Early evidence of implementation of District Residency Programme: experiences and challenges of residents in Rajasthan, India.

BACKGROUND: District Residency Programme (DRP) was introduced by National Medical Commission as mandatory three-months training program for postgraduate residents. The program was for the first time implemented in April 2023 in Rajasthan. However, it ran into several teething problems, especially for residents. With a lack of any precedence, this study was planned to explore experiences and challenges of residents posted in DRP. METHODS: Cross-sectional study was conducted at 12 DRP sites attached to SMS Medical College, Jaipur between August-October 2023. A self-administered questionnaire was used to collect information from residents who had completed DRP. Questions were scored on a five-point Likert scale. Mann-Whitney U test and Kruskal-Wallis H test was used to show association. RESULTS: Only around 17% residents felt that the learning objectives of DRP were fulfilled and nearly 60% residents felt isolated from academic activities and parent department. Over half of the residents were never posted with their concerned specialty services. Around four-fifth residents felt concerned about safety at least sometimes and more than three-fourth residents were dissatisfied with basic amenities. Kruskal-Wallis and Mann-Whitney tests showed significant association of gender and specialisation strata with multiple outcome variables. CONCLUSION: The study finds high degree of dissatisfaction among residents towards learning objectives, academic learning, and basic amenities during DRP. There was also a clear lack of specialty-exposure and high concerns of safety, especially for female residents. The study findings should alarm and inform policymakers and administrators to improve DRP implementation so as to better achieve laid objectives.

Comparison of USG-Guided Supraclavicular Brachial Plexus Block by Single-Point Versus Multiple-Point Injection Technique: A Prospective Randomized Trial.

Background This study investigated the success rate of ultrasonography (USG)-guided supraclavicular block using a single-point injection technique comparing it with multiple-point injection technique, in terms of nerve sparing, time taken to perform the procedure, time taken to onset of sensory and motor block. Materials and methods A total of 204 patients of American Society of Anesthesiologists (ASA) Status I and II, aged 18-60 years, with body mass index (BMI) ≤30 kg/m2, posted for upper limb surgeries were given USG-guided supraclavicular brachial plexus block with 15 mL of 0.5% Ropivacaine. The patients were randomly divided into group A (single-point injection) and group B (multiple-point injection), using an out-of-plane technique. Sensory and motor block was assessed for onset and maximum grade achieved, by using pinprick, cold, touch, and movement respectively. The efficacy of the block was tested by assessment in the territories of musculocutaneous, ulnar, radial, median, axillary, and intercostobrachial nerves. Procedural time was calculated from the insertion of the needle till the complete injection of the drug. Results Patients in both groups were comparable in terms of demography and ASA status. The success rate for group A was 60.8%, compared to 98% in group B. In group B, the intercostobrachial nerve was most commonly spared (7.84%), followed by ulnar (1.96%), and radial (0.98%). On the other hand, in group A, the most frequently spared nerves were ulnar and intercostobrachial (23.5% each), followed by radial (12.7%), axillary (10.8%), musculocutaneous (7.8%), and median nerves (6.9%). The onset of sensory and motor block was similar in both groups. The procedure time was longer in the multiple-point group. Conclusion Our observations suggest that nerve sparing is much lesser in the multiple-point injection technique used for USG-guided supraclavicular block. In a good number of patients using this technique, the intercostobrachial nerve gets blocked.

Prevalence, Patterns, and Predictors of Tobacco Consumption among Adolescents: An Observational Study from a Rural area of Rajasthan.

Background: The prevalence of smoking cigarettes among adolescents in India is nearly one in 10, and almost half of them initiate tobacco use before turning 10 years old. Our study objective was to assess the prevalence of tobacco consumption and the sociodemographic factors associated with tobacco consumption among adolescents in a rural area of Rajasthan. Materials and Methods: This community-based, cross-sectional study was conducted for a period of 1 year from April 2021 to March 2022 in village Naila, Jaipur. All 1083 adolescents of village Naila were contacted; however, 1049 were included in the study. Multivariate logistic regression (forward likelihood model) was used to assess the strength of the association of risk factors for the consumption of tobacco. Results: A considerable proportion, that is, 22.4% (235/1049), of adolescents were tobacco consumers. Out of 235 consumers, 104 were smokers, 65 were consuming smokeless tobacco, and 66 were consuming both forms of tobacco. In multivariate analysis, age, sex, grade of participants, pocket money, family history of tobacco and alcohol consumption, maternal education, and per capita income were found to be significant predictors of tobacco consumption (P < 0.05). Conclusion: Tobacco consumption is highly common in Rajasthan's rural adolescent population, and it begins at a very young age. Hence, corrective measures need to be initiated in an early stage of life. To reduce the impact of social norms, peer pressure, and family members who consume tobacco, the behavioral change communication activities must be strengthened.

Mineral Trioxide Aggregate as an Apexogenesis Agent for Complicated Crown Fractures in Young Permanent Incisor.

Traumatic dental injuries are extremely common in children, and trauma to developing permanent teeth can disrupt root maturation; vital pulp therapy is an appropriate treatment for these teeth. This case report describes a 9-year-old boy who suffered dental trauma while playing football, resulting in an enamel-dentin fracture with pulp exposure in the left central incisor with an open apex (Cvek's stage 3) and an enamel-dentin fracture in the right central incisor with an open apex (Cvek's stage 3). Apexogenesis with mineral trioxide aggregate was performed to preserve the neurovascular bundle, allowing normal radicular formation in the left central incisor. During a 2-year follow-up, the tooth showed no signs and symptoms, and radiographic examinations revealed no evidence of radiolucent lesions in the periapical region. This case study provides compelling evidence that the utilization of the described agent yields significant efficacy in treating traumatic fractures accompanied by pulp exposure.

Assessment of National Program for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS): An observational study in rural Jaipur, Rajasthan.

Introduction: Non-communicable diseases (NCDs) are increasing in trend and associated with modifiable risk factors and subsequently reducing physical activity; hence the Government of India (GOI) has launched a National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in 2010 to curb increasing prevalence. The present study was planned for assessment of the activities conducted under NPCDCS in rural Jaipur. Methods and Material: This observational study was conducted in rural Jaipur. NPCDCS reports, status of logistics and manpower were assessed for 1 year. Field level cross-checking survey was done to assess the gap between the actual screening work done and the work reported. All staffs were assessed for the level of awareness regarding NCDs as well as NPCDCS programs. Data were entered and analysed in Microsoft excel. Result: Around 48% (6674/13917) of persons >30 years were screened during 1 year study period. Around 51.5% of the screened persons had one or more NCDs (13.5% newly screened NCDs cases and 38% were prediagnosed of NCD cases). Status reports that 10 (83.33%) out of the total 12 expected reports were sent regularly on a monthly basis. Reason for not sending reports was a sudden lockdown due to COVID-19. Conclusion: The study concludes that the implementation of NPCDCS program activities is not in synch with the health staff awareness level. IEC activities were deficient and no work was done for adoption of behavioural change and healthy lifestyle. Actual cases of hypertension were more while cases of diabetes were less than the reported cases found on cross-check survey.

Prediction of the functional and radiological outcome on the basis of independent factors with special emphasis on the use of 3D printed models in craniovertebral junction surgery.

Background: The aim of the study was to evaluate the advantage of performing planned surgery using customized three-dimensional (3D) printed models versus performing surgery without using 3D printed models in patients with craniovertebral junction (CVJ) anomalies and traumatic CVJ fractures and dislocations. Methods: Forty-two patients with CVJ anomalies, who were planned for operative intervention in the Department of Neurosurgery at SMS Hospital from March 2019 to February 2021, were randomly divided into two groups and analyzed. First group was operated after rehearsal on a customized 3D printed model whereas the second group underwent operative intervention without the rehearsal of surgery on the 3D printed model. Results: Forty-two patients were enrolled for the study. Twenty-five of these patients had developmental CVJ anomalies, 16 had post traumatic Atlantoaxial dislocation (AAD), and one had congenital AAD. Twenty-three patients underwent surgical intervention using 3D printed models and 19 without using 3D printed models. The outcome in the two groups was compared using modified Japanese orthopedic association score (mJOA), recovery rate, incidence of complications such as screw malposition, postoperative neurological deterioration, vertebral artery (VA) injury, and radiological improvement based on Atlanto-Dental interval, the distance of the tip of dens from Wackhenheims clivus canal line, and the distance of tip of dens from the Chamberlain's line. The improvement in mJOA score postoperatively was found to be statistically significant in study group (P < 0.001) as compared to control group (P = 0.06). Recovery rate was better in study group than in control group (P = 0.023). In study group, the incidence of screw malposition and VA injury was lower than control group. Three patients deteriorated neurologically postoperatively in the control group and none in the study group. The average improvements in the radiological parameters were found to be better in study group as compared to control group postoperatively. Conclusion: The authors conclude that 3D printed models are extremely helpful in analyzing joints and VA anatomy preoperatively and are helpful in unmasking any abnormal bony and vascular anatomy effectively, making the surgeon confident about the placement of the screws intraoperatively. These 3D models help in intraoperative error minimization with better neurological outcomes in postoperative period. In our opinion, these models should be included as a basic investigation tool in patients of CVJ abnormalities. The models also offer other advantages such as preoperative simulation, teaching modules, and patient education.

Picture exchange communication system as a behavior modification technique for oral health assessment in autistic children.

OBJECTIVE: The aim of this study was to establish a modality for behavioral intervention for dental management in autistic children using Picture Exchange Communication System (PECS). STUDY DESIGN: A prospective interventional study was carried out on 30 autistic children in the age range of 4-18 years diagnosed with mild to moderate grades of autism to evaluate the effectiveness of PECS in improving oral health over a period of 6 months. RESULTS: PECS Phases showed a gradual rise from first to third visit, which was statistically highly significant (p < 0.001). Oral Hygiene Index-Simplified (OHI-S) scores improved significantly from first visit and second visit. Definitely substantial correlation was seen between PECS and OHI-S. CONCLUSION: Gradual decrease was observed in OHI-S scores over a period of 6 months, indicating an improvement in the oral hygiene status of autistic children. Gradual progress in Phases of PECS proved to increase cognitive ability of autistic children towards understanding the dental setup related PECS cards.

Effect of Addition of Incipient Carious Lesions in Caries Diagnostic Criteria on Prevalence of Caries in North Indian Preschool Children of East Lucknow Region.

AIM AND OBJECTIVE: To investigate the effect of the addition of incipient carious lesions into the WHO caries index on the prevalence of caries in preschoolers of East Lucknow city. STUDY DESIGN: A cross-sectional observational study was conducted on 530 participants in the age-group of 3-6 years. MATERIALS AND METHODS: The participants were randomly selected from nursery schools of the East Lucknow region. The dental caries status was assessed according to WHO and Ekstrand's criteria. In addition, the prevalence of cavitated and incipient carious lesions was also evaluated. The data were then subjected to statistical analysis. STATISTICS: Chi-square test and Wilcoxon signed-rank test were performed to carry out statistical analysis. p value < 0.005 was taken as statistically significant. RESULTS: Out of 530 participants examined, caries prevalence by WHO and Ekstrand's criteria was (36.8%) and (57.4%), respectively. The mean dmft values according to WHO criteria and Ekstrand's criteria were 1.16 and 1.60, respectively. The prevalence of cavitated carious lesions was higher (66.27%) when compared with that of incipient carious lesions (33.73%). CONCLUSION: A significant number of incipient carious lesions observed in the present study is an indication to include these lesions in caries diagnostic criteria. This would help in determining the exact prevalence of caries and aid in implementing proper preventive protocols for remineralization of incipient carious lesions. HOW TO CITE THIS ARTICLE: Asad F, Singh N, Rathore M, et al. Effect of Addition of Incipient Carious Lesions in Caries Diagnostic Criteria on Prevalence of Caries in North Indian Preschool Children of East Lucknow Region. Int J Clin Pediatr Dent 2021;14(5):644-647.

Prevalence of Malocclusion and Orthodontic Treatment Needs in Primary and Mixed Dentition Using Baby Roma Index and Index of Orthodontic Treatment Needs.

AIM AND OBJECTIVE: To find the prevalence of malocclusion and orthodontic treatment need in children of East Lucknow city. MATERIALS AND METHODS: The present study was conducted in the Department of Pedodontic and Preventive Dentistry, Babu Banarasi Das College of Dental Sciences, Lucknow. The nursery and primary schools of East Lucknow were included in the study. Baby-ROMA Index and Index of Orthodontic Treatment Needs (IOTN) were tested on 400 children, which were divided into two groups of 200 in each group, referred from the Out Patient Department and school camps. A single operator who was trained and calibrated for the use of indices evaluated children. RESULTS: Intra-reliability test showed higher reproducibility of the index. It is shown that around 70% of the patient presented malocclusion from both indices. CONCLUSION: Baby-ROMA Index and IOTN were helpful to assess the severity of malocclusion and the timing for orthodontic malocclusion in young patients (primary and mixed dentition). HOW TO CITE THIS ARTICLE: Singh A, Rathore M, Govil S, et al. Prevalence of Malocclusion and Orthodontic Treatment Needs in Primary and Mixed Dentition Using Baby Roma Index and Index of Orthodontic Treatment Needs. Int J Clin Pediatr Dent 2021;14(S-1):S22-S28.

Impact of early childhood caries on quality of life: Child and parent perspectives.

BACKGROUND: The aim of present study was to examine early childhood caries' impact on oral health-related quality of life from children's self report and parental perception. METHODS: 200 healthy children in the age group of 3-5 years and their parents/guardians were enrolled in the study. 100 children diagnosed with early childhood caries (interventional group) and 100 children without caries (control group) along with their parents/guardians participated in face to face interview and responded to Michigan oral health related quality of life scale - child and parent version. Four weeks after full mouth rehabilitation children with ECC and their parents responded to a survey for a follow-up assessment. Data was analyzed and evaluated using Statistical Package for Social Sciences Version 21.0 statistical software and Chi square test. RESULTS: In our study we have found that ECC subjects had poorer oral health-related quality of life compared to caries free subjects. Further one month follow up after complete treatment, the oral health-related QoL improved significantly in ECC children. CONCLUSIONS: Early childhood caries has a definite negative impact on the OHRQoL of children. At one month follow up after complete oral rehabilitation, the quality of life improved significanty as assessed by children's self reports as well as parental perceptions of their child's OHRQoL.

A Crossover Study Evaluating Effect of Timing of Levothyroxine on Thyroid Hormone Status in Patients of Hypothyroidism.

OBJECTIVE: Current literature shows a definite benefit of fasting state Levothyroxine administration. However, superiority of any specific timing is not yet established. Our study was designed to compare the effect of timing of levothyroxine administration, morning versus evening dose, on thyroid profile control in patients of hypothyroidism. METHODOLOGY: :A randomized double-blind crossover study was performed on 60 patients with primary hypothyroidism, euthyroid on stable levothyroxine regime of 100 µg daily, randomized into two sequence groups, morning dose first (AB sequence) versus evening dose first (BA sequence) with switch over after 6 weeks. Primary endpoints were change in thyroid function tests. RESULTS: There was an insignificant rise in TSH in morning dose first group (AB) at 6 weeks which reduced significantly in evening dose, [2.36(1.11) to 2.45(1.19) mIU/L (p=0.56)], [2.07(0.99) (p=0.006)] respectively. Levothyroxine evening dose first group (BA) showed significant reduction of TSH levels at 6 weeks followed by non significant increase [2.63(0.96) to 1.85(1.35) mIU/L, (p=0.002)], [2.14(1.16), (p=0.15)]. Group AB showed mild followed by significant rise in FT4 at 6 and 12 weeks respectively, [1.06(0.30) to 1.14(0.33) ng/dl (p=0.18)], [1.24(0.36) (p=0.008)]. FT4 of BA sequence significantly increased at 6 weeks followed by mild increase, [1.10(0.29) to 1.20(0.28) ng/dl (p=0.01)] [1.23(0.31) ng/dl (p=0.58)]. FT3 of AB revealed initial reduction (p=0.87), followed by significant rise (p=0.02). Group BA showed a significant rise (p=0.04) in FT3 followed by fall (p=0.63). CONCLUSION: Bedtime dosing of Levothyroxine showed improved thyroid hormone status control and could be a viable option in treatment of patients with hypothyroidism.

Prevalence, Demographic Profile, and Psychological Aspects of Epilepsy in North-Western India: A Community-Based Observational Study.

AIMS: This study was undertaken to determine the prevalence of active epilepsy, assess the sociodemographic profile, and psychological aspects of epilepsy in the Jaipur district of Rajasthan, India. METHODS: We conducted a community-based, cross-sectional observational study covering both rural (n = 165,660) and urban (n = 179,142) populations of Jaipur district using a house-to-house survey. An adapted, pre-designed World Health Organization screening questionnaire was used to identify the cases. Those confirmed by neurologists as true seizures were included in the study. Cases were classified as per the International League against Epilepsy recommendation. Global Mental Health Assessment Tool electronic questionnaire was used to analyze psychological aspects of cases. The caregivers of the patients participated in the knowledge, attitude, and practice (KAP) survey. RESULTS: A total of 380 patients (258 men, 122 women) were identified with active epilepsy. The estimated prevalence of active epilepsy was 1.1/1,000 population and 71% of cases belonged to low socioeconomic classes. Primary treatment gap was documented in 18.8% of cases in our study, 38% of cases were non-compliant to treatment with poorer compliance in those on pol-therapy, 76% had some psychiatric disorder, anxiety and depression being the commonest, and positive family history of epilepsy was found in 4.7%. KAP survey revealed that only 15% of the respondents believed that epilepsy is non-curable, 74% denied its infectious nature, 26% believed that epilepsy occurs due to past sins, and 81% said that they would not marry persons with epilepsy. CONCLUSION: A relatively low prevalence (1.1/1,000) of active epilepsy and a smaller primary treatment gap (18.8%) was found in our study population. Almost three-fourth of cases had an associated psychological problem, Though caregivers were aware of the nature of disease, majority would not prefer to marry a person suffering from epilepsy.

Comparative Evaluation of Electronic Apex Locators and Radiovisiography for Working Length Determination in Primary Teeth in vivo.

AIMS: The aim of this study was to evaluate the effectiveness of two different varieties of electronic apex locators and radiovisiography (RVG) for working length determination in primary teeth. MATERIALS AND METHODS: A total of 30 primary teeth indicated for pulpectomy in children aged 3 to 8 years were randomly selected and subjected to working length determination using two varieties of electronic apex locators and RVG separately. The data were then subjected to statistical analysis. RESULTS: A very strong correlation between electronic measurement methods and RVG length was observed. CONCLUSION: Radiovisiography and apex locators are equally effective in determining working length in primary teeth. How to cite this article: Abdullah A, Singh N, Rathore MS, Tandon S, Rajkumar B. Comparative Evaluation of Electronic Apex Locators and Radiovisiography for Working Length Determination in Primary Teeth in vivo. Int J Clin Pediatr Dent 2016;9(2):118-123.

Antimicrobial Efficacy of Probiotic and Herbal Oral Rinses against Candida albicans in Children: A Randomized Clinical Trial.

BACKGROUND: A growing number of dentists are embracing the philosophy that natural agents are better for children's oral health. Knowledge of probiotics on host immune system has entered a new phase of research, and progression in this field is likely to offer novel means by modulating host immunity for prevention and treatment of a wide variety of oral diseases. AIM: To compare the antimicrobial efficacy of probiotics in reducing salivary Candida albicans counts with commonly used antimicrobial agents like 0.2% chlorhexidine and herbal rinse. MATERIALS AND METHODS: A randomized clinical trial was conducted on 60 subjects aged between 6 and 14 years, for a period of 9 months. The subjects were randomly divided into three groups comprising 20 subjects in each group. Three oral agents were administered twice daily for a maximum period of 1 week. Candida albicans counts were recorded before and after intervention and the results were submitted for statistical analysis using Statistical Package for the Social Sciences (SPSS) version 15.0 software. RESULTS: The change in mean log10 colony-forming unit (CFU)/ ml of C. albicans in groups A to C was 0.43 ± 0.72, 0.68 ± 1.05 and 0.22 ± 0.66 CFU/ml respectively. CONCLUSION: Data obtained from the study demonstrated that probiotic rinse was equally effective as 0.2% chlorhexidine digluconate rinse in reducing C. albicans counts after 1 week of intervention. Herbal oral rinse was least effective. Probiotic oral rinses have opened new horizons in improvement of oral health by maintaining healthy ecosystem. However, a longitudinal study with larger sample size needs to be undertaken to evaluate the therapeutic effects of probiotics and herbal agents. How to cite this article: Mishra R, Tandon S, Rathore M, Banerjee M. Antimicrobial Efficacy of Probiotic and Herbal Oral Rinses against Candida albicans in Children: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2016;9(1):25-30.

Clinical performance of ICDAS II, radiovisiography, and alternating current impedance spectroscopy device for the detection and assessment of occlusal caries in primary molars.

OBJECTIVE: To investigate the clinical performance of International Caries Detection and Assessment System II (ICDAS II) (a ranked visual scale), radiovisiography (RVG) (a digital radiography device), and an alternating current impedance spectroscopy (ACIS) device for the detection and assessment of occlusal caries in primary teeth. MATERIALS AND METHODS: Twenty-five molars were assessed using all three systems under standardized in vivo conditions. They were then extracted and also assessed by examiners in vitro. Downer's histological scoring criterion was the validation gold standard. Sensitivity, specificity, positive and negative likelihood ratios, and area under the receiver-operator curves were calculated for enamel caries and dentine caries. Repeatability was analyzed using intraclass correlation coefficient (ICC). The performances of the systems between in vivo and in vitro settings by the same examiner were also compared. STATISTICAL ANALYSIS: SPSS version 17.0 (SPSS Inc., Chicago, IL, USA) was used to analyze the data. Comparison of the performance of all three systems for all caries and dentine caries using receiver operating characteristic curves was calculated using a range of cutoffs. Reliability was assessed using ICC method. RESULTS: ICDAS II system showed the highest validity and repeatability for assessing occlusal caries in the primary molars. RVG was less accurate than the ICDAS II for detecting caries lesions confined to enamel. However, when dentine was involved, RVG was found to be as effective as ICDAS II. CONCLUSION: Within the limitations of the study, the in vivo results of ICDAS II and RVG were satisfactory and comparable to those obtained in vitro, with ICDAS II performing better. The ACIS device was least accurate among the three systems for caries assessment.

Prediction of Angiographic Extent of Coronary Artery Disease on the Basis of Clinical Risk Scores in Patients of Unstable Angina.

BACKGROUND: The correlation of clinical risk predictors and clinical risk scores: Thrombolysis in Myocardial Infarction (TIMI), Platelet Glycoprotein IIb-IIIa in Unstable Angina, Receptor Suppression Using Integrilin Therapy (PURSUIT) and Global Registry of Acute Coronary Events (GRACE) scores in Unstable Angina with angiographic extent of Coronary Artery Disease (CAD) is not known. AIM: To know the correlation of clinical risk scores with angiographic extent of coronary artery disease. MATERIALS AND METHODS: This was a hospital based single centre, cross-sectional, observational, descriptive study conducted at a tertiary care teaching institute. One hundred and sixty patients with acute unstable angina were evaluated for presence of 9 clinical predictors and their 3 risk scores were calculated. All patients underwent coronary angiography. Correlation with Modified Gensini score and percentage stenosis in culprit artery was done. STATISTICAL ANALYSIS: Data were summarized in the form of Mean, Standard Deviation and Proportions. Multiple linear regressions, Student's t-test and Pearson's coefficient 'r' were also used. RESULTS: Use of aspirin, age >= 65 years & presence of Congestive Heart Failure (CHF) were stronger predictors of Modified Gensini score. Presence of elevated enzymes and age >65 years were more significant predictors of percentage stenosis of culprit artery. GRACE score had better correlation with Modified Gensini score, PURSUIT score had more correlation with percentage stenosis in culprit artery. CONCLUSION: Use of Aspirin, age >= 65 years, presence of CHF and presence of elevated enzymes are stronger predictors of extent of CAD. Hence we recommend that these factors be given more importance. GRACE and PURSUIT risk scores had more correlation with angiographic extent of CAD.

Profiling the Mortality due to Influenza A (H1N1) pdm09 at a Tertiary Care Hospital in Jaipur during the Current Season--January & February 2015.

BACKGROUND: The onset of winter of 2014-2015 saw an alarming spurt in influenza A (H1N1) pdm 09 leading to a significant mortality. Rajasthan was one of the foremost affected state bearing the frontal attack in which majority of deaths occurred early and in the young. OBJECTIVE: To sketch out the mortality profile with respect to demographic and clinical progression with an aim to identify the groups, this virus conspicuously picked up with a perspective to control some of the avoidable factors. METHODS: We analyzed the epidemiological data in 76 RT-PCR confirmed deaths of H1N1 patients that occurred between 1st January 2015 and 28 February 2015 over a period of 59 days at SMS Medical College Hospital, Jaipur. RESULTS: A total of 412 patients got hospitalized during two months period from 1st January 2015 to 28th February 2015, out of which 76 fatal cases presenting with category C symptoms along with radiological evidence of bilateral pneumonia were analyzed. 48.6% deaths occurred in the 18-40 years of age group. The mean age being 44.01 ± 15.07 years. Females had a marginally increased mortality rate (F: M-1.23:1). The mean time of onset of symptoms to hospitalization was 6.79 ± 4.63 days. Fifty-one (67.1% 0) patients were from urban areas, whereas 25 (32.89%) belonged to rural areas. Only 7.83% patients presented within 24 - 48 hours whereas 46% presented within 5 days of onset of symptoms. 66.9% succumbed within 5 days of hospitalization, despite of starting Oseltamivir in a dose of 150 mg/bd on the day of admission. 64.5% had predisposing risk factors. Bilateral pneumonia was observed in all the 76 patients, septicemia in 21.12%, MODS in 30.26% and AKI in 9.21%. CONCLUSIONS: The in-hospital mortality of 17.79% despite of starting Oseltamivir has raised concern about identifying the so called "Rapid Progressors" [66.9% succumbing within 5 days of hospitalization]. As a corollary of this analysis the authors are of the opinion that a rejig of the existing guidelines to identify and treat influenza like illness be made available at the national level. What factors promote rapid progression especially in a group without any predisposing risk condition should form the focus of future studies. As risk group individuals formed a major chunk of deaths, the need to vaccinate this group should form a scaffold on which future directions and interventions have to be built up to combat the morbidity and mortality.

Mean platelet volume in patients with acute coronary syndromes: a supportive diagnostic predictor.

BACKGROUND: Platelets and their activity have a crucial role in acute coronary events. Larger platelets are enzymatically and metabolically more active and have a higher potential thrombotic ability as compared with smaller platelets. OBJECTIVES: The aim of this study is to investigate whether there is an association between mean platelet volume (MPV) measurement and cardiac Troponin I( cTn I ) in patients admitted with a suspected diagnosis of ACS and to assess the potential diagnostic efficiency of MPV in the diagnostic workup for ACS. MATERIALS AND METHODS: After thorough evaluation of 215 eligible patients, 3 ml. Venous blood collected using Becton, Dickinson and company vacutainer and MPV measured within 1-2 hr of sample collection. Sample for cTn I collected at 6 hr and at 12 hrs, if required and level measured using Biosite analyzer. RESULTS: Mean platelet volume (MPV) was found to be higher among ACS patients as compared to non ACS, 11.44±1.23 vs 9.91±1.27 fl (p-value<0.001). The NPV of MPV in the diagnostic workup of chest pain suggestive of ACS within 6 hours of presentation were found to be 82.53% . CONCLUSION: In this study the MPV is significantly higher in patients with ACS than in those with chest pain of non-cardiac origin and its negative predictive value of 82.53%, it might be useful as an assisting rule-out test in conjunction with other markers in the early prediction of the risk of ACS.

Antimicrobial and plaque inhibitory potential of herbal and probiotic oral rinses in children: a randomized clinical trial.

BACKGROUND: Antimicrobial agents serve as an effective adjunct with mechanical means in plaque control. Chlorhexidine has been the gold standard in the field of dentistry, but these days a growing number of dentists are embracing the philosophy that natural agents are better for children's oral health, and the focus is shifted toward biogenic agents for oral hygiene maintenance in children. AIM: The aim was to evaluate antimicrobial and plaque inhibitory potential of herbal and probiotic rinses against Streptococcus viridans with commonly used antimicrobial agent like 0.2% chlorhexidine digluconate. MATERIALS AND METHODS: A randomized clinical trial was conducted on 60 subjects aged between 6 and 14 years and were divided into three groups comprising 20 subjects in each group. Three oral rinses were administered twice daily for a period of 1 week. Estimation of plaque scores and S. viridans counts was done before and after intervention, and the results were statistically analyzed. RESULTS: The change in mean plaque index in Groups A, B, and C was 0.28 ± 0.16, 1.37 ± 0.43, and 0.60 ± 0.35 respectively. Furthermore, change in mean log 10 colony forming unit (CFU)/ml of S. viridans in Groups A, B, and C was 0.13 ± 0.06, 0.53 ± 0.17, and 0.22 ± 0.06 CFU/ml, respectively. CONCLUSION: Based on observations done during the course of study herbal rinse proved equally effective as 0.2% chlorhexidine digluconate in reducing S. viridans counts and plaque accumulation after 1 week of intervention, whereas probiotic rinse was least effective. However, long-term clinical trial with larger sample size needs to be undertaken, especially to evaluate beneficial effects of biogenic agents such as herbal and probiotic rinses.