European Journal of Molecular & Clinical Medicine

In an era of unequal development, the interplay of pre-capitalist values and modern forces with the accentuation of the free-market economy and the consumer culture have become part of the complex and contradictory fabric of our present-day society.  Domestic violence is a term which finds equal importance in both life and literature. A life experience that will traumatize millions of women worldwide more than once is gender-based violence, which includes child sexual abuse, rape, sexual harassment at the workplace, sexual molestation/assault, and domestic violence. A woman grows up with this reality, which is permanently imprinted on her memory as a continual reminder of how her life will always be governed by a systematic and pervasive reality. The fact that silence is the norm and this pervasive reality is rendered invisible is what makes it so oppressive. The feminist movement has only recently pushed women to speak out against gender violence. Real life circumstances for women were private, personal, and personal sphere. To speak of sexual or domestic violence within the family in India is to open oneself up to shame, embarrassment, and skepticism. The family is a valued and private institution. Speaking of violent events outside of it invites scorn, shame, and moralising commentary from the general population. A new female literary tradition was created as a result of the formation of a female subculture and the development of a new sense of self revealed in their writings. Anita Desai's writings, which are influential in this field, are included in the study to show how the writings of women may be a potent tool for raising awareness and paving the way for the prevention of domestic violence. The study looks on the psychological effects of domestic violence trauma and how it affects women's health.

Partition 1947 has been the most traumatic events in the history of Indian sub-continent; people underwent a lot of sufferings and agonies during the time. The bloodbath that took place was totally incomparable and unimaginable. There was mass migration and flurry of rapes and abduction of women and children, besides hatred and scare hovering all around petrifying not only the human beings but also the air, and hence the degree of sufferings that the people underwent was astonishingly unbearable. Apart from the trauma that the people at large underwent, there were many who came out successful and unwavering, who tried their level best in re-building and reshaping their lives despite all the odds besides the toxic pains and agonies that they went through. The primary focus of the present paper is to put focus on the survivors who rebuilt their lives from the ashes/ruins and made themselves successful despite the hardships that they faced.

Endodontic emergencies usually result from inflammatory reactions in pulpal or periapical tissues. They constitute a major part of all dental emergencies ^1,2 and require immediate diagnosis and treatment. In general, emergencies are unscheduled visits by patients in severe pain, under emotional distress and seeking immediate relief. Although the endodontic emergency is disruptive and often inconvenient, proper management is satisfying to the dentist and much appreciated by the patient; improper treatment is frustrating and stressful.

The fracture of anterior teeth caused due to trauma is the most frequent type of injury in permanent dentition, especially among children and adolescents. The most commonly involved teeth are the maxillary central incisors because of their exposed position in the dental arch. Traumatized teeth require a quick functional and esthetic repair. Anterior crown fractures lead to psychological, esthetic, functional and phonetic problems that can affect social relationships and poses a challenge for the dentist to save these teeth. There is a loss of structural integrity, moisture and reduction in dentin toughness in endodontically treated teeth which necessitates special care during the treatment. Restoration of endodontically treated teeth should aim at replacing the missing tooth structure, maintain function, esthetics and protect against fracture and infection.  This clinical case report presents the use of Glass Fiber–Reinforced Composite Post and Core for restoration of traumatically fractured permanent right maxillary central incisor in a 16‑year‑old female patient. Post-retained crowns are indicated for endodontically treated teeth with severely damaged coronal tissue. Metallic custom made and prefabricated posts have been used over the years. However, due to unacceptable color, extreme rigidity and corrosion, fiber posts were introduced. These are flexible, aesthetically pleasing and have modulus of elasticity comparable to that of dentine.

Background: Corneal blindness is the fourth most common cause of blindness in the world (5.1%) and the significant causes are ulceration of cornea and trauma of eyes. The importance of microbiological evaluation of an etiological component and antibiotic sensitivity is very important. Aim: This study was conducted to evaluate sociodemographic risk variables, assess the diagnostic value of Gram staining, the responsible microorganisms, and examine the antibiotic sensitivity profile of bacterial isolates in this tertiary care centre. Materials and Methods: This study was conducted in a tertiary care hospital and was observational, descriptive, and cross-sectional in nature. Before collecting data, Institutional Ethics Committee (IEC) approval was obtained. 100 patients with corneal ulcers having an infectious aetiology were included in the study. Results: Male to female ratio was 1.2:1. The highest incidence of corneal ulcers was observed in industrial labours (32%), followed by housewives (24%). Staphylococcus epidermidis (30%), Staphylococcus aureus (20%) followed by Pseudomonas aeruginosa (11%) were the major organisms isolated in corneal ulcers. Sensitivity, Specificity, PPV and NPV of Gram staining with culture as a gold standard in present were 66.32%, 97.11%, 97.89% and 64.75%, respectively. Bacterial isolates were sensitive to Sparfloxacin (88%) followed by Ciprofloxacin (72%) and Netilmycin (64%). Bacterial isolates were resistant to Penicillin (83%) followed by Carbenicillin (70%) and Piperacillin (69%). Conclusion: Gram stain findings, culture data, and in-vitro tests of antibiotic sensitivity from microbiological work up can all be very helpful in determining the best course of treatment for bacterial keratitis.

In Kingdom of Saudi Arabia,preventable injuries are the second leading cause of death, accounting for about a fifth of all reported fatalities in the country. During the last decade, the importance of health-related quality of life (HRQOL) has been recognized as a principal outcome of these traumatic injuries. Hence this study is being carried out to assess the outcome and to determine the factors associated with it. Methodology: All the Patients attending orthopaedic department of King Khalid General hospital, Al Majmaah with history of trauma in the past 2 years were included in the study. After obtaining Verbal consent from the study subjects data was collected by an orthopaedic surgeon. SF-36 questionnaire was used to collect information on Health Related Quality of Life. Qualitative variables are expressed as frequency and percentages and Quantitative variables are expressed as median and range. For comparison between groups Chi-Square test was applied. Significance level is fixed as 5% (p<0.05). Results: Total 152 study subjects participated in this study, 135 (88.8%) among them were from Saudi, 93 (61.2%) were, most of them 36 (23.6%) belonged to 11-20 years age group. The median HRQOL score in this study was 59.25(25), it was highest for the domain “pain” [67.5(34)] and “GH” [67.5(65)] when compared to other domains. HRQOL scores were more among those from non-Saudi [54.22(34.17)], for females [56.85(31.87)], for those in the age group between 1-10 years [72.54(26.22)], for those with sprains [61.06(29.65)], for those with sport injuries [63.75(35.14)] and for those in whom duration since injury was 21-24 months [61.67(23)]. Conclusion: In this study, SF- 36 served as a simple and an easy tool to assess the health-related quality of life of post orthopaedic trauma patients. All the socio-demographic variables were found to be significantly associated with HRQOL scores.

AIMS: Emergency Medicine is a new discipline that started with the aim of effective and early resuscitation of critically ill patients. Medico-legal cases (MLC) are surged globally due to the population rise. Resource allocation for different MLC in terms of humans, infrastructure, and equipment is complicated. The present study aimed to find a pattern of Medico-legal cases with outcomes in the Emergency Department.
METHODS :This isaretrospective study done in a tertiary care teaching hospital over one year from January 2021 to December 2021. A total of 955 cases were registered, out of which 918 were selected. Patients data was recorded in proforma regarding the demographic profile, the pattern of MLC, and hospital outcome. Descriptive analysis expressed in frequencies and percentages using SPSS for Windows, Version 26.0. 
RESULTS : In 918 cases, males were 69.80 %, and females were 30.20%. The majority of patients were aged 21 to 40 years, accounting for 56.10%. The pattern of MLC cases is Road traffic accidents 34.50%, poisoning 23.10%, Assault 19.80%, Bites 13.6%, and burns 2.20%. Outcomes showed the discharges 55.10%, deaths 3.8%, Against Medical Advice 29.30%, and OPD Basis11.80%. Mortality was highest in road traffic accidents, accounting for 1.5%.
CONCLUSION : Present study concludes MLC cases were common in males of younger age groups. The majority of MLC cases are Road traffic accidents and poisoning. Mortality was more in Road traffic accidents. This study will guide the preparedness of the Emergency department in terms of resource allocation, training of staff, and formulation of hospital plans and policies by government /law agencies.

Emergency Medicine is a new discipline that started with the aim of effective and early resuscitation of critically ill patients. Medico-legal cases (MLC) are surged globally due to the population rise. Resource allocation for different MLC in terms of humans, infrastructure, and equipment is complicated. The present study aimed to find a pattern of Medico-legal cases with outcomes in the Emergency Department.

Retro pharyngeal abscess is infection followed by collection of pus in retro pharyngeal space. In the adult group they are usually secondary to trauma, foreign bodies, or as a complication of dental infections. Early diagnosis and the wide spread use of antibiotics have made these infections less common today . Non-specific acute retro pharyngeal abscess most commonly occurs in infants and young children. It is rare in adults mostly associated with tuberculosis of the cervical spine. Some cases of acute retro pharyngeal abscesses have been reported in adults following foreign body ingestion and in immunocompromised individuals. The present study attempts to document acute retro pharyngeal abscess in adults following trauma. Majority of patients recovered with conservative management but some required incision and drainage.  Diabetes mellitus was the comorbidity in one third of patients.  The management of these cases is based on antibiotics and surgical drainage.

The mortality rate for trauma ranges from 1 to 34 years of age due to uncontrolled
hemorrhage. Trauma occurs for various reasons, including accidents and war zones.
Cumulative mortality among different traumatic experiences is the leading cause of death.
This has spurred the research community to focus on advancements in hemorrhage control to
control the trauma-related mortality rate. This review discussed numerous care options during
pre-hospitalization, operation theater, and emergency room, emphasizing emerging
methodologies, the challenges involved in controlling bleeding, and public health initiatives.

Context: A prospective epidemiological study on corneal opacities in the age group of 10-70 years with objectives as to study the distribution of corneal opacities according to age, gender, education, occupation, residence (urban/rural), laterality of the eye, socio-economic status and also to assess various modifiable epidemiological factors and find preventive measures.
Methods: This is an observational prospective study conducted on patients presenting with corneal opacities to the outpatient Department of Cornea and Trauma in Sarojini Devi Eye Hospital for a duration of 18 months from November 2018 to March 2020. Patients with corneal opacities in the age group of 10-70 years were included. Congenital causes of corneal opacities, patients with corneal opacities below 10 years and above 70 years, patients with nystagmus, patients with pterygium were excluded. All the patients were explained about the study and detailed history of the patient and detailed evaluation was done, the data was collected in terms of Cause, Age and Gender distribution, Literacy, Rural/Urban, Occupation, Socio-economic status, Laterality and statistical analysis was done.
Conclusion: Keratitis was the commonest cause of corneal opacity found in our study followed by trauma.

Background: Trauma is a major cause of morbidity and mortality in both developed and developing countries. The usual causes are road traffic accidents, fall from height, assaults, occupational injuries. The present study was conducted to assess profile of trauma patients in a tertiary care centre.
Materials and Methods: The present study was a prospective study of trauma patients carried over a period of 3 months.Details of history and physical examination findings of all patients were recorded. Triage priority level was noted. as follows: All patients had routine blood investigations and relevant radiological tests. In‑hospital outcome of all the admitted patients was noted. The recorded data was compiled, and data analysis was done.
Results: In the present study total trauma cases were 1800 in which 68.81% were males and 31.38% were females. Maximum trauma cases were in the age group 31-40yrs followed by18-30 yrs. Maximum injuries were of triage priority level 2 (57.33%). In two-wheeler, four-wheeler, auto, other vehicle accidents triage priority level 2 was in maximum patients. Two-wheeler accidents were followed by pedestrian injuries. Other modes of injury included fall on level ground, fall from height, assault had maximum injuries of triage priority level 2. In workplace injuries, sports injuries maximum injuries of triage priority level 3 and in others type of injury maximum injuries of Triage priority level 1. In head, face, thorax, spine, vascular, extremity maximum injuries were of triage priority level 2. In Neck, dorsum maximum injuries were of triage level 3. In abdomen maximum injuries were of triage priority level 1.
Conclusion: The present study concluded that road traffic accidents and falls were the major cause of trauma and the maximum injuries were of triage level 2.

Background: Trauma is a major public-health problem in India. With a population over one billion and an annual urbanization rate of 26%, the magnitude of the problem is a cause for concern. An unpresented increase in number of vehicles has outpaced the development of adequate roads and highways. Trauma especially RTA’S are the invariable fall out in the rapid motorization and urbanization in India. Aim: To study the physiological causes and temporal pattern of trauma death in the study population.
Materials and Methods: Study Design: Institutional based Retrospective and prospective study. Study area: The study was done in the Department of in medical college. Study Period: Retrospective period of 6 months and Prospective for 6 months. Study population: All trauma patients fatalities in the hospital and Patients brought dead to accident and emergency. Sample size: A total of 92 patients were included in the study. Prevalence of head injury = 60% (last year records) with an Absolute precision of 10% at 95% confidence interval. Required sample size = 92. Sampling method: Simple Random sampling method. Ethical consideration: Institutional Ethical committee permission was taken prior to the commencement of the study. Study tools and Data collection procedure: All severely injured patients will be evaluated from the time they arrive to the duration of stay in the hospital and eventual cause of death will be estimated. The reported time of death will be noted and its significant pattern of trauma deaths will be noted. A graphical illustration of modal distribution of death with a simple bar diagram showing the physiological cause of death and time duration from 0 - 6 hours, 6 – 12 hours, 12 – 24 hours, 24- 48 hours, 48 – 72 hours ,72 hours – 1 week, > 1 week will be done respectively. Statistical Analysis: The data was collected, compiled and compared statistically by frequency distribution and percentage proportion. Quantitative data variables were expressed by using Descriptive statistics (Mean ± SD). Qualitative data variables were expressed by using frequency and Percentage (%).
Results: Among these causes in our study Intractable intracranial hypertension was seen in 63% (n-58) cases, Hemorrhagic shock/ Bleeding 25% (n- 23), Sepsis/Multi organ failure 6% (n– 5), Intracranial Hypertension and Sepsis 3% (n- 3), Ventilation associated Problems 1% (n- 1), Intracranial Hypertension and Hemorrhagic shock 1% (n – 1), Hemorrhagic Shock and Sepsis 1% (n- 1).
Conclusion: Retrospective judgments on clinical decision-making, based on case record findings, must be examined with extreme caution, and this study has been careful to use only objective parameters, like prolonged operative time, or pre-operative physiological status. If the results remain valid in other Indian hospitals, it is worth noting that better identification and management of trauma patients could save a quarter of million lives each year, based on a 50% reduction of the estimated half a million annual hospital trauma deaths in India.

Background: Common causes of vocal could paralysis are neoplasms (bronchial, esophageal, thyroid), trauma, idiopathic, neurological, inflammatory & miscellaneous. With limited resource at our disposal, present study was aimed to find out etiopathology & classification of vocal cord palsy at our tertiary hospital.
Material and Methods: Present study was single-center, prospective, observational study, conducted in confirmed cases of vocal cord paralysis.
Results: This study was done on 44 patients of vocal cord paralysis. Majority were from 41-50 years age group (29.55%) followed by 51-60 years age group (20.45%). Sex incidence in this series revealed 27 male cases and 17 female cases. In present study common causes of vocal cord paralysis were Neoplastic growth (32%) followed by surgical trauma (30%), Blunt Trauma over front of neck (4%), pulmonary tuberculosis (11%), Idiopathic (16%), Cardiac hypertrophy (4%), cranial polyneuritis (4%) & Corrosive ingestion (4%). Left cord palsy, right cord paresis and bilateral paresis was noted in 55%, 27% & 18% cases respectively. 8 patients in this study were suffering from bilateral vocal cord paralysis and rest of the patients (36) had unilateral paralysis. So total number of paralyzed cords was 52. Out of these, 47 vocal cords were paralyzed completely and incomplete paralysis was seen in case of 5 cords. n most of the cases (27) it was in paramedian in position. Paralyzed cord was in midline in 12 cases, cadaveric in 8 cases. Incomplete palsy with restricted mobility was seen in 5 cases.
Conclusion: Neoplastic growth, trauma (surgical and non-surgical) & pulmonary TB were most common causes for vocal cord paralysis. Vocal cord paralysis was common in male patients, on left side & unilateral involvement.

Aim: to determine the prevalence and clinical profile of patients presented with posterior fossa extra dural hematoma. Materials and methods: This retrospective observational research was carried at the Department of Neurology, Apex Hospital, Jaipur, Rajasthan, India. The data for this research was collected during a 2-year period and was analyzed. The clinical presentation, admission Glasgow Coma Scale (GCS), mechanism of injury, type of intervention, and postoperative prognosis were all examined retrospectively in the data. The Glasgow Outcome Score (GOS) was used to evaluate the outcomes at the time of discharge and at three months after discharge. Results: There were 39 patients in all, 28 of them were men and 11 of whom were girls. There were 29.21 years between the mean ages of the patients. At the time of admission, 24 patients had GCS 13-15, followed by 9 patients with GCS 9-12, and only 5 patients had GCS less than 9. The mean EDH volume was 28.7 milliliters. Thirty-six patients were operated on, and five patients were treated conservatively. Conclusion: Epidural haematomas in the posterior fossa are a rather rare occurrence. Because of the limited volume of the posterior fossa and the presence of critical tissues inside it, mortality may be significant if the haematoma is not detected and treated promptly.

Background: The risk of SARS-CoV-2 transmission cannot be eliminated during aerosol-generating dental procedures in most dental settings. The present study was conducted to assess impact of COVID- 19 on utilization of dental services.
Materials & Methods: 485 patients who obtained dental treatment before and during COVID- 19 period were enrolled. Type of complaints for which patients visited dental offices was recorded.
Results: Out of 485, males were 310 and females were 175. During pre- COVID period, 170 patients <18 years and 210 above 18 years visited dental office while during COVID period, 40 below 18 years and 65 above 18 years reported to dental clinics. The common complaints were periapical seen in 120 and 45, cellulitis in 80 and 30, cellulitis in 70 and 10 and trauma in 110 and 20 in pre- COVID and during COVID period. The difference found to be significant (P< 0.05).
Conclusion: COVID- 19 had strong impact on utilization of dental services among patients.

Superior orbital fissure syndrome is a complex of cranial nerve impairment that affects the CN III, IV, V and VI all of which enters the orbit through the superior orbital fissure. Superior Orbital fissure syndrome occurs as a result of compression of all or some of these nerves passing through the fissure. Three major factors contributing to the syndrome includes traumatic injury, neoplasm and inflammation. This article takes into account the various data previously reported in literature and aims at providing a detailed knowledge about the anatomy of the superior orbital fissure to provide a better understanding about the syndrome

Introduction. In practice, an open comminuted fracture treatment severity of long bones, with an extensive defect in the diaphysis bone tissue, the bone metadiaphyseal part, is due to an increased risk combination of developing infectious complications due to an open infected wound, with the need to restore a significant volume of bone tissue, to connect the proximal and distal fragments of long bones. Internal osteosynthesis of bone fragments is impossible due to the lack of the required diaphysis bone tissue volume, the bone meta-diaphyseal part, necessary to restore the normal bones length,and performing open reduction, immediately after trauma, negatively affects blood supply, leads to the complications development such as soft tissue necrosis, infection, and suppuration.The article describes the staged fracture treatment method with the defect replacement with autobone, while maintaining the limb length, reducing the developing pathological risk processes.
Purpose of the study – to study the open double comminuted fractures treatment effectiveness of the patient's long bones, with an extensive defect in the diaphysis bone tissue or bone meta-diaphyseal part, by staging the transosseous fixation use with Ilizarov or the rod-rod apparatus, bone grafting with a fibula graft according to the classical technique and intramedullary osteosynthesis.
Results and discussion. A temporary transosseous extrafocal limb fixation was performed with Ilizarov or the wire-rod apparatus until the acute period subsided, edema decreased, and blood circulation improved.The fibula was harvested with a length suitable to the defect site.Intramedular metal osteosynthesis or internal osteosynthesis with smooth wires and an apparatus for external fixation of long bones with the bone defect replacement with an autologous bone from the fibula was performed.After bone fusion, external fixators, metal intramedullary implants and internal wires were removed.Achieved preservation of 
the anatomical segment length, satisfactory restoration of limb function, all fixing structures were removed, and the limb does not contain foreign bodies.
Conclusion. The various techniques and technical facilities combination, external fixation, autotransplantation using the classical technique and intramedullary fixation, made it possible to completely restore the injured limb, reduce the complications risk, and obtain good clinical results.

Fractures of crown and root are common emergencies encountered in the dental office. Root fractures are defined as fractures involving the dentin, cementum and pulp. These root fractures are broadly classified as horizontal/transverse and vertical root fractures. The correct diagnosis is essential to ensure proper treatment of root fractures. Various treatment strategies have been proposed, each has its own advantages and disadvantages. Hence this review article presents an overview of various types of root fracture, their diagnosis and clinical management

Lefort classification is the historic classification which is widely used to classify mid facial fractures. The lefort classification was given by Rene Lefort ,who classified mid facial fracture into Lefort I , II and III. Lefort 2 fracture is referred as ‘ PYRAMIDAL or SUBZYGOMATIC FRACTURE .’ Lefort 2 is a floating maxilla which runs from the thin middle area of the nasal bones down either side , crossing the frontal processes of the maxilla into the medial wall of each orbit . Within the orbit , the fracture line runs across the lacrimal bone behind the lacrimal sac to cross the infra orbital margin medial to or through the infra orbital foramen . Extends downwards & backwards across the lateral wall of the antrum below the zygomaticomaxillary suture & divides the ptyergyoid laminae .Le fort fractures are blunt trauma facial fractures which involves specific pattern of facial bones injury. Pterygoid process of sphenoid bones is involved in all Le fort fractures. Lefort fractures are classified further depending upon the involvement of zygomatic, nasal and maxillary bones. Blunt facial traumas due to motor vehicle collision, assault, falls or sports injury are the most common causes. In our case, Le fort 2 fracture resulted from motor vehicle collision.

Orbit is a conical cavity in which the base lies anteriorly and the apex directed at Optic Foramen .By Age of 5 years orbital growth is 85% complete, finalized between 7 years of age. Orbit is formed from 7 bones (Maxillary, Zygomatic, Frontal, Ethmoid, Larimal, Palatine, and Sphenoid ). It consists of Four Walls – roof, lateral, medial, floor .Medial wall and floor are thin ,While Lateral wall and Roof are Stronger. Floor of orbit is weakened due to infraorbtal Canal passing through it. In Pure blowout fracture one orbit wall is affected, without involving orbital rims. The inferior and medial walls are affected most frequently. Clinical features are diplopia, infraorbital nerve paresthesia , entrapment of soft tissue within the maxillary sinus, restriction of ocular movements and enophthalmos. CT scan is most helpful method for diagnosis of orbital fracture. For orbit reconstruction, natural and synthetic materials are available. We report a case of 21 years old man, diagnosed with orbital floor fracture after slip and fall from his two wheeler The surgical treatment involved orbital floor reconstruction with titanium mesh under general anesthesia. The outcome was satisfactory and during followup visual disturbances or paresthesia was not present.

Pan facial fractures are complex to treat and hence have to be systematically managed . Several authors have quoted several principles regarding the repair of pan facial fractures in a stepwise fashion . The most important goal is to restore the occlusal relationship at the beginning of the treatment , so that all the other structures get aligned . The folllowing is a case of a traumatic pan facial fracture and its surgical management

Bifid condyle an exceptional and a rare disorder presents with the duplication of the condyle head. Incidence rate- 0.31% to 1.82%. Szentpetery et al, the incidence of bifid condyle to be 0.48% in 1,882 cadaveric skulls. In 1941, Hrdlica first diagnosed on a 21 cases of specimen Smithsonian Institution in Washington DC of which 18 were unilateral and 3 bilateral. In 1948, Schier reported the first live case of bifid condyle. According to Cowan and Ferguson 1997, at least 36 clinical cases of BMC

This study aims to present the development result of the trauma focused – cognitive behavior therapy (TF-CBT) website and to test the percentages of agreement of the content, software interaction and technical aspects of TC-CBT website known as internet TF-CBT (iTF-CBT). The iTF-CBT module consists of five modules, namely i. Psycho Education; ii. TF-CBT; iii. Exposure Therapy; iv. Cognitive Therapy; and v. Anxiety Management. All of these modules are supported by 12 activities. Besides, this study is divided into two phases: i. Module development phase; and ii. iTF-CBT testing phase. The first phase involved data collection by conducting interviews with the experts as well as literature review. The second phase involved getting the percentages of agreement for the development of iTF-CBT among 42 trainee counsellors of the Sultan Idris Education University (UPSI). Results of this study indicate that the mean of percentages of the agreement between content, software interaction and technical aspects in the final test of iTC-CBT are high between 93 to 100 percents. These findings show that TF-CBT modules are applicable in the training to enhance efficiency of trauma and mental health counselling. As a result, this study has further expanded the theory and practices of counselling in the context of mental health particularly in Post Traumatic Stress Disorder (PTSD) and trauma.

Background: Pain management results in better outcomes in traumatic patients in the emergency ward. Use of non-opioids facilitates the elimination of the adverse effects of opioid. Regarding this, the present study was conducted to examine the effect of ketamine as an adjunct to opioids for pain control in traumatic patients in a tertiary healthcare center in Tehran, Iran. Methods and materials: This double-blind randomized clinical trial was conducted on 160 traumatic patients admitted to the Emergency Department of Besat Hospital, Tehran, Iran, in 2018. The study population was randomly assigned into two groups of intervention and placebo. The intervention group one of which received 0.05 mg/kg opioid (i.e., morphine) plus 0.1 mg/kg ketamine, and placebo group the other one was provided with the same amount of morphine opioid plus placebo. The pain was recorded up to 120 min and compared between the groups. Results: Based on the obtained results, 23 (28.8%) and 16 (20%) patients in the ketamine intervention and control placebo groups had side effects, respectively, showing no significant difference (P=0.197). In addition, the pain significantly reduced in both groups (P=0.001). However, the results of repeated measures ANOVA revealed no statistically significant difference between the two groups in terms of pain reduction trend (P=0.275). Conclusion: Based on the results, it can be concluded that ketamine has no superior effect when administered as an adjunct to opioid for pain control in traumatic patients.

Changes in alveolar ridge in terms of volume, height and morphological features tend to be clinically significant and may result in difficulty for the placement of a conventional bridge or an implant-supported crown. Bone deformities or resorption from tooth removal can be prevented by a procedure called socket preservation. Studies have discussed the rationale of performing socket preservation as a therapeutic procedure following tooth extraction which includes the procedure done during or after the removal of tooth in order to reduce the risk of external ridge resorption and increase the formation of bone with the socket. This study aims to evaluate the site predilection for socket preservation in maxillary and mandibular anterior teeth following extraction. It is a retrospective study conducted by reviewing 86,000 patient case records of the Saveetha Dental College and Hospital, Chennai, India. A total of 25 consecutive case records of patients for a period of October 2019 to March 2020 with signed informed consent were selected from the Departments of Prosthodontics and Implantology based on the inclusion criteria of patients who have undergone socket preservation procedure indicated for implant placement. Information such as patient’s name, patient’s identification number (PID), age, gender and area of socket preservation were retrieved from the patients’ case records. Datas were entered in Excel and analyzed using SPSS software version 23.0. Descriptive analysis was done for the assessment of age, gender and area of socket preservation. Chi-square test was used to evaluate the association of socket preservation with age and gender. Significant level test was set at less than or equal to 0.05 (p≤0.05). In this study, higher prevalence of socket preservation was seen in the upper anterior region (60%) than the other sites. Most cases of socket preservation were seen in males (80%) as compared to females (20%). Socket preservation was done mainly in individuals within the 21-30 years age group.Within the limits of the study, socket preservation is done mainly in individuals within the 21-30 years age group with higher predilection in males compared to females. Most of the socket preservation procedures are done in the upper anterior region, followed by upper posterior, both upper anterior and posterior and lower posterior. However, there is no significant association between the area of socket preservation with age and gender.

An immature permanent tooth is a newly erupted tooth with incomplete root formation. Once the tooth erupts, it takes upto three years for root completion. Any trauma or pathology to the tooth during this tooth might cause the tooth to lose its vitality. This clinical scenario is a challenge to the clinician as root does not develop further and may fracture. The present study was undertaken to evaluate the types of open apices seen in immature non vital permanent teeth. Data was retrospectively collected from the clinical records of patients who visited the Department of Pedodontics and Preventive Dentistry, from June 2019 to March 2020. 34 patients who fulfilled the inclusion and exclusion criteria were included in the study. Data was analysed using chi square test.Results showed that 27 males (79.41%) had open apices compared to females (20.59%). Non blunderbuss(55.28%) canals were more common compared to blunderbuss canals (44.12%). Within the limitations of our study, we conclude that non blunderbuss canals were found to be more common. Male patients had higher prevalence of open apices compared to females.