Background: Initially the concept of pain was emotional rather than a sensory modality. The word pain is acquired from the Greek word poine which means “penalty”.1 The International Association for the Study of Pain (IASP) described pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”.2 Peripheral nerve blocks have become a popular anaesthetic option in the perioperative management of patients because nerve blocks provide better postoperative analgesia than does general anaesthesia, while avoiding the cardiopulmonary and central nervous system effects of general anaesthesia. Peripheral nerve block is a technique which uses local anaesthetic to be deposited around a target nerve and block the conduction of action potential thus not allowing pain signals to be transmitted to the pain centre in the brain. Materials & methods: A prospective randomised single blinded study was conducted at Vinayaka Missions Kirupananda Variyar Medical College & Hospitals, Salem from December 2019 to May 2021. A total of 60 Adult patients of both gender undergoing upper limb elective surgeries under brachial plexus block were allocated in two groups I & II and each group comprises 30 patients were selected for the purpose of the study. Results: The association of age group between both the groups was found to be statistically insignificant with mean age of 43.1+12.4 years of age in Group 1 and 43.3+11.9 years of age in Group 2. The mean time of onset of sensory block in group I was 16.47 mins & in Group II was 10.57 mins. This was found to be clinically highly significant with P < 0.0001. The duration of Sensory Block between both the study and control group was found to be statistically insignificant whereas the duration of Motor blockade was found to be statistically significant along with the no of RA given in 24 hours which was also found to be statistically significant. The difference of pulse rate between both the groups at various intervals was found to be statistically insignificant. The Oxygen saturation between both the group was found to be statistically insignificant till 60 minutes of the procedure and it was found to be statistically significant after 2 hours till the end of the study. Conclusion: We conclude that adding dexamethasone to the local anaesthetic provides rapid onset of both sensory and motor blockade, and prolongs the motor blockade and analgesia duration.

Background: Despite the enormous benefits associated with contraceptive use, only a few sexually active married adults in developing countries like Nigeria use contraceptive methods, this situation is even worst in rural areas across Nigeria. This study examines the influence of myths on the use of contraceptive methods in Calabar South Local Government Area, Cross River State, Nigeria. Methods: Using the mixed approach, data were obtained from 600 respondents, using a multi-stage sampling technique which in this study entails the selection of community clusters, streets, villages, housing units and respondents through simple random and purposive sampling techniques. In the analysis and interpretation of study findings, descriptive statistics were employed, and qualitative data were analyzed using content analysis. Results: The study shows that fear of pregnancy-related complications and fear of infertility are significant determinants of contraceptive use in Calabar South LGA, Cross River State, Nigeria. Conclusion: The study, therefore, concludes that myths associated with contraceptive use are real and a strong factor that discourages most married adults from the use of contraceptive methods. In the light above, this study calls for a more in-depth, useful, effective and aggressive grassroots contraceptive awareness campaign targeted at all categories of individuals irrespective of their literacy level and financial status in the rural area.

Background:  Vitamin  D  deficiency  and  anemia   are common problems that  increased  pathophysiology  in  the  chronic kidney disease (CKD) undergoing hemodialysis (HD). This study was conducted to assess the association between vitamin D  and  anemia status  in  HD  patients.  Methods:  This  was  a  cross-sectional  study  of 65 HD patients and EPO therapy were enrolled; compared with 25 age matched healthy individuals as controls. The current study was investigated serum hepcidin, iron status  was  included  serum  ferritin and iron levels, anemia hematological indices  such  as  RBC,  Hb,  MCV, and MCH, in addition to other  clinical parameters  of  kidney  function, and C-reactive protein (CRP)  as inflammation markers were  performed in both HD patients and controls. Results: The mean patient age was (45.65±13.34) years, with dialysis vintage of median (IQR) was (12 (3- 36) month. serum hepcidin were highly significantly increase in HD patients than in the control group  (622.3±139.6,  and 465.16±80.31pg/ml, respectively p = 0.0001). serum hepcidin significantly associated with 37% anemia severity about (692.4±119.8) pg/ml more than patient with 49.2% of moderate about (605.3±117.7) pg/ml, (p=0.007) as compared with 13.8% of mild anemia groups (531.8±99.12) pg/ml, (p=0.001). negative  significant  correlation between Vt.D levels and age (r = -0.283, p=  0.022), but  no  correlated with BMI (r= 0.127, p=0.314). A  negatively  significant  between  Vt.D with dialysis vintage (r=  -0.419,  p=0.0001),  Urea  (r=  -  0.422, p=0.0001), and creatinine (r= -0.491, p=0.0001), while its strong positively significant correlated with GFR (r= 0.800, p=0.0001), Ca (r= 0.339, p=0.0001), and serum iron (r= 0.592, p=0.0001), but no with ferritin (r= -0.063, p=0.616). Moreover, vitamin D a negative correlated with blood glucose (r= -0.489, p=0.0001),  and  CRP  (r=--0.598, p=0.0001). The study concluded that Vt.D was associated with risk hemodialysis outcome and anemia severity in HD patients.

Aim: Evaluate the patient satisfaction of monolithic zirconia crowns with vertical preparation technique and compare them to deep chamfer finish line preparation in single crowns restoring posterior teeth. Materials and methods: Fourty full coverage zirconia crowns were fabricated for posterior teeth. The patients were divided into two groups according to the preparation designs. Group1: (control group) horizontal finish line and Group2: (intervention group) vertical finish line. Monolithic zirconia was used for the final restorations. EXOCAD software was used to design the try-in & final restorations which were later produced by five axis milling machine. The cementation was done by using self-adhesive resin cement. Patient satisfaction was assessed immediately after cementation using the “Visual Analogue Scale” VAS. These measurements were repeated after one, three, six, nine, and twelve months respectively. Result: independent t-test was used to compare between the two groups. No statistically significant difference was detected between both groups for patient satisfaction over one year. Conclusion: Both horizontal finish line and vertical finish line revealed successful clinical performance in terms of patient satisfaction for zirconia full coverage restorations.

Chronic musculoskeletal pain affects nearly 30% of seniors, primarily due to degenerative changes in the spine and joints. Conventional treatments often focus on symptom management and can carry significant risks, particularly for elderly patients. Recent advancements in stem cell therapy (SCT) offer new hope for treating pain associated with degenerative conditions, such as disc degeneration and knee osteoarthritis. Animal studies have shown promising results with mesenchymal stem cells (MSCs) enhancing extracellular matrix production in intervertebral discs and improving cartilage health in knee models. Preliminary human studies have demonstrated mixed results, highlighting the need for controlled trials to establish efficacy. Despite these challenges, SCT may reduce the necessity for invasive surgeries and provide an alternative approach to pain management in the aging population. Further research is essential to optimize SCT techniques, confirm clinical benefits, and address safety and regulatory issues.

Designer or synthetic drugs which include legal highs and other “club drugs” are substances which have a propensity to cause euphoria, central nervous system stimulation, and hallucinations. Based on chemical formulae for opioids, mescaline, and cannabis, they are created in laboratories under lax conditions for no defined medical purposes. Because they vary in composition from batch to batch they are potentially dangerous for users. Furthermore, the chemical structure is continually changing in order to avoid legislation and therefore users can never be sure what they are taking. For the purpose of this article readers should use the terms legal highs, designer drugs, bath salts, herbal highs, ‘research’ chemicals, and novel psychoactive substances, interchangeably. Their main purpose is to induce psychoactive effects that mimic amphetamines, cannabinoids or psychedelic drugs. The term ‘research’ only infers that very little is known about these substances and information on adverse effects is often sparse. The reader should also bear in mind that it is beyond the scope of this article to include many other agents.

Introduction: Temporomandibular joint plays an important role in maintaining a balance between structures of oral-facial complex. And morphology of Condyle is an essential part of temporomandibular joint that response to functional load, masticatory muscle activity constantly even after completion of the growth. Therefore, its morphology directs the adaptations to these functional forces. Aim: To evaluate the TMJ morphology characteristics in various growth patterns using CBCT. Materials and Methods: The present study was conducted to evaluate and compare morphology of TMJ in different vertical growth pattern individuals in North Indian population using CBCT. Pretreatment cone-beam computed tomography (CBCT) images of 10 Hypodivergent, 10 Normodivergent and 9 Hyperdivergent subjects were analyzed using SN- mandibular plane angle. Morphological parameters of TMJ such as anterior, superior, posterior joint space, condylar axial angle, mandibular fossa depth, intercondylar distance, medio-lateral and anterio-posterior width were measured and statistical analysis were done using One Way ANOVA and Post hoc Tukey test. Results: A statistically significant difference was noted in the superior joint space among Group I(4.04±0.10), Group II(3.73±0.36) and Group III(3.06±0.22)with p=0.00 and significantly correlated to facial morphology. Conclusion: TMJ morphology varies according to different growth patterns. Patient with hyperdivergent growth pattern have decreased superior joint space, decreased mandibular fossa depth, decreased condylar head angle and condylar widths in comparison of hypodivergent and normodivergent facial patterns. The knowledge of TMJ morphological variations associated with different vertical skeletal patterns helps the clinician in understanding the TMJ pathology and planning the TMJ oriented orthodontic treatment for stable results.

Agriculture fulfils the basic needs of human kind  by producing food. Farmer used to produce food and commodities mostly for self-consumption or for exchange with others mostly in the same village or nearby places. At present, production  environment  has changed considerably from self- reliance to commercialization. Agriculture, generally means growing of crops and livestock while, marketing encompasses a series of activities from  the  point  of production to point of consumption. There are key factors influencing agriculture in both production and marketing may be classified as physical, social and economic factors. Mostly  marketing  in  Tamilnadu has been through various channels like  middlemen,  traders,  retailers and by direct marketing. To overcome  various  limitations  and  to provide greater benefits to  the  farmer  which  were  taken  by middlemen, Direct Marketing was implemented. The Government have taken steps in restructuring to regulate Agri Business and encourage entrepreneurs. The Government also  took  necessary  steps  like practicing fair trade price to the farming community to support the left behind farmers in the competitive marketplace and supporting  with latest technologies to reduce the loss incurred during various stages of harvesting. By implementing various technological ideas and through value addition agricultural business can be streamlined in this competitive market.

Case-based discussions (CBDs) are structured, reflective reviews that assess clinical decision-making, communication, and professionalism within medical education, particularly in surgery. This critical review examines the validity, reliability, practicality, and role of CBDs as an assessment tool. CBDs demonstrate strong face and construct validity, given their alignment with real-life clinical practice. However, concerns regarding their limited content and predictive validity, inconsistency in assessment, and the lack of assessor training challenge their effectiveness. CBDs have practical value in assessing judgment and professionalism but are resource-intensive. Formative feedback provided through CBDs enhances student learning, while their summative nature guides progress. To optimize CBDs' effectiveness, formal assessor training and consistent evaluation are recommended. A combination of assessment modalities is necessary to cover the entire curriculum and ensure comprehensive trainee development.

Insomnia is the most frequent sleep disorder. It is a symptom, and is defined as “chronic inability to obtain the amount of sleep needed for optimal functioning and well-being”. Untreated insomnia is associated with significant morbidity and mortality. Thorough assessment of insomnia is essential in choosing the most appropriate strategy for management. If a cause of insomnia is identified, initial treatment should be directed at specific factor. Since insomnia is a chronic condition, long-term and safe treatments are warranted. Non-pharmacologic options have been available for decades, but lack of physician awareness and training, difficulty in obtaining reimbursements and questions about efficacy have limited their use. These therapies offer the greatest potential for long term gains in preventing recurrence of insomnia. Pharmacological options are most useful for acute insomnia. They are commonly used but long term use of hypnotics can become complicated by drug tolerance, dependence or rebound insomnia. Non-pharmacological interventions produce reliable and durable clinical benefits in the treatment of primary insomnia, insomnia associated with medical or psychiatric conditions and insomnia in elders. Additional research is still needed to develop and validate treatment algorithms that would optimize outcomes and reduce morbidity. Author concludes that non-pharmacological therapies should always be a component in management of Insomnia. Method: Pubmed.gov was searched by using pre-determined key word. Objectives: To provide an update of the evidence regarding the efficacy, effectiveness, durability and generalizability of psychological and behavioural interventions for persistent insomnia.

Background: Chronic kidney disease (CKD) is a slow and progressive loss of

kidney function over a period of several years. CKD includes various causes like diabetes,

hypertension, infection, inflammation, malignancy and genetics which damage the kidneys

and decrease the glomerular filtration rate (GFR). Beta human chorionic gonadotropin (β-

HCG) is synthesized by the syncytiotrophoblasts of the placenta during pregnancy. β-HCG

shows sensitivity for choriocarcinoma, hydatidiform mole and testicular tumours, but its

level is also high in chronic renal disorder. Our study was aimed to assess and compare the

status of serum β-HCG level in chronic kidney disease subjects and healthy controls.

Materials and Methods: The case-control study was conducted on 220 CKD patients.

Cases (n = 220) were selected from the Medical OPD and ward of Jawahar Lal Nehru

Medical College and Associated Group of Hospitals, Ajmer. Age and sex-matched healthy

controls (n = 100) were selected from MOPD. The present study was approved by

Institutional Ethical Committee. Overnight fasting venous blood sample was collected from

all the participants under aseptic precautions for the estimation of biochemical parameters.

Results: The mean activity of Serum β-HCG was significantly higher in CKD patients as

compared to healthy controls (p < 0.0001). Positive pearson correlation of serum creatinine

with serum β-HCG was found (r= 0.73). Conclusion: Serum β-HCG can be used as a

biomarker for the early detection of CKD in the general population to prevent the morbidity

and mortality which are associated with CKD. If CKD is detected early and managed

appropriately the deterioration in kidney functions can be slowed and the risk of

cardiovascular diseases in renal patients can be reduced.