Nonnutritive sweeteners (NNSs) are the substances having an intense sweet taste with no or very low calories and are used as substitutes for simple sugars for reduction of energy intake. The consumption of NNSs is increasing at an alarming rate because of the ever evolving pandemic of obesity and Type 2 diabetes mellitus. NNSs have various positive and negative metabolic consequences on the health of the consumers. There are misconceptions and myths regarding the use of NNSs for which various professional bodies have issued guidelines. However, the overall long-term effects of the NNSs are still an area of debate and discussion.

Research is a scientific quest to find answers to certain questions. It makes us think with curiosity and wonderment about how to make something better. Research contributes in a major way to the development and maintenance of health and health care systems. Qualitative research is concerned with qualitative phenomena and includes subjective assessment of attitudes, opinions, and behavior. It is especially important in the behavioral sciences where the aim is to discover the underlying motives of human behavior. The critical incident technique (CIT) is a well-established qualitative research tool used in many areas of health sciences including nursing, medicine, dentistry, and their respective education systems. This technique is described as consisting of “a set of procedures for collecting direct observations of human behavior in such a way as to facilitate their potential usefulness in solving practical problems.” This review gives a gist of CIT and its application in different aspects of dental research.

Context: Lupus nephritis (LN) is the involvement of kidney in systemic lupus erythematosus (SLE) where various types of glomerulonephritis (GN) are seen which affects the therapy also. Aims: To find out the frequency of various types of LN and nonlupus lesion in the kidney of SLE patient. Settings and Design: Retrospective analysis. Subjects and Methods: Total 52 cases of LN were studied between the periods of January 2011 and June 2014. Statistical Analysis Used: Calculation of mean and standard deviation. Results: There was female (76.93%) predominance over males (23.08%). In 63.46%, both ANA and dsDNA antibodies were positive. Only 57.69% patient had typical features of SLE and 17.29% patient had only one clinical manifestation to suggest SLE. In rest cases, renal limited SLE with severe anemia was found. Type IV LN was more common (53.84%) while Type III LN, Type II LN, and Type V LN were seen in equal frequency (9.61% each). In 2 cases, a combination of Type V + IV was found. In 5 cases (9.61%), nonlupus type of lesion was seen. It included 2 cases (3.84%) of amyloidosis and 3 cases of severe chronic tubulointerstitial nephritis with focal segmental glomerulosclerosis (5.76% FSGS). Out of 28 cases of Type IV LN, crescentic GN was found in 10 cases (19.23% CGN). In another 44.44% cases, focal crescents were seen in <40% glomeruli. Conclusions: Thus our study concludes that in LN Type IV is the most common LN and nonlupus related lesions, e.g., amyloidosis, and chronic interstitial nephritis and FSGS can also be found in LN.

Introduction: The health planners in India have visualized primary health centers (PHCs) and community health centers (CHCs) as the key healthcare delivery institutions in rural areas. These centers are supposed to have health manpower, infrastructure, and service delivery as per the Indian public health standards (IPHS) guidelines (2010). Materials and Methods: A cross-sectional study was conducted in seven CHCs and 12 PHCs, randomly selected from eight blocks of Shimla District and evaluated in terms of health manpower, infrastructure, and services from September 2011 to August 2012. Data was collected from the selected units using structured data collection instruments designed by the IPHS. Results: The health centers were assessed according to IPHS guidelines. Outpatient department services and referral services were provided in all the centers studied. No specialist doctor was posted at any of CHCs against a sanctioned strength of at least four (surgeon, physician, obstetrician, and pediatrician) per CHC. In 3 (42.8%) CHCs and 8 (75%) PHCs, no pharmacist was posted. Eight (75%) PHCs did not have any staff nurse posted. Three (42.8%) CHCs and 10 (83.3%) PHCs did not have a laboratory technician. In CHCs, separate labor room was available in 6 (85.7%) whereas a separate laboratory was available in all seven. Separate labor room and laboratory were available in four (25%) PHCs. Conclusions: IPHS guidelines are not being followed at PHC and CHC levels of the district. Health manpower shortage is the key bottleneck in service delivery. Political advocacy is needed to ensure sufficient health manpower availability to deliver quality healthcare.

Aims: To access the quality of life in terms of functional capacity and to estimate the prevalence of depression among geriatric patients. Settings and Design: A hospital-based study was conducted in Civil Hospital, Ahmedabad between July and September 2006. The patients aged 65 years and above were included in the geriatrics outpatient department. Methods: The geriatric patients were interviewed during their geriatric clinic visit using a structured questionnaire regarding instrumental activities of daily living (IADL), basic activities of daily living (ADL), Nagi physical disability scale, and short version of the geriatric depression scale. Statistical Analysis Used: Data were analyzed using EPI-Info Statistical Packages. Using a scoring system, mean, standard deviation, and the significance of the results was tested using the Chi-square test and Z-test was used to compare quantitative data. Results: Mean IADL score of males is 4.05 whereas of females is 2.91 which is significant (P < 0.05). Overall scores for ADL showed no statistically significant results between male and female geriatric subjects. The mean scores of restriction of basic activities on the Nagi scale of physical disability were not significant among women. Mean scores of depression were highly significant in IADL, basic ADL, and limitation of basic movement while significant in a greater number of reported symptoms. Conclusions: Depression was due to combined effect of increased scores of IADL, ADL, and Nagi physical disability scale.

Introduction: Fungi have emerged as major opportunistic pathogens. Candida species account for nearly 96% of all opportunistic mycoses and is an important cause of bloodstream infections. There has been a progressive shift from the predominance of Candida albicans to nonalbicans Candida species as the major cause of candidemia all over the world. Resistance to antifungal drugs is more in nonalbicans Candida species. Hence, speciation and antifungal susceptibility testing is the need of the hour. Materials and Methods: This retrospective study was conducted in a multispecialty center in North India from January 1, 2014 to March 31, 2015. The blood culture samples that were positive for Candida species were processed further. Species identification was done by standard microbiological techniques. Antifungal drug susceptibility was done by disk diffusion method (Clinical and Laboratory Standards Institute M44-A2). Results: A total of 10893 samples were processed, 1440 (13.2%) blood cultures were positive. Candida species was isolated from 105 (7.3%) samples, of which 15 (14.3%) were C. albicans and 90 (85.7%) were nonalbicans Candida. Nonalbicans Candida included Candida tropicalis (50.5%), Candida glabrata (19.0%), Candida parapsilosis (14.3%) and one isolate each of Candida guillermondi and Candida krusei. Majority of the Candida spp. isolates were resistant to clotrimazole (55.5%) fluconazole (42%) and itraconazole (69%) and and ketoconazole (38%). All isolates were uniformly sensitive to amphotericin B. Conclusion: There is predominance of nonalbicans Candida species in hospital setting. A high index of suspicion, early diagnosis, and a prompt and appropriate therapy remains the cornerstone of treatment.

Background: Interventions involving the middle meatus are commonly performed because the majority of the paranasal sinuses open into the osteomeatal complex. Therefore, the aim of the present study was to locate the level of maxillary sinus ostium (MSO), to measure the distances between MSO and different anatomical landmarks, to measure the different dimensions of maxillary sinus and to compare the morphology of maxillary sinus between the right and the left sides. Materials and Methods: The study involved 50 computed tomography (CT) images of normal paranasal sinus anatomy in coronal and sagittal planes from the Department of Radiodiagnosis. The location of the sinus ostium (upper, middle, or lower third) was observed. Perpendicular distance from the sinus ostium to the lower border of inferior turbinate and hard palate were measured. The maximum vertical, transverse, and antero-posterior diameters of the maxillary sinus were measured. Results: Of 50 CT images, the MSO was located in the upper third in 40 cases while in 10 it was located in the middle third. The most common location of MSO was in the upper third. The dimensions of the maxillary sinus indicated bilateral symmetry. Conclusion: The dimensions of the maxillary sinus indicated bilateral symmetry, and there were no significant gender differences when compared. However, the distances of the MSO from the major anatomical landmarks were significantly different between males and females which are seldom reported earlier. This knowledge about the variations in the lateral wall of the nasal cavity is crucial during the endoscopic interventions and for functional endoscopic sinus surgeries.

Aim: Ascites is one of the major complications of liver cirrhosis. In addition, ascites can develop because of peritoneal tuberculosis, malignancy, cardiac, and renal disorders. The purpose of this study was to evaluate epidemiological data on the etiological profile of ascites in adults in a tertiary care hospital in the Northern hilly state of the Western Himalayas. Materials and Methods: A 1-year hospital-based cross section observational study was conducted in the Department of Medicine and Gastroenterology in a tertiary care center of Himachal Pradesh, located in the Northern India. In all 168 patients who were diagnosed as ascites on the basis of history, physical examination, ultrasonography, and of age >18 years were included in the study. Detail history examination and investigation were carried in each case as per protocol. Results: Cirrhosis of liver was the leading cause of ascites in our study (60.7%), tuberculosis was the second most common cause of ascites (13%), malignancy and cardiac disorders were the third (7.7%) most common causes for ascites. Alcohol was the leading cause of cirrhosis in 75 patients (73.5%). Conclusion: The study identified cirrhosis of liver as the leading cause of ascites and alcoholism as the most common cause of cirrhosis. The measures on taking care of preventable risk factors are desired.

Background: Malaria in the Western Kenya highlands is unpredictable sometimes leading to epidemics that result in dramatic emergencies in terms of severe morbidity and mortality. This places enormous strain on health facilities disrupting fragile health care services culminating into crises. This underlies the need for a better understanding of the disease dynamics and determinants to formulate specific and focused intervention strategies. Aim: One year study was undertaken in Kipsamoite and Kapsisiywa in Nandi County to evaluate Plasmodium species prevalence and transmission risk in the general population and specific age groups. Subjects and Methods: Positive blood smears were used to determine monthly malaria prevalence, age-group prevalence. Malaria risk in population was worked out using adult to child ratio (ACR). Results: ACR results indicated a less immune population in which all age groups and sexes were equally susceptible to malaria. Plasmodium falciparum was most prevalent (90%, n = 264) while Plasmodium malariae (10%, n = 30). There was significant difference in the malaria parasite species prevalence (χ²,P < 0.05), but there was no significant difference in parasite species prevalence between the study sites (χ², P > 0.05). Conclusions: Malaria transmission dynamics were similar in both sites, largely driven by seasonality, had an even age distribution implying that the threat of epidemics was real should all age-groups become exposed to parasites and conditions of disease transmission become favorable.

Background and Objectives: Cervical cancer is a leading cause of cancer mortality among women in India. Hence, the objectives of this study were to find out the perception of women towards cervical cancer and assess their health-seeking behavior for screening. Methodology: A cross-sectional study was conducted from November to December 2009 among married women above 15 years of age by systematic random sampling of households in Field Ganj, Ludhiana, India. Information was gathered by a questionnaire assessing the knowledge, attitude, and practices regarding cervical cancer. Results: Of the 304 women interviewed, 28.9% (88) had heard of cervical cancer and 12.2% (37) knew it could be preventable. Only 4.3% (13) of the women had heard about Pap smear. Interpretation and Conclusions: Inadequate knowledge about cervical cancer and Pap smear is the greatest obstacle to effective screening. Identifying individual and community-level barriers is important in increasing cervical cancer screening.

Background: Visually impaired children are unable to maintain good oral hygiene, as their tactile abilities are often underdeveloped owing to their visual disturbances. Conventional brushing techniques are often poorly comprehended by these children and hence, it was decided to evaluate the effectiveness of audio and audio-tactile methods in improving the oral hygiene of these children. Objective: To evaluate and compare the effectiveness of audio and audio-tactile methods in improving oral hygiene status of visually impaired school children. Materials and Methods: In this study, the total study group comprised 48 visually impaired children that were randomly divided into two groups, with one group receiving the audio method and the other group receiving the audio-tactile method. Periodic reinforcement of health education was performed at an interval of 2 months. Re-examination was carried out after 2 months of health education to assess plaque scores. Data were statistically analyzed using paired t-test. Results: There was reduction in plaque scores in audio-tactile group after health education. In the audio-tactile group, the mean plaque scores of pre- and post-health education were 1.28 and 0.95, respectively. The difference was statistically significant (P < 0.001). In audio group, the mean plaque scores of pre- and post-health education were 1.15 and 0.14, respectively. The difference was statistically nonsignificant (P < 0.07). Conclusion: Visually impaired children could maintain an acceptable level of oral hygiene when taught using special customized methods. However, reinforcement at regular intervals is required for the maintenance of oral hygiene.

Aim: The aim of this study was to compare instrumentation time and cleaning efficacy of manual instrumentation and two rotary systems in the preparation of primary molar root canals. Materials and Methods: The teeth were randomly divided into three experimental groups, Group 1 K-file (n = 30), Group 2 Mtwo (n = 30), Group 3 WaveOne (n = 30), and one control group (n = 30). The root canals were prepared using one of the three file systems followed by clearing the teeth with different demineralizing solutions. The instrumentation time in each root canal was measured by a chronometer. The results were statistically evaluated using Kruskal–Wallis tests.Results: In the coronal third, WaveOne showed more ink removal and the difference found was highly significant (P < 0.0001). In the middle third of the root canal, WaveOne performed better than Mtwo and K-file (P < 0.005). At the apical level, there was no statistical difference between the three systems. WaveOne was found to take significantly (P < 0.0001) less time than Mtwo and K-file. Conclusion: WaveOne took less time and showed better cleaning efficacy when compared to other instrumentation techniques, especially in coronal and middle one-third.

A 60-year-old man presented with multiple cranial nerve palsies on the right side. He was initiated on anti-tubercular treatment in view of lymphocytic pleocytosis on the cerebrospinal fluid study. Although he improved initially, later he worsened with cranial nerve involvement on the contralateral side. A diagnostic procedure was done, and the team reached a definitive diagnosis and patient responded to the targeted therapy.

Persistent left superior vena cava is the most common variation in the anomalous venous return to the heart. It is usually asymptomatic and discovered incidentally during imaging and the aberrant position of a pacemaker lead, central venous catheters, or retrograde cardioplegia for cardiac surgery. We present two different approaches of pacemaker implantation in this congenital anomaly.

Calcifying epithelial odontogenic tumor (CEOT) is a rare odontogenic neoplasm comprising <1% of all odontogenic tumors. It is commonly seen in the third to fifth decades of life without any gender predilection. It usually occurs in the mandibular posterior region. A painless, slow growing swelling with bone expansion is the most common clinical feature of CEOT. Radiographically, it presents as a mixed lesion with or without an associated impacted tooth. Confirmation of the diagnosis is by histopathological examination. We describe an unusual case of CEOT occurring in the maxillary posterior region and involving the maxillary sinus. The associated impacted third molar was displaced to the lateral wall of the nose and root resorption was seen in all the teeth associated with the lesion. There was no evidence of calcification in conventional as well as computed tomography images.

The most common odontogenic neoplasm, it accounts for only 1% of all jaw tumors. A variant of Ameloblastoma- Desmoplastic type is known for its unique features and propensity to recur. A 44 year old male patient, report with a swelling in anterior part of lower jaw. Radiograph reveals a mixed radiopaque and radiolucent lesion. Histopathology shows features of Desmoplastic ameloblastoma.

Interrupted aortic arch (IAA) is a rare congenital vascular malformation, which is defined as lack of luminal continuity, between the ascending and descending thoracic aorta. Many times it is associated with various congenital cardiac anomalies. Early diagnosis is mandatory to assess the patient condition and to plan medical and surgical treatment. Traditionally, chest X-ray, echocardiography, and conventional catheter angiography are the imaging tools being used. Multi-detector computed tomography (MDCT) can accurately diagnose and characterize the various forms of IAA and associated cardiac defects. We report a case of 8-year-old male child detected to have Type A IAA on MDCT with an associated ventricular septal defect and patent ductusarteriosus.

Complete extrusion of a permanent pacemaker is an extremely rare complication. We report a unique case of a patient presenting with syncopal episodes after complete extrusion of his implanted pacemaker. An 82-year-old gentleman with a history of pacemaker implantation, 6 years back, presented with syncopal episodes and was found to have complete extrusion of his pacemaker out of its pocket. An electrocardiography revealed complete heart block which would revert to paced rhythm when the pulse generator would be pushed back into the pacemaker pocket. Neglecting the pre-extrusion stage, he presented with syncopal episodes after complete extrusion and loss of contact of the unipolar pacemaker with the pacemaker pocket resulting in complete loss of pacing.

Intestinal obstruction due to internal herniation is rare. There is only 0.5–5.8% of incidence described in the available literature. In infancy, it is rarer. Internal herniation of Meckel's diverticulum through meso-appendix in an infant is an extremely rare emergency situation, and probably the first case to be reported in the literature.

Diagnosis of ulnar neuropathy at wrist remains challenging domain for neurophysicians as the clinical picture resembles proximal ulnar neuropathies. Inching across wrist and conduction to first dorsal interosseous remains mainstay of electrodiagnostic (EDX) procedures for distal ulnar neuropathy. Here, we present a case of distal ulnar neuropathy with review of its EDX procedures.

The thyroid gland is a highly vascular gland placed anteriorly in the neck and is supplied by the superior thyroid artery (STA), inferior thyroid artery (ITA), and sometimes the thyroidea ima artery. During the routine dissection for undergraduate students, variations in the arterial supply of thyroid gland were observed. The thyroid gland showed a lobulated appearance. On the left side, STA was found to be absent. However, two ITA were observed on the same side. These supplied the gland from its posterior surface. The knowledge of variations in vascularity of the thyroid gland is important in procedures such as emergency cricothyroidectomy, radical neck dissection, catheterization, reconstruction of aneurysms, and carotid endarterectomy.