There has been recent research on the use of dexamethasone as an adjunct to local anaesthetics to enhance the block characteristics and improve post-operative pain outcomes. Numerous studies have shown that perineural dexamethasone improves post-operative analgesia, along with other clinical benefits. Intra-space pterygomandibular twin mix anaesthesia is a novel technique for inferior alveolar nerve block used for mandibular anaesthesia. Twin mix anaesthesia has its advantages in shortening the latency and prolonging the duration of the soft tissue anaesthesia, along with improving the quality of life in the post-operative period after mandibular oral surgical procedures. The concern regarding the use of perineural dexamethasone has been discussed.

Sinusitis is an inflammation or else infection of the nose and paranasal sinuses. These cavities are adjacent, and any provocative or transferrable process that touches one also communicates and contaminates others. Consequently, the important entity in this regard to remember that the befitting locution is: rhinosinusitis preferably apart from sinusitis. Chronic sinusitis, more accurately termed chronic rhinosinusitis (CRS), is diagnosed more often than acute rhinosinusitis (ARS). Rhinosinusitis is founded on the four key symptoms of 'obstruction, drainage, smell loss and facial pain or pressure' in both ARS and CRS. CRS relates to a progressive upsurge in healthcare exploitation, expenses and healthcare cost remains high. It has been estimated that widespread antimicrobials prescribing and use for CRS cost in the USA was more than the US $150 million to 2.4 billion per year and in the UK, it is about ≤10 million, which finally promotes antimicrobial resistance (AMR). Multiple meta-analyses revealed that the respiratory fluoroquinolones (specifically moxifloxacin, levofloxacin and gatifloxacin) were not able to establish superiority to β-lactams and other classes of antimicrobials for the management of ARS regarding the efficacy and ADR. Thereafter, three additional meta-analyses revealed that there were no corroboration and affirmation of superior efficacy, usefulness and lower adverse effects observed with any definite group of antibiotics in sinusitis. The current understanding regarding the pathophysiology of CRS microbial infection cannot be established, and antimicrobials role should be dedicated in the management ARS episodes or their contagious impediments, and the choice of antimicrobials should be channeled by optimally obtained on endoscopic sinus culture.

Stress is a constraining force that causes bodily or mental tension and may be a factor in disease causation. The study showed that medical students have more proneness to higher stress than students study in non-medical fields. The objective of this study is to discover the stress as evident among Malaysian medical students and general positive effects of mentation programmes in stress management. The current study was worked with the review of literature of the past study reports regarding stress in Malaysian medical students and general positive effect of mentation in stress management. The study had used electronic databases for rummaging and reviewing literature articles published on stress and other psychological determinants among medical students and mindfulness in the management of stress. Stress, mindfulness and related terminologies are used in searching related articles. In the current study, data were extracted through reviewing various related research articles focussing more on the prevalence and stress management in medical students. Stress among medical students found to be more than 50% needs close attention and monitoring. The academically related stressors were found to be high with the existence of other stressors with financial and relationship problem. Mentors help and religious sources were used as coping strategy. Medical education is found to be highly stressful. Developing awareness effects of managing stress through mindfulness and mentation among students and teachers and facilitate students to cope with academic and other stress that can negatively affect students' mental health. Prospective studies are encouraged using matured mentation programmes in medical schools.

Lasers have completely changed the concept of dental treatment since three and half decades of 20^th century. After the invention of ruby laser by Maiman in 1960, laser has become the most magnetizing technology in dentistry. Diode Lasers have been used in initial periodontal therapy, surgery, and also in implant treatment. In many countries Laser has become a part of the dental armamentarium. The included articles were searched from PubMed, Trip Database, Google scholar and Cocharane database. The purpose of this review article is to critically analyze the effectiveness of diode laser on soft and hard tissue in the field of Periodontics.

Low-level laser therapy (LLLT) is a therapeutic approach to treat orofacial pain using a 600–1000 nm laser with a <500 mW power. The efficacy of LLLT is due to the chemical reactions causing an anti-inflammatory and analgesic effect on the affected regions. The aim of this study is to review the effects of low-level laser application on orofacial pain in the English articles released since 2017. Our search keywords were 'low-level laser therapy, temporomandibular disease (TMD), mucositis and orofacial pain'. The most relevant papers were clinical trial, review and meta-analysis articles. 26 out of 243 searched articles were selected from PubMed, Google Scholar and Science Direct and reviewed. Most of the studies reported the positive role of LLLT on orofacial pain relief regardless of their variable procedures; however, the exact mechanism of action still remains unclear. Some studies indicated that LLLT has significantly reduced pain, reduceamount of clicking and both masseter and temporal muscles activityin TMD. As an overall result, it is concluded that LLLT can be served as a therapeutic method for myofascial pain, mucositis and temporomandibular joint disorders and this is due to its analgesic features.

Objective: Echocardiographic assessment of cardiac functions in patients with idiopathic dilated cardiomyopathy before and after using statins as adjuvant therapy. Methodology: With the study duration of 12 weeks 40 patients with idiopathic dilated cardiomyopathy with the New York Heart Association Class II and III were selected and randomly divided into two groups. Group A patients received 10 mg/day of atorvastatin along with usual care and Group B patients received usual care of chronic heart failure. anthropometric, biochemical, echocardiography, 6-min walk test and serum lipid profile were done at baseline and at the end of the study in both the groups. All the data were statistically analysed using 't'-test. Results/Observations: In both the groups, mean ejection fraction (EF) was comparable. It increased in Group A, i.e., study group from 28.92% ±1.63% to 34.18% ±1.27% (P < 0.02). There was significant reduction observed in left ventricular and systolic volume from 194.9 ± 57.34 ml/m² to 154.15 ± 44.67 ml/m² (P < 0.002). At the end of the study, 6-min walk test's mean also improved from 310 ± 10.71 to 335 ± 8.71 m (P < 0.001). No major side effects, dropouts and deaths were observed. Conclusion: Statins as an adjuvant therapy improve EF decreases ventricular remodelling and also help in improving the functional class of patients suffering from idiopathic dilated cardiomyopathy.

Background: A large number of in vitro and in vivo studies in both animals and humans have reported that curcumin has antioxidant, anti-inflammatory, anti-carcinogenic, anti-microbial and anti-parasitic properties. Curcuma longa is also used externally for inflammation of oral mucosa. To overcome the adverse effects caused by the chemical agents, curcumin is proposed as an alternative for the treatment of gingivitis and periodontitis. Aim: This study aimed to evaluate and compare the role of topical application of oral curcumin gel with scaling and root planing (SRP) on chronic periodontitis. Materials and Methods: In this clinical study, forty participants with mild chronic periodontitis were included. Included participants underwent Phase I therapy, after which they were allocated into two groups (20 each), out of which only one group received curcumin gel for topical application. Plaque index (PI), bleeding on probing measured by sulcus bleeding index, probing pocket depth and clinical attachment level (CAL) were recorded at baseline and at the follow-up after 2 months. Results: Both test and control groups showed statistically significant reduction in PI, sulcular bleeding index, pocket probing depth and CAL. Curcumin gel group showed statistically significant difference compared to the control group with respect to PI (<0.001), sulcular bleeding index (<0.001) and pocket probing depth (0.006). Conclusion: Curcumin as an adjunct to SRP showed higher reduction in plaque accumulation, sulcular bleeding and pocket probing depth as compared to SRP alone.

Introduction: Different factors are effective in medication errors, but some dispensing errors may occur by the pharmacy technicians due to the expanded responsibilities of them and lack of standardised training. This study aimed to assess the pharmacy technician awareness in different dimensions including pharmacological knowledge, interventions and medication errors in employed technicians of Qom pharmacies. Methods: A cross-sectional study was conducted in all 101 employed pharmacy technicians in medical pharmacies of Qom, Iran, in 2017. The data collection conducted by a standard researcher-made questionnaire. The questionnaire was including demographic characteristics, pharmacological knowledge, intervention and medication errors. Data were analysed by t-test, analysis of variance and Pearson's correlation coefficient tests in SPSS. Results: The mean score in pharmacological knowledge, interventions and medication errors was 5.72 ± 2.35, 1.05 ± 0.744 and 6.68 ± 2.26, respectively. Moreover, the total score of pharmacological awareness was 13.45 ± 3.96. Only 12% of the pharmacy technicians in Qom educated in medical field, 45% were diploma and lower and 61% of participants reported that they have not passed any educational pharmacological courses. The mean score of pharmacological knowledge (P = 0.010) and errors (P = 0.026) and the total score of pharmacological awareness (P = 0.005) were significantly lower in 23 years' age group and higher in 23-year-old pharmacological technicians. Moreover, week-work is directly associated with medication errors. Gender, job history and educational field are related factors in pharmacological knowledge of pharmacy technicians. Conclusion: The mean score of pharmacological knowledge, intervention and medication errors of pharmacy technicians was moderate. Nevertheless, there was some main challenge in Iranian pharmacy staffs including irrelevant education of pharmacy technicians, low educational level and low experience job in drugstores.

Background: Preeclampsia, a pregnancy-specific syndrome, causes derangement in liver and kidney functions. Increase in maternal age increases the pregnancy-associated complications. Aim: The aim of this study was to compare liver and kidney functions among two groups of pregnant women presenting with preeclampsia: age <35 years and age ≥35 years (i.e., elderly gravidae). Materials and Methods: Pregnant women presenting with preeclampsia in age <35 years comprised the control group and pregnant women in age ≥35 years comprised the study group. Both the groups were tested for serum bilirubin, alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase for assessing liver function and serum urea, creatinine and uric acids for assessing kidney function. The mean value of measured parameters was compared by unpaired t-test with α = 0.05. Results: The mean age in control group (n = 50) was 22.44 ± 3.60 years and in study group (n = 50) was 36.22 ± 2.39 years. Liver function test parameters did not show any statistically significant difference in control and study groups. Urea and uric acid in study group (38.18 ± 7.28 mg/dL and 7.31 ± 0.84 mg/dL, respectively) were significantly higher than control group (32.92 ± 8.91 mg/dL and 6.19 ± 0.96 mg/dL, respectively). Conclusion: Elderly gravidae with preeclampsia showed a higher level of urea and uric acid when compared with women <35 years of age presenting with preeclampsia. Hence, an increase in maternal age in preeclampsia may increase the risk of kidney function deterioration.

Purpose: The purpose of this study was to study the utility of magnetic resonance urography (MRU) in the evaluation of obstructive urological diseases in comparison to intravenous urography (IVU). Materials and Methods: The study was carried out over a period of 2 years. A total of 55 patients were included in this study with ages between 14 and 70 years (average age 37 years). The patients were selected on the basis of ultrasonographic findings of hydronephrosis. The patients were subjected to IVU followed by static and dynamic MRU. The results obtained were compared and the inferences drawn thereof. Results and Conclusions: MRU has high sensitivity in the diagnosis of urinary tract obstruction, detecting the level of obstruction and acts as an aid in the diagnosis of obstructive uropathy, thus showing promising results. MRU is safer than IVU due to avoidance of iodinated contrast material and could also be done without using contrast material so having less contrast related events.

Introduction: Blood grouping has been one of the cornerstones of identification of biological material. Mostly, teeth and bones are the only significant tissues remaining in mass disasters such as aircraft crash or bomb blasts and hence used in human identification. It has also been suggested that blood group antigens in the pulp and dentine are preserved even up to 2 years after death of an individual. Aim: In the present study, an attempt was made to determine the ABO blood grouping from the dentine and pulp by absorption-elution (AE) technique. Materials and Methods: The study group included 60 patients requiring extraction due to periodontal or orthodontic purposes. Extraction procedure was carried out under local anaesthesia following an aseptic protocol. After extraction, the socket blood was collected for blood group determination which served as control for the study. The blood grouping was performed by AE technique using powdered dentine and dental pulp. Statistical Analysis: The statistical analysis was carried out using the Statistical Package for the Social Sciences version 19, SPSS Inc., Chicago, USA. The statistical analysis for comparison of teeth component with ABO blood groups with the age period and gender differentiation was done using Chi-square test. P < 0.05 was considered as significant. Results: Out of 60 samples tested for ABO blood grouping, dentine and pulp showed no significant difference with age and gender; results were more positive in the age group in which individuals were <20 years of age with the sensitivity decreasing with increasing age of the participants while pulp was better than dentine in expressing ABO antigens. Conclusion: On the basis of the results obtained from the present study, it could be concluded that both dentine and pulp are reliable sources of blood group determination for ABO blood grouping where teeth happen to be the only remnants available for personal identification.

Context: The police personnel resort to tobacco-associated habits often as a stress buster and consider that the nicotine rush will settle their nerves so that they can focus better on their work. Recently, some non-governmental organisations have taken a note of this and carried out health check-up camps for the police personnel in the city of Mumbai, but similar awareness for oral and dental health is still largely missing. Aim: The present study was carried out with the primary aim to determine the prevalence of tobacco-associated habits and oral lesions in the police personnel from Greater Mumbai. Materials and Methods: All the police personnel included in the study were subjected to a detailed case history elicitation and examination procedure after obtaining their informed written consent. Special stress was given in eliciting the history of tobacco-associated habits while care was taken to diagnose tobacco-associated oral lesions such as tobacco pouch keratosis, pre-leukoplakia, leukoplakia, oral submucous fibrosis and carcinomatous and other lesions. Statistical Analysis Used: The data so collected were tabulated and sent for statistical analysis and objective conclusions were drawn. Results: Use of tobacco with lime was found to be the most common habit present in the police personnel (34.0%) while the least common habit found was betel nut chewing (3.9%). In a sample size of 2388 police personnel included in the study, the overall prevalence of leukoplakia was found to be 11.12%, with homogeneous leukoplakia being the most common subtype encountered (96.24%) and the second most common subtype encountered being speckled leukoplakia accounting for 2.26% of the cases reported. Conclusion: The results of the present study indicated tobacco-associated habits to be very common in the police personnel from Greater Mumbai which emphasised specific efforts to be made to reduce tobacco usage by police personnel on active duty.

Background: Varied aetiologies have been proposed for the prevalence of neonatal jaundice (NNJ) in different parts of Nigeria. The aim of this study was to determine the clinical and sociodemographic correlates of NNJ in a cohort of neonates presenting at a Tertiary health Facility in Lagos, Nigeria. Materials and Methods: One hundred and fifty consecutive neonates that presented at the neonatal unit of the hospital were enlisted for the study after checking them with set inclusion and exclusion criteria. The transcutaneous bilirubin (TcB) readings of the individuals were obtained on the forehead, sternum and abdomen of the calm neonate in a supine position and blood samples for total serum bilirubin estimation were drawn from a peripheral vein within 10 min of TcB measurement. Results: One hundred and fifty neonates were included in the study of which 89 (59.33%) were males and 61 (40.67%) were females. Mothers that had only a primary level of education had babies that presented with significantly higher bilirubin values (P = 0.000). Male neonates, those that presented after 48 h, those between 40 and 42 weeks' gestational age and those that were <2.5 kg birth weight also had higher values though it was not statistically significant. Those that were delivered at home or in a church, delivered by an auxiliary nurse or a traditional birth attendant and those with jaundice extending to the sole of the feet also presented with significantly higher mean bilirubin scores (P = 0.000). Conclusion: Majority of individuals in this study with NNJ were males, while those delivered at home or in a church or by traditional birth attendants and auxiliary nurses and had mothers that were poorly educated had higher mean bilirubin values. It is thus imperative that advocacy is increased to intervene on modifiable risk factors for this condition.

Small cell carcinoma of the urinary bladder (SCCB) is a rare and aggressive non-urothelial tumour of the urinary bladder. It represents neuro endocrine type of malignancy, being diagnosed on histopathology and immuno histo chemistry. Bladder diverticulum tumours are rare and present with early lamina propria invasion. Furthermore, the risk of bladder perforation is high during resection due to the lack of muscle. Thus, these tumours have a risk of being under-staged and have a poor prognosis. Till now, very few cases have been reported of SCCB in bladder diverticulum. Multi-modality management in the form of combined chemotherapy and surgery is required for the optimal management. We report this rare case and review the literature for the management of SCCB in bladder diverticulum.

Achieving optimal aesthetics, function and phonetics with implant-supported restorations depends largely on the amount of bone present at the site where implant has to be placed. Sometimes, patient reports with compromised conditions which makes the implant placement difficult. Today, reconstruction procedures such as autogenous bone graft and guided bone regeneration make the implant placement possible in different ridge deficient cases. This case report describes step-by-step procedure of restoring the missing maxillary right central incisor with implant-supported prostheses. In missing left central incisor region, the alveolar bony defect was corrected by autogenous bone graft obtained from symphysis region, for restoration with implant prostheses.