Pravara Institute of Medical Sciences

Background To study the prevalence of genetic mutations in patients with gastrointestinal stromal tumors (GIST) using next-generation sequencing at a tertiary care center in northern India. Methods We performed genotypic analysis of histologically and immunohistochemically diagnosed GIST using Ion AmpliSeq Cancer Hotspot Panel v2 to identify mutations on resected biopsy samples. Results In our cohort of 41 patients, we observed a variety of genetic mutations. The corresponding prevalence for those mutations was Tumour Protein 53 ( TP53 ) 90%, KIT Protooncogene receptor tyrosine kinase ( KIT ) 88%, Platelet Derived Growth Factor Receptor ( PDGFRA ) 78%, HRas Proto-oncogene ( HRAS ) 61%, Phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha ( PIK3CA ) 56%, Kristen rat sarcoma viral oncogene homolog ( KRAS ) 54%, NRas Proconcogene GTPase ( NRAS ) 20%, Cyclin-dependent kinase inhibitor 2A ( CDKN2A ) 15%, and B-Raf proto-oncogene ( BRAF ) 7%. Conclusion GISTs host a variety of mutations that need to be further investigated for their interplay and overall effect on the Indian population so that we can tailor treatment for better prognosis. The incidence of GIST is rising worldwide. Advances in technology have made tailored theranostics a possibility in managing GIST. Detailed genetic presentation of GIST is still unclear. Next-generation sequencing has provided us with an excellent tool to prospectively analyze the genetic makeup of GIST and most of the tumors. The present study opens up a huge possibility for using molecular makers for risk stratification of GIST and for theranostics of such tumors.

A BSTRACT Background This systematic review aims to provide an overview of the current utilization of smart materials in pediatric dentistry and evaluate their advantages, limitations, and future perspectives associated with their use. Methods This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses. From January 2013 to January 2024, a systematic search for reference articles was conducted in electronic databases such as PubMed/Medline, Cochrane, Scopus, and Web of Science. The population included children aged 3 to 14 who received smart material as a treatment modality. All titles and abstracts for the identified studies were reviewed to determine eligibility for inclusion. Results A total of 100 articles from the electronic databases PubMed, Scopus, and Web of Sciences database were found using the initial keyword searches. Duplicates were removed from the search and records written in English only were included. Title and abstract screening were done to the 80 remaining articles. Out of these, 18 articles were extracted for full-text eligibility after 72 articles had been excluded based on their titles and abstracts. 11 were eliminated following full-text screening because they did not meet the age requirement. Therefore, this review contained a total of 7 articles. Conclusion Even though they are still in the early stages of development, these materials have the potential to revolutionise dental care in the future. Paediatric dentists must stay up-to-date with these innovations in order to fully utilise them and provide comprehensive, high-quality care.

A BSTRACT Introduction Three-dimensional filling of the root canal system is widely recognized as crucial for the success of endodontic treatment, the main reason for endodontic failure persists as microleakage that happens between the filling material in the root canal and the walls of the canal. A significant factor contributing to microleakage subsequent to endodontic procedures is the leakage of blood from the apex of the tooth. Therefore, it is imperative to provide a good apical seal to prevent reinfection by spread of microbial toxins. Root canal sealers combined with core obturating material are aimed to create a fluid tight apical seal. Aim To evaluate the sealing ability of MTA Fillapex, CeraSeal, CeraSeal-B and AH Plus. Objectives To evaluate and compare the sealing ability of MTA Fillapex, CeraSeal, CeraSeal-B and AH Plus. Material and Methods Sixty freshly extracted single rooted sound human teeth were selected based on inclusion and exclusion criteria. The samples were divided by simple random sampling method into 4 groups with 15 teeth in each group namely Group A: MTA Fillapex, Group B: CeraSeal, Group C: CeraSeal B, Group D: AH Plus. The teeth sealed with respective sealers were obturated using thermoplasticized gutta percha technique. The samples were stored at 37°C and 100% humidity to assure the setting of the sealer. The samples were immersed in 2% methylene blue solution for 7 days. The linear measurement of dye penetration from the root apex to the greatest coronal extent was evaluated under stereomicroscope at 20 X magnification. Results After complete statistical evaluation, it was inferred that the intergroup comparison showed MTA Fillapex, CeraSeal, AH Plus to have statistically non-significant mean difference (p>0.05). Cera Seal B had highest mean dye penetration (2.59 ± 1.11) and the difference was statistically significant (p<0.05). Conclusion Maximum dye penetration was seen in CeraSeal B, showing it had the lowest sealing ability. that CeraSeal had slightly higher sealing ability as compared to AH Plus and MTA Fillapex, although their difference was statistically non-significant.

Worldwide, attempted suicide and suicide death are one of the leading causes of morbidity and mortality. Women in South-East Asia are especially vulnerable, as almost 50% of all global female suicides occur in the 11 countries of the WHO South-East Asia Region. This scoping literature analysis aimed to identify and analyze the predictors or risk factors for attempted suicide and suicide death among South-East Asian women. A scoping literature review was conducted. Five databases—PubMed, MEDLINE, EBSCOhost, PsycINFO, and EMBASE—were searched. Forty studies and twelve literature reviews were eligible for inclusion. Women in South-East Asia, particularly those who are young and married, living in poverty, with low or no education, living in rural areas, with no employment outside the home, with lower socioeconomic position, and living within joint families are highly vulnerable to suicidality. This review identified gender disadvantage, infertility, domestic abuse, intimate partner violence, family conflicts, husband’s alcohol misuse, child marriage, forced marriages, and dowry disputes as the most significant predictors of attempted suicide and suicide death among South-East Asian women. A better understanding of the phenomenon is essential to develop effective gender-specific and culturally appropriate suicide prevention strategies or interventions.

Schwannomas are considered benign soft tissue tumors that originate from Schwann cells. Oral Schwannomas are rare and account for only 1% of all Schwannomas. Cellularschwannoma (CS) is a rare histological variant of schwannoma, characterized by high cellularity and cellular atypia. We present a case of localized growth of palatal mucosa that imitated the features of malignant peripheral nerve sheath tumor (MPNST) on histopathological examination; it was differentiated from MPNST by the correlation of clinical, histopathological, and immunohistochemical features.

Background: The risk of stroke in Adult Congenital Heart Disease (ACHD) is well established. However, the prevalence and impact of stroke in young ACHD-related admissions stratified by median household income remain underexplored. Methods: The National Inpatient Sample (2019) was utilized to identify the rate of stroke admissions among young (18-44 years) ACHD patients. We also evaluated comorbidities and outcomes (all-cause mortality [ACM], length of stay [LOS], disposition,&charges) based on the median household income quartiles and compared two cohorts of lowest (0-25th percentile) and highest (75-100thpercentile) median household income (LMHI vs HMHI). Results: Of 41950 young (18-44 years) ACHD patients, 5360 patients had stroke (12.8%). Patients in the LMHI group were relatively older (median age 36 years vs 35 years) and had a greater proportion of males (53.8% vs 46.0%) when compared to patients in the HMHI group. Patients admitted with stroke were of greater proportion in the LMHI group (13.2% vs 12.1%) compared to the HMHI group. Comorbidities like alcohol abuse (4.7% vs. 2.3%), depression (9.8% vs. 7.0%), hypertension (13.0% vs. 5.6%), obesity (21.2% vs. 18%), drug abuse (12.3% vs 4.2%), and tobacco use disorder (30.4% vs 11.2%) were higher for LMHI when compared to HMHI. Regarding in-hospital outcomes, ACM (3.7 vs. 1.9%) and discharge to home (71.6 vs. 66.5) were higher with HMHI, whereas the LMHI cohort demonstrated fewer routine discharges, higher transfers to other facilities, and prolonged LOS (5 vs. 3 days, p<0.001). When adjusted for confounders, there were statistically higher odds of AIS in ACHD patients from the LMHI group vs. the HMHI group [aOR 1.33; 1.02-1.74; p=0.045]. However, no association of income quartile with overall stroke risk was observed. Conclusion: The prevalence of stroke is significantly higher in the LMHI group. When controlled for confounders, there was a higher risk of AIS without any impact on overall stroke. Furthermore, the lowermost income quartile was associated with fewer routine dispositions, and frequent transfers can further adversely increase healthcare inequalities and healthcare costs.

Introduction: Ischemic heart disease (IHD) remains a significant cause of morbidity and mortality in the United States, with dietary risk factors playing a critical role. This study provides the first comprehensive estimate of the IHD burden attributable to various dietary risk factors over the last three decades, including the initial two years of the COVID-19 pandemic. Methods: Using the Global Burden of Disease Study 2021 tool, we estimated the deaths and disability due to IHD associated with twelve dietary risk factors across different age groups, genders, and years spanning from 1990 to 2021 in the US. Results: Over the period from 1990 to 2021, there was a 25% decrease in both the total percentage change (TPC) in deaths and years of life lost (YLLs), while years lived with disability (YLDs) saw a 35% increase (95% uncertainty intervals: 19%-86%). The highest mortality was associated with diets low in whole grains, resulting in 54,046 deaths, followed by diets low in Omega 3 fatty acids (36,886 deaths), and diets high in processed meat (27,280 deaths). Additional significant dietary factors included low fibre (26,681 deaths), low legumes (25,601 deaths), high sodium (21,484 deaths), high red meat (20,411 deaths), low fruits (18,551 deaths), low vegetables (13,000 deaths), low nuts and seeds (8,222 deaths), low omega 6 fatty acids (5,089 deaths), and high sugar-sweetened beverages (360 deaths). The age group with the highest number of deaths was 85-89 years old, accounting for 22,514 deaths. Males experienced a disproportionately higher disease burden compared to females over these three decades. Conclusion: Deaths due to IHD attributable to dietary risk factors accounted for 36.86% of all CVD-related deaths in the US in 2021. To reduce the burden of ischemic heart disease linked to dietary risks, targeted interventions such as eHealth education, mHealth apps for personalized diet tracking, and partnerships with influencers to promote evidence-based health messages are essential. These strategies can enhance public awareness and encourage healthier dietary choices, potentially improving public health outcomes significantly.

Introduction: Ischemic Heart Disease (IHD) is the primary cause of morbidity and mortality across Southeast Asia, East Asia, and Oceania. Although there has been a lack of comprehensive studies on the burden of IHD attributable to air pollution, this study is the first to estimate its impact over the last three decades, including the initial two years of the COVID-19 pandemic. Method: Using global burden of disease tool, we estimated deaths, disability adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs) due to IHD attributable to Air pollution by age, sex, year across the SEA, EA, and Oceania from 1990-2021. Results: From 1990 to 2021, the annual percentage change (APC) in total deaths due to ambient particulate matter pollution increased by 112% (95% UI: 79-151%), with DALYs rising by 77% (51-108%) and YLDs by 106% (91-120%). The age-standardized mortality rate (ASMR) increased by 124%, and DALYs rate by 102%. Timor-Leste observed the highest APC in ASMR at 329%, followed by China at 147%, while the highest DALYs rate was also in Timor-Leste at 321%, followed by the Solomon Islands at 141%. The highest number of deaths was recorded in the 80–84-year-old age group with 148,592, and DALYs were highest in the 70-74 age group at 2.2 million due to IHD attributable to AP in 2021. Males experienced a higher burden compared to females over the last three decades, with a total percentage change in deaths at 168% vs. 130%, YLDs at 128% vs. 153%, and YLLs at 112% vs. 73%. Conclusion: Urgent action is crucial to combat the escalating burden IHD due to AP in Southeast Asia, East Asia, and Oceania. Public stakeholders and policy makers must implement robust strategies to slash particulate matter pollution and protect public health.

Introduction: Cardiomyopathy (CM) and myocarditis rank as the fifth leading cause of death and disability in G20 countries amongst all cardiovascular disease related (CVD) deaths. Despite their escalating burden, there is a notable lack of consistent data across these nations. This study is the first to estimate the burden of these cardiac conditions over the last three decades, including the initial two years of the COVID-19 pandemic, highlighting the urgent need for improved surveillance and specific healthcare strategies to manage these critical health issues. Method: We estimated incidence, prevalence, deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs) due to CM and myocarditis by age, sex, year and location across the G20 countries from 1990-2021 using global burden of disease 2021 methodology. Results: From 1990 to 2021, the total percentage change (TPC) in prevalence counts increased by 64% (95% Uncertainty Interval: 53% to 75%), incidence by 57% (47% to 68%), and deaths by 37% (26% to 49%). Japan had the highest age-standardized incidence rate (ASIR) at 19.84 (16.38-24.21) cases per 100,000, closely followed by Sweden at 19.74 cases per 100,000. The highest mortality rate (ASMR) was observed in Latvia at 27.95 (23.89-31.99) cases per 100,000, with Russia following at 26.3 cases per 100,000 in 2021. Poland recorded the highest YLD rate (ASYLDR) at 16.13 (11.05-22.86), with Sweden next at 15.67 per 100,000 in 2021. The highest incidence occurred in the 70-74 age group with 76,173 cases (46,415-113,840), with the most deaths in the 80-84 age group at 31,289 (27,390-33,741), and the highest DALYs in the 55-59 age group at 750,723 (680,540-814,890) in 2021. Regarding gender, the TPC in incidence for males was 55% compared to 61% for females, in deaths 57% for males versus 16% for females, and in YLDs 67% for males versus 54% for females from 1990 to 2021. Conclusion: Deaths due to CM and myocarditis accounted for 2.04% of all CVD deaths in G20 countries in 2021. The increasing burden highlights the need of proactive initiatives, including tailored health education and advanced screening programs. It should be prioritized to address the needs of the most affected demographics and regions. Integrating technology and cross-border healthcare collaborations could play a pivotal role in mitigating the impact of this condition and enhancing overall public health resilience.

Introduction: Lower Extremity Peripheral Arterial Disease (PAD) ranks as the leading cause of incidence among all cardiovascular diseases (CVD) in the United States. Due to a significant lack of data on the overall burden of PAD, this pioneering study investigates the trends of PAD over the past three decades in the US, including the initial two years of the COVID-19 pandemic. Method: We estimated prevalence, incidence, deaths, and disability-adjusted life years (DALYs) due to PAD by age, sex, year and location across the US from 1990-2021 using the global burden of disease 2021 methodology. Results were presented in absolute counts and age-standardized rate (per 100,000 person-years) Results: From 1990 to 2021, the overall prevalence of PAD in the US rose from 8.6 million (95% uncertainty interval: 7.4-10 million) to 14.9 million (13.4-16.6 million). The total percentage change (TPC) in deaths increased by 93% (82%-102%), and DALYs by 87% (79%-96%). Pennsylvania recorded the highest increase in age-standardized incidence rate (ASIR) at 3%, followed by Delaware at 2%. Kansas saw the highest death rate (ASMR) increase at 20%, with Kentucky close behind at 19%. The 65-69 age group had the highest incidence count at 265,188, while the 85-89 age group saw the most deaths at 1,827, and the 70-74 age group recorded the most DALYs at 36,772 in 2021. Males experienced a higher increase in TPC across incidence, deaths, and DALYs compared to females, with figures at 85% vs 56%, 104% vs 85%, and 99% vs 76%, respectively. Conclusion: While deaths due to Peripheral Arterial Disease (PAD) constituted only 1.22% of all cardiovascular-related fatalities in the US in 2021, the growing burden of the disease highlights a critical area for public health focus. Although mortality rates remain relatively low, the high incidence compared to other cardiovascular diseases suggests the need for targeted prevention and early intervention strategies. Strengthening awareness, improving diagnostics, and enhancing treatment accessibility can help mitigate the rising impact of PAD and improve cardiovascular health outcomes nationwide.

Introduction: Ischemic Heart Disease (IHD) is the primary cause of death and disability among all cardiovascular diseases in India. As global warming escalates, the role of environmental changes, particularly high temperatures, has become a major concern. This study uniquely focuses on high temperatures (HT) as a significant environmental risk factor for IHD, providing the first estimates of its impact over the last three decades in India, including the initial two years of the COVID-19 pandemic. Method: Using the global burden of disease 2021 standardized methodology, we estimated deaths, disability-adjusted life years (DALYs), and years of life lost (YLLs) due to IHD attributable to HT in India by age, sex, year and location from 1990-2021. The results were presented in absolute counts and age-standardized rate (per 100,000 person-years). Results: From 1990 to 2021, the total number of deaths due to IHD attributable to HT in India rose from 10,874 (95% uncertainty interval: 2,320-19,061) to 40,245 (13,140-68,121). The age-standardized mortality rate (ASMR) saw a total percentage change (TPC) of 42% (19%-178%), and the DALYs rate, (ASDALR) increased by 33% (11%-156%) during this period. Uttar Pradesh recorded the highest total number of deaths at 6,202, followed by Gujarat with 4,821. The highest death counts were in the 70-74 age group, totalling 5,704 (1,888-9,578), and the highest DALYs were in the 55-59 age group at 132,936 (42,040-227,650) in 2021. In terms of gender, males exhibited a consistently higher burden over the last three decades, with a TPC in deaths of 56% for males compared to 30% for females, and DALYs of 44% for males compared to 21% for females. Conclusion: In 2021, deaths due to IHD attributable to HT accounted for 2.46% of all CVD-related deaths in India. The rapid urbanization, industrialization, and increasing pollution in India require urgent action from a public health policy perspective. Stakeholders, including government agencies and environmental groups, must collaborate to develop policies that address these issues effectively, aiming to reduce the health impact of environmental risks and enhance cardiovascular health across the nation.

Introduction: Ischemic heart disease (IHD), driven predominantly by modifiable risk factors such as high fasting plasma glucose (FPG), remains a leading cause of morbidity and mortality worldwide. In the United States, understanding the state-specific burden of IHD attributable to high FPG is critical for tailoring effective public health strategies. Method: Using Global Burden of Disease tool, we estimated Deaths, DALYs (disability adjusted life years), YLDs (years lived with disability) due to IHD attributable to FPG across the US by age, sex, year and location from 1990-2019. Results: Between 2010-2019, the annual percentage change (APC) showed a significant increase in deaths rose by 17% (95% Uncertainty Interval [UI]: 10-25%), DALYs by 19% (11-26%), and YLDs by 21% (12-30%). In terms of age-standardized mortality rates (ASMR), Vermont saw the largest increase at 9%, followed by South Dakota at 8%. Conversely, New York exhibited the most substantial decrease in ASMR, declining by 11%. The YLDs rate saw its most considerable rise in the District of Columbia, up by 12%, with Wyoming following at a 7% increase. In 2019, Oklahoma recorded the highest ASMR at 43.06 (25.18-67.9) cases per 100,000, whereas Mississippi had the highest YLDs rate at 786 (495-1160). Over the last three decades, older age groups experienced a heavier burden. A gender comparison revealed an increasing trend in females compared to males, with APC in deaths for males versus females at 32% vs. 37%, DALYs at 21% vs. 25%, and YLDs at 94% vs. 116% from 1990-2019. Conclusion: IHD attributable to high FPG accounted for 34.19% of all IHD deaths in 2019, underscoring the urgent need for public health policies that promote outdoor activities and regular exercise among youth, and discourage the consumption of processed foods to foster healthier lifestyles and mitigate this significant health burden.

Introduction: Non-Rheumatic Valvular Heart Disease (NRVHD) stands as the 5th leading cause of mortality and the 6th leading cause of disability in High-Income Asia Pacific (HIAP) nations. Despite its profound impact, there exists a dearth of comparable and consistent country-level measures for NRVHD. Method: Using global burden of disease methodology, incidence, mortality, and disability-adjusted life years (DALYs) due to NRVHD were estimated stratified by age, sex, year across HIAP countries from 1990-2019. Results: The total prevalence of NRVHD surged from 3 million (95%UI: 2.9-3.1) in 1990 to 5.8 million (5.5-6.2) in 2019, with deaths escalating from 6,023 (5307-6368) to 16,604 (11,447-19,355) over the same period. The age-standardized incidence rate (ASIR) witnessed a 6% annual percentage change (APC) from 1990 to 2019. Notably, Singapore exhibited the highest APC in ASIR at 53%, while Brunei Darussalam reported the highest mortality rate with a 45% increase, and DALYs rate with a 30% rise from 1990 to 2019. The highest incidence occurred in the 55-59 age group, accounting for 32,069 cases, while the highest number of deaths was observed in the 90-94 age group, totaling 4,450 cases, and DALYs peaked in the 85-89 age group, reaching 43,221 cases in 2019. Regarding gender disparities, females bore a higher burden compared to males, with APC in incidence rates of 52% versus 44%, deaths at 113% versus 214%, and DALYs at 47% versus 97% from 1990 to 2019. Conclusion: The study reveals a concerning rise in NRVHD burden across HIAP countries from 1990-2019, necessitating immediate attention and targeted interventions to curb its impact on public health. These findings provide vital insights for policymakers and healthcare stakeholders to formulate effective strategies in combating NRVHD.

Introduction: Cardiovascular Disease (CVD) is the primary cause of death and disability among women worldwide. Despite its escalating impact, there remains a significant gap in consistent and comparative global data on the burden of CVD in women. This groundbreaking study provides the first estimates of the CVD burden in women over the past three decades, including the first two years of the COVID-19 pandemic. Method: Using the Global Burden of Disease 2021 framework, we estimated the prevalence, incidence, deaths, disability-adjusted life years (DALYs), and years lived with disability (YLDs) due to cardiovascular disease (CVD) in women. This analysis spans ages, years, and locations across 204 countries and territories from 1990 to 2021. Results: From 1990 to 2021, the total percentage change (TPC) in prevalence of the condition increased by 108%, followed by a 91% increase in incidence, and a 47% increase in deaths. Regionally, the highest TPC in age-standardized incidence rate (ASIR) was observed in Central Asia at 14%, while the highest mortality rate (ASMR) was in Southern Sub-Saharan Africa at 15%, and the highest YLD rate (ASYLDR) was in Australasia at 8% from 1990 to 2021. Nationally, Uzbekistan saw the largest increase in ASIR at 69%, and the United Arab Emirates had the highest increase in ASMR at 82%. In terms of socio-demographic index, the highest ASYLDR was observed in middle SDI regions with a 1% increase, while other regions saw decreases. Regarding age, individuals aged 55 and over recorded the highest deaths at 8.4 million, followed by the 20-54 age group with 659,296, and under 20s at 37,034 in 2021. Ischemic heart disease constituted 43.46% of all CVD-related deaths in 2021. Conclusion: Deaths due to cardiovascular disease (CVD) in women attributable to metabolic risk factors accounted for 70.75% of all CVD-related fatalities. This was followed by behavioral risk factors at 34.64% and environmental risk factors at 31.62%. The disproportionate impact of metabolic, behavioral, and environmental risk factors on cardiovascular disease-related deaths in women highlights the critical need for targeted intervention strategies. Addressing these risk factors through comprehensive public health initiatives could significantly reduce the global burden of CVD in women.

Cholesteatoma is a progressive and destructive middle ear disease that can lead to severe complications such as hearing loss, bone erosion, and even intracranial infections if left untreated. Accurate preoperative evaluation is crucial for the successful surgical management of this condition. High-Resolution Computed Tomography (HRCT) has become the gold standard in evaluation of extent of cholesteatoma due to its ability to reveal anatomical details of the middle ear. This study compares the accuracy of clinical and preoperative HRCT findings with intraoperative observations in patients with Cholesteatoma. Fifty patients diagnosed with Cholesteatoma who underwent surgical intervention were retrospectively analyzed. Patients aged 18 years and above diagnosed with acquired cholesteatoma. Who underwent HRCT imaging and Clinical Evaluation prior to surgery and with complete intraoperative findings documented during surgery were included in this study. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the diagnostic performance of clinical evaluation and HRCT against intraoperative findings. A total of 50 patients were included in our study, out of which 30 were males and 20 were females. Majority of patients were within the 31–40 years age group. In our study the comparison between HRCT findings and intraoperative observations, we found that incus erosion through computed tomography (CT) 40 cases was almost the same as during surgical observation in 39 cases. Malleus appeared eroded on CT in 33 cases however, 37 cases were seen with that observation during operation.The sensitivity, specificity, positive predictive value, and negative predictive value were 100% for detecting sigmoid plate erosion, dura exposure and malleus-incus joint discontinuity through preoperative CT. Our findings show that HRCT has superiority in assessing the involvement of vital structures compared to clinical evaluation, making it a mandatory tool for preoperative planning.

Background Depression during pregnancy is associated with pre-term labor, low birthweight, post-partum depression and adverse child outcomes. There are concerns about the safety of anti-depressant medications during pregnancy. Many pregnant women with antenatal depression are neither aware about their depression nor do they have access to non-pharmacological interventions for depression. Evidence suggests that pre-natal yoga can improve antenatal depression. Yoga is native to the Indian culture and women can practice yoga as a ‘self-care’ intervention with minimal training. There is no study till date on the efficacy of yoga on antenatal depression in pregnant women in a low resource (rural) setting in India. This pilot randomized controlled trial aims to study the feasibility, acceptability, and preliminary efficacy of a YOGA -based lifestyle intervention for Antenatal D epression (YOGA-D) in Maharashtra, India. Methods We will undertake a single-blind individual randomized parallel group-controlled pilot trial with 1:1 allocation ratio. Adult women with 12–26 weeks of pregnancy, without any obstetric or medical complications will be randomly allocated to either the active intervention group (Yoga-Sanskar (YS)) or the Enhanced Usual Care (EUC) group. Trained yoga instructors will teach a pre-defined yoga sequence to the participants in the YS arm. In the EUC arm, participants will receive a single session of health education. We will assess trial feasibility using the recruitment, retention, and study completion rates. The primary outcome of depression will be measured using the translated Marathi version of the Patient Health Questionnaire-9. Assessments will be at the baseline, three-months post-randomization, and post-delivery. Discussion This study will help us to understand the barriers in implementation of a yoga-based intervention for antenatal depression in a low-resource/rural setting in Maharashtra, India. Based on the learnings of this pilot trial, we plan to undertake an explanatory randomized controlled trial in the next few months. Registration CTRI ( CTRI/2024/05/067176; 10/05/2024).

Root resection procedures are indicated in the treatment of periodontal furcation involvement and root fractures in one of the roots of multirooted teeth. Their long-term prognosis is comparable to that of implants. The present article is a case report of root separation and removal of the mesial root along with crown in mandibular first molar which was successfully employed as a part of the oral rehabilitation procedure.