to 23rd day and 1st to 17th day, respectively. CONCLUSION: The initial and robust release of GFs was seen in PRFM group at earlier days, whereas a steady and constant release of six GFs could be appreciated from PRF group upto 23rd day. Therefore, for a rapid and early healing and regeneration, both the platelet concentrates can be utilized in periodontal therapy.

Effect of non-surgical periodontal therapy on stress and salivary Chromogranin-A levels: A clinico-biochemical study.

AIM: The aim of the study was to compare chromogranin A (CgA) and stress levels before and after non-surgical periodontal therapy (NSPT). MATERIALS AND METHODS: A sample of 40 patients in the age range 25-60 years were included in the study and were divided into gingivitis (10 subjects), chronic periodontitis (CP) (15 patients) and aggressive periodontitis (AgP) (15 patients). The patients were asked to complete two sets of stress questionnaires, plaque index, gingival index, probing depth and clinical attachment levels (CAL) were recorded. Salivary samples were taken at baseline and were repeated three months post NSPT. RESULTS: CgA was detected in saliva samples of all the groups. A statistically significant correlation was established between levels of CgA and stress parameters, which was shown to be the highest in AgP (P < 0.001), followed by CP group (P < 0.005) at baseline. Following NSPT, an overall reduction was observed in the levels of CgA, which was correlated with the overall reduction in stress levels for AgP group (P < 0.005) followed by CP group (P < 0.037). Amongst the clinical parameters, CAL showed the strongest correlation with CgA both at baseline and after NSPT (P < 0.001). CONCLUSION: Stress was directly correlated to the levels of salivary CgA levels, which was the highest for aggressive periodontitis at baseline. NSPT showed a marked improvement in all the parameters. Levels of CgA and CAL showed a significant correlation in both the CP and AgP groups.