Upper aerodigestive space includes nasal and oral cavities, pharynx, larynx, trachea, and esophagus. The dimension of this space is maintained by the normal skeletal pattern and the anatomical soft tissue adapted to it. Any alteration in the development of the skeletal pattern or any soft tissue lesion can cause obstruction leading to difficulty in breathing, swallowing, and alteration in phonation. Difficulty in breathing is the most common problem that results in obstructive sleep apnea, leading to various complications. The evaluation of the upper aerodigestive space is a complex procedure that includes both physical examination and various imaging modalities. This article is to highlight the advantages of various imaging techniques that are best used to analyze the upper aerodigestive space.

Background and Objective: Institutional delivery (ID) is considered pivotal for ensuring maternal and neonatal health. Emphasis has been put on the same in India repeatedly with aim to reduce mortality in this vulnerable group. The aim of the study is to find out the determinants of ID in north India. Materials and Methods: Data for the ecological study were retrieved from District Level Household and Facility Survey 4 (2012-13) for 53 districts in three north Indian states, viz. Punjab, Haryana, and Himachal Pradesh. District wise proportion for ID and different demographic factors were considered along with Antenatal care service components. Regression was used to find out the determinants for higher rate of ID. Results: Overall, 80% ID has been documented in the present survey in district level. Among different variables, consumption of 100 iron folic acid (IFA) tablets and higher parity were negatively associated with higher rate of ID (coefficient = - 0.692 and - 0.573, respectively), whereas uptake of three or more ANC visits was seen to be associated with it positively (coefficient = 0.422). Conclusions: ANC visits, parity and consumption of IFA tablets are associated with higher rates of ID at district level in North India.

Background: Placenta previa complicates 0.3–0.5% of all pregnancies and is a major cause of third-trimester hemorrhage which is on the rise due to rise in incidence of cesarean sections. Significant maternal morbidity in form of increased incidence of fetal malpresentation, cesarean delivery, increased blood loss, and peripartum hysterectomy have been noted in cases of placenta previa and can lead to prolonged hospitalization in these women. Premature deliveries can occur which lead to higher admission to neonatal intensive care unit and stillbirths. Aim: To study all cases of placenta previa in scarred and unscarred uterus clinically. Materials and Methods: A retrospective study of 80 cases derived from case records, divided into two groups — A (scarred uterus) and B (unscarred uterus), was conducted in Department of Obstetrics and Gynecology at Mamata General Hospital, Khammam, over a period of 5 years from June 2011 to May 2016. Results: Incidence of placenta previa in scarred uterus (A) was 2.75% which was much higher than in unscarred uterus (B) - 1.4% [P value 0.001]. Anterior placenta was seen in 63.8% in group-A and 47.7% in group-B. P value for Type IIIA placenta previa was statistically significant [0.02]. Placenta was adherent in 13.9% of group-A and 4.5% of group-B. Obstetric hysterectomy was performed in 19.4% of group-A and 4.5% of group-B [P-value 0.01]. Conclusions: Incidence of placenta previa and its associated complications is definitely more in scarred group when compared to unscarred group although statistically significant values were obtained only in incidence of placenta previa, especially type III anterior and rate of hysterectomy.

Objective: To evaluate the efficacy of Zinc-carbonated hydroxyapatite in the reduction of postoperative sensitivity during composite placement. Context: Postoperative sensitivity after composite restoration still remains a major clinical challenge. Materials and Methods: Sixty class I cavities were prepared in 60 patients by the same operator with the following inclusion and exclusion criteria: The patients selected for the study were between 20–45 years with vital pulp and having remaining dentin thickness of 1mm. Previously restored, nonvital and tooth with periodical changes were excluded. Patients were randomly divided into two groups of 30 each—Group I self-etch and Group II selective-etch with Subgroup A- zinc-carbonated hydroxyapatite applied and Subgroup B- zinc-carbonated hydroxyapatite not applied. After the surface treatment, the teeth were restored with composite resin. The patients were evaluated with visual analogue scale (VAS) at the end of one week and one month. Statistical Analysis: Data were analyzed using Kruskal–Wallis one-way analysis. Results: Comparing within groups, Group I self-etch mean values showed statistically significant lower values compared with Group II selective-etch (P < 0.01). Zinc-carbonated hydroxyapatite Subgroup A showed statistically significant lower values compared with Subgroup B where zinc-carbonated hydroxyapatite was not applied (P < 0.01). Conclusion: Application of zinc-carbonated hydroxyapatite showed significant reduction in postoperative sensitivity after composite placement.

Context: Mycotic keratitis presents as an ophthalmic problem causing visual disability due to its protracted course and unfavorable response. People of low socioeconomic classes who often come in contact with fungal spores during day to day activities suffer from this infection more often. Aims: To study the magnitude of fungal corneal ulcer, identify the risk factors, identify the predominant etiological agents in this region. Settings and Design: Type of study—observational study. This was a cross-sectional hospital based study. Materials and Methods: We collected 50 number of corneal scraping samples from patients clinically suspected to have fungal corneal ulcer within the age group 15–60 years. Direct microscopy of 10% potassium hydroxide (KOH) mount, gram staining, fungal culture on Sabouraud Dextrose Agar (SDA) media were performed. Results: Fungal isolates were obtained in 32% of cases of which 68.75% were male. Predominant age group was 30–45 years (56.25%). Majority of patients (68.75%) belong to low socioeconomic class. The most common risk factor was trauma with vegetative matter in 62.5% of cases. Predominant fungal isolate was Aspergillus spp. in 43.75% followed by fusarium, candida, and curvullaria spp. Conclusions: Because of the serious consequences of infectious keratitis, it is important to know the exact etiology to institute appropriate therapy in time. Laboratory confirmation should be under taken to rule out fungal infection before prescribing corticosteroid and antibacterial antibiotics.

Background: Human Immunodeficiency Virus (HIV) is one of the important contagion issues in the world. It poses serious challenges not only to health professionals but professionals across industries. In India, in general, studies on HIV are carried out among medical and paramedical students and least among non- medical students, whose awareness is of prime importance. Aim: This study was designed to assess the knowledge, attitude, and behavior regarding HIV/AIDS among engineering students in and around Guntur, Andhra Pradesh. Patients and Methods: A cross-sectional study was conducted among 400 engineering college students in and around Guntur. A self-administered questionnaire was given and the results were tabulated and analyzed. Statistical Analysis Used: The data was entered in excel sheet and analyzed using SPSS v. 20.0 software. Data was analyzed using student's t-test and Chi-square test. Results: Out of 400 students, 257 (64.2%) were males and 143 (35.7%) were females. Maximum students (97.2%) indicated they know about HIV/AIDS. Eighty-nine percent (89.7%) of the students responded that needle prick injury can transmit HIV infection, whereas 82.5% of the responders knew that HIV/AIDS affects immune systems. A total of 66.5% of individuals agreed that there is no cure for HIV/AIDS and 72.0% of individuals responded that HIV/AIDS cannot be transmitted through saliva and 20.5% of the students felt that it is necessary to isolate the infected individuals from general public. Conclusions: In addition to medical and para medical students, it is very important for the youth to be aware of HIV/AIDS and its social implications.

Aims: The aim of this study was to compare color stability and surface topography of two different feldspathic porcelains, both qualitatively and quantitatively, after exposure to routinely consumed beverages over different time periods using a spectrophotometer and surface noncontact profilometer, respectively. Materials and Methods: In this in-vitro study, a total of 120 base metal alloy discs with a thickness of 0.5 mm were made following the conventional casting technique. They were randomly divided into two categories. Category-I was built with IPS.d.Sign (Ivoclar), Category-II was built with Ceramco 3 (Dentsply) each containing 60 samples. The samples were immersed into different beverages. Color stability and surface roughness were measured by a spectrophotometer and profilometer, respectively. Statistical Analysis: t-test between two categories and ANOVA within the same group. Results and Conclusion: Color difference (ΔE) between different test solutions at different intervals showed clinically acceptable range (below 3.3 units). Thus, ceramics were considered color stable and resistant to external staining. Scanning electron microscope and profilometer study revealed that there were significant surface roughness changes in both IPS.d.Sign and Dentsply metal ceramic materials when immersed in soft cola drink and coffee solutions for 90 days and compared to the control group which was immersed in distilled water.

Aim: To assess the periodontal knowledge among 18–50-year-old adult population living in the West Godavari state of Andhra Pradesh. Materials and Methods: We conducted a cross-sectional face-to-face interview survey from July 2014 to June 2015 among individuals between ages 18 and 50 years living in the West Godavari district of Andhra Pradesh using a stratified multistage sampling method. For data collection, a specially designed pretested proforma was used. The proforma consisted of demographic details such as name, age, sex, income, education, occupation, personal habits, and systemic diseases, if any. The proforma also included a structured, 14-item questionnaire to assess the knowledge levels of participants regarding periodontal health and diseases. t-test and analysis of variance were used to analyze the collected data. P value less than 0.05 was considered statistically significant for all comparisons. Results: The lowest percentage of correct answers was related to gum care during pregnancy (11.6%) and the effect of systemic diseases on periodontium (30%). A majority of the participants had higher level of knowledge scores related to the use of toothpaste (95.2%) and food accumulation leads to gum diseases (80.8%). There was no significant difference in mean knowledge score among different gender and occupation groups (P > 0.05). Participants with high economic status had the highest periodontal disease knowledge (P = 0.015). Conclusion: Knowledge concerning periodontal health and disease is still poor in West Godavari; therefore, more dental health education is needed to improve oral health. In this study, positive attitudes toward prevention were related to better knowledge.

Context: Dental students go through the process of professionalization and imbibe attitude, knowledge, and working skills essential to practice dentistry. Aim: To assess the effect of different stages of professionalization on health locus of control among undergraduate students of dental colleges in Bengaluru city. Settings and Design: A cross-sectional study was conducted among 511 undergraduate students of the selected four dental colleges in Bengaluru, India. Materials and Methods: Nonprobabilistic sampling was adopted and the students who were present on the day of the study were included in the study. The 18-item Multidimensional Health Locus of Control (MHLC) scale consisting of three 6-item subscales (Internal, Chance, and Powerful Others) was administered to the respondents. Statistical Analysis: Analysis of variance was used to find the overall variance and post hoc to determine the intergroup variance. P value of <0.05 was accepted to be statistically significant. Results: A comparison of the mean scores for the three subscales from first Bachelor of Dental Surgery (BDS), final BDS, and interns showed that the mean internal score increased in the order of first BDS (25.9), final BDS (26.3), and interns (27.19); the scores varied significantly between first BDS and interns (P = 0.023). The overall variance was also found to be statistically significant (P = 0.04). Conclusion: Internal health locus of controls was very strong in the study population, and the mean internal scores increased from first BDS till internship.

Background: Anthrax is a disease of herbivorous animals, caused by Bacillus anthracis and humans incidentally acquire the disease by handling infected animals and their products. Though the disease has become rare, endemic outbreaks occur in tropical countries, where veterinary control of livestock is marginal and environmental conditions favor an animal-soil-animal cycle. Materials and Methods: Eight tribal men from Kodipunjuvalasa village of Araku valley presented with painless ulcers associated with vesiculation and edema of surrounding skin on upper limbs without any constitutional symptoms. There was a history of slaughtering and consumption of cooked meat of sick goat 1 week to 10 days prior to the development of skin lesions. Cutaneous anthrax was suspected and smears, swabs were taken for culture and polymerase chain reaction (PCR). All the cases were treated with intravenous followed by oral antibiotics. Appropriate health authorities were alerted and proper control measures were employed. Results: Smears from the cutaneous lesions were positive for Bacillus anthracis in all our cases and this was confirmed by a positive culture and PCR of smears. All the cases responded to antibiotics. Conclusion: We report eight cases of cutaneous anthrax in tribal area of non-endemic district, Visakhapatnam, Andhra Pradesh.

Internal hernia is a rare cause of small bowel loop obstruction. Hernia through a defect of the broad ligament is extremely rare. We report a case of small bowel obstruction resulting from the herniation of small bowel through a unilateral defect in the broad ligament in a woman who had no prior abdominal surgery, uterine surgery, delivery trauma, and pelvic pathology. Congenital abnormality should be considered the cause of the defect in the broad ligament.

Flash pulmonary edema (FPE) is a rare clinical presentation of renal artery stenosis. It is an episode of abrupt onset pulmonary edema that resolves rapidly. It occurs in patients with bilateral renal artery stenosis or unilateral renal artery stenosis with a solitary functioning kidney. We report a patient of diabetic end-stage renal disease on maintenance hemodialysis who manifested FPE on a few occasions which responded to renal revascularization. The indications of renal revascularization have been narrowed to poor blood pressure control, when progressive loss of renal function is encountered, or when circulatory congestion is a prominent feature.

Intussusception is a rare event in adults which constitutes 1–3% of all cases of intestinal obstruction. Malignant etiology as causes of intussusception is more common in large bowel accounting for 60–65% cases. Intussusception due to colonic lipoma is rare. The present case is a 45-year-old woman who had a polypoidal growth in the descending colon. She was operated and the growth was histopathologically diagnosed as lipoma. Though rare, colonic lipoma should be considered as a probable etiology for intussusceptions.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. The most commonly accepted classification is that of Ridley and Jopling, which is primarily based on immunity but has been correlated with clinical, histopathological, and bacteriological findings. In majority of cases, there is concordance between clinical findings and histopathological findings. But in few cases, there is discordance between them. Categorizing leprosy in a particular spectrum is necessary to decide the plan of management where histopathology plays a major role. Here we present a case where there was an extreme degree of discordance and patient presented with clinical features of lepromatous leprosy but turned out to have tuberculoid leprosy on histopathology.

A 32-year-old male patient reported with a painless swelling over right cheek and is slowly growing in size for the past 2 years. Incisional biopsy revealed the lesion as Ossifying fibroma (OF), which is not very common in the maxilla. Surgical excision and primary closure was successfully carried out with no postoperative complications. The case was followed for a period of 3 years with no evidence of recurrence.

Undifferentiated pleomorphic sarcoma (UPS) previously described as malignant fibrous histiocytoma (MFH) is a common soft tissue sarcoma, but relatively rare in oral cavity. In this article we report a case of 23-year-old male patient diagnosed UPS in left side of maxilla anterior region which had a deceptive clinical and orthopantomogram findings. Patient had diffuse swelling left upper side of the face with periapical radiolucency involving 21, 22, 23 regions and decreased response to electric pulp testing in those teeth. Patient underwent surgical removal of the entire lesion with wide marginal clearance followed by radiation and chemotherapy. This case report highlights the importance of tissues to be sent for histopathological examination for definitive diagnosis.

Chronic myeloid leukemia (CML) is a clonal hematopoietic disorder characterized by a reciprocal translocation between chromosome 9 and 22 resulting in bcr-abl1 fusion gene. Patients usually present with symptoms of anemia, splenomegaly, and hyperleukocytosis. Initial presentation with visual disturbance, without other symptoms, is rare in CML. No specific treatment has been described for ocular lesions in leukemia. Treating the underlying malignancy would aid in resolution of the symptoms. We report a case of CML presenting with retinal hemorrhages.

Adenoid cystic carcinoma (ACC) accounts for about 1% of all head and neck malignancies and 6–10% of all salivary gland neoplasms. ACC is a rare slow growing salivary gland neoplasm with a high recurrence rate. It can occur in any salivary gland site, but approximately 50–60% develop within the minor salivary glands especially palate. Rarely, ACC arising intraosseously have also been reported. ACC is characterized for its wide local infiltration, perineural spread, local recurrence, and distant metastasis. Pain is a common and important finding, occurring early in the course of the disease before there is a noticeable swelling, which is mainly due to neoplastic cell neurotropism. This report describes a case of ACC in the left posterolateral portion of the hard palate in a 36-year-old woman, along with review of literature on ACC.