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October-December 2020
Page Nos. 521-721
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Role of biologics – Platelet-rich plasma in treatment of moderate osteoarthritis of the knee p. 521
Aditya Pundkar, Swapnil Date, Sandeep Shrivastava, Bhushan Patil, Kiran Saoji, Prateek Upadhyay
DOI:10.4103/jdmimsu.jdmimsu_265_20
Background: Osteoarthritis is a degenerative disease of the joints which involves cartilage. Osteoarthitis of the knees is the most common joint disease. It is a chronic progressive degenerative disease. It affects 30% of the people having an age more than 50 years. Various studies have shown that osteoarthritis leads to a major burden on the economy of many developing countries. The basis for biologics such as platelet-rich plasma (PRP) therapy in osteoarthritis of knees is the stimulation of the natural healing and regeneration due to the presence of large number of platelet-derived growth factors directly at the site of treatment. There is a lack of clarity regarding the number and frequency of injections for proper effectiveness as well as the ideal treatment for different stages of In our study, we have tried to analyze PRP as a treatment modality in osteoarthritis of the knee. Materials and Methods: Thirty patients of osteoarthritis of bilateral knees and who fulfilled inclusion criteria and were managed with two sessions of intra-articular PRP infiltration 3 months apart between the duration May 2018 and May 2020 were included in our study. Maximum follow-up was done for 8 months. Functional assessment was done with the help of the Western Ontario and McMaster Universities (WOMAC) score and Visual Analogue Scale (VAS) score. Results: The mean age group of the patients in our study was 53.9 years. Out of 30 patients, 13 (43.333%) were males and 17 (56.666%) were females. Out of 30 patients, 9 patients (30%) had Grade I osteoarthritis of knees according to Kelgren-Lawrence grading, while 16 (53.333%) had Grade II and 5 (16.666%) had Grade III osteoarthritis, i.e., majority of the patients had Grade II osteoarthritis. The mean ± 2 standard deviation WOMAC scores before intervention, at 1-month follow-up, 3-month follow–up, and 8-month follow-up are 49.833 ± 5.854, 40.103 ± 8.08, 30.033 ± 6.976, and 19.666 ± 4.26, respectively. The mean VAS scores before intervention, at 1-month follow-up, 3-month follow–up, and 8-month follow-up are 4.4, 3.2, 2.9, and 2.5, respectively. There were no major complications in our study. The complication rate of our study was 6.6667%, i.e., only two patients had complications. Out of 30 patients, 24 (80%) were satisfied with this treatment modality, 3 (10%) were partially satisfied, and 3 (10%) were not satisfied. Discussion: Even though the results and observations of our study are comparable with other studies on this subject, there are some limitations in our study like short duration of follow-up, lack of radiological modalities for judging functional outcome, and small sample size. Conclusion: Multiple (2) intra-articular PRP injections are a new modality in the treatment of early osteoarthritis. In our study, symptomatic and functional improvement was seen in cases of bilateral early osteoarthritis. This technique is cost-friendly and has very low complications rates. Hence, this modality can be used in the treatment of early osteoarthritis as an alternative to other established modalities.
Assessment of efficacy of urine reagent strips for cerebrospinal fluid analysis as emergency workup in critical care setup p. 526
Rashmi Wankhade, Arvind Bhake
Background: Meningitis is a medical emergency that requires to be diagnosed at earliest for early therapeutic interventions for favorable outcome. Cerebrospinal fluid (CSF) biochemistry plays an important role in diagnosis of meningitis. Point-of-care availability of CSF examination for its biochemical parameter is a necessity for resource-limited hospitals. Objectives: The present study evaluates urine reagent strip for leukocyte count, glucose, and proteins for its diagnostic utility in samples of CSF in suspected cases of meningitis. Materials and Methods: 50 CSF samples were evaluated by urine reagent strip method. The results of it were compared with results of definitive test. The values for sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio, positive predictive value (PPV), and negative predictive value were evaluated for reagent strip method. Results: Sensitivity and specificity of reagent strip method for thin-layer chromatography were 83.35% and 100%, respectively, and for glucose, it was 100% and 78.95%, respectively. Sensitivity and specificity of reagent strip method for protein were 78.57% and 100%, respectively. The overall PPV for reagent strip method was 97.06% and PLR was 7.12%. The overall sensitivity and specificity were 86.27% and 87.88%, respectively. Conclusion: The urine reagent strip method works satisfactory at CSF sample evaluation in predicting the diagnosis of meningitis. A resource-limited hospital might find it useful as a point-of-care laboratory workup of CSF.
Aptitude, awareness, and knowledge of cardiac rehabilitation in patients of acute coronary syndrome after treatment p. 533
Aditya Khandekar, Sourya Acharya, Samarth Shukla
Background: Acute Coronary Syndromes result from an imbalance in oxygen supply and demand in the coronary circulation. Unfortunately, after treatment by a Percutaneous Coronary Intervention (PCI) or Thrombolysis, most patients are not educated about guidelines they should follow to resume routine activities. Thus, a study was undertaken with the aim of assessing the awareness of cardiac rehabilitation in such patients. Methods: Seventy patients having acute coronary syndrome, admitted to a rural tertiary care centre, were interviewed using a validated questionnaire. They were assessed on awareness regarding drugs that had been prescribed, knowledge of rehabilitation guidelines, and sincerity of adherence to treatment plan. Scores were compared with three parameters, namely age, level of education, and socioeconomic classes. p values were calculated for each category, and results obtained. Results: Younger patients were more aware of rehabilitation guidelines compared to patients in the geriatric age group. Well-educated patients knew more about the mechanism of actions of drugs being prescribed as compared to lesser-educated peers. Also, patients from the Lower socioeconomic class knew lesser about guidelines of cardiac rehabilitation compared to peers from higher classes. Conclusion: Patients from lesser-educated communities and lower socioeconomic classes need to be focused on for further integration into the process of cardiac rehabilitation. Setting up of dedicated units for the same can prove beneficial for such patients.
Role of ultrasonography and elastography of palpable breast masses in pregnancy and lactation with clinical correlation p. 539
Samida Abdul Samad, Suresh Vasant Phatak
Introduction: Pregnancy and lactation represent unique physiologic states that induce notable changes in the mammary glands. Early detection and diagnosis of breast pathologies by noninvasive modalities is of great demand. In this prospective cross-sectional clinical study conducted among 62 pregnant and lactating patients, we focused on role of sonoelastography in diagnosing clinically suspected breast pathologies among these patient groups. Results: In our study, we concluded sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of ultrasound strain elastography for differentiating benign and malignant breast masses were calculated to be 92.6%, 90%, 86.6%, 91.4%, and 93.5%, respectively, which is more than the conventional sonography alone which had sensitivity, specificity, PPV, NPV, and accuracy as 86.21%, 83.5%, 88.6%, 85.3%, and 86.2%, respectively. This finding is found to be matching with the finding of literature studies. Conclusion: Sonoelastography can be used as an imaging modality of choice in diagnosing breast lesions during pregnancy and lactation.
Burnout among resident doctors working at tertiary care hospital in the central India: A cross-sectional study p. 547
Abhishek Upendra Joshi, Vasant V Wagh, Abhay B Mudey, Prashil P Jumade
Introduction: Burnout is considered an epidemic of modern society, and the issue of occupational stress and burnout is receiving increasing attention worldwide. Burnout is an increasing problem among medical staff and is highly prevalent in health-care settings. Burnout syndrome can have a detrimental effect on employee satisfaction, work productivity, mental and physical health, rates of absenteeism, and staff turnover and can affect family roles and functions. Aim and Objectives: The aim of the study was to study the prevalence of burnout among resident doctors working tertiary care hospital in the central India and to study the association of variables associated with burnout. Materials and Methods: It was hospital-based cross-sectional study; all the eligible resident doctors were included in the study, i.e., complete enumeration method was used. The final sample size achieved was 146. Burnout was measured with the Copenhagen burnout inventory, which is a reliable and validated 19-item questionnaire. Observations and Results: out of 146 respondents, 54, i.e., 37% were female residents, whereas 92, i.e., 63% were male residents. In regards to overall burnout, it was found that 74.2% of all having burnout belonged to surgical specialty and about 79.2% of all not having burnout belonged to medical specialty. The association between overall burnout and specialty was found to be statistically highly significant (P < 0.001), indicating that surgical specialty residents are more prone for burnout. Conclusions: The overall prevalence of burnout among interviewed resident doctors was found to be 64%. Surgical specialties had significantly higher levels of overall burnout as compared to medicinal specialties. 3rd-year residents had significantly higher levels of burnout as compared with 2nd-year residents.
Assessment of knowledge, attitude, and practices among the healthcare workers regarding biomedical waste management in a tertiary care hospital from Central India p. 551
Shobha Joshi, Rutuj Waghmare, Pramita Muntode, Abhishek Joshi, Aaliya Rukhsar Mohammad Ashfaque, Rahul Thakur
Introduction: Biomedical waste (BMW) means any waste that is generated during the diagnosis, treatment, or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biological and including categories mentioned in Schedule I, of the BMW rules, 2016. Compared with any other type of waste, the waste produced during healthcare operations carries a greater risk of infection and injury. Insufficient awareness of the treatment of sanitary waste may often have negative safety effects and major environmental impacts. This study was planned to assess the knowledge, attitude, and practices among the healthcare workers from a tertiary care hospital regarding BMW management. Material and Methods: A cross-sectional study was conducted in tertiary care medical college teaching hospital in Rural Central India. Sampling was done by complete enumeration method, 483 participants were included in this study, and data were collected using a predesigned and pretested questionnaire. Results: Mostly, nurses (89.92%) followed by the doctors (84.25%) knew that there is a need to disinfect BMW before disposal while only 50% of laboratory technicians knew the BMW disinfection before disposal. In case of disposal of sharp instruments in a punctured proof container, around 98.81% of doctors and 90.64% of nurses followed by 90.47% of laboratory technicians and 75% of sanitary staff workers had good practices. Conclusion: This study shows that attitude of healthcare workers was relatively good regarding BMW, but the implementation of the existing knowledge must be increased in day-to-day practice.
Comparative study of safety and efficacy of dispersive versus cohesive ophthalmic viscosurgical devices in cataract surgery after phacoemulsification p. 555
Vishal Bhaskarrao Kalode, Pradeep Sune
Background: To compare efficacy and safety of dispersive versus cohesive ophthalmic viscosurgical devices in cataract surgery after phacoemulsification to prevent endothelial cell loss. Material and Method: Total 40 consecutive patients of senile cataract with hard nucleus (grade 3/4) who attended AVBRH eye Opd were selected. 40 cases were randomly divided in two groups depending on the use of two different OVD's as – Group 1 Dispersive (20 cases): Hydroxypropyl methylcellulose (2 %), Group 2 Cohesive (20 cases): Sodium hyaluronate (1.4%). Preoperative examination and evaluation of BCVA, corneal thickness by pachymetry and endothelial cell count by specular microscope was done. ECCE with PCIOL implantation by phacoemulsification was performed by a single surgeon. Postoperative all the parameters were recorded on day 1, 1 week, 1 month and 3 months using the same methods and instruments. Results: In our study there was no significant change was seen preoperatively in age, visual acuity, intraocular pressure, and endothelial cell count among the two groups. Postoperatively rise in IOP was seen in both groups i.e. 30 % in group A and 10 % in group B, corneal endothelial cell loss was seen in both groups after performing phacoemulsification, there was no significant difference in the change in cornea thickness in eyes among two groups (P=0.20). Conclusion: Our study shows no significant difference in endothelial cell count and corneal thickness in eyes between two groups.
Evaluation of the association of dental development with chronological age and body mass index in children visiting rural hospital p. 565
Aarati Panchbhai, Anjali Vasistha, Alka Hande
Background: The degree of dental development may be crucial in the selection of treatment protocol, especially in pedodontics and orthodontic considerations. Childhood underweight or obesity is a matter of concern as it may influence the dental development that in turn may affect the dental or oral treatment of the child. The study evaluated the association of dental development/age with chronological age and body mass index (BMI) in children. Materials and Methods: The ethics committee approved study was conducted at dental hospital in 100 children in the 10–18 years age range. The weight and height of the patients were recorded, and the BMI was derived using the Centers for Disease Control and Prevention BMI percentile. The dental development was evaluated on orthopantomogram using the modified Demirjian method. The t-test and Pearson's correlation coefficient was used for statistical analysis. Results: The present study revealed the inconsistent association between dental age, BMI, and chronological age in various age groups under study with underestimation of dental ages than chronological ages. In obese children, the dental age acceleration was seen only in 13 year age group. Notably, an insignificant positive correlation was seen between chronological age and dental age, and insignificant negative correlation was seen between BMI and mean dental age in both males and females. Conclusion: The study highlights implication of correlation of dental development with chronological age and BMI in children. The observations in a given sample in Indian population need to be confirmed conducting extended study with the broader representation.
Experience of tear-drop-shaped excision with modified limberg transposition flap among sacrococcygeal pilonidal sinus diseases p. 573
Md Jawed Akther, YR Lamture
Background: Sacrococcygeal pilonidal sinus disease (PSD) is notorious for prolonged morbidity and recurrence. Mild pain, shorter hospitalization, mild risk of complications, early return to routine activities, better cosmesis, and minimal recurrence rate are the suggested criteria of ideal treatment of PSD. In Limberg flap technique, flattening of the intergluteal cleft is flattened, and the scar is placed away from the midline. This eliminates the causative factors of PSD. However, the drawbacks of this procedure are necrosis of flap at its vertex and maceration of skin at the incision site. This study aimed to perform tear-drop-shaped excision and reconstruction with modified Limberg transposition flap technique among patients for PSD at the sacrococcygeal region and discuss the clinical results. Materials and Methods: Eleven patients with primary sacrococcygeal PSD were included in the study between September 2017 and September 2018 at the JNMC, Wardha, Maharastra, India. It was planned for each case to undergo tear-drop-shaped resection and reconstruction with a modified Limberg transposition flap with a suction drain. Drains were removed after 48 h. Results: The mean age of the patient was 28.2 ± 8.4 years. All were male with a mean duration of symptoms of 3.8 ± 1.3 years. The mean operative time was 84 ± 23 min. Primary healing was obtained in all patients. Stitch was removed on the 14th postoperative day. The average hospital stay was 10 days as 2/3rd patients wanted discharge after stitch removal. The mean time to resume work was 22.6 ± 7.2 days. The mean follow-up period was 18 ± 6 months without any documented recurrence except hypoesthesia on the flap among two cases. Conclusions: More cases are required to conclude better methods among the two procedures of tear-drop-shaped modified Limberg flap and classical Limberg flap.
Ganglion impar neurolysis in chronic perineal pain p. 578
Gaurav Sharma, Apurv Mahalle, Pankaj Banode, Aruna Chandak
Background: Chronic perineal pain (CPP)-mediated through ganglion impar produces complex symptoms causing functional impairment and chronic disabling persistent pain. Ganglion impar which is a solitary midline sympathetic ganglion receives afferent pain fibers from various pelvic organs mediates this type of nociception. A procedure such as ganglion impar block-neurolysis allows blockade of pain reception and mediation, providing effective pain relief. This study is aimed at analyzing the technical feasibility, safety, and efficacy of trans-sacrococcygeal ganglion impar neurolysis in patients with CPP at a rural territory care center. Materials and Methods: Twenty-six patients with CPP were prospectively evaluated for trans-sacrococcygeal ganglion impar neurolysis following good response to diagnostic block under fluoroscopy guidance. Numeric Pain Rating Scale (NPRS) score was observed at various time intervals. The number of attempts and procedural complications was also noted. Results: Out of 26 patients, 16 (62%) were of cancer origin and 10 (38%) cases of noncancer pain with a mean age of 53 and 34 years, respectively. The average NPRS score at 6 weeks in the cancer group was three, while the score was zero in noncancer group. NPRS score at presentation and at 8 weeks follow-up showed significant improvement in both groups. There was no more than a single attempt made to access ganglia through our approach. No procedural-related complications were found. Conclusion: Social burden of CPP, especially in the rural population, is neglected and may appear demanding both to patients and treating professionals. Transsacrococcygeal Ganglion impar block and neurolysis offer a safe, convenient day-care procedure without any significant complications. In cancerous origin of pain, neurolysis could be a good adjuvant.
Association between ABO blood groups and dermatoglyphics with periodontal status among individuals: A pilot study p. 582
Namisha Khara, BS Shilpa, Sneha Sinha, Vidya Baliga, SD Vasudevan
Aim: The present study will be conducted to determine any correlation between periodontal diseases and ABO blood groups and dermatoglyphics pattern. Material and Method: Periodontal examination will consists of probing pocket depth, and clinical attachment level. Healthy participants displayed periodontal pocket depth and attachment loss <3 mm, and no clinical sign of gingivitis. The gingivitis patients displayed periodontal pocket depth >4 mm, no attachment loss with signs of gingivitis. Periodontitis patients exhibited at least one site with periodontal pocket depth more than 4 mm and attachment loss more than 3 mm.Thumb prints of each patient were recorded using ink pad method. They were then classified into different forms like arches, whorls and loops. Result: It was observed that there was no statistical significant association between periodontal status and blood groups. On statistical analysis significant association was found only between Left Thumbprints and periodontal status where patients with radial thumbprint were more prone to develop periodontal status. Conclusion: Within the limits of the study dermatoglyphics can be of potential diagnostic aid in determining genetic basis of periodontal diseases. However, further large scale qualitative and quantitative research will aid in proving the rightfulness of present study and investigate the biological plausibility to explain the association.
Evaluation of knowledge, attitude, and practice about bioethics and biosafety in use of biomaterials among dental practitioners p. 586
BS Shilpa, Sudhir Ninave, Prasad V Dhadse, Pavan Bajaj, Vidya S Baliga, SD Vasudevan
Context: There has been a plethora of biomaterials being routinely used for comprehensive oral rehabilitation. Dental professionals therefore need to take great care, both clinically and ethically, in analyzing the risks and benefits that may come with the use of these materials. Aims: The present questionnaire study was undertaken with the aim to evaluate the knowledge, attitude, and practice of dental practitioners regarding biosafety and bioethics in use of biomaterials. Settings and Design: The study was a questionnaire based. The data were gathered over a period of 3 months and had cross-sectional design. Materials and Methods: A questionnaire was drawn up containing questions pertaining to profile of the participant, knowledge of specialist regarding biomaterials, importance of patient autonomy, informed consent and bioethics and biosafety issues. The total number of participants was 100 professionals, equating to 66.66% of the total study sample. Results: The study revealed that knowledge showed significant association with qualification and years of work experience. Ninety-six percent of specialists agree that it is necessary to explain biological effects of biomaterials to the patients. Ninety percent of specialists were aware of bioethics and biosafety issues with the use of biomaterials. Only 79% of specialists referred to the biosafety manual of the biomaterials. Conclusions: Eighty percent dental practitioners have adequate knowledge regarding bioethics and biosafety of biomaterials. Even though these have considerably enhanced the treatment outcomes, but at times, the improper application and lack of safety precaution with these have raised many moral and ethical issues.
Surgical and functional outcome of management of displaced midclavicular fractures by locking compression plate p. 591
Kushal Surana, Swapnil Date, Kiran Kharat, Kiran Saoji
Background: Fractures of clavicle are one of the most common fractures, accounting for 4% of all the fractures. Earlier it was thought that fractures of clavicle unite without any intervention owing to nonunion rates of 0.2%–0.8% seen in historic literature. However new literature has shown nonunion rates of 10%–15% with conservative treatment. Hence, surgical management is againg gaining popularity. There are various modalities of internal fixation of clavicle, but in particular locking compression plate which can be bent into S shape according to the shape of the clavicle can be used to achieve and maintain better anatomical reduction of the fracture. Hence, in our study, we have used locking compression plate for fixation of displaced midshaft clavicle fractures with aim to gain a better idea about functional outcomes and complications associated with this procedure. Materials and Methods: Twenty patients of displaced mid-shaft clavicle fractures who met the inclusion criteria and operated with open reduction internal fixation with locking compression plate between August 2018 and August 2020 were included in the study. Functional outcome was assessed with help of Constant-Murley score. Follow was done on 1st, 2nd, 3rd month postoperatively and on 6th month. Results and Observations: The mean age of all the patients in the study was 34.333 years. In our study, clavicle fractures were classified on the basis of Robinson's classification and it was found that out of 20 fractures 16 (80%) were Type 2B1 and 4 were Type 2B2. In our study, the average duration between injury and intervention was 4.5 days. The mean duration of union was 3.2 months. There were no major complications noted in any of the patients in our study. The rate of minor complications was 15%. The mean Constant-Murley score at 1 month, 3 months', and 6 months' follow-up was 74.733, 82.8, 91.733, respectively. Conclusion: Treatment of displaced midshaft clavicle fractures with Locking Compression Plate is an effective modality with excellent functional outcomes, very low chances of nonunions and major complications and few minor complications not requiring any additional surgical intervention.
Role of actigraphy for evaluation of the therapeutic response in patients with depression and schizophrenia: A study protocol p. 597
Ramdas Ransing, Pradeep Patil
Background: Sleep parameters are important diagnostic, prognostic, and therapeutic markers among patients with schizophrenia and depression. However, their role in evaluating the therapeutic response among these patients is limited. In this study, we have planned to evaluate their role using actigraphy. Materials and Methods: This study is an observational, longitudinal, comparative, and single centric being conducted at a tertiary care teaching hospital of central India. A total of 59 patients in each group are being assessed using actigraphy, Hamilton depression rating scale, positive and negative syndrome rating scale, and Pittsburgh sleep quality index. Participants are serially assessed and followed up at baseline, on day 7th, day 14th, and day 28th of admission. The primary outcome is to compare actigraphy parameters among the two groups. Secondary outcomes include the estimation of the relationship of actigraphy parameters with clinically administered scales. Conclusion: It is a prospective study with a robust design and adequate sample size. To the best of our knowledge, this is the first Indian study to explore the role of actigraphy parameters for evaluating the therapeutic outcome among these patients. This study also holds promise to estimate the difference between the two groups in terms of sleep-activity parameters.
Purishaja Krimi in school-going children – A survey study in rural area of Wardha District, Maharashtra p. 601
Ashwini Bolane, KB Jyothy, Nikhil Dhande
Introduction: Ayurveda strongly suggests that diagnosis of a disease is based on its premonitory symptoms that are considered as the first stage of disease followed by clinical signs and symptoms. Purishaja Krimi is a problem of concern in developing countries like India where unhygienic practices and poor sanitary conditions are prevalent. Worm infestations are not noticed easily but can lead to some significant problems, affecting multiorgan systems such as anemia in hookworm infestation. Methodology: This descriptive cross-sectional study was carried out from November 2018 to April 2020 in school-going children in Salod village, Maharashtra. Participants were approached through inpatient department, outpatient department, and specialty camps in the area. Informants or parents were explained the details and the purpose of the study. When they gave willingness to participate in the study, informed consent was obtained. All the study participants were interviewed using the predesigned questionnaire and examined for Lakshana and general profile. They were further asked about the causes and their weekly duration of exposure. Randomly stool samples were collected from 10% of the participants for stool examination at the clinical laboratory of the institution. Results: Overall 306 children participated in this study; out of these, 46.42% belong to the 5–8 years of age group. Purishabheda, Shula, Vishtambha, Guda Nishkraman, Karshya, Parushya, Loma Harsha, and Agni Sada were the main Lakshana found in the participants with Purishaja Krimi. Conclusion: The prevalence of Purishaja Krimi with respect to signs and symptoms as described in Ayurveda was confirmed by the presence as 88% in the children.
Study to determine visual outcome and intraoperative complication during phacoemulsification surgery in posterior polar cataract p. 606
Sohan Lohiya, Sana Beg
Aims and Objectives: To study the visual outcome of posterior polar cataract after phacoemulsification with intraocular lens implantation and its intraoperative and postoperative complications. Settings and Design: It is a prospective, longitudinal study of 1 year duration. Thirty patients who were diagnosed with posterior polar cataract were taken into study after they gave their informed consent and taking into consideration the inclusion and exclusion criteria. Methods and Material: After enrollment of the subject to the study all subjects had undergone a thorough ophthalmic examination and preoperative evaluation, enrolled patients underwent phacoemulsification surgery for cataract extraction and intraocular lens implantation with all necessary precautions noting any intraoperative complications and type of intraocular lens implanted. Patient was followed up on day 1, day 7 and 6 weeks postoperatively and 6 months and any postoperative complication was noted. Statistical analysis used: Descriptive statistics. Results: Most common intraoperative complication was posterior capsular rupture and step in which it happened the most was cortex aspiration and happened mostly in PPC>4mm diameter. In most of the patients, PCIOL could be placed and good visual outcome was achieved. Most common post operative complication was posterior capsular opacification for which NdYAG laser capsulotomy was done. Conclusions: Rate of posterior capsular rupture was higher in patients with posterior polar cataract, but good visual outcome was achieved when proper intraoperative precautions were taken.
Study of synovial fluid for crystals by polarized microscopy for degenerative and metabolic joint diseases p. 612
Tabish Hassan, Arvind Bhake
Background: Synovial fluid cytology is indicated in many joint diseases. There light microscopy fails to detect the pathognomic crystals deposited within synovial fluid which is closely related to the pathogenesis of osteoarthritis (OS) and other crystal related arthropathies. The polarized microscopy, therefore, is indicated for the examination of such fluids. Objectives: The comparison was drawn between light microscopy synovial fluid examination and polarized microscopy in the detection of pathognomic crystals. Materials and Methods: Thirty synovial fluids with varied clinicoradiological diagnosis aspirated from mostly large joints underwent conventional cytology by light microscopy and polarized microscopy. The rate of detection of crystals was evaluated. Results: The thirty patients in an age range of 21–80 years were recruited for the study. The crystals of calcium oxalate, monosodium urate, Charcot–Leyden crystals, cholesterol, homocysteine, and calcium pyrophosphate were assessed for deposition. It showed that light microscopy examination detected in six samples, whereas polarized microscopy detected in 14 samples. The rate of detection of crystals by polarized microscopy is more than twice that of light microscopy. The PPV and NPV for polarized microscopy are 100. Conclusion: Polarized microscopy of synovial fluid is advised to be carried out in the detection of crystal deposition in arthropathies for the earliest and appropriate management of the patient.
Spectrum of ovarian masses at a tertiary care hospital of Central India p. 618
Soumya Rathi, Anuja Bhalerao, Rupeshri Bhoyar
DOI:10.4103/jdmimsu.jdmimsu_70_20
Background: Carcinoma of the ovary is among the most common cancers in the world. It is also a significant cause of mortality. The present study was initiated to analyze ovarian tumors with respect to age, presentation, diagnosis, and treatment, and to correlate the duration of symptoms and stage of disease. Materials and Methods: The present study was a retrospective observational study, done at NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra. The study duration was of 10 months, carried out from July 2018 to April 2019. The total sample size for the present study was fifty. Results: In the present study population, out of the total ovarian masses, 52% had neoplastic and 48% had nonneoplastic ovarian masses. Majorly affected age group was 36–45 years, which comprised 26% of the nonneoplastic and 20% of the neoplastic masses, including 10% each of benign and malignant masses. On analyzing the malignant ovarian masses, it was found that serous cystadenocarcinoma/surface epithelial tumor was most commonly encountered, accounting for 70% of the total malignant ovarian masses. Conclusion: Epidemiological studies analyzing economically feasible screening tools should be identified, which will help screen risky population, to detect the disease at early stage and improve the prognosis.
Effectiveness of valsalva bearing-down techniques during the second stage of labor on maternal and neonatal outcome among primigravida mothers p. 622
Shital Vinayak Waghmare, Sheela Upendra
Background: Maternal bearing-down efforts plays a vital role in the expulsive phase of labor. Various types of bearing-down efforts have got its own advantages and disadvantages on mother and fetus. The scholar personally felt that there is a need to investigate the best bearing-down technique with less complications to the mother and newborn. Objective: (1) To assess the effect of Valsalva bearing-down technique during the second stage of labor on maternal and neonatal outcomes among primigravida mothers admitted in selected hospitals of Pune city. (2) To assess the effect of spontaneous bearing-down technique (control group) during the second stage of labor on maternal and neonatal outcome among primigravida mothers admitted in selected hospitals of Pune city. (3) To compare the effectiveness of Valsalva bearing-down techniques and spontaneous bearing-down techniques and duration of the second stage of labor on maternal and neonatal outcome among primigravida mothers admitted in selected hospitals of Pune city Methods: In the present study, the quantitative research approach is applied and this approach is applied and preexperimental, posttest only control group design is used. The setting of the study was selected hospital of Pune. The sample size for the pilot study was forty, selected using a probability clustered sampling technique. The structured questionnaire and observation checklist were administered. To establish the reliability of the tool inter rater method was used. The scores were calculated and the reliability was established by the Kappa method, which was 0.90. Results: The analysis performed on the various components of maternal and neonatal outcome suggests that on comparison of the mean score of both technique valsalva bearing-down technique has more effectiveness and various components for good maternal and neonatal outcome. Conclusion: Valsalva bearing-down technique has various benefits toward the better health of the mother and the neonatal outcome, so it should be accepted as best clinical evidence-based practice.
Combined effect of spiral suit and physical therapy in rehabilitation of quadriplegic cerebral palsy patients in rural areas p. 626
Nivedita Singh, Mohd Irshad Qureshi, Sachin Damke, Ashish Bele, Madhuri Wane
Background and Objectives: In cerebral palsy, the pattern of clinical presentation may vary from time to time because of development of increased tone, growth, and maturation of the brain. Spiral suit and ankle foot orthosis (AFO) has been utilized as the stability device in combination with the physiotherapeutic exercises such as stretching, strengthening for weak muscles, weight bearing exercises, balance training on balance board and gait training. As manual stabilization is not so supportive, there is a need of such a stabilization device. The study aims to investigate the utility of spiral suit along with physical therapy to improve motor functions in quadriplegic cerebral palsy patients. Methods: Fifty children with cerebral quadriplegia of both sexes (3–12 years) included in the study. Gross motor function measure (GMFM)-88 version is utilized to assess and evaluate gross motor functions (GMFs). Treatment included various physiotherapeutic exercises as stretching, strengthening exercises for weak muscles, weight-bearing exercises, balance training on balance board, and gait training along with the spiral suit and AFO as a stability device. The treatment session of 40–45 min 6 days a week was provided for a month. The patients were reassessed using GMFM-88 scale. Results: Statistical analysis was done using descriptive and inferential statistics. Children showed a significant improvement in motor functions of quadriplegic cerebral palsy children when assessed post treatment on GMFM-88 (t = 98.86; P < 0.001). Interpretation and Conclusion: This study concluded that the combined effect of spiral suit with the physical therapy intervention showed a significant improvement in GMF of quadriplegic cerebral palsy children.
A review of global mistakes in the spread of COVID-19 and the approach of India towards it p. 633
Nikita Seth, Ashish Bele, Mohd Irshad Qureshi, Nivedita Singh, Madhuri Wane, Shalaka Dhankar
Background: The COVID 19 outbreak has led to various global health crises that is having a great impact on the way we perceive our world and everyday life. The present paper aims to call into question the global mistakes that cause this crises and the unique way of India to fight this outbreak the core problem is Carelessness of many countries which lead to its spread worldwide. Methods: The data were collected from the various electronic databases like Google scholar, Springel publication, Journal of travel medicine,WHO guidelines, etc. Result: This review indicated that lapses of various countries like China, Iran, Italy, Spain etc. that caused the spread of this coronavirus and how India worked strategically on the desire to actively pre-empt not only prevent. Conclusion: The study concludes the various mistakes that China and Italy made are most leading cause of worldwide spread of this crisis. The big mistake of Europe and US is that people aren't wearing the masks, since masks prevent the droplets that carry infectious virus from infecting others. The other major mistake in US was limited lockdowns which made it worse, since the coronavirus transmits so silently, due to which the total actual scale of problem was not able to be captured, and people moved to less restricted part of the US and they have unknowingly taken the virus with them. Early preventive measures would have prevented this outbreak.
Association between cognitive decline and oral health status in the aging population of Nagpur City: A prospective study p. 637
Sunita Kulkarni
Background: Till date, no longitudinal prospective study has investigated the association between the oral health status and cognitive decline in the geriatric population, possibly due to past studies differing in target groups and methodologies. We aimed to investigate the association between tooth loss, as evaluated through clinical oral examinations, and the development of cognitive decline in the older adults while considering baseline cognitive function. Objectives: The purpose of this study is to find the association between oral health status and the subsequent development of cognitive decline in older adults of Nagpur, Maharashtra state while considering baseline cognitive function. Materials and Methods: This 1-year prospective cohort study followed 140 participants without cognitive impairment aged ≥65 years (mean age: 70.9 ± 4.3 years) living in the Nagpur, Maharashtra. Cognitive function was evaluated with the Mini-Mental State Examination (MMSE) in the baseline and follow-up surveys, whereas oral health examination was carried out using Oral Hygiene Index to investigate the association between oral health status and cognitive decline, we applied a multiple logistic regression analysis adjusted for age, gender, hypertension, diabetes, cerebrovascular/cardiovascular disease, hypercholesterolemia, depressive symptoms, body mass index, smoking status, drinking status, duration of education, and baseline MMSE score. Results: In 1 year after the baseline survey, we have obtained an overall incidence of 20.71%. population who developed cognitive decline (i.e., MMSE scores of ≤24). Multivariable logistic regression analysis indicated that participants with compromised oral health were more likely to develop cognitive decline than those with mild-to-moderate oral health were (odds ratio: 3.31; 95% confidence interval: 1.07–10.2). Age: 1.15 (1.04–1.31), male gender: 4.65 (1.27–16.4), and baseline MMSE scores: 0.49 (0.32–0.75) were also significantly associated with cognitive decline. Conclusion: Poor oral health status was independently associated with the development of cognitive decline within 5 years among the geriatric population of Nagpur. This finding corroborates the hypothesis that oral health may be a predictor or risk factor for cognitive decline.
Evaluation of utilization of postnatal care services among women of Urban Slums in Rajahmundry, Andhra Pradesh, India p. 643
Saptarishi Bose, KM Lavanya, Ganapathi Swamy Chintada, Nageswara Rao Vutharkar
Background: Ensuring appropriate postnatal care (PNC) is critical to safeguard maternal and newborn health. The timing of PNC is also crucial to the well-being of the mother and baby. PNC coverage is in a decreasing trend in comparison to other maternal and infant health services. Although there is provision of PNC services, women are not utilizing them effectively. Objectives: (1) To estimate the utilization rate of PNC services among postnatal women (PNW) in urban slums of Rajahmundry, Andhra Pradesh. (2) To analyze the factors influencing the utilization of PNC services among PNW. Materials and Methods: A community-based cross-sectional study among 205 PNW in urban slums of Rajahmundry. Results: The utilization rate of PNC package was 82%. About 71% of the women were in the age group of 21–25 years, 46% were Hindus, 66% had completed high school, and 59% belonged to lower class of socioeconomic status (SES). The utilization rates of PNC services were significantly higher among primi mothers (82%), literates (99%), among women from lower socioeconomic class, and among PNW who resided in joint families. Conclusion: The utilization of PNC services was very good, which was influenced by the level of literacy, SES, and parity of the women. Policy makers must emphasize health teaching about postpartum care into the health system at every level of care including primary, secondary, and tertiary involving health personnel at every level, in order to reach complete utilization of PNC services.
Salivary resistin: A noninvasive mirror of attributes of type 2 diabetes mellitus p. 649
Afreen Arshad Choudhry, Preeti Sharma, Tapan Kumar Mohapatra, Mahendra Prasad, Pradeep Kumar
Background: The long-term complications associated with diabetes can be delayed by early screening and diagnosis. This requires venipuncture at regular intervals of time which causes anxiety and discomfort to the patient discouraging the patient further. Studies are being conducted to develop saliva as a tool for the screening and monitoring of systemic diseases. It is reported that resistin along with other adipokines functions as a pro-inflammatory cytokine, promotes insulin resistance (IR), and can be detected in the saliva of healthy adults. Aim: The aim of this study is to compare and correlate the serum and salivary levels of resistin in normal and diabetic patients. Furthermore, to establish salivary resistin as a tool to assess IR and inflammatory and glycemic status in type 2 diabetes mellitus (DM) patients, its correlation with homeostatic model assessment-IR (HOMA-IR), C-reactive protein (CRP), and glycated hemoglobin (HbA1c) along with fasting blood sugar is also studied. Materials and Methods: Blood glucose, HbA1c, and resistin were estimated by glucose oxidase–peroxidase method, high-performance liquid chromatography, and enzyme-linked immunosorbent assay, respectively. CRP was estimated using immunoturbidimetry and fasting insulin by chemiluminescence. HOMA-IR was calculated from basal (fasting) glucose and fasting insulin concentrations. Statistical analysis was done on SPSS 16. Results: The results show a strong and significant correlation of salivary resistin with serum resistin, HOMA IR, and CRP levels. The salivary resistin levels also correlated with fasting plasma glucose and HbA1c. Conclusion: Salivary resistin can be used as an effective tool for monitoring the different attributes of diabetes. Standardization of the techniques for the estimation of salivary resistin and setting up a reference range will also make it useful to surveil the prognosis of DM.
Evaluation of glycemic status and its correction with lipid profile, oxidative stress, and thyroid profile in Type 2 diabetic patients p. 654
Manoj Kumar Yadav, Pradeep Kumar, Preeti Sharma, Tapan Kumar Mohapatra
Background: In India, type 2 diabetes mellitus (DM) is an epidemic disorder because of social impact and changes in way of life. According to the WHO, 72 million people were affected by DM in India in the year 2017, a figure expected to almost double to 134 million by 2025, the largest number in any country in the world. Aims and Objectives: The aim is to evaluate the glycemic status and its correlation with oxidative stress, anti-oxidant, lipid, and thyroid profile in type 2 diabetic patients. Materials and Methods: One hundred and fifty-eight patients (age-matched subjects) with newly diagnosed type 2 DM were identified from outpatient services of the Department of Medicine along with one hundred and fifty-eight healthy controls were taken as controls. Results: The mean age of type 2 diabetic subjects had higher 44.52 ± 8.17 years and in 40.20 ± 7.42 years for healthy controls. Similarly, the mean BMI of type 2 diabetic subjects was higher 25.28 ± 2.55 as compared to 23.07 ± 1.49 healthy controls. Fasting blood sugar and hemoglobin A1C (HbA1c) shows positive correlation with age, height, weight, and body mass index. Fasting blood sugar shows positive correlation with HbA1c, total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-c), very low-density lipoprotein cholesterol (VLDL), FT3, thyroid-stimulating hormone (TSH), malondialdehyde (MDA), and Glutathione (GSH) while negative with high-density lipoprotein cholesterol (HDL-c) and FT4. Similarly, HbA1c shows positive correlation with TC, TG, LDL-c, VLDL, FT3, FT4, MDA, and GSH, while negative with HDL-c and TSH. Conclusion: Type 2 diabetes is an ongoing reformist infection, described by hyperglycemia and dyslipidemia, making expanded helplessness of cells lipid peroxidation and irritation because of oxidative pressure which assumes a significant function in the pathogenesis of diabetes and its difficulties. These perceptions propose that steady treatment focused on oxidative pressure may help forestall the improvement of complexities in type 2 DM.
Aortic dissection – Ultrasound and doppler diagnosis p. 659
Rishabh Gupta, Suresh Phatak, Kaustubh Madurwar, Gulam Marfani
Aortic dissection is the most common form of acute aortic syndromes and a type of vascular disease. It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks along the media, forming a second blood-filled channel within the wall. On grey-scale ultrasound (USG), the transverse image of the abdominal aorta shows a vertical linear hyperechoic structure, which represents the dissected intima. On color Doppler, there is a flow on both sides of the dissected intima indicating flow in the false and true lumen. Thus, aortic dissection is easily and readily diagnosed on USG, which is the most widely available investigation, making the availability of early treatment option to a patient.
Bilateral 180° rotated maxillary second premolars: A rare case report p. 662
KV Suresh, Chan Yi Zhong, Seema Yadav
Developmental dental anomalies are an important category of dental morphologic variations encountered by clinicians. The positional anomalies such as ectopic eruption, rotation, and impaction of teeth result from disturbances in the eruption pattern of the dentition. The genetic and environmental factors play a crucial role in the development of such anomalies. The occurrence of minor rotation along the longitudinal axis of teeth is a common finding in human dentition. However, occurrence of bilateral symmetrical complete 180° rotation of maxillary second premolars has not been reported in the literature. Here, we report an interesting case of bilateral 180° rotated maxillary second premolars with normal crown morphology and also an attempt has been made to discuss its etiology in light of current information from the literature.
A case of pulmonary tuberculosis with stroke: A rare presentation p. 665
Ulhas Jadhav, Deepanshu Chawla, Pankaj Wagh, Babaji Ghewade
Tuberculosis (TB) is one of the most leading causes of death worldwide. India is one of the highest burden nations. The disease affects various organs and can have different presentations. Central nervous system is one of the dreaded complications of TB, and studies have shown that 5%–10% exposed to Mycobacterium TB can develop neurological TB. We report a case of a male patient with pulmonary TB presenting with right-sided hemiparesis with left-sided facial deviation and global aphasia. The patient was sputum CBNAAT positive, and magnetic resonance imaging brain was suggestive of acute evolving infract in the left fronto-temporo-parieto-occipital region suggestive of acute infarct in the left middle cerebral artery territory. TB could be a factor leading to thrombus formation causing stroke. In patients of TB risk for stroke though rare, but should be taken into consideration.
Intratesticular and extratesticular varicocele: Ultrasound and doppler appearance p. 669
Bharat Lohchab, Suresh Phatak, Sharvari Gulve, Shreya Tapadia
Extratesticular varicocele is a commonly encountered condition affecting young male adults. Intratesticular varicocele is a rare entity seen invariably in association with extratesticular variety. Characteristic appearances on B-mode and Doppler ultrasound evaluation help in confirming the diagnosis. We present a case of a 17-year-old male who complains of scrotal swelling and dull-aching left testicular pain for 3 months. Ultrasound and Doppler evaluation was performed which aided in confirmation of diagnosis.
Hemorrhagic omental cyst in a child presenting with hemoperitoneum: Ultrasonography diagnosis p. 672
Apoorvi Shah, Suresh Phatak, Soumya Jain, Sameeda Samad
An omental cyst is a rare intra-abdominal pathology in children, and a high index of suspicion is required for its diagnosis. Children are most commonly present with small-bowel obstruction with abdominal distention with or without a palpable lump. We present a case of omental cyst in 4-year-old male child presented with abdominal distention and severe anemia. Ultrasonography and computed tomography of the abdomen was performed, and the diagnosis of omental mass with hematoperitoneum was made. The presentation with profound anemia and shock due to the hemorrhage into the cyst is unusual. Laparotomy and excision of the cyst were performed and pathology confirmed by histopathology examination of the specimen. This pathology is extremely rare and should be thought of in the differential diagnosis in cases presenting with similar complaints.
A rare case of adult granulosa cell tumor of ovary as a cause of huge abdominal mass and postmenopausal bleeding p. 675
Sri Nayana Kolli, Manjusha Agrawal, Yogesh Khithani, Kanan Kotdawala
Adult granulosa cell tumor (GCT) is a rare ovarian malignancy with incidence of 1%–2% of all tumors. They are usually detected in an early stage as they often have features of hyperestrogenism unlike epithelial ovarian tumors. Treatment consists of surgery to remove the tumor and depending on the extent of the tumor, additional treatments may also be used. Surgical management of granulosa tumors is based on the stage of the tumor as well as age of the patient. In postmenopausal women and those who have completed childbearing, surgery consists of a total abdominal hysterectomy and bilateral salpingo-oophorectomy, along with standard surgical staging. The prognosis of granulosa cell tumors is comparatively better than other epithelial tumors. For the optimal management of these unusual neoplasms, prospective multicentric trials are required to assess the function of adjuvant therapies. Knowing more about GCT's molecular pathogenesis can determine appropriate targeted disease management therapies.
Congenital angular deformities of the leg: Case series p. 679
Nareshkumar Dhaniwala, Mukund Dhaniwala
Congenital angular deformities of tibia are uncommonly seen. Posteromedial bowing is more uncommon than anterolateral bowing. Anterolateral bowing is more discussed due to its association with pseudarthrosis and neurofibromatosis. Posteromedial bowing may get partially corrected with growth up to 4 years of age. The case series describes two cases of posteromedial bowing and one case of anterolateral bowing in both legs due to its rarity and to stress the need of regular follow-up.
Emergency extraction of foreign body from the ear by "Artery, Syringe, and Needle Technique" during SARS-COV-2 pandemic travel restrictions and lockdown p. 683
Akash Kasatwar, Ritesh Pimpalshende, Jayshri Nandanwar
Incidental entrapment of the foreign body (FB) in the ear is the most common findings in outward patient department. Aural foreign bodies constitute around 25% of all the patients in emergency department. The most common site of impaction of FB is at the bony-cartilaginous junction of the external auditory meatus (EAM) due to its tortuous passage. Removal of the FB from ear becomes an extremely skillfull task because of the excruciating pain during removal. Delayed removal of FB from the ear may result in the development of severe complications ranging from acute otitis media to perforation of tympanic membrane to more severe conditions such as meningitis, and other neurological problems. Several techniques in the literature have been recommended in the past for its retrieval. The purpose of this article is to describe simple but effective technique for salvaging the FB from the EAM in a case of 3-year-old child during severe acute respiratory syndrome (SARS)-COV-2 pandemic travel restrictions and lockdown.
Carcinoma prostate presenting as abdominal lump without osseous metastasis: A rare case report p. 686
Nilesh Guru, Bhushita Guru
Carcinoma prostate has varied presentations. We here present a rare presentation of prostate cancer as an abdominal lump without osseous metastasis. On investigating, the patient had raised serum prostate-specific antigen levels (>100 ng/ml) and histopathological report of the prostate showed Gleason grade 9 (5 + 4) prostatic adenocarcinoma and that of abdominopelvic mass was suggestive of metastatic prostatic adenocarcinoma. A bilateral orchidectomy was done and the patient was advised to follow-up. Carcinoma prostate presenting as lymphatic metastasis as a first clinical manifestation is a rare occurrence. A high index of suspicion should be exercised to establish a diagnosis in such cases, which would avoid delay in the management.
Management of pyogenic granuloma p. 690
Kiran Rajesh Sethiya, PV Dhadse
Pyogenic granuloma (PG) is a disease of the oral cavity characterized by hypertrophy of tissue caused by hormonal factors or physical trauma. It is benign and more oftenly found in adults, gingiva is a common site. In this case, there is a female patient and discusses about histopathologic and clinical features with the management of PG.
Optical coherence tomography-based monitoring of traumatic choroidal rupture and pneumatic displacement of submacular hemorrhage p. 693
Pranaykumar Shinde, Roohi Gupta
A middle-aged man presented in the emergency department 4 days after injury to his right eye with a mobile phone. Best-corrected visual acuity was 20/50 and vertically linear-shaped choroidal rupture nasal to the fovea with subretinal heme at the macula was noted. Intravitreal C3F8 injection was given with postinjection head positioning in a prone position. Subretinal heme started resolving with scarring of choroidal rupture.
Retinal capillary macro aneurysm in diabetic retinopathy p. 696
Swapneel Mathurkar, Pradeep Tekade, Neha Namdeo
Diabetic macular edema (DME) is one of the major cause of visual impairment in patients with diabetic retinopathy.1-3 Multiple anti- vascular endothelial factor (VEGF) agents and steroids are used in the treatment of DME. Laser photocoagulation is an option, but it is becoming less popular due to the better results of anti- VEGF therapy.4 The first line of treatment is anti-VEGF agents.5,6 if the response to pharmacotherapy is poor, we switch to another anti- VEGF agent or steroid. We report a case of 76 year old gentleman complaining of diminution of vision in both eyes since a year. On examination patient was pseudophakic and having moderate diabetic retinopathy changes with clinically significant macular edema. Patient was treated with anti VEGF in past but showed minimal response to treatment. On examination left eye had large macroaneurysm temporal to fovea. One month later, post laser edema was completely resolved. We think retinal capillary macroaneurysm is an important biomarker in diabetic retinopathy which may not respond to antiVEGF or Steroid but respond well to focal laser.
Systemic lupus erythematosus in an adolescent male as tuberculosis mimic p. 698
Keerti Swarnkar, Sarika Gaikwad, Punam Uke, Maithali Joshi
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by involvement of different organ systems with varied manifestations, and the presence of circulating autoantibodies directed against self-antigens occurs in both children and adults, commonly affecting females of reproductive age. Childhood-onset SLE (cSLE) has more severe disease and more widespread organ involvement as compared to adults. There are two opinions regarding age to define pediatric-onset lupus, which is either before age 16 or onset before age 18. Here, we report a case of SLE in a 14-year-old male child due to its rare occurrence in the pediatric age group, especially in males presenting as tuberculosis mimic with complaints of not gaining weight and fever.
Techniques to record posterior palatal seal: A review p. 702
Shanvi Agrawal, Seema Sathe, Dipak Shinde, Tanvi Balwani
A denture which is fabricated having adequate retention helps in patient's esthetic, physiological, and functional factors. The diagnostic assessment of the posterior palatal seal (PPS) and its placement is of pronounced significance. With an accurate recording of PPS area, we can establish the border seal in the posterior region of the maxillary denture. There are a number of dentures which have become unsuccessful due to the inadequate establishment of the posterior limit and an improper PPS. This article review focuses on the importance of the PPS and about different techniques associated with recording of it.
Interocclusal records: A review p. 709
Aditya Sonawane, Seema Sathe
To achieve a successful prosthesis, it is important to achieve harmony between the maxillomandibular relationship and anatomy of the patient. This relationship is not a simple opening or closing but a complex relationship which exists in three dimensions. Variations may occur in any direction – vertical, anteroposterior, or mediolateral. Thus, it is essential to record this relationship with the least possible error to obtain a successful prosthesis. However, when relating the maxillary and mandibular dental casts, the ultimate accuracy depends on the accuracy and dimensional stability of the material and the technique used to record the maxillomandibular relationship. An accurate interocclusal record minimizes the need for intraoral adjustments during prosthesis insertion. They are essential in providing high-quality restoration and reducing treatment time and cost. The success of the prosthetic rehabilitation treatment depends on several aspects related to the precise mounting of casts in the articulator for full-mouth situations. This article helps us in understanding the various materials and techniques for prosthetic rehabilitation.
Role of inflammation and inflammatory biomarkers in dental implant procedures: A comprehensive review p. 715
Preet Jain, Meetu Jain, Rahul N Gaikwad, Jigar R Doshi, Punit Fulzele
Currently, dental implant procedures for prosthodontic rehabilitation of edentulous situations have received widespread acceptance. Osseointegration is a process, which signifies the simultaneous activity of the osteoclasts, and osteoblasts in the process of bone repair, bone formation, and bone adaptation for better functioning process. Various inflammatory biomarkers have critical role in the wound healing in the placement of dental implants. Hence, this particular review was planned for assessing inflammation of peri-implant tissues and various biomarkers in the restoration of edentulous arches by dental implants.
The bridging vessel sign: A diagnostic clue to determine the origin of pelvic mass p. 719
Suvarna Deshpande, Suresh Phatak
Physiotherapists' response to COVID-19 p. 721
Qais Gasibat


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RETURN, by Lien Pham (Vietnam) was made during the IPA Mentorship Program.
Dancing With A Cobra, by Alison McCauley was made during the IPA Mentorship Program.
Death fell upon a protected colony of Egrets in Hong Kong in June during prime breeding season when their tree sanctuaries were callously pruned.
The first land reclamation in Hong Kong was during the early Western Han Dynasty (206 BCE – 9 CE) when some beaches were turned into salt pans.
When dusk falls in Singapore, a nocturnal forest of lust and desire emerges. Lust and Caution, by Colin Seow was made during the 14th Edition of the IPA Mentorship Program.
Alvin Lau was a recipient of the IPA Mentorship Grant. Meditating Mortality was made during the 14th Edition of the IPA Mentorship Program.


Have you been told that you're the only one getting in your way of success? Do you overanalyze to the point that it's hindering your business?
It's common that we're our own worst enemy.
As a newer real estate investor, it's easy to have "analysis paralysis". You analyze the deal so much that you're not quick enough to secure the deal or you talk yourself out of it.
It usually comes down to confidence and with time and experience, your analysis paralysis should go away.
When you're looking at a deal, have solid formula in coming up with repairs, ARV (after repaired value), and your offer. If you're stuck on if something needs to be replaced or repaired, assume it needs to be replaced so you don't set yourself up to go over budget.
In addition, stop assuming that other investors are going to outbid you. Know what price you're able to pay in YOUR business and stand by that price.
You never want to overpay for a property just to beat out the competition.
There will be more leads.
There will be more properties to purchase.
Don't Get Emotionally Tied to a Property!
You have to go into a property and not get attached to it.
You aren't buying it for you. You're buying it to make money.
Like we talked about above, don't overpay for a property because you love the location and the details of the property.
Buy the property because it will make you money once you sell it.
Also, don't choose updates that you like, choose updates that are neutral and most people will be okay with.
Don't buy expensive tile for the bathrooms because you just love it. Buy an affordable, neutral tile that a buyer would be happy with.
On rehabs, it can be easy to walk in and feel like you need a say in every little detail.
This not only will slow the rehab down, but it will teach your contractors to be codependent on you, which will lead to more time out of your day being wasted.
Hire people you trust, fire those you don't.
Have a property manager who understands your budget, your timeline, and your desired style so that they can run with the rehab. This will reduce your stress, allow you more time to focus on getting more deals, and everyone will be happier.
By getting out of your own way, it will allow you to reach your highest potential without resistance along the way. This business is unique because most of us start out doing everything ourselves but we have to get away from that model as soon as we're able to.
Don't hold yourself back and let's see what you've got!


When will a variety of textbooks become available?
Soon. Every day, there are more and more textbooks available in the bookstore since Apple's agreement with all of the major textbook companies. As a result, these companies will be losing money if they don't create content for the iPad within the next calendar school year.
How do you explore finding Apps?
How do you figure out which apps are the best?
What is the best way to find out about new apps that would be most useful for students to use?
How do I research apps for my specific curricula use?
How do I find a website which recorded all of the teachers who have great projects using the iPad?
How do you get your school to buy iPads for teaching staff?
All schools are different. The best way for schools to look to get iPads for the faculty is to look work as a department, division, or even just a team, and propose ideas of what they can do with the iPads and why they want them. Most schools will need to make requests in the budget for purchasing technology, so work with your technology team to make this happen.
How do you help all faculty to catch up? Is there a realistic time line for this?
No, this is no realistic time line, nor is there a magical way to help all faculty catch up. It's all about exploring. People within schools will always have different skills and abilities, in all things, not just technology It simply has to be about playing, experimenting, and exploring at your own pace.
How can I take a video of myself using the iPad writing on a piece of paper?
Try out Explain Everything, Educreations, ShowMe, or Screenchomp.
What is the effect of iPad and computer use on a child's fine motor development?
Actually, I would say they will improve. There have been numbers of studies done in the past 10-20 years that have showed that children who play video games in combination with other daily activities develop better eye-hand coordination, as well as display improved creativity, memory, and decision-making ability. You also have people creating apps designed to improvement fine motor development (http://itunes.apple.com/us/app/dexteria-fine-motor-skill/id420464455?mt=8).
Are there things that might be simply done between with pencil and paper? Are we just too fascinated with technology?
Of course there are things that are better with pencil and paper. And there are also things are better down with an iPad.
Will we need to teach typing or handwriting?
Will too much content and skills be lost at the expense of teaching with or how to use an iPad?
Not really. The iPad is a tool. It's not an end-all, be-all. It's a tool no different than a pencil or a calculator. There are times when it is helpful and times when it isn't.
How do you work with a class of students with different iPad proficiencies without losing the focus on the lesson content?
Focus more on the objectives and content, and let the skills take care of themselves. Encourage the students to work together, and share helpful tips and information. Skills can developed simply by usage.
Can I export a Keynote program from my laptop with lots of video clips into my iPad?
What is the best word processing app?
What are some strategies for sharing documents between students and teachers? Among students?
Right now, it would be Dropbox. Share folders in Dropbox with your students and they can put work and assignments into their dropbox folder that is shared with you (or other students) for editing, proofreading, and grading. Google just released Google Drive which allows for viewing of all of your Google Docs. The app will soon feature the collaborative editing that you can only currently do with the web-based version of Google Docs. Once this is released, then using Google Docs becomes the best way for sharing documents.
How do I download work from a classroom set of iPads? Is there an easier way than downloading from each one?
It really depends on the app. Some apps allow you to export or send to a Dropbox folder. Others require syncing and downloading from each iPad individually. It also depends on the type of work that the students are doing. You might find that you can simply take a screenshot of the student work (if it is a drawing, painting, or annotated document) and share via email.
How can I use the iPad to make class more engaging and interactive?
Focus on student-generated content; rather than having the teacher create screencasts, podcasts, and videocasts for "flipped" learning, ask the students to produce these records of what they learned. Use apps creatively and ask the students to arrive at new ways to use apps. Perhaps have an app exploration assignment: students create strategies for using the app.
If iPads are used in a library, would it differ from usage elsewhere in the school and if so, why?
To start, the iPads could become part of the usual library functions of reading and researching, but the focus would be on using the unique qualities of ibook to annotate, highlight, and create flashcards and the ease of using the iPad to sync content with other devices.


text:
12 dead, including 8 children, in Philadelphia fire at house converted into apartments
It took 50 minutes to get the fire under control, the fire department said.
By Mark Morales and Taylor Romine
Philadelphia officials updated the death toll in Wednesday morning's fire at a three-story row home that was converted into two apartments.
"Fire officials now confirm that 12 people — eight children and four adults — died in the fire on N. 23rd Street. That total is one less than the number reported in an earlier press conference, when recovery operations were still ongoing," an updated news release from the city said.
Philadelphia Deputy Fire Commissioner Craig Murphy initially said 13 people were killed; two others were taken to hospitals; and eight people were able to escape by themselves, Murphy said.
Firefighters faced heavy smoke, heat and limited visibility on all floors when they entered the building, according to the release, and were able to rescue one child, who did not survive.
The fire took place at home that records show is owned by the Philadelphia Housing Authority, a municipal agency that leases homes to people with low income.
"This is without a doubt one of the most tragic days in our city's history — loss of so many people in such a tragic way," Mayor Jim Kenney said at a news conference late Wednesday morning.
"Losing so many kids is just devastating. ... Keep these babies in your prayers," Kenney said.
Firefighters responded to flames around 6:40 a.m. Wednesday at the row house at 869 N. 23rd St. in the city's Fairmount neighborhood.
Firefighters found "heavy fire" in a kitchen area in front of the second floor, and there was "nothing slowing that fire from moving," Murphy said.
"It was terrible," Murphy said. "This is probably one of the worst fires I ever been to."
Twenty-six people lived in the three-story building — eight on the first floor, and 18 on the second and third floors, fire officials said.
The housing authority was not aware 26 people were living in the building, said Dinesh Indala, the agency's senior executive vice president of operations. The agency is checking how many were allowed to live there, he said.
The cause of the fire will be investigated, Murphy said.
Philadelphia's district attorney said the city "owes it to the victims, the survivors, and to all Philadelphians to conduct a thorough investigation into this travesty, so that we can make sure it never happens again."
"I join Philadelphians in expressing my heartbreak over the tragic loss of life in Fairmount today," District Attorney Larry Krasner said.
Pennsylvania Gov. Tom Wolf tweeted he was devastated.
"My heart goes out to the loved ones left to cope with this heartbreaking loss of life. Thank you to the brave first responders who got the fire under control," his tweet read.
First Lady Jill Biden also tweeted Wednesday, saying her heart was with the families and loved ones of the victims.
Some smoke detectors did not operate, official says
Murphy initially told reporters that four smoke detectors were in the building, "and none of them operated."
Murphy later indicated that Philadelphia Housing Authority records showed that at least six battery-operated smoke detectors had been installed there from 2019 to 2020.
However, Indala, the housing authority official, said the agency had different information about the detectors.
One of the apartments, the "A unit," had seven smoke detectors and three carbon monoxide detectors at its last inspection, Indala said. He did not specify the year of the inspection, and CNN has requested clarification.
The other apartment, the "B unit," had six functional smoke detectors and three functional carbon monoxide detectors as of its last inspection in May 2021, Indala said.
Two batteries and two smoke detectors were replaced then, Indala said. Smoke detectors also were replaced in the B unit in an inspection in September 2019, according to Indala.
When a reporter asked why smoke detectors would not have worked if they were inspected in May 2021, Indala replied, "I don't know if they were replaced or tampered with. ... We are working with the fire department at this time to do further inspections."
It wasn't immediately clear which floors the A and B units covered.
Faulty smoke detectors are treated as emergencies and are replaced in 24 hours if requested, and the authority does inspections annually, Indala said.
Row home was legally subdivided, city official says
The row home has been legally subdivided into two apartments since the 1950s and has had no violations, according to a spokesperson for the Philadelphia Department of Licenses and Inspections.
The home has had three minor complaints since 2019, all related to trash maintenance, department spokesperson Karen Guss said.
One complaint was about trash on the exterior of the property in September of 2021 and October 2021. A complaint about trash and poorly maintained interior surfaces was made in 2019, Guss said.
The building, according to records, was estimated to have been built in 1920.
The home is about 2.5 miles northwest of Philadelphia's Center City district.

redpajama_set_name: RedPajamaCommonCrawl


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Blayney looking forward to tournament start
Qantas Matildas midfielder Leah Blayney just can't wait for this Sunday, even though she expects to be sitting around for most of it.
Qantas Matildas midfielder Leah Blayney just can-t wait for this Sunday, even though she expects to be sitting around for most of it.
However for US-based Blayney, a bolter in the Qantas Matildas squad for the AFC Women-s Championships starting this weekend in Adelaide, she won-t be too disappointed, knowing that she has a tough job to oust those players in the starting eleven.
Blayney-s call up at the expense of experienced Lana Harch was the only major surprise in the 20-women squad that plays its first game against the dangerous Korea Republic on Sunday at Hindmarsh Stadium, kicking off at 2.30pm.
"Four weeks ago, I would have said Leah was not in the picture," said Qantas Matildas coach Tom Sermanni. "So yes, her inclusion in the squad has come late in the piece."
"Last year Leah was a regular member of the Matildas squad, but going to the US took her out of the picture a little bit."
However following the AFC Under 20 Women-s Championships in Malaysia, where Blayney was a key member of the side, the former Blue Mountains girl, has impressed at several camps involving the Qantas Young Matildas.
"Leah-s form was very, very good at several Qantas Young Matildas camps we have had recently and continued to improve at each one. She didn-t figure in the series against Mexico and China, but her form was such that we decided to include her ahead of Lana, who we felt had lost a bit of confidence and form over the last few months."
Blayney is grateful for the chance to get back into the Qantas Matildas squad, having not played for the national team since October 2005 when they played Mexico in the US.
Asked if she thought she would be a chance of starting against Korea Republic on Sunday, while remaining hopeful, she knows she is behind the other girls and will have to force her way into the side with good performances if she gets the chance.
"I would say I wouldn-t start at the moment," Blayney said from Adelaide. "It will all depend on how well I do in training, to see if I get a start or not. Hopefully if I do get on, I can play well."
With Australia to play four qualifying games in eight days, Sermanni is sure to play the majority of his squad at some stage in the tournament and Blayney-s versatility could help her get that chance.
"Another reason for Leah-s inclusion was her versatility," said Sermanni. "She can play right across the midfield and can even play up front. Those are the type of players I want in the squad and those attributes in modern day footballers are invaluable.
As for Leah, she will be looking to make every post a winner if she does get the chance.
"I-ve just got to try and put in a few good performances. It-s tough competition; it-s a great squad, the depth within the squad is awesome."
"Coming back for the last few Young Matildas camps down in Canberra, I felt like I was in pretty good form. I-ve been working hard, so hopefully if all goes well, I-ll be able to keep it going here in Adelaide."
As one of five Qantas Young Matildas members in the full squad, Blayney has already experienced a major AFC tournament and believes this will be bigger, especially in front of home fans.
"Yes, most definitely," she said if this was the biggest tournament she had played in to date. "I have been away in the US for the last year and this is my first time back with the Matildas team and to come back for the World Cup qualifiers is very exciting time.
"I was away with the Youth team in Malaysia for their Asian Championships and that was a sensational feeling, especially that first game (against China). Qualifying (for the World Championships) and defeating Japan was just awesome and hopefully I can relive all that this week."
"Everyone is really excited within the team and we-re all relaxed and looking forward to our first game on Sunday.
"It-s really good down here in Adelaide, with lots of posters around advertising the tournament, there has been a fair bit of media at our training sessions and things like that, so its really, really good. It will be great to step out in front of big home crowd."
Blayney has put her US university studies and football career on hold in order to concentrate on her national team commitments with the Qantas Matildas and Young Matildas over the next few months.
Even if she only plays a bit part role in this tournament, she has no doubt the experience will be invaluable come the FIFA Women-s Youth Championships in Russia next month.
"I think its just awesome being amongst the senior players, like the Di Alagich-s and Jo Peter-s, who have been numerous World Cup-s," Blayney said. "Seeing how they carry themselves at these Championships, hopefully will brush off on some of us girls and we will take back into the youth team.
So what are the girls expectations for the tournament ahead?
"We are confident that we can win," Blayney said emphatically. "I think the success of the Socceroos at the World Cup was really a confidence booster for everybody and if you use the Socceroos as an example then anything is possible."


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Posted June 28, 2014 , Updated July 4, 2016 , Permalink
Cult of the Fiver | June 2014
Agent 47, the conspicuously bald but undeniably deadly master assassin, has been sent to take care of a personal contract. His former handler has gone rogue and must be eliminated. What seems like a straightforward assignment quickly goes pear shaped, though, as he finds himself protecting a young girl from the agency that was once his employer.
Hitman: Absolution is worth your $5 because… it takes the Hitman series in a thoroughly enjoyable direction. I wasn't a big fan of some of the older games in the series, but this one really scratches that stealth gaming itch. The "instinct" system can give you hints about clever ways to approach your current objective. It also allows you to keep tabs on the situation with your enemies, and allows you to "blend in" at times when you'd normally get caught. There are a variety of challenges to complete, and playstyles to master. The "Contracts" mode allows you to challenge yourself and others by turning every level and every enemy into a potential target.
But don't pay full price for Hitman: Absolution, since… there are some weird, tasteless, and downright creepy parts of the game. There are more fake breasts on display than a plastic surgeon's office. The major antagonists seem to like to sling around homophobic slurs, and the overall portrayal of women is terrible and made me uncomfortable. Just say no to sleaze, game developers.
The $5 Deal: Amazon w/Steam DRM | Steam | Humble
Instinct only depletes when you're using "point shooting" or using it to trick enemies that would otherwise catch you. You can use it to look for hints and to see guards through walls for free.
There's no score penalty for killing enemies silently, if you hide their bodies. The fiber wire leaves the cleanest kill. Also, you can knock out and then hide civilians for no score penalty. This makes getting disguises easy.
Look for clever ways to take out your enemies that make their deaths look like accidents. This saves you a lot of time and effort in many ways, although these situations can be tricky to set into motion.
It's Batman. You really need a… oh, fine. There's this rich guy, see, and he has this thing for justice. So, he dresses up like a bat and punches people. In this installment, all hell has broken loose at Blackgate prison. A younger, less experienced, and more angsty Bruce Wayne must suit up and contain the damage. Quickly, though, it's revealed that the criminal underworld has decided to get rid of Batman once and for all. In addition to dealing with super criminals, an army of mercs is out for Batman's head. Something more sinister is at work here as well… what could it be? (It's the Joker. Duhhhhh.)
Batman: Arkham Origins is worth your $5 because… it's Batman. The Arkham series has been the height of video game Batman-ning, what with its fluid combat and emphasis on Batman's deductive skills. There are some really cool crimes to solve, where Batman will have to reconstruct the crime scene and scrub through the timeline to uncover clues the police have missed. The shock gloves reduce the "annoyance factor" of fighting certain otherwise tricky enemies. Once again, there's a large map packed with interesting things to do, and most importantly, lots of thugs to punch.
But don't pay full price for Batman: Arkham Origins, since… this is not the greatest Batman game in the world, no. This is just a tribute. Rocksteady (the original Arkham architects) are off working on Arkham Knight, and it shows. There are many repeated elements from the first two games here. Even some of the supposedly "new" things are just old things with new names, like the glue grenades. The Arkham voice actors didn't reprise their roles, and in particular I missed Mark Hamill's Joker. The climax just doesn't do the characters justice. It's still Batman but it could be Batmanner.
Don't bother going after the Enigma Data Packs until you've got the Glue Grenades. By this point you'll be able to do them all, but it's not always obvious which ones can be done and which ones can't be done without a particular upgrade.
In combat, it's easy to get a flow going by hitting a bunch of thugs in a row. Just push towards the next enemy and hit the strike button right after your last blow lands.
In Predator encounters, you generally want to hunt whichever baddie has gone off on his own. This makes it easy to take them out without the others knowing.
Skulls of the Shogun
The afterlife's just not all it's cracked up to be. After almost becoming Japan's most powerful warlord, our hero is stabbed in the back by his lieutenant. Bummer. Worse, his lieutenant has beat him to the afterlife, where he's using his former master's name to wreak havoc! In this turn-based strategy game, you'll need to raise an army (literally) to fight back and claim the eternal reward you so richly deserve.
Skulls of the Shogun is worth your $5 because… it's an intriguing turn-based strategy game in a miniature package. There are interesting concepts like units stationed next to each other form a "wall" that can't be flanked or fired through. The Shogun himself is a unique unit who charges at the start of a battle. Bringing him out early means he's weaker, but you get more time for him to deal damage.
But don't pay full price for Skulls of the Shogun, since… it's ultimately a better mobile game than desktop game. The limit of moves per turn means that you have less micromanagement, but it also means that having a numerical advantage is less important than it seems.
The $5 Deal: Amazon w/Steam DRM | Steam
Units can hang out on a rice paddy to recover health each turn, even if that unit didn't haunt the paddy in the first place.
Eating three skulls will turn a unit into a demon, which will grant it a second action per-turn.
When killed, units will drop any skulls that they have consumed, and these skulls are neutral and can be eaten by any team.
Kingdom Rush is tower defense game that was massively popular on iOS, before being ported to Android and also to PC. Lots and lots of orcs and other baddies are trying to pass your defensive line, but you've got to hold them back with knights, wizards, archers, explosives, and other fun orc-destroying toys.
Kingdom Rush is worth your $5 because… it's a very polished and well done tower defense game. Each tower has two distinct upgrade tracks you can take it down, which means the towers can fill different roles depending on how you upgrade them. The levels are varied, and the bosses are interesting.
But don't pay full price for Kingdom Rush, since… it's technically just an upscaled version of a phone game, and the phone game is pretty cheap. Unless you really want to tackle the challenge levels, the game is relatively short.
The $5 Deal: Steam | Humble
I actually did a 2-part guide for the mobile version of this game, so check it out!
Bastion is the story of "the Kid" – one of few survivors of an apocalyptic event that decimated civilization. He makes his way to the titular Bastion, a floating city that becomes his new home, and might give him a chance to avert the disaster that started the whole mess. He meets a few other survivors, some of whom are friendly, and some who… aren't so much. Along the way, the Kid will fight off the hostile denizens of the ruined world with an arsenal of upgradeable weapons and perk-like "tonics."
Bastion is worth your $5 because… it tells an interesting, engaging story with excellent gameplay mechanics to back it up. The narrator, Rucks, is probably among the top 10 video game narrators, ever. The music is haunting and beautiful and still gives me chills, years after finishing it. The combat is varied, with different weapons, upgrades, perks, and challenges to overcome. It's got a decently long campaign and a new-game plus mode for when that's over with.
But don't pay full price for Bastion, since… well, pay whatever they want for it. It's worth every penny.
The $5 Deal: Steam
Tonics are like perks that you can swap out whenever you visit the Bastion.
Try to pick a set of weapons that compliment one another. For instance, a weapon for close quarters and one for ranged encounters.
The Unworthy
Galcon Legends – Sometimes when you strip a game concept down to its most minimal form, it gets super fun. Other times, not so much. This minimalist RTS game is in the second category.
HAWX 2 – I like arcade-y flight sims, and I liked the original HAWX. However, this one is full of stupid design decisions like always-on DRM that will actively eject you from campaign levels without saving. The AI is terrible. I had a wingman crash his plane into a mountain while he was delivering a line once. It's too bad, too, because the overall game is pretty fun.
Ittle Dew – Do you like the 2-D Zelda games? Sure you do! Do you wish you could play one that is focused on a lot of block pushing puzzles? What if it frequently wasn't clear whether or not you had the tools to solve them at the moment? How about if we take away 80% of the interesting gear? Not so much? Me neither.
More like this: Core Gaming, Cult of the Fiver
What Kinect games are good for small children?
Rise of Nations: Extended Edition Review: Extended Play
Top 5 Things I Hate About Grand Theft Auto 5
Should I Care About Steam Trading Cards?
Using a Mouse and Keyboard for Console Games


Helen Mahy CBE (appointed 14 June 2013) is an experienced chairman and non-executive director. In addition to being Chairman of the Company, Helen serves as a non-executive director for SSE plc and Bonheur ASA. She is also currently Chairman of MedicX Fund Limited. However, this company has announced a merger with Primary Health Properties plc (PHP) which is expected to complete in March 2019. On completion, Helen will step down as Chairman of MedicX Fund Limited and become Deputy Chairman and Senior Independent Director of PHP.
Previous directorships include SVG Capital plc, Stagecoach Group plc and Aga Rangemaster Group plc. Helen was Group Company Secretary and General Counsel of National Grid plc and was a member of its Executive Committee from September 2003 to January 2013 when she retired from National Grid plc. Helen qualified as a barrister and was an Associate of the Chartered Insurance Institute. In 2015 she was awarded a CBE for services to business, particularly relating to diversity in the workplace. Helen is a resident of the UK.


This tutorial is a great introduction for people who are new to the ASP.NET MVC Framework and who want to get a sense of the process of building an ASP.NET MVC application. The purpose of this tutorial is to give you a sense of "what it is like" to build an ASP.NET MVC application.... More events. Okay, the onclick event from last chapter was easy, but let's try creating all the code required to use an event from scratch. We will also add yet a new control, to make things more interesting - the DropDownList, which allows the user to select an item from a list.
More events. Okay, the onclick event from last chapter was easy, but let's try creating all the code required to use an event from scratch. We will also add yet a new control, to make things more interesting - the DropDownList, which allows the user to select an item from a list.