Health & Allied Sciences

Social support and household disaster evacuation readiness in a flood-affected rural village in Tamil Nadu, South India Venkatesh Ashok, Bijaya Nanda Naik, Ravi Philip Rajkumar, KC Premarajan International Journal of Health & Allied Sciences 2019 8(2):77-82 OBJECTIVE: To assess the social support and household disaster evacuation readiness among flood-affected households in a rural village of Tamil Nadu. METHODS: We conducted this cross-sectional analytical study in the flood-affected Koonimedu village of Villupuram District, Tamil Nadu, 8 months after the flood. One adult member (age >18 years) from each of the flood-affected households was included and interviewed face to face at his/her house. Information on sociodemographic details, loss of property, and household evacuation readiness plan was obtained using a semistructured pretested questionnaire. Social support was measured using the Crisis Support Scale (CSS). RESULTS: Nearly 60% of the households were still waiting for government assistance for house repair. Less than a quarter of households reported adequate social support. Availability of people to listen to them, able to discuss their thoughts and feelings, and contact with people in similar situations showed improvement after 8 months of flood. CSS score on feeling letdown showed a significant increase 8 months after the flood. Although all the households were ready to evacuate if flood recurs, none have undergone training on disaster preparedness. Majority of the households reported to secure ration card first during evacuation. CONCLUSION: The level of adequate social support during flood as well as 8 months after the flood was low among the study population. Although all households have their own disaster evacuation plan, none have been given information and training on disaster preparedness.

Feasibility of endoscopic dacryocystorhinostomy in patients with coexistent atrophic rhinitis and chronic dacryocystitis Satvinder Singh Bakshi International Journal of Health & Allied Sciences 2019 8(2):83-86 AIM: Atrophic rhinitis and chronic dacryocystitis are common in India. Sometimes, both of these conditions coexist. Conventionally, these patients are operated by external approach; however, we endeavor to prove the efficacy of the endoscopic approach in these patients. MATERIALS AND METHODS: Six patients with atrophic rhinitis and chronic dacryocystitis were seen by the authors over a period of 2 years. They were treated preoperatively for atrophic rhinitis for 6–8 weeks, following which they were operated by endoscopic approach. RESULTS: A total of ten eyes were operated, two of which required revision surgery, which was also operated by the endoscopic approach. The operative time and blood loss were comparable to those of normal patients; however, there was increased crusting and delayed wound healing, requiring prolonged follow-up. CONCLUSION: Meticulous preoperative preparation and regular postoperative follow-up help improve the results of endoscopic dacryocystorhinostomy in patients with atrophic rhinitis.

Sociodemographic determinants of substance use among school-going adolescents in Delhi, India T Varun Kumar International Journal of Health & Allied Sciences 2019 8(2):87-91 BACKGROUND: Adolescents experience a rapid physical and emotional growth. Conflicting and influential cultural messages account for the unique nature of their health concerns. Recent studies have found an increased use of substance among adolescents, and the present study is designed to find the socioeconomic determinants of substance use among adolescents in Delhi, India. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted using a self-administered questionnaire adapted from the Global Youth Tobacco Survey among school-going adolescents from February 2017 to September 2017 in Delhi, India. All the students studying in classes 11 and 12 were included in the study. RESULTS: The study found that the prevalence of ever smokers and current smokers was 16.4% and 13.1%, respectively. Alcohol consumption was found in 12.5% of the study participants. Approximately 1.1% and 0.4% of the study participants reported using hashish and solvent, respectively. All forms of substance use were found to be significantly more among male adolescents (P = 0.000). CONCLUSION: The prevalence of substance use was high among school-going adolescents in Delhi, and there is an urgent need to take effective steps in curbing this problem.

Stress assessment of mandibular incisor intrusion during initial leveling in continuous arch system with different archwire shapes of superelastic nickel-titanium: A three-dimensional finite element study Pornpat Theerasopon, Weerachai Kosuwan, Chairat Charoemratrote International Journal of Health & Allied Sciences 2019 8(2):92-97 INTRODUCTION: Orthodontic leveling of mandibular teeth with deep curve of Spee usually creates an intrusive force on mandibular incisors with labial tipping. After placing an archwire, a deactivation force causes tooth movement within the periodontal space which induces the first step and is the first signal for further remodeling processes. This study aimed to investigate stress distribution and types of mandibular incisor movement after initial leveling with different nickel-titanium (Ni-Ti) archwires using finite element analysis. MATERIALS AND METHODS: A three-dimensional finite element model of well-aligned mandibular teeth with a deep curve of Spee was created to investigate intrusive force on mandibular incisors within the periodontal ligament (PDL) space. Round, square, and rectangular superelastic Ni-Ti archwires of 0.016” in height were tested to compare stress magnitude and the pattern of distribution on the root surface and PDL as well as the pattern of tooth displacement between the archwires. RESULTS: Intrusive force by an archwire within the PDL space caused the highest stress at both labial and lingual cervical roots, but much higher stress was found at the labial than the lingual cervical roots. The highest labial stress was more cervical than lingual in all models. Round wires showed much higher stress than either square- or rectangular-shaped archwires. Displacement in the labial direction of round wires moved the farthest, whereas square and rectangular wires showed less labial displacement. CONCLUSIONS: Lower incisor intrusion with round wires produced more stress at the labial cervical root and tipped more labially compared to square and rectangular archwires.

Assessment of Rasa dusti lakshanas among patients with polycystic ovarian disease Rajani Kulkarni, M Subash Chandra Bose, DT Usha International Journal of Health & Allied Sciences 2019 8(2):98-102 BACKGROUND: Rasadushti doashas can predispose a patient to metabolic disorders such as polycystic ovarian disease (PCOD). Hence, it is important to screen patients of PCOD with Rasa dusti lakshanas in routine clinical checkups. This study conducted to assess the presence of Rasa dusti lakshanas in PCOD. METHODS: This cross-sectional hospital-based study was conducted among fifty consecutive previously diagnosed patients with PCOD attending JSS Ayurveda Hospital from January to December 2017. After obtaining written informed consent, the data on demographic details, duration of PCOD, prognosis of disease, and rasa dushti lakshanas were collected in a pretested structured questionnaire by interview technique. RESULTS: Among the fifty patients with PCOD included in the present study, majority belonging to 21–25 years' (44%) age group and majority 15 (30%) were obese Category II. It was observed that, as the Rasa dusti nidana scores increase, there was also increase in the Rasa dusti lakshanas among patients with PCOD. This correlation was found to be strong and statistically significant (r = 0.764, P < 0.05). As the Rasa dusti lakshana scores increase, there was also increase in the clinical signs and symptoms of PCOD among the study patients. This correlation was found to be strong and statistically significant (r = 0.631, P < 0.05). CONCLUSION: The present study has revealed that Rasa dusti nidana was seen evidently in the manifestation of PCOD.

Asymptomatic respiratory dysfunction in patients with gastroesophageal reflux disease K A Sudarshan Murthy, M Bhanukumar, CM Tejamani, Aparna R Menon International Journal of Health & Allied Sciences 2019 8(2):103-107 BACKGROUND: Gastroesophageal reflux disease is the primary cause for many conditions affecting extraesophageal structures. OBJECTIVE: The objective of the study is to investigate the relation between reflux disease and asymptomatic respiratory dysfunction and examine correlation between the respiratory dysfunction with severity of gastroesophageal reflux disease (GERD) spectrum. METHODOLOGY: A total of 242 patients were subjected to pulmonary function test (PFT) using spirometer-G procedures. Forced expiratory volume 1 s (FEV1), forced vital capacity (FVC), FEV1/FV C ratio, and peak expiratory flow rate (PEFR) were measured. Patients in test group were treated with proton-pump inhibitor (PPI) and esomeprazole 40 mg twice daily for 3 months. They were subjected to PEFR at the end of the study. Analysis was performed using SPSS version. RESULTS: Age and PFT parameters FEV1, forced expiratory flow (FEF) 25–75, PEF, and PEFR were compared groupwise and were found to be statistically significant except FEV. As the severity of GERD increases, severity of pulmonary disorder also increases. In Group 1A, 56.5% patients had normal PEFR and 43.4% PEFR was reduced showing statistically significant. In patients with abnormal PFT, 74.2% had mild esophagitis, 15.1% had moderate esophagitis, and 10.6% had severe esophagitis showing statistically significant. Mean PEFR before treatment showed 344.1 ± 79.22. After 3 months of esomeprazole 40 mg, twice daily mean increased 409.08 ± 100.00. In Group 1B, PEFR before treatment noted 342.0 ± 53.77. Significant improvement was seen in PEFR with mean of 506.00 ± 52.64 with PPIs. CONCLUSIONS: GERD is associated with asymptomatic respiratory dysfunction. There is strong and direct relationship between the severity of respiratory disorders, detected by FEV1 and FEV1/FVC, FEF25–75, PEF, PEFR, and severity of GERD. This study demonstrated significant improvement in PEFR values, with adequate treatment of GERD.

Intestinal carriage of drug-resistant Gram-negative bacteria belonging to family Enterobacteriaceae in children aged 3–14 years: An emerging threat Raminder Sandhu, Aditi Aggarwal, Pallavi Sayal, Surinder Kumar International Journal of Health & Allied Sciences 2019 8(2):108-115 BACKGROUND: Intestinal colonization by the members of family Enterobacteriaceae represents a major step in the development of systemic infection. MATERIALS AND METHODS: A total of 100 stool samples were taken from healthy children aged between 3 and 14 years. A structured questionnaire concerning child's lifestyle, predisposing factors as well as risk factors was illustrated. Detection of microorganisms was done by standard laboratory procedures which included microscopy, culture identification, and antibiotic susceptibility testing. RESULTS: Thirty-three of 100 participants (33%) carried Escherichia coli (66.7%), Klebsiella spp. (27.3%), and Citrobacter freundii (6.1%). Underweight children showed the highest colonization rate (84.8%). Previous exposure to antimicrobial agents (60.6%), rural housing (60.6%), maternal education (57.6%), and nonimmunized status (51.5%) were significantly associated with high carriage among children. The pathogens revealed high resistance to ampicillin (E. coli, 90.9%; Klebsiella spp., 100%; and C. freundii, 100%), co-trimoxazole (E. coli, 81.8%; Klebsiella spp., 88.9%; and C. freundii, 100%), cefuroxime and cefotaxime (E. coli, 81.8% and 63.6%; Klebsiella spp., 100% and 88.9%; and C. freundii, 100% and 100%). Aminoglycoside depicted good susceptibility (gentamicin and amikacin) with resistance rates of 27.3% and 13.6% in E. coli, 33.3% and 44.4% in Klebsiella spp., and no resistance in C. freundii. Carbapenems (imipenem and meropenem) looked promising with low resistance levels (E. coli, 27.3% and 13.6%; Klebsiella spp., 33.3% and 22.2%; and C. freundii, 50% and 00%). CONCLUSION: High rate of colonization in healthy children with drug-resistant members of family Enterobacteriaceae was observed. The fecal flora of children in the community represents a huge potential reservoir of strains resistant to multiple antimicrobial agents and can be challenging to treat, as their therapeutic options are few.

Relevance and interrelationship of progesterone receptor, Ki67, and p53 in meningiomas: An immunohistochemical analysis in 273 cases Ishita Pant, Sujata Chaturvedi, Chandra Bhushan Tripathi, Gurbachan Singh International Journal of Health & Allied Sciences 2019 8(2):116-122 BACKGROUND: Meningiomas are among the most common of central nervous system neoplasms. These are classified into meningiomas with low risk of recurrence and aggressive behavior (World Health Organization [WHO] Grade I) and meningiomas with greater likelihood of recurrence and aggressive behavior (WHO Grade II and Grade III) according to the WHO 2016 criteria. A host of markers are implicated in the genesis, progression, and recurrence of meningiomas. This study was undertaken with the aim to analyze the sociodemographic profile of various grades of meningiomas and to assess the relevance and correlation between progesterone receptor (PR), Ki67, and p53 among these. MATERIALS AND METHODS: Retrospective analysis was performed for 273 cases of intracranial and intraspinal meningiomas. All intracranial and intraspinal meningiomas were graded according to the WHO 2016 criteria. Immunohistochemistry was performed using PR, Ki67, and p53 in 273 cases. Statistical analysis was performed. RESULTS: According to the WHO 2016 grading system, 254 were Grade I (93.04%), 14 were Grade II (5.13%), and 5 were Grade III (1.83%) meningiomas. According to the histological type, among Grade I, 207 meningiomas were transitional (75.82%), 11 meningothelial (4.03%), 11 angiomatous (4.03%), 8 psammomatous (2.93%), 6 fibroblastic (2.19%), 5 microcystic (1.83%), 4 metaplastic (1.47%), and 2 secretory (0.73%). Among Grade II, there were 13 cases of atypical meningiomas (4.76%) and 1 case of clear-cell meningioma (0.37%). Among Grade III, 3 meningiomas were rhabdoid variant (1.09%) and 2 cases were anaplastic meningiomas (0.37%). In all the cases, correlation with PR, p53, and Ki67 was assessed. CONCLUSION: Immunohistochemical evaluation of PR status, p53 expression, and Ki67 labeling index do add information to the routine histopathological evaluation of meningiomas. In addition, these markers do help in assessing the biological behavior of meningiomas.

Attitude of future doctors toward psychiatry: A cross-sectional study at a medical college in Eastern India Snehanshu Dey, Soumya Swaroop Sahoo, Udit Kumar Panda, Jigyansa Ipsita Pattnaik, Subhankar Swain International Journal of Health & Allied Sciences 2019 8(2):123-127 INTRODUCTION: Psychiatry is one of the emerging branches in medicine which has made rapid strides of late. However, the attitude of students toward psychiatry has not been favorable and it is one of the less popular subjects in the medical curriculum. In the present study, we explore the attitudes toward psychiatry (ATP) among the final-year students of a medical college of eastern India. MATERIALS AND METHODS: In this cross-sectional descriptive study, 147 final-year students were approached, of which 104 students consented for the study. They were assessed regarding their ATP as a subject, psychiatric patients, and illness and the treatment under the respective domains of ATP-30 scale. The analysis involved descriptive analysis of the data. RESULTS: A neutral to negative attitude was observed toward psychiatry as a subject in the students. The mean ATP score among the female students was slightly higher than the male students. The most neutral responses were received in the items such as “psychiatric illness deserves at least as much attention as physical illness,” “psychiatric hospitals have a specific contribution to make,” and “if we listen to them, psychiatric patients are just as human as other people.” CONCLUSION: The finding in our study is an indication of lacunae in the present undergraduate curricula and training in relation to psychiatry as subject of medical science. There is a need to reevaluate this aspect of undergraduate psychiatry teaching and look for potential solutions.

Laser-assisted root coverage procedure in gingival recessions: A randomized controlled clinical study R Divakaran, Joann Pauline George, Ankita Jha, Smiti Bhardwaj, Divya Khanna International Journal of Health & Allied Sciences 2019 8(2):128-134 BACKGROUND: Laser de-epithelialization (LD) facilitates periodontal wound healing. This clinical trial aims to evaluate the clinical outcome of coronally advanced flap with subepithelial connective tissue graft and LD (CAF + SCTG + LD) and compare it with CAF + SCTG in the treatment of gingival recession. MATERIALS AND METHODS: Fifteen patients presenting with one pair of bilaterally symmetrical Miller's Class I/Class II buccal gingival recessions were enrolled for the study. De-epithelialization of the test sites was performed with diode laser (810 m), whereas control sites received sham laser application followed by CAF and SCTG. RESULTS: Six months postsurgically, comparable complete root coverage was observed in sites treated with CAF and SCTG with LD and CAF and SCTG alone. Mean root coverage (MRC) in the control group and the test group was similar (P > 0.05). Photogrammetric analysis showed similar MRC in the control group and the test group (P > 0.05). CONCLUSION: The clinical outcomes of recession coverage with CAF and SCTG and LD are comparable to CAF and SCTG. LD did not show any added clinical advantage over CAF and CTG in the management of gingival recessions.

Studia Logica

Book Reviews

Introduction to the Special Issue on Logic and the Foundations of Game and Decision Theory (LOFT12)

Book Reviews

The Monodic Fragment of Propositional Term Modal Logic Abstract We study term modal logics, where modalities can be indexed by variables that can be quantified over. We suggest that these logics are appropriate for reasoning about systems of unboundedly many reasoners and define a notion of bisimulation which preserves propositional fragment of term modal logics. Also we show that the propositional fragment is already undecidable but that its monodic fragment (formulas using only one free variable in the scope of a modality) is decidable, and expressive enough to include interesting assertions.

Dynamic Epistemic Logics of Diffusion and Prediction in Social Networks Abstract We take a logical approach to threshold models, used to study the diffusion of opinions, new technologies, infections, or behaviors in social networks. Threshold models consist of a network graph of agents connected by a social relationship and a threshold value which regulates the diffusion process. Agents adopt a new behavior/product/opinion when the proportion of their neighbors who have already adopted it meets the threshold. Under this diffusion policy, threshold models develop dynamically towards a guaranteed fixed point. We construct a minimal dynamic propositional logic to describe the threshold dynamics and show that the logic is sound and complete. We then extend this framework with an epistemic dimension and investigate how information about more distant neighbors' behavior allows agents to anticipate changes in behavior of their closer neighbors. Overall, our logical formalism captures the interplay between the epistemic and social dimensions in social networks.

The Dynamics of Epistemic Attitudes in Resource-Bounded Agents Abstract The paper presents a new logic for reasoning about the formation of beliefs through perception or through inference in non-omniscient resource-bounded agents. The logic distinguishes the concept of explicit belief from the concept of background knowledge. This distinction is reflected in its formal semantics and axiomatics: (i) we use a non-standard semantics putting together a neighborhood semantics for explicit beliefs and relational semantics for background knowledge, and (ii) we have specific axioms in the logic highlighting the relationship between the two concepts. Mental operations of perceptive type and inferential type, having effects on epistemic states of agents, are primitives in the object language of the logic. At the semantic level, they are modelled as special kinds of model-update operations, in the style of dynamic epistemic logic. Results about axiomatization, decidability and complexity for the logic are given in the paper.

Jan von Plato, Saved from the Cellar. Gerhard Gentzen's Shorthand Notes on Logic and the Foundations of Mathematics

Logics for Moderate Belief-Disagreement Between Agents Abstract A moderate belief-disagreement between agents on proposition p means that one agent believes p and the other agent does not. This paper presents two logical systems, \(\mathbf {MD}\) and \(\mathbf {MD}^D\) , that describe moderate belief-disagreement, and shows, using possible worlds semantics, that \(\mathbf {MD}\) is sound and complete with respect to arbitrary frames, and \(\mathbf {MD}^D\) is sound and complete with respect to serial frames. Syntactically, the logics are monomodal, but two doxastic accessibility relations are involved in their semantics. The notion of moderate belief-disagreement, which is in accordance with the understanding of belief-disagreement in everyday life, is an epistemic one related to multiagent situations, and \(\mathbf {MD}\) and \(\mathbf {MD}^D\) are two epistemic logics.

Completeness and Cut-Elimination for First-Order Ideal Paraconsistent Four-Valued Logic Abstract In this study, we prove the completeness and cut-elimination theorems for a first-order extension F4CC of Arieli, Avron, and Zamansky's ideal paraconsistent four-valued logic known as 4CC. These theorems are proved using Schütte's method, which can simultaneously prove completeness and cut-elimination.

Truthmakers and Normative Conflicts Abstract By building on work by Kit Fine, we develop a sound and complete truthmaker semantics for Lou Goble's conflict tolerant deontic logic \(\mathbf {BDL}\) .

Medical Humanities

Greetings

Authoring Autism: On Rhetoric and Neurological Queerness

The Cambridge Social History of Modern Ireland

Keith Haring, Felix Gonzalez-Torres, Wolfgang Tillmans, and the AIDS Epidemic: The Use of Visual Art in a Health Humanities Course Abstract Contemporary art can be a powerful pedagogical tool in the health humanities. Students in an undergraduate course in the health humanities explore the subjective experience of illness and develop their empathy by studying three artists in the context of the AIDS epidemic: Keith Haring, Felix Gonzalez-Torres, and Wolfgang Tillmans. Using assignments based in narrative pedagogy, students expand their empathic response to pain and suffering. The role of visual art in health humanities pedagogy is discussed.

Dancing Intercorporeality: A Health Humanities Perspective on Dance as a Healing Art Abstract As a contribution to the burgeoning field of health humanities, this paper seeks to explore the power of dance to mitigate human suffering and reacquaint us with what it means to be human through bringing the embodied practice of dance into dialogue with the work of the French philosopher Maurice Merleau-Ponty. Merleau-Ponty's conceptualisation of subjectivity as embodied and of intersubjectivity as intercorporeality frees us from many of the constraints of Cartesian thinking and opens up a new way of thinking about how dance functions as a healing art through its ability to ground and reconnect us with self, world, and others--with our humanity. It is argued that through a Merleau-Pontian framework, we can come to appreciate the true potential of dance as a positive and deeply humanising experience, demonstrating how expressive arts practice understood through the lens of philosophical theory can open up new dimensions of understanding and experience in relation to well-being and self- (and other-) care.

Don't be the "Fifth Guy": Risk, Responsibility, and the Rhetoric of Handwashing Campaigns Abstract In recent years, outbreaks such as H1N1 have prompted heightened efforts to manage the risk of infection. These efforts often involve the endorsement of personal responsibility for infection risk, thus reinforcing an individualistic model of public health. Some scholars—for example, Peterson and Lupton (1996)—term this model the "new public health." In this essay, I describe how the focus on personal responsibility for infection risk shapes the promotion of hand hygiene and other forms of illness etiquette. My analysis underscores the use of constitutive and stigmatizing rhetoric to depict individual bodies, rather than environments, as prime sources of infection. Common among workplaces, this rhetoric provides the impetus for encouraging individual behavior change as a hedge against infection risk. I argue, though, that the mandating of personal responsibility for infection risk galvanizes a culture of stigma and blame that may work against the aims of public health.

Illness Doula: Adding a New Role to Healthcare Practice Abstract In this article, we explore the possibility of adding a new role to the clinical encounter: an illness doula. Even though research and education in medical humanities and narrative medicine have made improvements in humanizing healthcare, progress is slow and ongoing. There needs to be an intervention in the practice of healthcare now for people currently going through the system. An illness doula, like a birth doula, would facilitate and insure that attention is paid to the personal needs and desires of the patient in the present system. We envision illness doulas having the ability and availability to accompany the patient throughout the healthcare process, to help communicate with clinicians, and to ensure that patient preferences are understood and respected along the way. We discuss how this idea emerged through the clinical encounters of two of our authors, the possibilities and limitations of creating a new role for illness doulas, and the logistics of how to put this new role into play.

"Even Heroes Get Depressed": Sponsorship and Self-Stigma in Canada's Mental Illness Awareness Week Abstract In 1992, the Canadian Psychiatric Association launched Canada's first national campaign against mental illness, Mental Illness Awareness Week (MIAW). I stress that pharmaceutical sponsorship of the first five years of MIAW (1992-1997) was integral to shaping the trajectory of the campaign and marks a shift in the way stigma is conceived and resisted in Canada: what was an interpersonal process based on social norms becomes refigured as "self-stigma," or an individualized process in which lack of information, education, and self-assessment contribute to an inability to consider oneself as at-risk for a disease, condition, or disorder.

Disability, Depression, Diagnosis, and Harm: Reflections on Two Personal Scenarios Abstract In this article I draw on two scenarios from my personal life—the diagnosis of my newborn grandnephew with CHARGE syndrome and the diagnosis of my father with depression—to reflect on whether and when diagnosis may be harmful to patients (and their families). Despite the great differences between the two scenarios, I argue that in both cases the tendency of diagnosis to generalize, categorize, and stigmatize can lead to insidious and counterproductive effects. The perspective of disability studies can help physicians to anticipate, minimize or avoid these negative ramifications. I also reflect on the matter of who "owns" a particular diagnosis, whose purposes it serves, and how.

Approaches to Multidimensional Health in Representations of Islamic Themes among Black Male Characters in American Film and Television Abstract Historically, representations of Islamic themes in media narratives of Black men have been characterized by personal transformations in the midst of surviving in crime-ridden inner city areas. These young Black men are usually at-risk due to their statuses as Black, economically disadvantaged men. Beginning with Malcolm X and Alex Haley's The Autobiography of Malcolm X, the Black male Islamic redemption narrative has become a common theme in Black popular culture, as it is usually supplemented with unique methods of confronting the various dimensions of health. Throughout this study, the representations of these approaches among Black men in contemporary film and television are examined throughout realms of spiritual, emotional, mental, physical, social, and vocational health.

Environmental Science and Bio/Technology

Seaweed biorefinery Abstract Seaweed offers a wide range of interesting bioactives. With over 10,000 species globally, it is of great interest to be able to extract these compounds. Hence, seaweed fractionation into a wide spectrum of valuable products using multistage cascade processes offers a sustainable approach of exploitation of this resource to produce bioactive ingredients, chemicals and biofuels. This biorefinery processing approach should be adapted to local conditions to maximize the biomass utilization and to lower the waste fractions or preventing any waste materials re-enforcing the circular economy. This review presents an overview of the potential uses of waste generated after seaweed processing for food and other uses, as well as the utilization of invasive species biomass and other invasive species. Graphical abstract

Application of alkali-activated materials for water and wastewater treatment: a review Abstract Alkali-activation (or geopolymer) technology has gained a great deal of interest for its potential applications in water and wastewater treatment during the last decade. Alkali-activated materials can be prepared via a relatively simple and low-energy process, most commonly by treating aluminosilicate precursors with concentrated alkali hydroxide and/or silicate solutions at (near) ambient conditions. The resulting materials are, in general, amorphous, have good physical and chemical stability, ion-exchange properties, and a porous structure. Several of the precursors are industrial by-products or other readily available low-cost materials, which further enhances the environmental and economic feasibility. The application areas of alkali-activated materials in water and wastewater treatment are adsorbents/ion-exchangers, photocatalysts, high-pressure membranes, filter media, anti-microbial materials, pH buffers, carrier media in bioreactors, and solidification/stabilization of water treatment residues. The purpose of this review is to present a comprehensive evaluation of the rapidly growing prospects of alkali-activation technology in water and wastewater treatment.

Removal of cesium ions from aqueous solutions using various separation technologies Abstract Cesium is the major fission product of uranium, which widely exists in radioactive wastewater. Radiocesium has potential adverse effects on human health and ecological environment. Different methods such as chemical precipitation, coagulation/co-precipitation, solvent extraction, membrane process, chemical reduction, and adsorption have been used to remove radioactive cesium from aqueous solution. However, the development of innovative technologies capable of selectively removing radioactive cesium is still imperative yet challenging. This review focused on cesium removal using various separation technologies, including chemical precipitation, solvent extraction, membrane separation, and adsorption. The key restraints for cesium removal, as well as the recent progress of these methods have also been discussed. Particular attention has been paid to the adsorption methods, which has been highlighted by introducing the latest advances in inorganic adsorbents (such as metal hexacyanoferrates, clay minerals, carbon-based-adsorbents, and ammonium molybdophosphate), organic adsorbents (such as ion exchange resin, metal–organic frameworks and supramolecular/indicator grafting adsorbents), and biosorbents (such as agroforestry wastes and microbial biomass). Adsorption-based methods are high efficient in separation of cesium ions from aqueous streams, and adsorption of cesium ions has been investigated intensively and even used in practical applications, there is still considerable scope for improvement in terms of adsorption capacity and selectivity.

Keratin based thermoplastic biocomposites: a review Abstract Fibre reinforced composites have become important materials for manufacturing a diverse range of industrial products. Keratin-rich materials including sheep wool and poultry feathers can have added value by partially substituting synthetic polymers in the production of biocomposites with improved mechanical properties. The strong intermolecular disulfides, hydrogen, ionic and hydrophobic interactions of keratin make it behave as a thermoset material which is not easy to process and thermally blend with other polymers. Therefore, different plasticizers, compatibilizers and coupling agents were investigated in order to make keratin a processable material. This review discusses recent developments in the production of thermoplastic keratin blend biocomposites. In particular, the processing and preparation conditions has been discussed, and their strengths and limitations are enumerated and critically evaluated. Graphical abstract

Polymers derived from hemicellulosic parts of lignocellulosic biomass Abstract Furfural, which is directly derived from the hemicellulosic parts of lignocellulosic biomass, is considered as one of the most promising platform chemicals to manufacture commodity chemical products such as polymers and their monomers. Its production has already been commercialized. In this review, potentially relevant methods for producing important chemicals from furfural, which are used as monomers for different polymers, and for the polymerization of furfural and its derivatives (e.g., furfuryl alcohol), have been discussed. First, the production of furfural from different lignocellulosic biomasses is presented. Next, the synthesis of various monomers and their highest available yields from furfural are discussed. The polymers that can be directly produced from furfural and its derivatives are explored. Finally, the challenges of producing furfural-based products have been highlighted.

Current research trends on microplastic pollution from wastewater systems: a critical review Abstract Microplastics have been widely considered as contaminants for the environment and biota. Till now, most previous studies have focused on the identification and characterization of microplastics in freshwater, sea water, and the terrestrial environment. Although microplastics have been extensively detected in the wastewater, research in this area is still lacking and not thoroughly understood. To fill this knowledge gap, the current review article covers the analytical methods of microplastics originating from wastewater streams and describes their sources and occurrences in wastewater treatment plants (WWTPs). Studies indicated that microplastic pollution caused by domestic washing of synthetic fibers could be detected in the effluent; however, most microplastics from personal care and cosmetic products (PCCPs) can be efficiently removed during wastewater treatment. Moreover, various techniques for sampling and analyzing microplastics from wastewater systems are reviewed; while, the implementation of standardized protocols for microplastics is required. Finally, the fate of microplastics during wastewater treatments and the environmental contamination of effluent to environment are presented. Previous studies reported that the advanced wastewater treatment (e.g., membrane bioreactor) is needed for improving the removal efficiency of small-sized microplastics (< 100 µm). Although the role of microplastics as transport vectors for persistent organic pollutants (POPs) is still under debate, they have demonstrated abilities to absorb harmful agents like pharmaceuticals.

Anaerobic ammonium oxidation in marine environments: contribution to biogeochemical cycles and biotechnological developments for wastewater treatment Abstract Microbial processes are responsible for most reactions involved in the nitrogen cycle in the oceans, which determine the fluxes of this crucial nutrient in these environments. The present review provides an overview of the contribution of anaerobic ammonium oxidation (Anammox) to marine biogeochemical processes. Besides the conventional Anammox process, anaerobic ammonium oxidation coupled to the microbial reduction of alternative electron acceptors, such as sulfate (Sulfammox), ferric iron (Feammox), and natural organic matter (NOM-dependent Anammox) is also described in the context of global marine biogeochemical cycles. Also, the complex interactions among the oceanic biogeochemical cycles of N, S and Fe are discussed at the light of the new findings available in the literature. The review also underlines the important role of the microbial processes performing the Anammox reaction in the development of wastewater treatment systems for the removal of nitrogen from saline effluents. Strategies to enrich and immobilize Anammox bacteria in different reactor configurations for the treatment of saline wastewaters are also described as well as future directions for novel biotechnological developments based on Anammox.

A review on emulsion liquid membrane (ELM) for the treatment of various industrial effluent streams Abstract The excessive release of toxic metal ions by the several industrial effluent streams into the environment has imposed a serious threat to the ecological system. Therefore, the removal of these toxic metal ions from the wastewater of various industrial effluent streams has received a considerable amount of interest and also currently becoming an imperative area of research. Since last few decades, ELM based separation processes have been become an attractive and efficient way for the removal of toxic metal ions, organic and inorganic acids, and industrial pollutants of the various aqueous waste effluent streams. ELM is an emerging alternative technique to the conventional solvent extraction processes with an additive advantage of low solvent inventory and energy requirements. Moreover, it also preconcentrates the solute by performing both extraction and stripping operations simultaneously in a single unit. The main aim of this review paper is to elucidate the comprehensive review on the ELM (its pertinent properties/characteristics), its membrane phase compositions, its stability, and its process parameters respectively and also to delineate the applications of this technique for the removal of various low concentrated solutes.

The effects of electric, magnetic and electromagnetic fields on microorganisms in the perspective of bioremediation Abstract Some studies show how exposure to fields can enhance or reduce cell activity, with possible applicative consequences in the field of biotechnology, including biological techniques for depollution. In order to identify full-scale conditions that are suitable and potentially applicable for use in electromagnetic fields to stimulate and accelerate bioremediation processes, this paper offers an examination of the scientific literature that is available on the effects of fields on microorganisms, and a critical analysis of it. The biological effects at times contrast with each other.

A review on greywater reuse: quality, risks, barriers and global scenarios Abstract Greywater is wastewater collected from household sources without input from toilet or commode streams. Greywater represent ca. 65% of total household wastewaters globally. Different aspects of greywater, including its production sources, its characteristics, the barriers and the global scenarios of its reuse, have been critically reviewed in this paper. Given the current projections on acute water scarcity in many regions of the world, the importance of water management cannot be overlooked and a decentralized approach, segregating wastewater streams of a household with proper sanitation is a potential option for recycling greywater. This paper aims to explore the improvements achieved in the reuse of greywater. Therefore, reutilization rates were estimated, hazards and risks associated with the use of untreated greywater were analyzed were summarized. Guidelines for greywater treatment were established and barriers for successful implementation of reuse strategies were identified. Global scenarios of successful implementations of greywater reuse were presented.

Anaesthesia

How to design a questionnaire Sandhya Yaddanapudi, LN Yaddanapudi Indian Journal of Anaesthesia 2019 63(5):335-337

Integrating perioperative medicine with anaesthesia in India: Can the best be achieved? A review SB Shah, U Hariharan, R Chawla Indian Journal of Anaesthesia 2019 63(5):338-349 Integrating perioperative medicine with anaesthesia is the need of the hour. Evolution of a new superspeciality called perioperative anaesthesia can improve surgical outcomes by quality perioperative care and guarantee imminent escalation of influence and power for anaesthesiologists. All original peer-reviewed manuscripts pertaining to surgery-specific perioperative surgical home models involving preoperative, intraoperative and postoperative initiatives spanning the past 5 years have been reviewed using PubMed and Google Scholar. Whether the perioperative surgical home model is feasible or still a distant dream in the Indian perspective has been analysed.

A prospective survey on knowledge, attitude and current practices of pre-operative fasting amongst anaesthesiologists: A nationwide survey Pratibha Panjiar, Anjali Kochhar, Homay Vajifdar, Kharat Bhat Indian Journal of Anaesthesia 2019 63(5):350-355 Background and Aims: Pre-operative fasting is a routine practice to minimise the risk of pulmonary aspiration. The leading societies of anaesthesia have adopted more liberal fasting guidelines to avoid the adverse effect of prolonged fasting. This survey was conducted to assess the knowledge, attitude and current practice of fasting guidelines among Indian anaesthesiologists and to analyse the reasons for non-compliance of these guidelines. Methods: A questionnaire consisted of 11 questions was distributed via 'Survey Monkey' software to 621 anaesthesiologists who attended the annual conference of the Indian Society of Anaesthesiologists held in Ludhiana, in 2016. American Society of Anaesthesiologists (ASA) practice guidelines for fasting were the standard of assessment. Results: The response rate to the survey was 52%. Of the respondents, 69% described correctly the practice guidelines to pre-operative fasting. Only seven percent respondents were aware of the benefits of liberalised fasting. More than 2/3rd of the respondents advised fasting as per ASA guidelines during pre-anaesthetic check-up (PAC). However, only about 50% respondents confirmed that these guidelines are actually followed in their institution. Not having control on scheduling of cases in operation theatre and poor knowledge of ward nurses and surgeons were the common reasons for non-compliance of these guidelines. Twenty four percent respondents did not use routinely any drug for aspiration prophylaxis. Conclusion: Majority of the respondents were aware of the ASA fasting guidelines. However, the implementation of the guidelines and knowledge regarding benefits of liberalised fasting is poor among respondents.

Comparison of ultrasound-guided transversus abdominis plane (TAP) block versus local infiltration during paediatric laparoscopic surgeries Priyanka P Karnik, Nandini M Dave, Harick B Shah, Ketan Kulkarni Indian Journal of Anaesthesia 2019 63(5):356-360 Background and Aims: The purpose of this study was to compare the analgesic efficacy of ultrasonography-guided transversus abdominis plane (TAP) blocks with local port site infiltration in children undergoing laparoscopic surgeries. Methods: After ethics committee approval and informed consent, 92 children aged 2–12 years posted for laparoscopic surgeries were randomly divided into Group T and Group L. Port site infiltration was performed in Group L by the surgeon at the time of port placement and end of surgery with 0.4mL/kg of 0.25% bupivacaine. Bilateral TAP block was performed in Group T after induction of anaesthesia, under ultrasonographic guidance with a Logiq E7 GE portable ultrasound unit and a linear 5–10 MHz probe. A 22G hypodermic needle and 0.4 mL/kg of 0.25% bupivacaine were used on each side for the TAP block. The parameters recorded were intraoperative haemodynamics, opioid requirements, postoperative pain scores and the need for rescue analgesia in the first 6 h postoperatively. Results: The median (interquartile range) pain scores were significantly lower in the TAP block group than the local infiltration group at 10 min [2 (0–2.5) vs 2 (3–4); P = 0.011], 30 min [1.5 (0–3) vs 3 (2–5);P < 0.001], 1 h [1.5 (0–2) vs 2 (2–3);P < 0.001] and 2 h [2 (0–2) vs 2 (1.5–2.5); P = 0.010] postoperatively. The need for intraoperative opioids and rescue analgesia was also significantly lower in the TAP block group (P < 0.001). Conclusion: TAP block is superior to local infiltration for intra- and immediate postoperative analgesia in paediatric laparoscopic surgeries.

Optimised reversal without train-of-four monitoring versus reversal using quantitative train-of-four monitoring: An equivalence study Ardyan Wardhana, Juni Kurniawaty, Yusmein Uyun Indian Journal of Anaesthesia 2019 63(5):361-367 Background and Aims: Less residual paralysis in recovery room was demonstrated when train-of-four (TOF) monitoring was applied. The aim of this study was to know whether optimisation of neostigmine reversal without TOF monitoring was equivalent to reversal using TOF monitoring. Methods: Seventy two patients, aged 18–60 years, undergoing elective surgery under general anaesthesia (sevoflurane and rocuronium) with intubation were randomised into two interventions: an optimised neostigmine reversal strategy without TOF monitoring (group A, n = 36) and a neostigmine reversal strategy using quantitative TOF monitoring (group B, n = 36). Per-protocol analysis was performed to compare incidence of residual paralysis in the recovery room between the two groups. Results: Six residual paralyses occurred in group A in the recovery room, whereas one case occurred in group B. The equivalence test showed that the 95% confidence interval of this study was outside the range of equivalence margin (15%). The absolute difference was 13.9%: standard error (SE) =0.068 (P = 0.107; 95% confidence interval (CI): 1%, 27.2%). No subjects had TOF ratio <0.70 in the recovery room. The TOF ratio in the recovery room did not differ between the two groups (mean difference: −2.58; P = 0.05; 95% CI: −5.20, 0.29). One respiratory adverse event occurred in this study. Conclusion: An optimised reversal strategy without TOF monitoring is not equivalent to a reversal strategy based on quantitative TOF monitoring. TOF monitoring should be used whenever applicable, although neostigmine is optimised.

Chronic pain following thoracotomy for lung surgeries: It's risk factors, prevalence, and impact on quality of life - A retrospective study Prachi Kar, K Durga Sudheshna, Durga Padmaja, Archana Pathy, Ramachandran Gopinath Indian Journal of Anaesthesia 2019 63(5):368-374 Background and Aims: Chronic post thoracotomy pain (CPTP) is a nagging complication and can affect quality of life (QOL). Studies conducted across globe have found a wide variability in the risk factors predisposing to chronic pain following thoracotomy. As no study on CPTP is available from India, we aim to detect the prevalence of CPTP, assess the predisposing factors implicated in its causation and study the impact of CPTP on QOL. Methods: After obtaining clearance from Institutional ethics committee, medical records of patients who underwent open posterolateral thoracotomy between January 2012 and December 2015 were reviewed. Data on perioperative variables, address, and contact number were collected from the patient records. All patients were mailed the Telugu translation of medical outcome study short form -36(MOS-SF-36) QOL questionnaire and were contacted telephonically to enquire about presence of CPTP and QOL. A univariate analysis was done to assess factors associated with CPTP and a multivariate logistic regression analysis was done subsequently to identify independent risk factors of CPTP. QOL indices were compared between those patients who suffered from CPTP and those who did not. Results: The prevalence of pain in our study was 40.86% (85/208). The factors implicated in the causation of CPTP were diabetes mellitus, preoperative pain, rib resection, and duration of chest tube drainage with odds ratio of 9.8, 2.6, 6.7, and 1.03, respectively. The health-related QOL showed poor scores in all domains in patients suffering from CPTP. Conclusion: The prevalence of CPTP was high. It significantly impacts health-related QOL.

Hemi-diaphragmatic paresis following extrafascial versus conventional intrafascial approach for interscalene brachial plexus block: A double-blind randomised, controlled trial Basavaraja Ayyanagouda, Vinod Hosalli, Prableen Kaur, Uday Ambi, SY Hulkund Indian Journal of Anaesthesia 2019 63(5):375-381 Background and Aims: Hemidiaphragmatic paresis occurs in almost all patients undergoing interscalene block for proximal upper limb surgeries. This study tested hypothesis that ultrasound-guided extrafascial approach of interscalene block under nerve stimulator guidance reduces incidence of hemidiaphragmatic paresis in comparison to intrafascial approach by achieving same degree of anaesthesia and analgesia. Methods: Sixty patients undergoing proximal upper limb surgeries were randomised to receive an ultrasound-guided interscalene brachial plexus block (ISB) with the aid of nerve stimulator for surgical anaesthesia and analgesia using 20 mL 0.5% ropivacaine by extrafascial (Group E) or intrafascial (Group I) approach. The incidence of hemidiaphragmatic paresis was measured by M-mode ultrasound before and 30 min after the procedure. Secondary outcomes such as respiratory functions (forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate) were measured, and complications were recorded and compared. The statistics was obtained using SPSS Version 19. Levene's test and paired and unpaired t-test were used. P value <0.05 was considered significant. Results: The incidence of hemidiaphragmatic paresis was 17% and 46% in Group E and Group I, respectively (P < 0.0001). All other respiratory outcomes were preserved in Group E compared with Group I. Conclusion: Ultrasound-guided ISB with the aid of nerve stimulator through extrafascial approach reduces the incidence of hemidiaphragmatic paresis and also reduces respiratory function impairment when compared with intrafascial approach.

Post-operative analgesia for shoulder arthroscopic surgeries: A comparison between inter-scalene block and shoulder block Nibedita Pani, Sidharth S Routray, Soveena Pani, Soumyakanta Mallik, Santiswaroop Pattnaik, Amit Pradhan Indian Journal of Anaesthesia 2019 63(5):382-387 Background and Aims: Shoulder arthroscopic surgeries can produce intense post-operative pain. Inter-scalene block (ISB) provides good analgesia after shoulder surgery, but concerns over its associated risks have prompted the search for alternatives. Shoulder block (SHB), which includes suprascapular block along with axillary nerve (AN) block, was recently proposed as an alternative to ISB, but evidence of its efficacy is conflicting. The aim of our study was to compare SHB with ISB in shoulder surgery for post-operative analgesia. Methods: A total of 76 patients scheduled for shoulder arthroscopic surgery were equally divided into 2 groups of 38 patients each: ISB group and SHB group. Both the nerve blocks were achieved by using ultrasound and a nerve stimulator. Visual analogue scale (VAS) scores were evaluated at 1, 4, 6, 12 and 24 h post-operatively. The time to first analgesia request, total analgesic requirement for 24 h post-operatively, patient satisfaction and any complications were recorded. Results: SHB provided equivalent analgesia to ISB in terms of post-operative VAS scores. Time to first analgesic request was 6.2 ± 1.3 h in ISB group and 5.9 ± 1.2 h in SHB group, which was not statistically significant. Complications like subjective dyspnoea and weakness of arm were significantly higher in ISB group compared to SHB group. Patient satisfaction scores were also significantly higher in SHB group compared to ISB group. Conclusion: SHB is as effective as ISB for post-operative pain relief and with fewer complications due to selective blockade of suprascapular and axillary nerves.

Effect of immobilised cervical spine on oropharyngeal sealing pressure with Ambu AuraGain™ Supraglottic airway: A randomised crossover trial Duraiyarassu Uthaman, Suman Lata Gupta, Sandeep Kumar Mishra, Satyen Parida, Prasanna Udupi Bidkar, Muthupillai Senthilnathan Indian Journal of Anaesthesia 2019 63(5):388-393 Background and Aims: Ambu® AuraGain™ laryngeal airway (AuraGain) is one of the newer supraglottic airway device introduced in 2014. Cervical spine stabilisation with hard cervical collar makes insertion of supraglottic airways and tracheal intubation difficult. This study was conducted to investigate whether the presence of a cervical collar affects the oropharyngeal sealing pressure (OSP) and fibreoptic view of the glottis (Brimacombe score) in airways secured with the AuraGain. Methods: The study was a randomised crossover trial. Thirty five ASA 1-3 patients undergoing elective surgery under general anaesthesia were recruited for the study. In each patient AuraGain was inserted twice in a crossover manner once with and once without a hard cervical collar in situ, with the sequence of insertion randomised. During each insertion of AuraGain the OSP, fibreoptic view of the glottis, insertion parameters, ventilator data and complications were noted. Results: The mean OSPs in both the groups were similar with no significant difference (29.6 ± 3.7 cmH2O without collar and 30.1 ± 3.1 cmH2O with collar [P = 0.310]). The fibreoptic view of glottis was also similar in both groups. The insertion with collar was more difficult than without collar. The number of attempts for successful insertion was same in both the groups. The time taken for appropriate placement of LMA was significantly prolonged in patients with collar. Conclusions: We conclude that the Ambu AuraGain can be used to provide effective ventilation in patients whose cervical spine is immobilised with a hard cervical collar.

Development and validation of a questionnaire for a survey on perioperative fasting practices in India Pradeep A Dongare, S Bala Bhaskar, SS Harsoor, M Kalaivani, Rakesh Garg, K Sudheesh, Umesh Goneppanavar Indian Journal of Anaesthesia 2019 63(5):394-399 Background and Aims: Perioperative fasting guidelines have been published and updated to standardise practices. Hence, Indian Society of Anaesthesiologists decided to conduct a survey to assess the fasting practices and the food habits across India, which would be subsequently used for developing preoperative fasting guidelines for the Indian population. We detail and discuss herewith the content validity of the questionnaire developed for the survey. Methods: Thirty-six questions related to perioperative fasting practices were framed based on the collected evidence and relevance to regional diet and concerns. Subsequently, an information sheet was prepared and sent to 10 experts to grade each question. The responses were tabulated, and item-wise content validity index (I-CVI), scale-wise content validity index (S-CVI) and modified kappa statistic were calculated in Microsoft Excel™ sheet. Results: Seven of the 10 experts completed the assessment and grading as per the instructions provided and submitted a completed proforma. S-CVI for relevance, simplicity, clarity and ambiguity was 0.72, 0.86, 0.72 and 0.72, respectively. S-CVI/average or average congruency percentagewas 0.95, 0.97, 0.95 and 0.95 for relevance, simplicity, clarity and ambiguity, respectively. Question 2 received an I-CVI of 0.71 in terms of clarity and question 23 received an I-CVI of 0.71. They were modified as persuggestions of the experts. Conclusion: We conclude that our questionnaire designed to ascertain the preoperative fasting practices for a surveymet the content validity criteria both by qualitative and quantitative analyses.

Neurology

Imprecise eponyms in stroke medicine – A growing need for uniform terminologies/definitions across the globe Kamble J Harsha Neurology India 2019 67(2):364-369 Background: Remarkable advancements in the understanding of etiological risk factors and pathophysiology of cerebrovascular diseases have led to the refining of definitions and terminologies in stroke medicine periodically. We aim to analyze the utility and meaning of different eponyms in the stroke medicine literature during the last 20 years. Materials and Methods: A systematic search was performed in Google Scholar for the words “stroke,” “TIA,” “cerebrovascular accident (CVA),” “cerebrovascular insult,” “cerebrovascular event,” “cerebral ischemia,” and “cerebrovascular disease.” Each of the words were searched yearwise from 1996 to 2015, and the numbers of articles using these words were collected and analyzed. Results: “ Stroke” has been the most common terminology used in literature, which showed a progressive increase in its usage until 2010, after which its use drastically reduced. “Cerebrovascular events” and “cerebral ischemia” are the second most commonly used terminologies with variable definitions; there was a steep increase in the use of these words until 2012. Conclusions: The most imprecise term that continues to be used is “CVA”. The precisely defined entity like “cerebrovascular disease,” which is a group of diseases, continues to be used inappropriately. All the terms are not defined uniformly across the globe, whereas most continue to use the World Health Organisation definition of stroke, defined in the 1970s. It is essential to condemn the use of imprecise terminologies and promote the use of recently defined precise terms “stroke” and “transient ischemic attack (TIA)”. Unless the same terms with precise definitions are used in clinical practice or literature, the progress of stroke medicine will continue to be hampered.

Should neurosurgeons retire? Krishnan Ganapathy Neurology India 2019 67(2):370-374 Being a neurosurgeon is a protracted, time-consuming, and labor-intensive occupation. It presupposes excellent, continuing physical and mental competence, and a passion to always do better than the best. During the last two decades, the exponential deployment of operative technology has resulted in a radical transformation, making a neurosurgeon trained four decades ago, run the risk of being outdated. Expectations from patients have reached an all time high level. Socioeconomic and medicolegal aspects cannot be brushed aside. It is universally accepted that in spite of increasing longevity in the educated upper middle class, the process of ageing per se continues relentlessly. When is enough enough? Is there a risk that a “senior, experienced” neurosurgeon may even become a liability to his patients some day? Should there be a mandatory time point at which a neurosurgeon should necessarily stop operating. The author reviews the published literature and opines that after the age of 65 years, all seniors should agree to their operating privileges being formally reviewed regularly every 2 years.

Proxy war against head injury: Myriads of conflicting laws and gender-based discrimination Nishant S Yagnick, Manjul Tripathi, Sandeep Mohindra Neurology India 2019 67(2):375-376 This article is the culmination of two axioms. The first is the authors' belief that the practice of medicine is, if anything, a social profession. The second is the glaring realization that conscience is the worst motivator. When we combine the two, we understand why a war needs to be waged for a stronger legislation making the wearing of helmets compulsory, and why doctors need to be at the forefront of this war.

The neurovascular syndromes: A review of pathophysiology – Lessons learnt from Prof. Chandy's paper published in 1989 Harjinder S Bhatoe Neurology India 2019 67(2):377-388

The infamous story of incident stroke and inflamed gall bladder! M V Padma Srivastava, VY Vishnu Neurology India 2019 67(2):389-390

Cholecysto-cardiac link: The heart of the matter Madhu Nagappa, Arun B Taly Neurology India 2019 67(2):391-392

Can cognitive decline be the nemesis of motor improvement secondary to deep brain stimulation? Milind Deogaonkar Neurology India 2019 67(2):393-394

Medical Journal of Dr. D.Y. Patil Vidyapeeth

Sleep that knits up the Ravel'd sleave of care…Nature's second course…the Bard said it all Amitav Banerjee Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):187-188

Sleep assessment in psychiatry - To be awake to every possibility Suprakash Chaudhury, Adnan Kadiani Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):189-192

Chronic insomnia: A review Suprakash Chaudhury, Rakesh Kumar Singh, Dolly Kumari, Chetan Diwan, Swaleha Mujawar, Daniel Saldanha Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):193-201 Chronic insomnia is a fairly common condition affecting one-fourth of the clinical population. It has been variously defined and is related to a large number of conditions. A thorough assessment of the patient presenting with chronic insomnia is of vital importance for the treatment. Treatment consists of modifying sleep habits to reduce autonomic and cognitive factors and education about healthier sleep practice. Drug treatment should be reserved for the short-term alleviation of insomnia. Appropriate treatment of chronic insomnia improves the quality of life. The prevention of insomnia consists of a balance of rest, recreational exercise in combination with stress management and a healthy diet.

Framing a De novo curriculum on sleep disorders for an Indian medical graduate using Kern's model Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):202-206 The six-step Kern's model is used to develop a de novo curriculum and link the same to the health-care needs of the general population. The available estimated data from India suggest that the incidence of sleep disorders has increased in all the age groups. Considering the shortage of specialists dealing with sleep hygiene, at present, most of the patients either do not avail health care or are handled by some subspecialists. It is a fact that the current undergraduate curriculum offered to a medical student in India is not holistic and does not incorporate skills to identify and manage sleep disorders in all 4 years of the undergraduate course. In short, there is limited scope for an Indian medical graduate (IMG) to get sensitized about sleep medicine and thus is not competent to identify, evaluate, treat, and prevent sleep disorders. Thus, Kern's model was employed to develop a curriculum on sleep disorders which can be used for the benefit of an IMG.

Screening for sleep disorders and their medical and psychiatric comorbidities Nikhil Sanjay Mankar, Sharmishtha S Deshpande Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):207-210 Background: Sleep disorders are common in medical out-patients. They are seldom addressed despite being known to worsen overall health of patients. Detailed evaluation to differentiate these into primary sleep disorders, psychiatric and medical co-morbidity or both can be done by a liaison Psychiatrist. Managing these is necessary for providing good quality recovery for the patient. Method: Cross-sectional survey of 148 randomly selected medical out-patients in a tertiary care hospital was carried out to assess various sleep disorders. Pittsburgh sleep quality index was used for assessment. They were assessed by qualified psychiatrist to establish Psychiatric diagnosis by clinical interview as per ICD-10 classification. Co-occurrence of these with chronic medical problems as diagnosed by clinician was documented. Results: Sleep disorders were common in medical out-patients (48.64%). Commonest among them was difficulty initiating sleep and reduced duration. A significant number screened to have sleep disorders, also had psychiatric co-morbidities (63.8%), Depressive disorders being the commonest (52.1%). Chronic medical illnesses were present in 50 (33.8%) of the all patients assessed for having sleep disorders. Co-occurrence of medical and psychiatric co-morbidities was not statistically significant. Conclusion: Considering high prevalence, patients should be routinely assessed for various sleep problems by Physician and referred to Psychiatrist for management as many of them also have psychiatric co-morbidities. Physician and Psychiatrist liaison is important in managing complex medical and psychiatric co-morbidities associated with sleep disorders.

Sleep disturbance and its effect on work performance of staffs following shifting duties: A cross-sectional study in a medical college and hospital of Tripura Kaushik Nag, Anjan Datta, Nabarun Karmakar, Tamal Chakraborty, Partha Bhattacharjee Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):211-216 Introduction: Sleep disturbance among night-shift workers results in serious adverse effects on their health affecting almost all the systems of the body. Recently, the World Health Organization has also identified night-shift work as being carcinogenic to human. Objective: The main objective is to study the prevalence of sleep disturbance and its effect on work performance of health-care staff working in shifts in a Medical College Hospital of Tripura. Materials and Methods: An institution-based cross-sectional study was conducted in February 2018, among 135 staffs working in shifts, including resident doctors, intern doctors, nursing staffs, security guards, technicians, ward boys, and ward girls of the Tripura Medical College and DR. BRAM Teaching Hospital. Systematic random sampling was used to collect the required samples with a predesigned and pretested interview schedule designed based on the Pittsburgh Sleep Quality Index. Data entry and analysis were done in the Statistical Package for the Social Sciences software version 16.0 (SPSS Inc. SPSS for Windows, Chicago, Illinois, USA). Data were represented in percentages in tables and charts, and the Chi-square test was applied to find out the statistical association. Results: Of the total 135 participants, the majority (28.9%) were interns and nursing staffs and paramedical students (26.7%). The prevalence of sleep disturbance was 54% among the participants, and it was significantly higher among those residing in hostel and quarter as compared to their own home (P = 0.003). Sleep disturbance was also found to be significantly decreasing their performance at work (P < 0.001). Conclusion: This study showed the high prevalence of sleep disturbance among shift workers, which significantly hampered their work performance in this institute. To find the measures to prevent sleep disturbance among staffs having a shifting duty, further research work can be done based on the findings of the study.

A study on thyroid profile and prolactin level in hypothyroid females of a rural population of a developing country Samarjit Koner, Arunima Chaudhuri, Abhijit Biswas, Debasis Adhya, Rajarshi Ray Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):217-224 Background: In patients with primary hypothyroidism, there are increased levels of thyrotropin-releasing hormone (TRH) which can cause rise of prolactin (PRL) levels and these patients may have galactorrhea. Aims: Considering the clinical importance of hyperprolactinemia in ovulation disorders, sterility, and menstruation disorders, the present study was conducted to observe the prevalence of hyperprolactinemia and related galactorrhea in newly diagnosed hypothyroid females and correlate serum PRL level with thyroid-stimulating hormone (TSH) in hypothyroid females in a rural population of East India. Materials and Methods: This pilot study was conducted in Burdwan Medical College on 200 newly diagnosed female hypothyroid participants after taking institutional ethical clearance and informed consent of the participants. Age and gender-matched 100 controls were taken. Serum TSH, serum free thyroxine (fT4), and serum PRL levels were assessed. A questionnaire was designed for the evaluation of hypothyroidism symptoms for all the participants. These symptoms were galactorrhea, dryness of skin, feeling cold, hair loss, weakness, weight gain, constipation, loss of libido, and menstrual abnormalities. A total number of hyperprolactinemic patients were 42; out of them, 30 females were clinical and 12 were subclinical hypothyroid patients. One hundred and fifty-eight patients had normal PRL level. Results: Significant difference was found between clinical and subclinical hypothyroid females for body mass index (BMI) (P = 0.002), TSH (P < 0.0001), fT4 (P < 0.0001), and PRL (P = 0.002). The prevalence of hyperprolactinemia was 21% in hypothyroid females, 23.07% in clinical or overt hypothyroid females, and 17.14% in subclinical hypothyroid females. The prevalence of galactorrhea is 1% in all hypothyroid females and 1.53% in clinical hypothyroid females. A significant positive correlation was found between TSH and PRL in hypothyroid patients. Conclusions: Incidence of hyperprolactinemia is found to be notable in hypothyroid females including clinical and subclinical hypothyroidism, and hypothyroid females show positive correlation between TSH and PRL levels. Hence, PRL levels need to be assessed in all hypothyroid females.

Hyperprolactinemia and hypothyroidism Viroj Wiwanitkit Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):225-226

Neurological soft signs in positive and negative subtypes of schizophrenia Spandana Devabhaktuni, Daniel Saldanha, Suprakash Chaudhury, Samiksha Sahu Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):227-232 Background: Schizophrenia, a heterogeneous clinical syndrome, has fascinated researchers since times immemorial. An increasing number of studies have implicated multiple brain regions, variations in the localization, and severity of brain impairments in schizophrenic patients that could ultimately lead to unraveling the etiopathogenesis of schizophrenia. A direct, easily administered, and inexpensive way of investigating brain dysfunction in schizophrenia is the study of neurological soft signs (NSS). Aim: To document the presence of NSS in positive and negative subtypes of schizophrenia and compare them with normal controls. Materials and Methods: The study was conducted on 52 schizophrenic patients diagnosed according to the International Classification of Diseases 10 Diagnostic Criteria for Research and 52 normal controls matched for age and education. All the patients gave written informed consent. NSS were assessed using Neurological Evaluation Scale (NES). Results: The prevalence of NSS in this study was estimated to be 77%. Statistically significant correlations were observed between the negative symptom subscale of Positive and Negative Syndrome Scale and the NES scores among the patients with schizophrenia. Conclusions: The comparison of the mean NES scores among cases and controls in this study reveals a very highly significant difference between the two groups studied. This suggests that NSS are highly prevalent among patients with schizophrenia.

Handwashing practices among caregivers of children Ibrahim Aliyu, Abdulsalam Mohammed, Bashir Mariat Zubayr, Godpower Chinedu Michael, Bukar Alhaji Grema, Umar Isah Umar, Mahmud Jahun Gambo, Halima Umar Ibrahim Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):233-238 Introduction: Handwashing has been proven to reduce the risk of acquiring infection; this is why every 15th October is being set aside as Global Handwashing Day, which aims at improving global awareness on the importance of handwashing. Materials and Methods: The study was cross-sectional, parents/caregivers were consecutively recruited over 8 months, and pretested questionnaire was administered by the researchers and trained assistants. Results: There were 102 (32%) males and 217 (68%) females with a male-to-female ratio of 1:2.1. A total of 279 (87.5%) respondents reported that they were aware of the moments of hand hygiene. Their relations (38.3%) were the most common source of information on hand hygiene. However, soap and water (72.4%) were the predominant items used for handwashing. Furthermore, 317 (99.1%) respondents were incorrect on the steps of handwashing technique. All respondents (100%) reported washing their hands after using the restroom. However, their educational and social status had no significant relationship with their ability to mention the steps in handwashing and the critical moments in hand hygiene, respectively, (educational status: ‡Fisher's exact = 0.440; P = 1.00, and $Fisher's exact = 3.308; P = 0.282, respectively) and (social class: ‡‡Fisher's exact = 0.756; P = 1.00 and $$Fisher's exact = 1.232; P = 1.00, respectively). However, there were statistically significant relation with adhering to the principles of handwashing (educational status: †χ2 = 7.835; df = 2; P = 0.019) and (social class: ††χ2 = 7.952; df = 2; P = 0.019), respectively. Conclusion: Majority of the respondents wash their hands especially after soiling with dirt; and water and soap were mostly used; however, the technique of handwashing was poorly understood by caregivers and this was shown to be less influenced by their educational or social status.

Oral Care and Research

Impact of different laser treatments on push-out strength of post luted with resin cement: An in vitro study Sylvana Achammada, Shamsheer Thayyil, Joseph Joy, Namitha Divakar, Saurabh Sathe, Sreehari Sathyanathan International Journal of Oral Care and Research 2018 6(4):49-53 Background: The interface of the post and resin cement is a site of likely failure of adhesion. This interface adhesion of the post surface can be improved through different pretreatments such as laser. So the aim of this study was to investigate the effects of erbium-doped yttrium aluminum garnet (Er:YAG) and erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser irradiation on the push-out bond strengths of fiber-reinforced composite (FRC) posts and resin cement. Materials and Methods: Thirty extracted mandibular premolar teeth were taken and randomly divided into three groups, Group 1 (control group), Group 2 (Er,Cr:YSGG), and Group 3 (Er:YAG). FRC post cementation was performed with Etch-and-rinse resin cement. Push-out strength was tested using a universal materials tester. Statistical analysis was carried out using Statistical Package for the Social Services (SPSS), version 20. Results: Highest push-out bond strength was observed in Group 3 (i.e., Er:YAG, 18.1±0.4MPa) followed by Group 2 (i.e., Er,Cr:YSGG, 17.6±0.9MPa) and least strength was seen in Group 1 (i.e., control, 14.7±1.5MPa). A statistically significant difference was observed when the groups were compared to the untreated or control group (P = 0.000). Conclusion: It was concluded that laser treatment, that is, Er:YAG and Er,Cr:YSGG, significantly improved the push-out bond strength of FRC posts luted with resin cement.

Effects of disinfection procedures on surface roughness of hard chairside relining and denture base acrylic resins: An in vitro study Chandrasinh Rajput, Keval Shah, Hiren Rana, Bhagyashree Dave, Yashpreet S Bhatia, Rutu Shah International Journal of Oral Care and Research 2018 6(4):54-57 Objective: There is a concern that disinfection procedures may adversely affect the surface roughness of relining and acrylic denture base resins. Hence, this in vitro study was conducted to evaluate the effect of chemical and microwave disinfection on surface roughness of commonly used hard chairside relining (Ufi Gel hard and Kooliner) and acrylic denture base resins (Lucitone 199). Materials and Methods: Powder (polymer) and liquid (monomer) were mixed according to manufacturer’s instructions to prepare 20 specimens from each material. Specimens were divided into two control and two test groups. Surface roughness measurements (Ra, μm) were made after polymerization and water immersion (control groups) and after chemical and microwave disinfection (test groups). Measurements of roughness were statistically analyzed. Result: When compared with control groups, the surface roughness of all three types of materials evaluated were significantly increased (P ≤ 0.05) by both chemical disinfection (Ufi Gel hard, from 0.16 to 0.28 μm; Kooliner, from 0.18 to 0.29 μm; and Lucitone 199, from 0.14 to 0.26 μm) and microwave disinfection (Ufi Gel hard, from 0.16 to 0.26 μm; Kooliner, from 0.18 to 0.25 μm; and Lucitone 199, from 0.14 to 0.23 μm). For all three types of materials, specimens disinfected in microwave (Ufi Gel hard, 0.26 μm; Kooliner, 0.25 μm; and Lucitone 199, 0.23 μm) showed lower mean surface roughness values than those that were chemically disinfected (Ufi Gel hard, 0.28 μm; Kooliner, 0.29 μm; and Lucitone 199, 0.26 μm) but the difference was significant only for Kooliner (P = 0.015). Conclusion: The result of this in vitro study favored the use of microwave disinfection method as it had less adverse effect on surface roughness of materials compared to that of chemical disinfection.

Assessment of knowledge and attitude of school teachers regarding emergency management of dental trauma in Udaipur city, India: A cross-sectional study Mukesh Panwar, Dinesh Rao, Shubha Arehalli Bhaskar, Sunil Panwar International Journal of Oral Care and Research 2018 6(4):58-63 Background: Dental trauma is common in childhood. The home, school, and playground are the most common places where one can find a noticeable risk of traumatic injuries. Teachers are usually in proximity to children and are often called upon to provide initial care. The aim of this study was to evaluate the school teacher’s knowledge and attitude toward emergency management of dental trauma (EMDT). Material and Methods: The cross-sectional study was carried out among 400 school teachers from 24 selected schools in a city by simple cluster sampling. A closed-ended, structured, modified questionnaire was used for the survey. Data obtained from 400 completed questionnaires were statistically analyzed using descriptive statistics. Results: The study achieved around 88% response rate. Majority of school teachers accepted that their knowledge of EMDT was not enough. Maximum of teachers wanted future education in EMDT. Very few teachers reported that they were unable to provide proper action when needed in case of dental trauma. Conclusion: The present study revealed considerably low knowledge and attitude of school teachers regarding EMDT.

Effect of two desensitizing agents on crown retention using zinc phosphate cement Mohammed A Mapkar, Amit Jagtap, Syed Ruby Syed Asadullah International Journal of Oral Care and Research 2018 6(4):64-68 Introduction: Preparation of vital teeth involves removal of sound tooth structure, which causes opening of dentinal tubules, thereby causing displacement of the dentinal tubular fluid, leading to dentinal hypersensitivity. After cementation of crowns in such teeth, incidence of pain and hypersensitivity has been reported. An extensive use of desensitizing agents has been observed over the past few decades because of the introduction of newer agents and the increased incidence of post-cementation sensitivity. Dentin desensitizing agents are commonly used in dental practice. But their effects on crown retention have been anecdotal. Materials and Methods: Thirty-three extracted human maxillary first premolar teeth were selected for the study, which were prepared using a special assembly and divided into three groups (i.e., ZP + U, ZP + G, and ZP) to compare the effect of Gluma (Heraeus-Kulzer, Germany) and Ultraseal (Ultradent, USA) on crown retention using zinc phosphate cement. Results: It was seen that the group ZP + G was statistically significant with groups ZP and ZP + U. However, no such difference was observed between ZP and ZP + U. Conclusion: Both the agents can be used and prove effective when used with zinc phosphate cement. However, the major mode of failure was adhesive in nature with the cement being retained on both the crown and the tooth structure.

Buccal mucosal alterations: A mirror of diabetes mellitus Mitali Dhebri, Sanskriti Gandhi, Rushda B Kazi, Vaibhavi Gore, Prachi Baldawa, Ajit Koshy International Journal of Oral Care and Research 2018 6(4):69-72 Background: Oral exfoliative cytology can be used as a simple chairside investigation for microscopic study of Diabetes Mellitus. Exfoliative cytology gives an insight to the cellular changes occurring in the buccal mucosa of diabetic individuals, serving as a mirror for diabetes mellitus. Aim: To evaluate the qualitative changes in oral epithelial cells using exfoliative cytology and its correlation with glycosylated hemoglobin in patients with Type 2 Diabetes Mellitus. Materials and Methods: Study group consisted of 100 patients with Type 2 Diabetes. Approval from the ethics committee was taken. HbA1c was measured. Buccal smears were collected using exfoliative cytology and were subjected to Rapid Papanicolaou (PAP) stain. Smears were scrutinized under Leica Research Microscope. Individuals who smoke, are dependent on alcohol, or have malignancy were excluded to eliminate its effect on cellular shape and morphology. Statistical Analysis: Spearman Rank Correlation. Results: A statistically significant increase in cytological changes are seen in the buccal mucosa as the levels of glycosylated hemoglobin increase. Exfoliated buccal cells revealed micronuclei, enlarged nuclear area, and increased inflammatory cells. Conclusion: On the basis of the results obtained, a strong correlation exists between the levels of glycosylated hemoglobin and buccal mucosal alterations. We are encouraged to venture with a suggestion that exfoliative cytology can be significant as a chairside adjunctive diagnostic tool in the detection of Diabetes Mellitus, apart from regular standard tests.

Effectiveness of a training program related to infection control and waste management practices in a dental college: A quasi-experimental study Mayank Das, L Vamsi Krishna Reddy, Pooja Sinha International Journal of Oral Care and Research 2018 6(4):73-77 Introduction: Biomedical waste is an important public health concern regarding waste management and diseases related to this issue in developing countries. Aim: This study was undertaken to assess the effectiveness of training related to infection control and waste management among undergraduate students in a dental institution. Materials And Methods: This was a quasi-experimental study carried out in two dental colleges, including 100 final year students of both the colleges. In group A (experimental group) and group B (control group) at the baseline, a questionnaire and a lecture were given. Follow-up and assessment were conducted at 1 and 3 months, and at the end of 6 months. Collected data were analyzed, and independent t test and one-way analysis of variance test were used for the analysis. Result: Knowledge and attitude scores in the experimental group showed a statistically significant increase. Practice scores in the experimental group showed a statistically significant increase in scores from 1 to 3 months and from 3 to 6 months. Conclusion: The training program was found to be effective in improving knowledge, attitude, and practice regarding infection control and waste management among undergraduate dental students.

Assessment of orthodontic brackets for the shear bond strength bonded with and without primer: In vitro study Ayub Khan, Abdul Mueez, Mohsin Reza, Mohammed A Rasheed, Sweta Kattimani International Journal of Oral Care and Research 2018 6(4):78-80 Introduction: The elementary function of primer is to boost the efficiency of the final bond. Secondarily, they are also pronounced to protect the enamel from the consequent demineralization by the acid etching and to reduce marginal leakage. The use of primer adds a step in the bonding procedure, which necessitates increased chair time risk of moisture contamination and an increased procedural cost. Materials and Methods: Eighty extracted premolars were procured and divided into two groups, that is, a conventional adhesive system with and without primer. Later, acrylic blocks were made and the teeth were bonded and then the shear bond strength (SBS) was measured using a universal testing machine. Results: Group I (with primer) has the bond strength value of 10.22±2.4MPa and Group II (without primer) has the bond strength value of 9.11±1.596MPa. Conclusion: A conventional adhesive system with and without primer showed SBS in the range satisfactory for clinical usage.

Antibacterial efficacy of herbal alternatives and 2% chlorhexidine on biofilm: An in vitro study Neelam Chandwani, Pooja P Bopche, Neetu Maurya, Aastha Ranka, Abhishek Pal, Tanvi Fuladi International Journal of Oral Care and Research 2018 6(4):81-84 Aim: To evaluate the efficacy of natural agents for disinfection of root canal system, such as the effect of Azadirachta indica (neem), thyme oil, and 2% chlorhexidine gluconate (CHX) on multispecies biofilm of most commonly found pathogens such as Streptococcus mutans and Enterococcus faecalis in the field of endodontics. Materials and Methods: To visualize the antibacterial effectualness of the methanolic extracts of the medicated plants and CHX, an in vitro dentin model was used. A polymicrobic biofilm was grown on human extracted teeth for 21 days. Microbial load in the form of colony-forming units per milliliter (CFU/mL) after the antimicrobial treatment was calculated. Data were statistically analyzed using analysis of variance and Bonferroni post hoc tests. Results: Plant extracts showed remarkable antibacterial efficacy along with 2% CHX compared with that of control. A significant statistical difference was found with 2% CHX. Conclusion: The methanolic extract of A. indica, thyme oil, and CHX has shown considerable antimicrobial activity against polymicrobic dentinal biofilm of S. mutans and E. faecalis.

Assessment of determinants in successful regeneration of class II furcation involvement by guided tissue regeneration: An overview Sunil Kumar Vaddamanu, Ravi Kadur Sundar Raj, Shankar T Gokhale, Mukhatar A Javali, Mohasin A Khader, N Raghavendra Reddy International Journal of Oral Care and Research 2018 6(4):85-88 The ultimate goal of periodontal therapy is to regenerate lost periodontal tissues caused by periodontal diseases. Furcation involvement in multi-rooted teeth caused by chronic periodontitis is a difficult task in achieving the periodontal regeneration. Various treatment modalities are available, among them, guided tissue regeneration (GTR) placement has shown promising results. Various prognostic factors such as anatomical and systemic factors have to be considered for the final outcome of periodontal therapy while placing membrane. The aim of the paper was to evaluate various determinants in class II furcation defect by GTR procedure.

Role of maxillofacial radiology in expediting forensic odontology Shruti Sinha, Charu Singh, Sunira Chandra, Siddharth Kumar Singh, Palkin Mehta International Journal of Oral Care and Research 2018 6(4):89-92 In the last few decades, forensic odontology has developed as a separate specialty that deals with examination of dental evidences, their proper evaluation, and correct management for law proceedings in the interest of justice. It is mainly concerned with person identification, age estimation, gender determination, human abuse, bite mark investigation, and DNA analysis, in incidents of natural disasters and medico-legal cases. Maxillofacial radiology is a promising tool in forensic science as radiographs capture the exact anatomic and skeletal features that can then be matched with the original records for person identification and can also provide minute forms of comparison between antemortem and postmortem radiographs in cases of mass disasters. The use of imaging is increasing day by day as it is efficient, quick, and comparatively easy, less expensive as compared to available DNA technologies, and can also be applied to both living individuals as well as dead. The present article aims to discuss the various trends that have evolved in forensic radiology and to appraise their contribution in the field of forensic odontology.