Percentage of patients shifting to another treatment modality: An experience-guided decision

ABSTRACT Objective: This study aimed to assess the frequency with which orthodontic patients decided to shift to another type of orthodontic appliance, among conventional metal brackets, ceramic brackets, lingual brackets and clear aligner, based on their personal experiences of pain, ulcers, bad breath, hygiene issues and social difficulties. Material and Methods: This study comprises of patients seeking orthodontic treatment. The sample (n = 500; age group = 19-25 years) was divided equally into four groups based on the treatment modality: conventional metal brackets, ceramic brackets, lingual brackets and clear aligner. Patients rated the questionnaire using a visual analogue scale, to assess variables (such as pain, ulcer etc) that impact various treatment modalities. Subsequently, patients from all groups provided feedback regarding their treatment experiences, and expressed their preference for an alternative modality. Intergroup comparison among the four groups was done using one-way analysis of variance with Tukey's HSD post-hoc test (p ≤ 0.05). Results: Patients who received lingual brackets reported higher levels of pain and ulceration, as compared to those who received clear aligners. All four groups showed statistically significant differences for ulcers during treatment (p ≤ 0.05). Of the 125 patients who received conventional metal brackets, 28% expressed a preference for clear aligner therapy, while 20% preferred ceramic brackets. In the lingual group, 56% of 125 patients preferred clear aligner therapy, and 8% preferred ceramic brackets to complete their treatment. In the ceramic group, 83% did not want to switch, whereas 17% desired to switch to clear aligner, while in aligner group no patient desired to switch. Conclusions: A higher percentage of patients from lingual brackets group chose to shift to clear aligners, followed by conventional metal brackets group and by ceramic brackets group, in this descending order. The clear aligner group demonstrated fewer issues than the other treatment modalities.

RESUMO Objetivo: Este estudo teve como objetivo avaliar a frequência com que pacientes ortodônticos decidiram mudar para outro tipo de aparelho ortodôntico, entre braquetes convencionais de metal, braquetes cerâmicos, braquetes linguais e alinhadores transparentes, com base em suas experiências pessoais de dor, aftas, mau hálito, problemas de higiene e dificuldades sociais. Material e Métodos: Esse estudo foi composto por pacientes que procuram tratamento ortodôntico. A amostra (n = 500; faixa etária = 19-25 anos) foi dividida igualmente em quatro grupos, com base na modalidade de tratamento: braquetes metálicos convencionais, braquetes cerâmicos, braquetes linguais e alinhadores transparentes. Os pacientes responderam a um questionário, usando uma escala visual analógica, para avaliar variáveis como dor e aftas, que impactam diferentes modalidades de tratamento. Posteriormente, os pacientes de todos os grupos forneceram feedback sobre suas experiências de tratamento e expressaram sua preferência por uma modalidade alternativa. A comparação intergrupos entre os quatro grupos foi feita usando análise de variância unidirecional com teste post-hoc HSD de Tukey (p ≤ 0,05). Resultados: Os pacientes que usaram braquetes linguais relataram níveis mais elevados de dor e aftas, em comparação com aqueles que usaram alinhadores transparentes. Todos os quatro grupos apresentaram diferenças estatisticamente significativas para aftas durante o tratamento (p ≤ 0,05). Dos 125 pacientes que usaram braquetes metálicos convencionais, 28% expressaram preferência pelo tratamento com alinhadores transparentes, enquanto 20% preferiram braquetes cerâmicos. No grupo com braquetes linguais, 56% dos 125 pacientes preferiram o tratamento com alinhadores transparentes e 8% preferiram braquetes cerâmicos para completar o tratamento. No grupo com braquetes cerâmicos, 83% não queriam trocar de tratamento, enquanto 17% desejavam mudar para os alinhadores transparentes; enquanto no grupo de alinhadores nenhum paciente desejou mudar. Conclusões: Uma porcentagem maior de pacientes do grupo com braquetes linguais optou pela mudança para alinhadores transparentes, seguido pelo grupo com braquetes metálicos convencionais e pelo grupo com braquetes cerâmicos, em ordem decrescente. O grupo de alinhadores transparentes demonstrou menos problemas do que as outras modalidades de tratamento.

A Comparative study of insight in patients of depressive spectrum disorders attending outpatient department of tertiary care centre.

Introduction: Poor insight is a common feature of bipolar depression and unipolar depression with and without psychotic symptoms (PS) which may lead to poor clinical outcome. Studies on insight in these populations are relatively limited and the majority of studies were published over the previous decade. Methods: This was a cross-sectional, observation study conducted in Psychiatry O.P.D. of tertiary care hospital. The sample consisted cohort of 20 outpatients each with unipolar depression, unipolar depression with psychotic symptoms and bipolar disorder current episode depression with psychotic symptoms. The depression was assessed by HAM-D and insight by Item G12 of the General Psychopathology section of PANSS. Results: Significant difference in insight is seen in all three groups. Bipolar patients with PS had the poorest insight, patients with unipolar depression had best. Statistically significant correlation is present with older age and lack of insight among patients of unipolar depression with PS (rho =.599, P =.005) and bipolar depression with PS (rho =.686 P=.001). Conclusion: Insight in depressive illness is affected by multiple factors; this study shows that age, bipolarity and presence of psychotic symptoms are associated with poor insight. Management of the patients of depressive spectrum should incorporate strategies to improve insight

Prevalence of Malocclusion in Rural and Backward Area (Seemanchal) in Bihar-India

Malocclusion is the biggest challenge in the world and its existence varies. Diagnosis and treatment Plan predict the occlusal Problem and its occurrence. Interceptive and preventive treatment needs more manpower for prediction of malocclusion. In Katihar (Seemanchal) area there is no any malocclusion related studies. The aim of this study is to evaluate the existence of different types of dental malocclusion in this rural and backward area. Methods: The study was done in 2109 patient who have visited the dental department of dentistry, of Katihar medical college in between September 2015 to February 2019. The different parameter was recorded and analysed. Chi Square test is done for the significance of gender and it the difference is p < 0.05. Results: In our study it is found that angle class I malocclusion is 59.5% with Class II malocclusion is 36.8% and 8.2% of class III malocclusion. The most problem in this area is crowding 81.1% followed by increased overjet, deep bite, crowding and spacing. Except deep bite there is no gender significance difference exist. Conclusion: The result in this study shows the prevalence of malocclusion and decreased of awareness which set a base line for awareness programme and interceptive and preventive orthodontic service and future study in Katihar (SEEMANCHAL) population

Cosinor Analysis of Circadian Rhythm of Peak Expiratory Flow in Young Adults

Introduction: Peak expiratory flow (PEF), exhibit a 24 hour circadian rhythm with nadir in the early morningand peak in the evening. This diurnal variability gets accentuated in asthmatics. Rhythm characteristics ofsuch time series data can be better explained using Cosinor analysis by fitting a cosine curve. Also itmakes easier to compare data even when there is a difference in sampling time points. Data of PEFcircadian rhythms in Indian population with Cosinor analysis is lacking making it difficult to frame guidelineto diagnose asthma.Methods: PEF was recorded from 249 subjects using Wright’s portable Peak Flow Rate meter at 5:00, 8:00,11:00, 14:00, 17:00, 20:00, and 23:00 hours for one day. Cosinor analysis was done and rhythm characteristicswere determined for individual subjects.Results: The mean PEF values after a minimum in morning at 05:00 hours tend to increase throughout theday peaking in afternoon and there is a regular fall in PEF levels after 17:00 hours till 05:00 hours. Meandiurnal variation expressed as amplitude percent mean (A%M)is 8.81±4.8. With Cosinor analysis significantrhythms were detectable in 64% of subjects. For this population MESOR (Midline Estimate Statistic ofRhythm) is 528.49 L/min, Amplitude is 8.2% and acrophase is 15.49 Hours.Conclusion: Results are comparable with the data published in other studies for other populations. Thevariability (amplitude) in normal subjects is lesser than that of smokers and asthmatics. Amplitude andacrophase characteristics will help unifying the data and guide in deciding the cut-off values for diagnosingasthma

A study to assess awareness regarding eye donation among post graduate medical students admitted through NEET pre PG 2014 of Gajra Raja medical college Gwalior, M.P., India.

Background: According to WHO estimates India has 10 million blind populations. Corneal problems cause a significant proportion of blindness in India. Although effective strategies to prevent corneal blindness are likely to be more cost effective, visual rehabilitation by corneal transplantation remains the major treatment for restoring sight in those who already have corneal blindness. The requirement of donor corneas per year is at least 20 times the current procurement. Objective: To assess the knowledge and attitude of post graduate medical students regarding eye donation and their willingness to pledge eyes for donation. Methods: The present study was a cross sectional study conducted using a pretested questionnaire on 116 Post graduate Medical Students but only 106 actually participated in the study. Results: A total of 106 students actually participated in the study. Among them 63 (59.43%) were males and 43 (40.57%) were females. The maximum percentages of the students were of age group 26-29 years. All the students were aware regarding eye donation but still they felt it was necessary to obtain consent from family members. Conclusion: These data showed that although the awareness is good but still there is imperative need to emphasize to evade myths concerning eye donation to promote eye donation.

Tiwari Ranjana, Jain Vikas, Rajput Ajit Singh, Bhagwat A K, Goyal Manish, Tiwari Sakshi.

Background: Obesity is emerging as a serious problem throughout the world, not only among adults but also children, teenagers and young adults. Medical education is stressful throughout the whole course of training. Overweight and obesity is one of the preventable cause of morbidity and mortality. The social implications of obesity are a major problem that is often neglected. Objectives of current study were to assess the prevalence of overweight and obesity in medical students and to assess the factors influencing the development of overweight and obesity. Methods: The present study was a cross sectional study of IInd semester medical students in which, a total of 131 students were included. The study involved administration of a pretested questionnaire to the students and their anthropometric measurements. Results: In a batch of 150 students 131 participated in the study in which 90 (68.70%) were males and 41 (31.30%) were females. The prevalence of overweight was 13 (9.93%) and the prevalence of obesity was 2 (1.53%). Conclusion: The study showed a high prevalence of overweight and obesity among the medical students. At the time of anthropometric measurements awareness was created for their weight and for the promotion of physical activity among medical students.

Impedance cardiography for monitoring changes in cardiac output.

Impedance Cardiography (ICG) is a non invasive method useful for continuous monitoring of cardiac output but, it still has not found wide usage for measuring cardiac output in clinics and research. Most studies focused on comparing the cardiac output measured at rest with reference methods. In the present study we evaluated the validity of ICG against Doppler Echocardiography (DE) in measuring cardiac output changes that occur during static exercise. Cardiac output of 30 healthy males between 18-26 yrs of age was measured during supine rest, during and 5 min after completion of 3 minute static exercise by ICG and DE. The increase in cardiac output during exercise measured with ICG and DE does not differ significantly (1.04±0.72 L/min and 1.05±1.24 L/min respectively) and has significantly high correlation (r=0.76, P<0.001). The bias and limits of agreement are (–0.01±0.83) in acceptable limits. The pooled means of cardiac output measured by ICG and DE do not differ significantly and bears a significant correlation (r=0.812, P<0.001). The bias (d±s) calculated is 0.15±0.64 L/min. ICG could provide valid information regarding the relative changes in cardiac output.

Effect of examination stress on mood, performance and cortisol levels in medical students.

Stress produces definable mental and physiological reactions in the body. Mild stress is beneficial in cognitive tasks and performance but persistently high stress may lead to neuropsychiatric illnesses like anxiety and depression. Examinations act as stressor and activate hypothalamicpituitary adrenal axis causing an increase in cortisol level, which is reflected in saliva. Present study was done on 35 medical students. Their mood parameters were assessed, using Depression Anxiety Stress Scale (DASS) scoring, and salivary cortisol levels using quantitative ELISA. Subjects were evaluated for mood parameters two times, one during relaxed state (with no examinations in preceding 2 weeks and in coming 2 weeks) and another during stressed state (on the day of viva voce examination). The levels of mood parameters and salivary cortisol were significantly raised during examination stress. The changes in stress level significantly correlated with change in levels of anxiety and salivary cortisol though there was no significant effect on the performance. Males and females showed similar changes in mood parameters. This study suggests that as examinations act as unavoidable stressors, the medical educators as well as students should be made aware of the negative consequences of stress faced during medical training. Efficient relaxation program as well as counseling services should be provided to stressed students so that they are able to cope better with examination stress.