Use of hand signals for communication during dental procedure

Introduction: Fear of dental treatment and anxiety about dental procedures are highly prevalent and have an impact on the quality of dental treatment. Use of a means of communication during the treatment procedure, which is the crucial point of communication, is not much studied. Aim: The aim of this study was to assess the perception of patients and practices of dentists regarding the usage of hand signals during dental procedure. Materials and Methods: A cross-sectional questionnaire study was conducted among 150 outpatients attending a dental institute and 150 dental practitioners practicing in North Chennai. The questionnaire constituted five questions based on difficulty in communication and attitude toward hand-sign usage. The data were subjected to Pearson's Chi-square statistical analysis. Results: About 76.7% (n = 115) of the respondents felt uncomfortable to communicate with dental practitioner when there is instrument in the mouth. About 66% (n = 99) of the respondents experienced fear, when they were unable to express their pain with instruments in their mouth during any dental procedure. Among the respondents, 71.3% (n = 107) agreed that using hand signals during a dental treatment might help them to overcome the difficulty in communication. About 30% (n = 45) of the dental practitioners preferred patients to talk, 54% (n = 81) preferred use of hand signals, and 16% (n = 24) preferred making sounds. About 63.3% (n = 95) of the dental practitioners informed their patients to raise their hand as a signal to stop the procedure. Conclusion: Majority of the practitioners and patients prefer the usage of hand signals over other means of communication to reduce fear and anxiety and improve rapport

Trichoscopic Patterns of Scalp Dermatoses: An Observational Cross-sectional Study

Introduction: Trichoscopy is a well-acclaimed diagnostic tool for numerous dermatoses. Scalp disorders contribute to a significant percentage of daily visits to the outpatient dermatology department, and a multitude of trichoscopic signs have been documented in the literature. The consistency and repeatability of these signs add weight to their diagnostic value. Aim: To determine the various trichoscopic patterns observed in classical cases of scalp dermatoses and to differentiate between different scalp disorders. Materials and Methods: The present observational crosssectional study included 100 newly diagnosed cases of scalp dermatoses attending the Dermatology Outpatient Department at Sree Balaji Medical College and Hospital, Chennai, India. The study was conducted over a period of six months (180 days) from December 2021 to May 2022. After obtaining a thorough history and conducting clinical examinations, patients underwent trichoscopy. Photographs were taken, and the data obtained were systematically tabulated. The scalp disorders studied included Androgenetic Alopecia (AGA), Alopecia Areata (AA), Telogen Effluvium, Tinea Capitis, Trichotillomania (TTM), Seborrhoeic Dermatitis, Scalp Psoriasis, Discoid Lupus Erythematosus (DLE), Lichen Plano-Pilaris (LPP), and scalp verruca. All data were entered into Microsoft excel and analysed using Statistical Package for Social Sciences software. Results: Trichoscopic findings from the 100 cases were categorised and tabulated according to pattern and condition for better understanding and comparison. Trichoscopic patterns observed were categorised as dots, vessels, shaft patterns, and changes in the inter and perifollicular areas. Out of the 100 patients, 67 presented primarily with alopecia, of which 56 patients (83.5%) had non scarring alopecia and 11 patients (16.4%) had scarring alopecia. The highest number of cases was observed in alopecia areata (n=20), where exclamation mark hairs were seen in all individuals, followed by coudability sign, yellow dots, and black dots. Among the androgenetic alopecia cases (n=18), anisotrichosis, pearly white dots, yellow dots, and an increased vellus-to-terminal hair ratio were observed in 100% of cases. Conclusion: While certain signs/findings are specific, most trichoscopic patterns overlap in various skin conditions. Therefore, dermatologists should be aware of the patterns observed in trichoscopy and the need to stay updated with the latest findings

Clinical Profile and Outcome in Children with Post Diphtheritic Paralysis in a Tertiary Care Hospital in South India

Abstract Objectives Post-Diphtheritic Paralysis (PDP), one of the most severe complications of Diphtheria, is caused by exotoxin of Corynebacterium diphtheria. Since there has been a resurgence of diphtheria in India in the recent years attributed to a number of epidemiological factors, this study was planned. Materials & Methods Thirty-five children with Post-Diphtheritic paralysis (PDP) were studied in a tertiary care hospital in Southern India. Neurological complications occurred in 38.5% of 91 patients of faucial diphtheria. Thirteen (37.1%) children were unimmunized, 12 (34.3%) were partially immunized, two (5.7%) were completely immunized and unknown status in eight (22.6%). Isolated bulbar palsy in 20 (57.1%) and bulbar palsy followed by limb weakness was seen in 15(42.9%) of patients. The first symptoms of PDP occurred 5-34 days after the onset of local diphtheria infection. Eleven (31.4%) out of 35 patients had received anti-toxin between days 5-7 of illness. Ventilation dependent respiratory failure occurred in three (8.6%) patients with PDP. Nine patients (25.7%) had evidence of co-existent myocarditis while myocarditis with renal failure was seen in two (5.7%) patients. Four (11.4%) patients died, three from severe cardiomyopathy and one from aspiration. Demyelinating neuropathy was noted in 64%.  Bulbar palsy recovered by 4-7weeks, while limb symptoms improved by 6-17weeks. Conclusion Post-Diphtheritic paralysis should be considered in any child presenting with bulbar palsy/ quadriparesis following previous history of fever/ sore throat. Awareness and availability with timely administration of ADS within 48 hours is important to reduce PDP, as antitoxin seems ineffective if administered after the second day of diphtheritic symptoms