Oral mucosal lesions are a common occurrence and very often dentists are called on to see such patients. Among many causes, trauma is one of the leading for oral mucosal diseases. Oral traumatic lesions are diverse in which some present as acute lesions while the majority are chronic lesions. Clinical presentation of traumatic lesions varies significantly and most of the occasions, the cause and the effect can be established with thorough history and clinical examination. Although biopsy of such lesions is not required in most of the occasions, some may warrant histological investigations to exclude conditions which clinically mimic traumatic lesions. This paper provides an overview of common and some rare traumatic conditions of the oral mucosa.

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The color of a lesion is due to its nature and to its histological substratum. To ease diagnosis, oral cavity lesions have been classified according to their color. In the oral cavity, jaundice is classified under yellow lesions as diffuse macular yellow lesions. This interpretation of the lesions by its color is the first step to diagnosis. It should be taken into account that, as happens with any other classification, the yellowish group of lesions includes items with different prognosis as well as possible markers of systemic disorders. In this case report, the author discusses the oral manifestations of a patient with icterus and its dental implications.

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Rheumatoid arthritis (RA), an auto-immune inflammatory disease is one of the challenging conditions for the physicians to handle due to its chronicity, incurability, complications, morbidity, etc. In spite of potent anti-inflammatory agents and powerful immune-suppressive agents, its prognosis is not good, as these drugs have certain limitations including dependency and other side effects restricting quality of life. Considering these inconveniences, alternatives are being searched from traditional systems. Ayurveda through its armamentarium can provide leads in the management of this condition that is similar to Amavata in its clinical presentation. Amavatari rasa is one of the familiar medicaments used throughout India by Ayurvedic physicians for Amavata. In the current study, a clinical experience with Amavatari rasa is placed. A 32-year-old female with diagnosed history of RA was treated by Amavatari rasa. She received 250 mg of Amavatari rasa thrice a day with lukewarm water for 8 weeks and at the end of the treatment, 35% improvement was observed in the overall effect of therapy.

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Introduction: Immunization is one of the most effective public health tools available to prevent death and disease. Serious adverse events following immunization (AEFI) are rare. However, coincidental sudden-infant-death-syndrome (SIDS) deaths do occur temporally associated with vaccination. In 2010, the Government of India (GoI) introduced a new standard operating procedure (SOP) to report AEFI. There have been stray newspaper reports of deaths soon after the administration of the pentavalent vaccine (PV) which was introduced by the GoI in December 2011. This study was conducted to examine if there is an epidemiological signal from the data collected passively under the new SOP. Materials and Methods: We used data provided by the GoI on the number children who received three doses of diphtheria-tetanus-pertussis vaccine (DTP), the number receiving PV and the number of deaths in the vaccinated within 72 h. Results: After PV was introduced in the states, 45 million infants received DTP vaccination and 25 million received PV. There were 217 deaths within 72 h after DTP was administered and 237 following PV. There were 4.8 deaths per million vaccinated with DTP (95% confidence interval [CI]: 4.2–5.5) and 9.6 deaths (95% CI: 8.4–10.8) per million vaccinated with PV (odds ratio 1.98 (95% CI 1.65-2.38) There were 4.7 additional deaths (95% CI: 3.5–5.9), per million, vaccinated with PV instead of DTP (P < 0.0001). Discussion: Deaths following DTP vaccination would include the natural rate of deaths within that window period, plus deaths if any, caused by DTP. For purposes of this study, we assumed that all the deaths associated with DTP are coincidental SIDS deaths. Taking that as the base rate of SIDS, we look for any increase in the death rate after PV. This study demonstrated an increase in reports of sudden unexplained deaths within 72 h of administering PV compared to DTP vaccine. Whether improvements in AEFI surveillance system or other factors contributed to this increase cannot be ascertained from this study. Conclusion: These findings do not warrant deviation from current vaccination schedule, but the differential death rates between DTP and PV do call for further rigorous prospective population-based investigations.

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Antidepressants can be classified into 13 different classes based on their pharmacological mechanisms of action. As of this present moment, 11 out of these 13 classes of antidepressants accomplish their pharmacoactivities by blocking one or more of the reuptake transporter pumps and/or receptors for the three monoaminergic neurotransmitters, namely serotonin, norepinephrine, and dopamine. The 12^th class inhibits the enzyme monoamine oxidase, while the 13^th class works by blocking the N-methyl-D-aspartate (NMDA)-glutamatergic ionoceptor. Previous experimental results suggest that depression is associated with hyperfunction of NMDA-glutamatergic receptors (NMDARs) in the subcortical regions (i.e., hippocampus, locus coeruleus, and amygdala); whereas at the same time, there is hypofunction of NMDARs in the cortical regions (i.e., prefrontal, perirhinal, and temporal cortices). Moreover, this finding has led to a conclusion that postulates the new “Glutamatergic hypothesis of depression” which is now moving our understanding of the pathophysiology of major depression disorder (MDD), a step further from the several decades' old “Monoaminergic theory of depression.” Collectively, clinical data suggest the involvement of the glutamatergic neurotransmission system in the pathophysiology of MDD or bipolar depression or schizoaffective depression, which includes disruptions in glutamatergic substrate concentrations and NMDAR alterations. Although the role of glutamatergic systems is yet to be fully elucidated, a “proof of concept” clinical study reported that the noncompetitive NMDAR antagonist ketamine produced rapid-onset and prolonged antidepressant effects in patients suffering from MDD or bipolar depression or schizoaffective depression. Still, this has generated tremendous interest in developing new drugs that will target the glutamatergic neurotransmission mechanisms for the treatment of MDD or bipolar depression or schizoaffective depression. These potential drug targets are the NMDAR as antagonist or inverse agonist or partial agonist, metabotropic glutamatergic receptors as positive or negative modulator, excitatory amino acid transporter-2 (EAAT-2) as a reuptake enhancer, and as a terminal presynaptic glutamate release inhibitor.

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Introduction: Proper diet is essential from the very early stages of life for proper growth and development. Increasing the variety of foods and food groups in the diet helps to ensure adequate intake of essential nutrients. The study was conducted with the objective to assess the dietary diversity pattern and to find the association between dietary diversity score and selected sociodemographic variables among adult population, if any. Materials and Methods: A community-based cross-sectional study was conducted between December 2016 and January 2017 among 216 adults with the help of dietary diversity questionnaire from rural and urban field practice area of the Department of Community Medicine, IQ City Medical College, Durgapur, West Bengal, India. Pearson's Chi-square test, Mann–Whitney U-test, and binary multivariable logistic regression analysis were performed using SPSS software. Results: The median dietary diversity score of the participants was 6. Nearly 45.4% of participants had adequate dietary diversity scores. Most common food groups consumed by the participants were starchy staples (100%), followed by oil and oil-based items (99.5%) and milk and milk products (86.1%). Age, residency, type of family, and occupation have a significant association with adequate dietary diversity. Conclusion: Awareness program on dietary diversity should be organized to make people aware about the importance of dietary diversity. Proper diet is essential from the very early stages of life for proper growth and development. Increasing the variety of foods and food groups in the diet helps to ensure adequate intake of essential nutrients.

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One of the promising innovations in the field of surgical dentistry is the use of platelet-rich fibrin (PRF), alone or as an additive with other biomaterials. It accelerates the healing mechanism of the tissue and reduces the inflammation. The following article summarizes the role of PRF in the process of healing, its advantages, disadvantages, and clinical implications including advanced surgical dentistry.

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The umbilical polyp is a rare congenital lesion characterized by bright reddish round mass resulting from the persistence of omphalomesenteric duct enteric mucosa at the umbilicus. Umbilical tissue specimens are uncommonly received in the Histopathology Department of Nnamdi Azikiwe University Teaching Hospital. Approximately, one is seen out of every 300 samples received in this center. The aim of this article is to report a rare case of umbilical polyp which was present at birth in a 3-year-old male child who presented with umbilical ulcer with a bloody discharge on contact. This article is the first of its kind in Nigeria and therefore aims to create awareness of this rare condition among Nigerian histopathologists and to differentiate it from more common umbilical anomalies.

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Background: The role of ultrasound in acute viral hepatitis (AVH) is limited to exclude the surgical causes of jaundice. However, there are certain ultrasound features which can help us to suspect AVH in the initial few days before the onset of clinical jaundice. Therefore, the aim of the present study was to detect the changes in the hepatobiliary system on ultrasound in the cases of AVH and to find the significance of these ultrasound findings by comparing them with controls. Materials and Methods: All serologically proven cases of enterically transmitted cases of AVH formed the study group and all healthy patients with clinical diagnosis of lower urinary tract symptoms who had no hepatobiliary disease were taken as controls. Results: Out of 120 cases, 102 cases were male and 18 cases were female. Maximum number of cases 54 (45%) were seen in 21–30 followed by 24 cases (20%) in the age group of 31–40 years. Hepatomegaly was seen in 104 (86.6%) of cases and 38 (25.3%) of controls (P < 0.01). Gall bladder (GB) wall thickening was seen in 91 (75.8%) of cases and 22 (14.6%) controls Contracted GB was seen in 75 (62.5%) cases of AVH and 16 (10.6%) of controls (P < 0.01). Porta nodes were seen in 72 (60%) cases and 15 (10%) controls (P < 0.01). Splenomegaly was seen in 33 (27.5%) of cases and 24 (16%) of controls. Periportal cuffing was seen in 28 (23.3%) of cases and 24 (16%) of controls. Conclusion: The ultrasound findings of hepatomegaly, enlarged porta hepatis nodes, contracted gallbladder and GB wall thickening are significant suggesting a role of ultrasound in the early diagnosis of acute viral hepatitis.

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Background: Stainless steel and titanium are two different metals with different mechanical and metallurgical properties. Stainless steel is twice more stiffer than titanium. Internal fixation of fractures with stainless steel plates is likely to produce more rigid fixation than titanium plates. Hence, stainless steel plate fixation is likely to produce healing of fracture site with minimum callus/primary healing. This study analyzes whether these properties of the metals influence the healing of the fractures and their outcomes. Materials and Methods: Thirty-five cases of fractures of radius and ulna were treated by internal fixation using stainless steel limited contact-dynamic compression plate (LC-DCP) (Group I) in 17 patients and titanium LC-DCP (Group II) in 18 patients. Follow-up was done at 6 weeks, 12 weeks, 6 months, and 1 year for clinical and radiological healing and complications. Results: All the fractures united in time. 10 (62.5%) patients in Group I and 9 (56.2%) patients in Group II showed primary union and 6 (37.5%) patients in Group I and 7 (43.2%) patients in Group II showed union with callus formation. No complications were observed. Conclusion: Stainless steel and titanium are two different metals with different mechanical and metallurgical properties. However, fixation of fractures with these metals failed to show the difference in the patterns of fracture healing.

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Chronic insomnia is a fairly common condition affecting one-fourth of the clinical population. It has been variously defined and is related to a large number of conditions. A thorough assessment of the patient presenting with chronic insomnia is of vital importance for the treatment. Treatment consists of modifying sleep habits to reduce autonomic and cognitive factors and education about healthier sleep practice. Drug treatment should be reserved for the short-term alleviation of insomnia. Appropriate treatment of chronic insomnia improves the quality of life. The prevention of insomnia consists of a balance of rest, recreational exercise in combination with stress management and a healthy diet.

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

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Background: Increased abdominal obesity is related to adverse metabolic markers. Waist circumference (WC) alone has been shown to correlate more strongly to direct measures of abdominal fat accumulation. Waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) are other parameters to estimate abdominal obesity. Increase in total cholesterol (TC), and triglyceride (TG) increases health risks; whereas, decrease in high density lipoprotein cholesterol (HDL-C) increases future health risk. Aim: The aim of the present study was to find if any correlation exist between central obesity and serum lipid profile in otherwise healthy young adults. Materials and Methods: A cross-sectional study was conducted with 76 (male = 41, female = 35) apparently healthy young adults. Weight, height, WC, and hip circumference were measured. WHR and WHtR were calculated from measured parameters. Serum lipid profile parameters were obtained from venous blood collected after overnight fasting (i.e., 12 h fasting). Pearson's correlation (with α = 0.05) was used to obtain a correlation between central obesity parameters and lipid profile parameters. Statistical analyses were performed in GraphPad Prism 6.01 windows based software. Results: Mean age of the subjects was 18.83 ± 0.85 years. Correlation of WC with TC (r = 0.08, P = 0.45), TG (r = 0.21, P = 0.05) and HDL-C (r = −0.06, P = 0.56) was insignificant. Correlation of WHR with TC (r = 0.07, P = 0.49), TG (r = 0.26, P = 0.02) and HDL-C (r = 0.07, P = 0.50) and WHtR with TC (r = 0.09, P = 0.41), TG (r = 0.17, P = 0.12) and HDL-C (r = 0.03, P = 0.74) also showed insignificant correlation. Conclusion: Indirectly measured central obesity has an insignificant correlation with serum lipid profile in healthy young adults.

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Context: It is needless to state that health and hygiene go hand in hand and of the various categories of hygiene, oral hygiene has a colossal contribution to positive health for any individual. Zealous and correct lifestyle characteristics are related to high standards of oral hygiene, and good habits must be inculcated in the early years of one's life. With this background, a study was conducted among some school-going adolescents. Aims: The aim of this study is to find out the status of their oral hygiene and oral health along with their associated risk factors. Methodology: It was a school-based, observational, cross-sectional study conducted among students of standard 7^th, 8^th, and 9^th of the school who were approached, and the parents of 151 students gave their consent for the oral checkup. Students first filled in a self-administered questionnaire following which their oral health and hygiene were examined. Data were analyzed using statistical package of social science software version 16.0 (IBM, SPSS Inc., Chicago, USA) Descriptive statistics and inferential statistics were performed. Results: Among 151 students, 64.2% had poor oral health, 52.3% and 64.2% student had unsatisfactory awareness toward oral health and oral hygiene practice, respectively. Females had better oral health awareness and better practice scores than males. Factors such as satisfactory practice of oral hygiene (odds ratio [OR] = 6.7 [3.4–12.2]); satisfactory awareness toward oral health (OR = 2.9 [1.9–3.5]); and gender (OR = 2.9 [1.5–5.8]) were associated with good oral health. Awareness toward oral health (OR = 5.8 [2.8–12.2]) are also strongly associated with the good practice of oral hygiene. In the final model of multivariable logistic regression analysis, factors such as the practice of oral hygiene (adjusted OR [AOR] = 6.8 [3.2–14.5]) and awareness toward oral health (AOR = 2.1 [1.3–3.6]) retained significance. Conclusion: Oral health promotion programs and periodic health checkups are needed.

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Vaginal foreign body is a rare condition. We present a 6-year-old girl who had dysuria and itching in the perineum; examination revealed a vaginal foreign body which was a broken safety pin. Radiographs after its removal revealed a pin of the safety pin left in the vagina which was later removed under anesthesia. A high index of suspicion for a vaginal foreign body should be present while evaluating a child with genitourinary complaints. Vaginal foreign body in children may be an indicator of possible sexual abuse; although in the present case, it was a prank by her elder sibling. Importance of postprocedural radiographs has been emphasized after removal as multiple/broken pieces may be present, which may not have been visualized initially. Evaluation for concurrent sexually transmitted diseases is paramount if sexual abuse is suspected.

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Background and Objectives: Hemophagocytosis in bone marrow aspirates is fairly common and can be observed in a spectrum of clinical conditions. This study aimed at evaluating the clinicopathological profile of patients showing hemophagocytosis on bone marrow aspirates examined for varied clinical indications. Materials and Methods: In this study, all those bone marrow aspirate smears sent with various clinical indications and which showed hemophagocytosis were included. Finally, 25 bone marrow aspirates were studied. Results: Of 25 patients, 18 (72%) were males and 7 (28%) were females. The age of the patients ranged from 2 to 73 years. Two common clinical indications with which bone marrow aspirates were sent were fever of unknown origin 10 (40%) and HIV-positive patients with cytopenias 7 (24%). Anemia was the most common cytopenias observed followed by cytopenias in other combinations. Microcytic hypochromic anemia was the common morphological type of the anemia encountered in these patients 17 (68%). Twenty-three (92%) of the bone marrow aspirates showed cellular bone marrow with features of hemophagocytosis. Bone marrow aspirate from a HIV-positive patient showed erythroid hyperplasia (78% early erythroids) with giant erythroblasts and features suggestive of parvovirus B19 infection and hemophagocytosis. Conclusions: Hemophagocytosis in the bone marrow aspirates should not be overlooked and always be documented and reported. The presence of hemophagocytosis may be the only clue to the underlying conditions such as systemic infections or hemophagocytic lymphohistiocytosis (HLH). It is therefore recommended that every case which shows hemophagocytosis needs to be reported and further workup be done to confirm the diagnosis of HLH.

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India has recently announced the “Ayushman Bharat–National Health Protection Scheme (AB-NHPS),” one of the largest government health insurance schemes in the world. The scheme aims to provide quality health care to the poor and vulnerable families, a step forward toward the government's commitment on universal health care. The beneficiary households under the AB-NHPS will be based on the deprivation and occupation status of the family, drawn from the Socioeconomic and Caste Census database. The scheme will take care of all the secondary health care and most of the tertiary health care procedures. The road map envisaged for the implementation of the scheme consists of number of challenges such as funding, acceptance by the states, exclusion of primary health care, and outpatient expenditure from the scheme. We conclude that successful implementation of the said scheme will require robust planning, stringent regulations, simplified processes, and continuous monitoring using advanced technological E-health platforms.

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Introduction: Hospital-acquired infections complicate 7%–10% of hospital admissions. Patients in the Intensive Care Units (ICUs) are more likely to be colonized or infected. Most of these infections are spread by carriage of microorganisms on the health-care workers' (HCW) hands. Hand hygiene (HH) is the single most important measure to prevent this. Despite relative simplicity of HH procedures and recommendations, compliance with HH is still poor. Aim and Objectives: To assess HH compliance among health-care personnel in the ICU of Ram Manohar Lohia Institute of Medical Sciences, Lucknow. Materials and Methods: A prospective cross-sectional observational study using direct observation technique was done. A single observer collected all HH data. A survey was done, before the study, pertaining to perception and knowledge, opportunities, steps, actions, and attitude toward HH. The nursing staff, doctors, and allied health-care personnel were taken as a sample size. The observations were noted for all five moments of HH before and after patient contact. Results: A total of 10 HCW were observed over 50 h of observation period, spread over 1 month, which created 535 HH opportunities. HH actions actually performed by the HCW were 498, and overall compliance of the study group was 93.1%. Conclusion: The average level of compliance with recommended HH techniques among health-care personnel was 93.1% which is appropriate for critical care areas.

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Background: Women in emerging economic and social markets are more stressed than those in developed countries. Aims: We aimed to study the prevalence of stress and its relation to different precipitating factors among urban females of reproductive age group. Materials and Methods: This descriptive cross-sectional study was conducted in a tertiary care center of West Bengal after taking institutional ethical clearance and informed consent of the participants. A sample of 7500 women was selected after proper randomization using an online randomizer. On the first appointment, history of the participants was carefully taken, pulse and blood pressure were recorded, and body mass index (BMI) and waist/hip (W/H) ratio were measured. Parameters assessed were Presumptive Stressful Life Events Scale (PSLES) scores and Perceived Stress Scale (PSS) scores. Results: Among 7500 participants, 3245 (43.27%) had mild-to-moderate stress and 4255 (56.73%) had severe stress. Mean ± standard deviation value of PSLES score of participants recruited for the study was 237.99 ± 79.45, and PSS score was 23.76 ± 5.24; there was a positive correlation between PSLES scores and PSS scores with r = 0.8. There was no significant difference in age between the two groups (22.8 ± 3.22 vs. 22.64 ± 3.15; P= 0.26). There was a significant difference in PSLES scores between the two groups (312.93 ± 27.19 vs. 162.99 ± 25.63; P < 0.001). There was a significant difference in values of PSS scores, BMI, W/H ratio, and pulse rate between the two groups. Marital conflicts, family conflict, and conflict with laws were the highest percentages of problems reported by these groups of participants as cause of stress. Conclusions: We observed that 100% of our participants were stressed, and family conflict, marital conflict, problems with in-laws, and abuse by husbands were some of the main contributors of stress in the population studied. Stress levels are increasing in females and require early intervention. To address gender disparities in mental health, multiple actions need to be implemented at various levels. In particular, national mental health policies must be developed that are based on an explicit analysis of gender disparities in risk and outcome.

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Introduction: Neck pain is a frequent complaint of the era. The muscles around the neck tend to get shorter, leading to restricted neck mobility. There are not much data about the effectiveness of deep friction massage in comparison with static stretching for reducing nonspecific neck pain. Purpose: The purpose was to find out whether these two interventions gave similar results and if one method is better to the other which could be the substitute of remedy. Study Design: This study was based a randomized control trial. Place of Study: This study was conducted at the Department of Physical Therapy, Mayo Hospital Lahore. Materials and Methods: Fifty-six patients with nonspecific neck pain were randomly located to have static stretching (Group A, n = 28) and deep friction massage (Group B, n = 28). Group A received six sessions of static stretching during 3 weeks (two sessions per week), whereas Group B received six sessions of deep friction massage during 3 weeks (two sessions per week). Results: Paired sample t-test was used. Statistically significant improvement was observed in both the groups in improving pain, Neck Disability Index (NDI), and range of motion (P > 0.05). No difference was found between the deep friction massage and static stretching in improving pain and range of motion. However, deep friction massage shows superior effects in NDI (P > 0.05). Conclusion: Deep friction massage and static stretching are equally effective in reducing the nonspecific neck pain in terms of alleviating pain and improving ranges of neck movement. However, deep friction massage shows superior effects in NDI.

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Ovarian torsion (OT) is the fifth most common gynecological emergency with a reported prevalence of 2.5%–7.4%. A 19-year-old unmarried girl, known the case of the polycystic ovarian syndrome (PCOS) was referred with sudden onset left-sided lower abdominal pain for the past 7 days, associated with vomiting. On examination, lower abdominal tenderness, exclusively to the left side was present. Ultrasound showed a bulky left ovary of 6 cm × 8 cm × 6 cm with no vascularity and fluid in POD. Laparoscopy revealed a gangrenous left ovarian cyst of 8 cm × 8 cm, twisted five times over the fallopian tube which was adherent to lateral pelvic wall and omentum. Left oophorectomy was done. In all patients of PCOS with acute abdomen, ovarian torsion should be included in differential diagnosis, and early recourse to laparoscopy is the key for prevention of the dreaded complication of the gangrenous ovary and ultimately oophorectomy.

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Introduction: Many recent studies have shown an increased association between patient's satisfaction levels, patient's compliance, and success of treatment. Aim: The aim of this study is to assess the level of satisfaction among patients who have utilized the outpatient department services provided in the primary care level health institution. Materials and Methods: A health center-based observational cross-sectional study was conducted from July 2011 to October 2011 at Guskara Primary health center, Burdwan among 422 patients using a pre-designed pre-tested structured schedule. Results: Overall, mean satisfaction score was 2.97 ± 0.37. Highest satisfaction scores were observed among 18–20 years, males were more satisfied regarding technical quality of care, whereas females reported higher satisfaction regarding interpersonal manner, unmarried/single group reported the highest satisfaction with most of the services, literate group reported higher satisfaction than the illiterate group, affluent patients reported higher satisfaction regarding technical quality of care, financial aspect. Conclusions: Causes of dissatisfaction were long waiting time, the inadequacy of seating arrangement in the waiting area, inadequate cleanliness of surroundings, inadequate toilet facilities, nonavailability of medicines, and behavior of doctor.

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