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Objective: Despite the literature on dydrogesterone, studies on dydrogesterone utilization patterns are largely lacking in Indian patients. Methods: This was a multi-center, retrospective, observational, cross-sectional, and descriptive study across 817 centers in India. Data of patients who received dydrogesterone in past and provided consent for future use of their medical record for research purpose was were retrieved and analyzed. Results: Data of 7287 subjects (aged 29.55±4.84 years) was analyzed. Threatened abortion was the most common indication for which the subjects received dydrogesterone (46.9%) followed by recurrent pregnancy loss. Polycystic ovary syndrome (PCOS), thyroid disorders and anemia were the most common comorbid conditions and prior pregnancy loss, advanced maternal age and obesity were the most common risk factors seen in subjects who received dydrogesterone. Total 27.5% of subjects received a loading dose of dydrogesterone, and majority (64%) received 40 mg as loading dose. 10 mg dose was used as maintenance or regular dose in 81.4% of the subjects. Twice daily (BID) was the most common dosing frequency (66.6%). The most common concomitant medications being taken by the subjects on dydrogesterone included folic acid (45.1%), iron supplements (30.3%) and calcium and vitamin D3 supplements (25.5%). Another progesterone preparation (oral, injection, vaginal, tubal) other than dydrogesterone was used concurrently in 7.8% of subjects. Conclusion: The study helped to identify the patient population that is benefitted by dydrogesterone and the preferred indications, risk factors, comorbid conditions and concomitant medication used in this patient population at real-life scenario.
Subject(s)
Dydrogesterone , Progestins , Humans , Female , Retrospective Studies , India , Dydrogesterone/therapeutic use , Dydrogesterone/administration & dosage , Adult , Cross-Sectional Studies , Pregnancy , Progestins/therapeutic use , Progestins/administration & dosage , Young Adult , Abortion, Threatened/drug therapy , Abortion, Habitual/epidemiology , Abortion, Habitual/drug therapyABSTRACT
Abstract Objective: Despite the literature on dydrogesterone, studies on dydrogesterone utilization patterns are largely lacking in Indian patients. Methods: This was a multi-center, retrospective, observational, cross-sectional, and descriptive study across 817 centers in India. Data of patients who received dydrogesterone in past and provided consent for future use of their medical record for research purpose was were retrieved and analyzed. Results: Data of 7287 subjects (aged 29.55±4.84 years) was analyzed. Threatened abortion was the most common indication for which the subjects received dydrogesterone (46.9%) followed by recurrent pregnancy loss. Polycystic ovary syndrome (PCOS), thyroid disorders and anemia were the most common comorbid conditions and prior pregnancy loss, advanced maternal age and obesity were the most common risk factors seen in subjects who received dydrogesterone. Total 27.5% of subjects received a loading dose of dydrogesterone, and majority (64%) received 40 mg as loading dose. 10 mg dose was used as maintenance or regular dose in 81.4% of the subjects. Twice daily (BID) was the most common dosing frequency (66.6%). The most common concomitant medications being taken by the subjects on dydrogesterone included folic acid (45.1%), iron supplements (30.3%) and calcium and vitamin D3 supplements (25.5%). Another progesterone preparation (oral, injection, vaginal, tubal) other than dydrogesterone was used concurrently in 7.8% of subjects. Conclusion: The study helped to identify the patient population that is benefitted by dydrogesterone and the preferred indications, risk factors, comorbid conditions and concomitant medication used in this patient population at real-life scenario.
Subject(s)
Humans , Female , Comorbidity , Risk Factors , Abortion, Threatened , DydrogesteroneABSTRACT
STATEMENT OF PROBLEM: Determining the vertical dimension of occlusion for an edentulous patient depends on clinical judgment and the skill and experience of the dentist. Though many methods have been advocated, a universally accepted method of determining the vertical dimension of occlusion in edentulous patients is lacking. PURPOSE: This clinical study aimed to find a correlation between the intercondylar distance and occlusal vertical dimension in dentate individuals. MATERIAL AND METHODS: This study was conducted on 258 dentate individuals aged 18 to 30 years. The Denar posterior reference point was used to determine the center of the condyle. The posterior reference point was marked on either side of the face with this scale, and the intercondylar width between these 2 posterior reference points was measured with custom digital vernier calipers. A modified Willis gauge was used to measure the occlusal vertical dimension from the base of the nose to the lower border of the chin when the teeth were in maximum intercuspation. The relationship between the ICD and OVD was analyzed with the Pearson correlation test. Simple regression analysis was used to formulate a regression equation. RESULTS: The mean intercondylar distance was 133.5 mm, and the mean occlusal vertical dimension was 55.4 mm. A statistically significant correlation (R=0.619) was found between the intercondylar distance and occlusal vertical dimension in the study population (P<.001). CONCLUSIONS: A significant correlation was found between the intercondylar distance and occlusal vertical dimension of the participants. Occlusal vertical dimension may be predicted from the intercondylar distance by using a regression model.
Subject(s)
Mouth, Edentulous , Nose , Humans , Vertical Dimension , Dental OcclusionABSTRACT
Context: The need for physicians qualified in the field of occupational safety and health (OSH) is growing with the growth of manufacturing and service sectors where maximum number of work-related morbidity and mortality occur. Aims: This article aims to assess the effectiveness and feasibility of the certificate course in occupational safety and health for training and capacity building of primary care physicians in OSH. Methods and Material: Guideline for reporting evidence-based practice educational interventions and teaching (GREET) was used for describing educational interventions. The outcome was assessed by comparing the mean scores. t test with P < 0.005 was considered a level of significance. Results: The result showed significant improvement in the cumulative pre- and post-test scores after each module. The certificate course is suitable for adult learning as there was no intergroup difference in knowledge after the program. Consistent with the findings, the improvement scores indicate that training has made a difference in the knowledge and learning of the trained physicians. Conclusions: This customized training intervention has high potential for scaling up while optimally addressing the scarcity of trained physicians in the OSH in high population density settings like India where a high number of vulnerable workforces work in the informal economy.
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Background and objectives: Fluoride varnishes are being used to prevent caries in children. The high concentration of fluoride in varnishes apart from caries prevention may cause changes in surface properties of esthetic restorations. The study aims to evaluate and compare the effect of four commercially available fluoride varnishes with added calcium and phosphate on microhardness of three esthetic materials namely conventional GIC (Fuji II), high viscosity GIC (Fuji IX), and nanocomposite (Filtek Z350). Materials and methods: A total of 28 pellets were made of each material and stored in distilled water at 37 °C for 48 hours. The microhardness of the pellets was tested which served as a baseline. These were then randomly divided into four subgroups. In one subgroup Profluorid varnish was applied, second subgroup MI varnish was applied, third subgroup Embrace varnish was applied, and in the fourth subgroup Enamel Pro varnish was applied as per protocol. Thereafter, all the pellets were subjected to microhardness testing (load = 100 g for 15 seconds). Results: The fluoride varnishes increased the microhardness of conventional GIC (Fuji II) whereas in case of high viscosity GIC (Fuji IX) the application of varnishes reduced the microhardness. In case of nanocomposite restorative material (Filtek Z350) only Profluorid varnish increased its microhardness. Conclusion: Fluoride varnish and calcium-phosphate containing fluoride varnish effect on the microhardness of restorative material is material dependent. So, the choice of fluoride varnish with or without proprietary additives depends on the nature and composition of the restorative material. How to cite this article: Shetty RS, Bhat SS, HK Sundeep, et al. Effect of Fluoride-based Varnishes with Added Calcium and Phosphate on Microhardness of Esthetic Restorative Materials: An In Vitro Study. Int J Clin Pediatr Dent 2022;15(2):187-193.
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Thyroid dysfunction has various manifestations which include orofacial abnormalities like delayed eruption, retained deciduous teeth, etc. Early detection of this deregulation of thyroid homeostasis can prevent associated complications. This report is a case of congenital hypothyroidism (CH) in a 4-year-old boy who presented with a completely edentulous maxilla and hypodontic mandible. Based on various biochemical and radiographic investigations, a diagnosis of CH was established. He was prosthodontically rehabilitated with removable dentures. How to cite this article: Bhat V, Bhat VS, Vadakkan J, et al. Prosthodontic Management of Congenital Hypothyroidism with Anodontia: A Case Report. Int J Clin Pediatr Dent 2021;14(4):586-589.
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PURPOSE: The current in vitro study was conducted to assess the remineralization potential of CPP-ACP and a customized dentifrice (tricalcium-phosphate) on artificial carious lesions using DIAGNOdent. MATERIALS AND METHODS: Fifty-one extracted premolars that satisfied the inclusion criteria were painted using acid-resistant nail varnish. A window of 4 × 4 mm was exposed on the center of the buccal surface of each tooth. After 20 minutes of drying, the baseline reading of enamel specimens was assessed using DIAGNOdent. The teeth were then immersed in a bath of demineralizing solution. An incubation period of 96 hours at 37°C resulted in artificial caries-like lesions on the specimen. Readings of the specimen within the window after demineralization were recorded using DIAGNOdent for all the samples. The specimens were divided into three groups randomly [group I-casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), group II-customized dentifrice, group III-artificial saliva]. Samples were subjected to the daily treatment regimen for a period of 30 days. The samples were evaluated for remineralization by laser fluorescent device (DIAGNOdent) on the 15th and 30th day, respectively. RESULTS: The statistical analysis was done using the Friedman test, Kruskal-Wallis test, Wilcoxon sign rank test, and Mann-Whitney test. The results showed that both CPP-ACP and customized dentifrice showed almost similar remineralization potential but CPP-ACP showed significant remineralization (p < 0.001). CONCLUSION: The DIAGNOdent observation conclusively proves that CPP-ACP and customized dentifrice remineralizes the demineralized tooth samples in vitro with CPP-ACP showing significant remineralization. HOW TO CITE THIS ARTICLE: Arjun DS, Bhat SS, Hegde SK, et al. Comparative Evaluation of Two Remineralizing Agents on Artificial Carious Lesion Using DIAGNOdent. Int J Clin Pediatr Dent 2021;14(2):192-195.
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OBJECTIVE: Dilated common bile duct (CBD) (8-15 mm) with normal liver function tests is seen not infrequently, while management of such patients is ambiguous. We propose a treatment algorithm for this cohort of patients after observing them over a period of 8 years. METHODS: Seventy-eight such patients were managed from 2009 to 2017 and categorized as: Group A-dilated CBD with post-cholecystectomy status (n = 15); B-dilated CBD with cholelithiasis (n = 34); C-dilated CBD without cholelithiasis (n = 16); D-dilated CBD with no cause identified and underwent CBD excision (n = 13). Causes for CBD dilatation were evaluated. The outcome of patients in Group B + C without any cause (n = 33) was compared with Group D. RESULT: Median age, CBD diameter, bilirubin and alkaline phosphatase were 51 years (13-79), 10 mm (8-20), 0.6 mg/dl (0.2-2.5) and 126 IU (60-214), respectively. Group-A patients who did not manifest any cause of CBD dilatation were managed conservatively. The aetiology was identified in 17/50 patients in Group B & C [acute pancreatitis (n = 6), passed CBD calculi (n = 3), perivaterian diverticulum (n = 3), viral aetiology (n = 4) and tumour (n-1)]. In Group-C, 7 patients with no obvious cause underwent endoscopic sphincterotomy, pancreatoduodenectomy (n = 1), and the rest were managed conservatively (n = 8). There was no significant difference in the complication between Group B + C (without any cause) and Group D (3/33 vs. 1/13; p = 0.58) at a median follow-up of 72 months (30-90). CONCLUSION: Dilated CBD with normal LFT's without apparent cause is mostly benign and of no consequence. Excision of the CBD is not required for most of these patients.
Subject(s)
Gallstones , Pancreatitis , Acute Disease , Adolescent , Adult , Aged , Cholangiopancreatography, Endoscopic Retrograde , Common Bile Duct , Humans , Liver , Liver Function Tests , Middle Aged , Young AdultABSTRACT
BACKGROUND: Functional dyspepsia (FD) is a commonly encountered entity worldwide and is difficult to treat. Most of the treatment modalities have low-quality evidence for use, except for proton pump inhibitors. Aerobic exercise has been shown to improve the symptoms, but its direct effect on symptoms has never been studied. The objective was to study the effects of moderate aerobic exercise on symptoms of FD and to compare the effect of conventional treatment alone vs. exercise plus conventional treatment. METHODS: Out of 112 patients, 72 were randomly divided into controls (conventional treatment; n=36) and experimental (aerobic exercise for 30 min per session, 5 times a week for 6 weeks with conventional treatment; n=36) groups. Both the groups were assessed on day 1 and at the end of 6 weeks, using Glasgow Dyspepsia Severity Score (GDSS), Depression Anxiety Stress Scales-42 (DASS-42), and visual analogue scale (VAS). RESULTS: Pre-treatment GDSS, DASS-42, and VAS in the experimental group were significantly different as compared to the post-treatment scores (p=0.00019, p=0.0002, p=0.00019, respectively). Even in the control group, pre- and post-treatment GDSS, DASS-42, and VAS scores were significantly different (p=0.00019, p=0.0002, p=0.00019, respectively). However, on the head-to-head comparison of the 2 groups, scores at the end of 6 weeks were significantly different (p< 0.05), in favor of the experimental group. CONCLUSION: Aerobic exercise as an auxiliary therapy to conventional treatment has better outcomes in the functional well-being of dyspepsia.
Subject(s)
Dyspepsia , Dyspepsia/therapy , Exercise , Humans , Proton Pump Inhibitors , Quality of LifeABSTRACT
BACKGROUND: Dental caries is a chronic disease among children and pneumonia is often seen in young children. Soluble CD14 (sCD14) protein is released by monocytes and changes in periodontal infection. The study aimed to estimate the level of salivary sCD14 in children with early childhood caries in association with pneumonia. METHODS: This case-control study was conducted on 52 children aged between 2 to 5 years. A total of 17 children who were caries free, with no past systemic illness; 17 children with dental caries with no history of systemic illness or dental treatment for caries, and 18 children with caries and pneumonia were included in the control and test groups respectively. Unstimulated saliva of all children was collected. All samples were tested using a commercial available sCD14 ELISA kit. RESULTS: The sCD14 level was elevated in all three groups. One-way ANOVA was used to compare the mean level of sCD14 values between the groups. Control group had the highest mean sCD14 values (15070.99 ± 4296.44), followed by the caries group (13629.83 ± 5603.76) and pneumonia group (8566.86 ± 4778.81). There is a significant difference between the groups with p=0.001. CONCLUSION: Based on the results of the study, it can be concluded that sCD14 can be used as an indicator of the healthy functioning of the oral cavity.
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AIM: The aim of this study was to compare and evaluate the correlation of the facial measurements (interalar, intercommissural, intercanthal, and interpupillary distance) with the combined mesiodistal width of the maxillary anterior teeth between males and females. OBJECTIVES: The objectives of this study were: (a) To evaluate the correlation of the facial measurements (interalar, intercommissural, intercanthal, and interpupillary distance) and combined mesiodistal width of maxillary anterior teeth. (b) To compare the correlation of the facial measurements (interalar, intercommissural, intercanthal, and interpupillary distance) with the combined mesiodistal width of maxillary anterior teeth between males and females. MATERIALS AND METHODS: This study was carried out on 120 dentate Subjects selected from Yenepoya Dental College, Mangalore. The vernier caliper was used to measure the interalar, intercommissural, intercanthal, and interpupillary distance. The mesiodistal width of maxillary anterior teeth was measured on the cast. For accuracy, every distance was measured three times and the mean taken. RESULTS: Comparison of parameters between males and females was calculated using independent sample t-test. The values obtained for each variables are interalar distance: for males 38.89 ± 2.19 and for females 35.58 ± 2.33. Intercommissural distance: for males 50.96 ± 2.99 and for females 47.15 ± 2.97. Intercanthal distance: for males 31.92 ± 1.46 and for females 30.46 ± 2.07. Interpupillary distance: for males 65.15 ± 2.82 and for females 61.78 ± 3.18. Mesiodistal width of maxillary anterior teeth: for males 52.55 ± 1.82 and for females 51.33 ± 2.50. CONCLUSION: Within the limitations of this study, the study concluded there is a significant correlation between interalar, intercommissural, intercanthal, interpupillary distance, and mesiodistal width of maxillary anterior teeth in total subjects. In females, there is a significant correlation between interalar, intercanthal, interpupillary distance, and mesiodistal width of maxillary anterior teeth.
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AIM: The aim of this study is to assess the maternal risk factors and its relationship with early childhood caries (ECC) among preschoolchildren in Mangaluru city. METHODS: Children aged 3-5 years attending preschool (Anganwadi) and their mothers were included in the study. A total of 120 child-mother pairs participated in the study. The maternal risk factors were assessed by a pretested questionnaire. After obtaining the consent, the mother and their children were clinically examined for dental caries using the WHO criteria (1997). Results were analyzed using SPSS 18.0. RESULTS: Significant difference was found in mother's caries activity, high level of Streptococcus mutans, brushing frequency, diet of the mother, and their child's caries experience. CONCLUSION: A relationship between maternal risk factors and ECC is a result of a multifactorial and a comprehensive model that includes psychological and behavioral aspects. Caries prevention strategy should be that every child should receive oral care before age of one so that needful children can be instituted with preventive measures and their parents can be targeted for educational programs.
Subject(s)
Dental Caries/epidemiology , Mothers , Child, Preschool , DMF Index , Dental Caries/microbiology , Female , Humans , India/epidemiology , Male , Risk Factors , Saliva/microbiology , Streptococcus mutans/isolation & purification , Surveys and QuestionnairesABSTRACT
AIM: To compare the acidogenic potential of plain milk, milk with sugar, milk with cornflakes, and milk cornflakes with sugar by assessing the salivary pH. MATERIALS AND METHODS: The study was carried out on 40 school children of 8 to 12 years; 20 boys and 20 girls were randomly selected. The salivary pH was assessed before and after the consumption of milk; milk and sugar; milk and cornflakes; and milk, sugar, and cornflakes. Baseline unstimulated saliva was collected in sterile plastic tube and the pH was recorded. The change in the salivary pH from the respective groups after consuming the test meal was recorded as follows: (1) after 5 minutes; (2) after 10 minutes; (3) after 15 minutes; (4) after 30 minutes; (5) 120 minutes. Statistical analysis was done using Statistical Package for the Social Sciences 18.0 (SPSS). RESULTS: The average baseline salivary pH among all the groups was 7.26. A fall in pH at 5 minutes was seen in all the four groups. However, at different time intervals 5, 10, 15, 30, and 120 minutes, the pH values between the groups showed a significant difference at p < 00.7, 0.005, 0.001, 0.010, and 0.028 respectively. CONCLUSION: The fall in pH in all the groups was not significant to a limit of critical pH. Milk when added with sugar and/or cornflakes as a meal did not pose a threat as there was not significant decrease in pH. HOW TO CITE THIS ARTICLE: Bhat SS, Hegde SK, Bhat VS, Ramya KM, Jodalli PS. Acidogenic Potential of Plain Milk, Milk with Sugar, Milk with Cornflakes, and Milk Cornflakes with Sugar: A Comparative Study. Int J Clin Pediatr Dent 2016;9(3):218-221.
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INTRODUCTION: Advanced fertilization techniques like frozen embryo transfer (FET) and assisted reproductive technology have become popular and commonly used methods to treat patients suffering from infertility. Incidences of infertility are on a rise due to increased representation of females in the work place, delay in marriages, stress, and ignorance. METHODS: We performed this prospective therapeutic study to compare FET and fresh embryo transfer in the treatment of infertility in terms of conception rate, patient acceptance, complications, and patient's compliance. A prospective screening therapeutic study on 108 patients, from September 2013 to September 2014 in Karnataka, India, randomized the patients into 2 groups (n = 54), Group-I treated with day-3 FET while Group-II was treated with fresh embryo transfer, after performing ICSI. RESULTS: In 108 patients, 45 % patients were within 35 years of age, 35 % were in the age group 35-39. Significantly, 22 (40.75 %) patients treated with FET conceived (P = 0.022), whereas 16 (29.63 %) patients treated with fresh embryo transfer conceived (P = 0.59). DISCUSSION: There is limited published literature from the subcontinent, comparing techniques like FET and embryo transfers in the treatment of infertility. Awareness and economic reforms must be formulated in India to facilitate individuals facing infertility problems to conceive. CONCLUSION: FET has better and significant conception rates compared to fresh embryo transfers. FET shares an advantage of providing good quality embryos for future and subsequent implantations in cases of failure. Patient counseling and motivation play a pivotal role in the success of therapeutic procedure.
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Mesenteric fibromatosis is a part of the clinical-pathologic spectrum of deep fibromatoses. We report this rare case of primary mesenteric tumor that was diagnosed to be a mesenteric fibromatosis on histopathological examination. In majority of patients it may remain asymptomatic and the management of these tumors depends on histopathological examination. Postoperatively, patient was well and subsequent follow up showed normal recovery.
Subject(s)
Fibromatosis, Abdominal/pathology , Mesentery/pathology , Peritoneal Neoplasms/pathology , Diagnosis, Differential , Humans , Male , Middle Aged , Rare DiseasesABSTRACT
A rare case of extra medullary plasmacytoma (EMP) of thyroid gland in a 60 year old male, occurring against a background of Hashimoto's thyroiditis is reported. The fine needle aspiration cytology (FNAC) initially done as an outpatient procedure, showed atypical epithelial cells on a background of amyloid. Considering these findings we gave a diagnosis of medullary carcinoma. Histology of the total thyroidectomy specimen showed an extensive infiltration of neoplastic plasma cells against a background of Hashimoto's thyroiditis, with a bizarre Hurthle cell change. Immunohistochemistry on the histology sections confirmed the diagnosis of solitary plasmacytoma of thyroid against a background of Hashimoto's thyroiditis.
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Preservation of the pulp in a traumatized immature fractured incisor tooth is of prime importance in order to achieve apexogenesis, a natural apical closure. The main factor influencing this is pulpal protection by a bioactive material proving optimum marginal seal in preventing any microleakage. This case report presents an 8-year-old female diagnosed with Ellis Class 3 fracture of immature tooth 11 involving the mesial pulp horn. Under rubber dam isolation, a partial pulpotomy was performed and the pulp was sealed using a new bioactive material BIODENTINE to stimulate apexogenesis, dentine replacement and pulp protection. The fractured segment was reattached for optimum esthetics, which was a concern for the patient. The patient was followed-up for 1, 3, 6 and 12 months, which revealed continued apical closure and maintenance of pulp vitality. The patient remained asymptomatic. This case report provides evidence for the potential use of Biodentine as an effective pulp capping material in the future.
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Synovial sarcoma is a mesenchymal spindle cell tumor with variable epithelial differentiation. It is unrelated to the synovium as the name might suggest but arises in the soft tissues of the extremities around the knee joints and tendon sheaths. The tumor cells are thought to resemble normal synovial tissue histopathologically, hence named "synovial sarcoma" (SS). Head and neck lesions are less common and oral cavity involvement is extremely rare. Few cases in tongue, soft palate, mandible, buccal mucosa and floor of mouth have been described in the literature. Here, we probably report the first case of primary biphasic SS (BSS) involving gingiva in the retromolar area of the mandible in a 21-year-old male patient.
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We compared the duration of surgery, blood loss, and complications between patients in whom both uterine arteries were ligated at the beginning of total laparoscopic hysterectomy (TLH) and patients in whom ligation was done after cornual pedicle. Using a prospective study in a gynecologic laparoscopic center, a total of 52 women who underwent TLH from June 2013 to January 2014 were assigned into two groups. In group A, uterine arteries were ligated after the cornual pedicles as done conventionally. In group B, TLH was done by ligating both uterine arteries at the beginning of the procedure. All the other pedicles were desiccated using harmonic scalpel or bipolar diathermy. Uterus with cervix was removed vaginally or by morcellation. The indication for TLH was predominantly dysfunctional uterine bleeding and myomas in both groups. In group A, the average duration of surgery was 71 minutes, when compared to 60 minutes in group B (P < 0.001). In group A, the total blood loss was 70 mL, when compared to 43#x2009;mL in group B (P value < 0.001). There were no major complications in both groups. To conclude, prior uterine artery ligation at its origin during TLH reduces the blood loss and surgical duration as well as the complications during surgery.
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The study of gross specimens is an integral part in learning oral pathology. Unfortunately their storage and handling using traditional formalin is discouragingly difficult. This review describes an alternative approach called "plastination" to study and teach gross specimens using silicone polymers. The process is simple, inexpensive, and can be carried out in any histology laboratory to produce dry, odorless, durable, life-like, maintenance-free, and nonhazardous specimens. Unfortunately the process of plastination for oral specimens has received little attention since its invention. Therefore, an innovative attempt on oral specimens using locally available resin was tried by us. The specimens remained well preserved in dry state without any color change. We recommend this process for any oral pathology department for maintaining museum and for both undergraduate and postgraduate training.