Background: Considerable number of people in the prediabetic stage will go on to develop type 2 diabetes. Early diagnosis and intervention of prediabetic and their cluster of risk factors can prevent the cardiovascular events and other complications of diabetes. Objectives: To estimate the prevalence of prediabetes and associated factors among adults attending fixed mobile clinic in a rural block in Tamil Nadu. Materials and Methods: A cross-sectional study was carried out among 544 individuals over the age of 20 years through our fixed mobile clinic among 30 villages of a block in Tamil Nadu with a structured interview schedule. Results: A total of 544 participants above the age of 20 years were studied of which 72.6% were women and 27.4% were men. The prevalence of prediabetes was 8.5% and diabetes was 10.1%. Higher risk of being prediabetic and diabetic was noted above the age of 40 years (odds ratio [OR] = 7.79, 2.17), male gender (OR = 1.46, 2.34), body mass index of more than 23 kg/m ² (OR = 1.52, 2.13), waist hip ratio of men >1 and women >0.8 (OR = 1.49, 2.28), alcohol intake (OR = 1.59, 2.45), and systolic blood pressure of more than 140 mm of Hg (OR = 2.23 and 2.15). Conclusion: Identifying people with prediabetes and creating awareness on the prevention of diabetes by lifestyle modification and development of cost-effective strategy to prevent or delay the progression of the prediabetic stage to diabetic stage is the need of the hour for the prevention of diabetes in country like India.

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The currently available clinical antidepressants can be classified into 13 different classes based on their mechanisms of action. These basic pharmacological concepts thoroughly elucidate and unravel the therapeutic actions and side effects of the wide range of antidepressants currently available. The two classical mechanisms are exhibited by tricyclic antidepressants (TCAs) and by monoamine oxidase inhibitors (MAOIs). Regarding the 11 relatively nonclassical antidepressants, the most widely prescribed agents are the selective serotonin reuptake inhibitors (SSRIs). The mechanisms of action for the other classes of antidepressants that exhibit additional actions on serotonergic neurotransmission are dual serotonin-norepinephrine reuptake inhibition (SNRI), serotonin receptors antagonism with serotonin reuptake inhibition (SARI), serotonin 5-HT_1Aautoreceptor partial agonism with serotonin reuptake inhibition (SPARI), serotonin-norepinephrine reuptake inhibition and serotonin receptors antagonism antidepressant with potent antipsychotic D2 receptor blockade/antagonism (SNRISA with potent antipsychotic D2 receptor blockade/antagonism), norepinephrine reuptake inhibition with serotonin receptors antagonism (NRISA), noradrenergic α₂-receptor antagonism with specific serotonergic receptors-2 and-3 antagonism (NASSA), and atypical antipsychotics that exhibit weak D₂receptor antagonism with potently strong 5-HT_2Areceptor blockade. Furthermore, the two classes that exhibit selective norepinephrine reuptake inhibition (NRI) and dual norepinephrine-dopamine reuptake inhibition (NDRI) define separate novel classes of antidepressants that have a direct action on the noradrenergic neurotransmission system but have no direct action on the serotonergic neurotransmission system, while the last remaining one class of N-methyl-D-aspartate-glutamatergic ionoceptor antagonist/inverse agonist/partial agonist also represents a separate novel class of antidepressants with a direct action on the excitatory glutamatergic neurotransmission system but no direct action on the serotonergic, noradrenergic, or dopaminergic neurotransmission systems. Lastly, this review remarkably advocates for the incorporation of the atypical antipsychotics and NMDA-glutamatergic ionoceptor antagonist/inverse agonist/partial agonist as new member classes of the antidepressant agents because of their clinically significant roles in the management of depression disorders.

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This article aims at giving a broad overview on competency-based education to those who are currently in the predominantly knowledge focused discipline-based curriculum and so are uninitiated to the competency-based educational paradigm. This is done by taking them through the curricular trends in medical education that have happened elsewhere in the world and providing them with a gist of what is competency-based medical education, how it is different from the earlier paradigms of instruction, the advantages that this paradigm of mastery learning presents to help the learner acquire competencies needed for doing the professional tasks and duties that are in alignment with health needs of the country, the framework and the broad steps involved in its implementation, the challenges that its implementation presents particularly with regard to benchmarking for assessment as revealed by the experiences in the Western world that resulted in a three-decade lag between intention to change and actual change and the way forward to overcome these challenges particularly through faculty capacity-building using longitudinal faculty development programs or series of faculty retreats to ensure that it can be successfully implemented and sustained to serve the purpose of producing job-ready professionals.

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Background: High blood pressure is on the rise globally, affecting more women than men in many developing countries. It is the leading cause of mortality worldwide, and hospitalization in sub-Saharan Africa. Many known risk factors to hypertension, though prevalent in Nigeria, are controllable. Prevention, however, is difficult where there is poor awareness, attitude, and practices. Objectives: The study aims at determining the level of knowledge of hypertension and its associated factors, attitudes, practices, and prevalence among rural Nigerian women. Materials and Methods: Cross-sectional design was used to study 252 subjects in Sanga Local Government Area. Subject selection was by purposive and stratified sampling techniques. Data were collected using self-administered, semi-structured questionnaire after informed consents were obtained both verbally and in writing. Data were analyzed using SPSS statistical package. Level of significant was taken at 0.05. Results: Prevalence of hypertension was 24.2%. Average level of risk factor awareness was 65.4% with excessive salt intake (77.4%) being the most recognized. Asymptomatic nature of hypertension was recognized by 61.5% of the respondents, while 44.4% only knew the standard method for hypertension detection. While 17.5% strongly believed that hypertension can be managed effectively with drugs, it was only 9.1% that strongly disagreed that it could be caused by evil spirits. The average number of those with good preventive life style practices was 61.3%. Knowledge was associated with several factors and seems to affect practices (P < 0.05). Conclusion: Fair but inadequate level of knowledge and attitudes affected by several factors, as well as moderately high prevalence was recorded.

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Low birth weight (LBW) is a significant public health concern at global level. LBW is the outcome of interplay of multiple maternal factors. Maternal age is an important variable leading to LBW and preterm births. The literature review was done with extensive search from Medline, the Educational Resources Information Center, and the Combined Health Information Database for publications that identified the studies related to maternal age and birth weight. With exception of few studies which concluded that age did not significantly affect birth weight of newborns, majority of research indicated that a very young maternal age is causally implicated with an increased risk of having LBW and preterm births. Little research has been conducted on births to older mothers, even though such births are becoming increasingly common in developed countries. Advancing maternal age is associated with a decreased potential for fetal growth, possibly reflecting biological aging of maternal tissues and systems or the cumulative effects of disease. Results of multivariate analysis showed a U-shaped relationship between maternal age and LBW among whites, with the youngest (younger than 15) and the oldest (aged 40 and older) mothers being at high risk than 25-29 years old; older teenagers were not at any significantly higher risk. For the black, the risk of LBW rose steeply with maternal age (mothers aged 15-19 years are significantly lower risk than those of 25-29 years for LBW infants).

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Background: Thyroid hormone is a key substance in normal homeostasis, having variable influence on cell metabolism on different organs. Hypothyroidism is common, potentially serious, often clinically overlooked, readily diagnosed by laboratory testing, and eminently treatable. Aim: This study was conducted with the aim of finding the effect of regular physical exercise of medium-intensity on thyroid function in patients already undergoing treatment for hypothyroidism. Materials and Methods: A total of 20 ambulatory treated hypothyroid patients were included in the study. Serum samples were collected and evaluated for triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH) both before and after 3 months of daily 1 h physical exercise, from those patients doing exercise and from those who did not do any physical exercise. T-test was used to find a significant difference between the two groups. Results: Serum TSH was found to be significantly decreased in patients of regular exercise group postinterventionally (P < 0.001) when compared with nonexercise group (P = 0.43). Serum T3 and T4 were also found to be significantly raised in regular exercise group postinterventionally (P = 0.007 and P < 0.001 respectively) but not in nonexercise group (P = 0.92 and P = 0.73 respectively). On inter group comparison significant decrease in TSH was found in regular exercise group (P = 0.002) and significant increase was found in levels of T3 (P = 0.002) and T4 (P = 0.001) in regular exercise group. Mean weight was also found to be decreased in regular exercise group postinterventionally. Conclusion: Every hypothyroid patient should do regular physical exercise along with thyroxine replacement to improve thyroid function.

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Concept of field cancerization was first introduced over six decades ago in the setting of oral cancer. Later, field cancerization involving histologic and molecular changes of neoplasms and adjacent tissue was explained. Field cancerization involves the lateral spread of pre-malignant or malignant disease and contributes to the recurrence of head and neck tumors. The overall hypothesis underlying this work is that endothelial cells actively participate in tumor cell invasion by secreting chemokines and creating a chemotactic gradient for tumor cells. The article tries to explain the conflicting aspects of field cancerization in the setting of oral cancer.

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Context: Stress in medical education is common and process-oriented. It often exerts a negative effect on their academic performance, physical health, and psychological well being. Aims: This study aims at identification of such susceptible students in the early stage i.e. first year of medical education, and to provide them essential support in the form of an intervention program to lessen the negative consequences of stress. Materials and Methods: A cross-sectional survey was carried out among the First MBBS students of NKP Salve Institute of Medical Sciences and Research Center, Nagpur, India. A 41-item questionnaire was designed to assess the sources of stress and their severity. Likert's 5-point scale was used to quantify the extent of severity on each item. Coping strategies adopted by students were assessed by using a 22-item stress inventory, and a questionnaire based on 19 institutional stress-reducing factors was used to identify its role. Results: The survey resulted into an overall response rate of 87% (131 out of 150 students). Median stress level based on 41 items was evaluated for each student. About 29% (40 students) had median stress level greater than 3. Female students were more stressed (17.19%) than male students (14.93%). The study revealed that students generally adopt active coping strategies rather than avoidant strategies like alcohol and drug abuse. The study indicated that emotional support system is a major stress-relieving factor for students. Conclusion: Prevalence of perceived stress is high among medical students. It seems that academic-related problems are greater perceived stressors. Review of academics, exam schedules and patterns, better interaction with the faculty and proper guidance, intervention programs and counseling could certainly help a lot to reduce stress in medical students.

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Objectives: The paranasal sinuses are complex anatomical structures with a significant inter-individual variation. The dimensions of maxillary sinuses are particularly significant when considering endoscopic sinus surgery . The aims of this study were to estimate different dimensions of the maxillary sinuses measured on head CT, and their relations to sex of the individuals. Materials and Methods: Cranial computerized tomographic images (CT) of 200 normal subjects between the age groups of 18 and 80 years were observed in this study. The height, width, and depth of the maxillary sinuses were measured with a Philips Brilliance 64 CT. The statistical analysis for sex and age comparison for all the parameters was done. Results: The mean width, height, and depth of maxillary sinus in male on both right and left side were 27.8, 28.2, 39.9, 39.6, and 40.0, 39.7 mm but in females were 26.6, 26.7, 36.8, 37.1, and 36.6, 37.4 mm. The discriminative analysis showed that the accuracy of maxillary sinus measurements i.e. the ability of the maxillary sinus size to identify gender was 55% in females and 69.5% in males. Conclusion: This study on CT dimensions of maxillary sinuses may be beneficial for the ENT surgeons when planning for endoscopic sinus surgery and to support gender determination.

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Background: Stress is a fact of life that every human deals with on a daily basis. In the transitional nature of student life in professional courses like nursing, initial period of course is stressful and it adversely affects the emotional, physical, social, and academic functions. Even though the perception and response to stress and way of coping differs individually, it may produce questionable behavioral patterns in student nurses during the course of their study like feeling of loneliness, nervousness, sleeplessness, and worrying. Thus, the student nurse faces a lot of challenges and problems at the time of I Year. Objectives: The present study aimed to determine the level of stress and coping mechanisms adopted by I Year B.Sc. nursing students. Materials and Methods: A total of 60 I Year B.Sc. nursing students were selected by using non-probability convenient sampling technique. The tools used for data collection were perceived stress scale, structured coping scale, and socio- demographic proforma. Results: The studies revealed that majority of students (95.1%) were in the age group of 17-19 years. The results showed that only one student (1.7%) has severe stress, 46.7% has moderate stress, and remaining 51.6% has mild stress, and majority of the students (100) had average coping. There was no significant correlation (-1.167) between stress and coping mechanism of I Year B.Sc. nursing students. Conclusion: Majority of students had mild stress and average coping. The nurse administrator should plan and organize educational program for nursing students, in order to prepare them to cope up with any stressful situations. Hence, the researcher emphasizes the need for more research to improve the knowledge and by applying the research finding for future.

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Recent times have seen a shift in interest from a focus upon the deficits of individuals to a focus upon individual's strengths. Resilience is a positive psychology construct that has been investigated for decades, prior to this paradigm shift. This article reviews definitions of resilience over time. Although there is no single agreed definition; resilience is commonly described as the ability to bounce back. The risk of stress and negative life events in triggering mental illness has long been recognized. Similarly, the positive outcomes of some individuals to highly adverse situations have also been of interest for a long time. These positive responses or outcomes in the face of significant risk or adversity are generally known as resilience. This article provides a review of definitions of resilience and resilience related phenomena as well as a historical review of the focus of resilience research across the decades in order to inform future research and theorizing. The article concludes with recommendations to researchers to explicitly define their definition and conceptualization of the construct as well as the imperative to move towards a unified view of the construct of resilience. Further, it is clear that research on resilience has progressed and evolved over the decades however this does not denote that research in the area is complete. As such researchers should still seek to understand the complexities of resilience, how to build resilience in different populations, or in individuals experiencing similar adversities.

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Dermatophytes cause superficial skin infections of skin, nail, and hair known as dermatophytosis. It is commonly called as “ring worm” infection. There has been an emergence of an epidemic of recurrent and chronic dermatophytosis in India. Several reasons have been implicated that are related to the agent, host, and the treatment. Topical steroid misuse has been considered as an important contributor that has led to the persistence and atypicality of the infection. This article emphasizes on the salient features of the current dermatophyte epidemic to sensitize all physicians who treat the infections.

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Impacted molars have been widely reported. However, kissing molars is a rare finding which refers to impacted molars which have occlusal surfaces contacting each other in a single follicular space and roots pointing in opposite directions as reported in this case. This is the second case of kissing molars involving third and fourth molar and the only case fulfilling the criteria of kissing molars.

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Infectious rates and peripheral intravenous cannulae-associated complications are very common in patients with intravenous therapy. This study was aimed to assess the incidence of intravenous cannulae complications among patients after 72 hours in situ and to examine the impact of structured teaching program on knowledge and practices of staff nurses. In this study, researcher used descriptive and quasi-experimental approach; a non-probability convenient sampling technique was adopted to select 80 staff nurses, each 40 in experimental and 40 in control group. 67.79% of patients developed peripheral intravenous cannulae-related complications with grade 1 (33.05%) and grade 2 (34.74%) complications. Result revealed that it was highly significant at 0.05 level (t = 9.978; P < 0.05) for knowledge and not significant (t = 0.974; P > 0.05) for practice. The post-test knowledge found to be highly significant at 0.05 level (t = 3.909; P < 0.05), whereas practice score was not significant (t = 0.426; P > 0.05). It could be inferred that there is no significant difference between the pre-test and post-test practice score of staff nurses who attended the structured teaching program regarding prevention of intravenous cannulae complications.

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Introduction: Neonatal sepsis is one of the leading causes of neonatal deaths in developing countries. The organisms responsible for early onset and late onset sepsis are different. Infections with multidrug-resistant organisms are also increasing in incidence. Objective: To identify the organisms causing septicemia in neonates and to determine the antimicrobial susceptibility pattern of the isolates. Materials and Methods: This prospective study was conducted by analyzing the blood cultures and the sensitivity reports of 195 newborns who were admitted to the NICU between June 2011 and May 2012 with sepsis. Results: A total number of 75 patients (38.46%) had positive blood cultures. Klebsiella pneumoniae (30.66%) was the most common organism isolated. Majority of organisms isolated were resistant to commonly used antibiotics. Maximum sensitivity was seen for Carbapenems in gram-negative bacilli, Vancomycin for gram-positive cocci. Conclusion: Multi-drug-resistant organisms were isolated from neonatal septicemia. Therefore, great caution is required in selection of antibiotics.

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Background of the study: The growing fetus depends entirely on its mother's healthy body for all needs. However, sometimes it can be a time of fear of suffering and death, in case women begin pregnancy with low or absent stores of iron because of previous pregnancy, poor iron intake, substance abuse; increased fetal demands of iron leads to iron deficiency anemia. Iron deficiency anemia is the most common form of malnutrition in the world and is the eighth leading cause of death in pregnant women in developing countries leading to the low birth weight, which is in turn an important risk factor for infant mortality. Objectives: To determine the knowledge of antenatal mothers regarding management of anemia during pregnancy. Materials and Methods: Non-experimental descriptive study was conducted to assess the knowledge of antenatal mothers from Yenepoya Medical College Hospital. A sample size consists of 50 antenatal mothers were selected through non-probability purposive sampling. The data was collected by using pretested structured knowledge questionnaire. Data was analyzed using SPSS version 16 and the results expressed as proportions. Results: The majority of the antenatal mothers (54%) had satisfactory knowledge, 38% had poor knowledge, and 8% had good knowledge regarding anemia during pregnancy. Conclusion: The overall knowledge in the study population was 29.9%. Hence, the researcher emphasizes the need for more research to improve the knowledge of antenatal mothers on anemia during pregnancy.

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Aim: We studied the causative microorganisms and antibiotic susceptibility of urinary tract infections (UTI) for both male and female in Nagaland, North-Eastern India. Materials and Methods: This is a retrospective study done at Christian Institute of Health Sciences and Research, Dimapur, where urinary samples received for culture and sensitivity in the laboratory from January 2012 to June 2013 were included. Organisms were identified by doing standard culture method, and antibiotic sensitivity was done by Kirby-Bauer Disc diffusion method from mid-stream clean catch urine sample. Results: A total of 1789 samples were analyzed in this study, where 502 (28.1%) showed significant growth, 330 (18.4%) showed insignificant growth, and the rest 957 (53.5%) showed no growth. The most commonly isolated bacterium was Escherichia coli both in an outpatient department (31%) and in-patient department (38%) patients followed by Klebsiella pneumonia, Pseudomonas sp., Enterococcus, Staphylococcus aureus, Candida, and Proteus. Analysis of the samples showed that UTI was more common in females (60%) as compared to males (40%). It was also observed that the samples responded effectively to chloramphenicol (29%), gentamicin (28%), imipenem (26%), and amikacin (21%). High degree of resistance was shown for nalidixic acid, ciprofloxacin, norfloxacin, amoxyclav, and ofloxacin. Conclusion: Antibiotics have been in use for a long period and more often the misuse of antimicrobial drugs has today led to a general rise in the emergence of resistant bacteria. This study may aid health professionals in choosing the appropriate treatment for patients in North-Eastern India.

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Background: Diabetic treatment satisfaction, medication adherence, and glycemic control are widely recognized as the cornerstones for successful management of diabetes and proxy indicators of quality of care. However, in Nigeria, nothing is known on the role of diabetic treatment satisfaction on medication adherence and blood glucose control. Aim: The study was aimed at determining the role of diabetes treatment satisfaction in medication adherence and glycemic control among ambulatory type 2 diabetic Nigerians in a primary care clinic in Southeast Nigeria. Materials and Methods: This was a descriptive study that was carried out on 120 type 2 diabetic Nigerians who were on treatment for at least 3 months at the primary care clinic of a tertiary hospital in Nigeria. Diabetes treatment satisfaction and medication adherence were assessed in the previous 30 days using pretested, interviewer-administered questionnaire on self-reported satisfaction and adherence to therapy, respectively. Glycemic control was assessed in the previous 1 month. A patient was defined to have goal glycemic control if the fasting blood glucose at the end of the study, visit was between 70 and 130 mg/dL. Results: Diabetic treatment satisfaction, medication adherence, and glycemic control rates were 85.8%, 72.5%, and 61.7%, respectively. Diabetic treatment satisfaction was significantly associated with medication adherence (P = 0.025) and glycemic control (P = 0.04). Conclusion: Diabetic treatment satisfaction was significantly associated with medication adherence and glycemic control. However, treatment satisfaction did not translate marginally to higher medication and glycemic control. Diabetic treatment satisfaction should be integrated into a standard care package for diabetic patients in primary care settings.

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Context: Avulsion injury is a severe form of dental trauma. Due to the complexity of this injury, the neurovascular supply is severely compromised and usually results in the loss of pulp vitality. A variety of factors can influence the success of replantation especially the storage media and storage period. Casein phosphopeptides are derived from casein which accounts for 80% of the total protein in bovine milk. They can function as carriers for several minerals especially calcium and also have known to have antibacterial properties. Aim: The purpose of this study is to evaluate the efficacy of GC Tooth Mousse Plus in comparison with chilled Homogenous pasteurized whole milk as a storage media. Materials and Methods: Thirty healthy premolars that are extracted for orthodontic purpose will be divided into three groups: (1) Group A: Control (Saline), (2) Group B: Positive control (Chilled Homogenous milk), (3) Group C: Experimental (GC Tooth Mouse Plus). These groups were further divided into two subgroups, each indicating storage period of 30 min and 60 min. The periodontal ligament (PDL) cell viability will be checked using tryphan blue staining. Results: Data were analyzed using Student's t-test. Conclusion: GC Tooth Mousse Plus can be used as a storage media to prevent desiccation of PDL cells up to the duration of 60 min.

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The huge burden of sickle cell disease (SCD) coupled with a correspondingly high morbidity and mortality, particularly in Sub-Saharan Africa, has made it really imperative to invest more in ways of reducing the prevalence of this disorder. The SCD genetic counseling and testing have been shown to educate individuals on SCD and also offer those at risk the opportunity of making informed decisions on marriage and pregnancy. We reviewed available data on genetic counseling and testing for SCD, using the PubMed, PubMed Central, Google Scholar, and African Index Medicus search engines, through a combination of words and phrases relevant to the subject and attempted to highlight how this can be better applied in a resource-poor setting such as Nigeria, with a huge disease burden. More advanced countries with significant population of patients with SCD and other hemoglobinopathies have evolved functional genetic and counseling protocols, with remarkable impacts on disease epidemiology; this feat however does not appear to be replicated in a number of African countries. This paper reviewed genetic counseling and testing for SCD in countries with high disease burden, with particular emphasis on Nigeria, which has a disease prevalence and carrier rate of 2-3% and 20-30%, respectively.

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Magnets have generated great interest within dentistry. They have been used for various applications in orthodontics and prosthodontics. Earlier use of magnets was limited due to the unavailability of small size magnets, but after the introduction of rare earth magnets and their availability in smaller sizes, their use has increased considerably. They can be placed within prostheses without being obtrusive in the mouth. Their main use in orthodontics has been for tooth movement and in prosthodontics has been in maxillofacial prosthesis and in overdentures as retentive aids. This article reviews the types of magnets available and their application in maxillofacial prosthesis and overdentures, followed by other advantages and disadvantages.

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Ectopic eruption of teeth in non-dental sites is a rare phenomenon and such cases have been reported to occur in the nasal cavity, chin, maxillary sinus, mandible, palate, and orbital cavity. Ectopic tooth eruptions in maxillary sinus are usually asymptomatic or may present with recurrent sinusitis. Majority are found incidentally during routine clinical or radiological investigation. We present a case of an ectopic upper second premolar tooth that caused chronic purulent sinusitis in relation to the right maxillary sinus. The tooth was attached to the posterior wall of the sinus without an associated dentigerous cyst. The case was innovatively managed by endoscopic approach through sublabial route.

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Objectives : To investigate the anti-convulsant activity of ethanolic extract of Moringa concanensis leaves on maximal electroshock-induced seizures (MES) and pentylenetetrazole (PTZ)-induced seizures in Swiss albino mice. Materials and Methods : The ethanolic extract of Moringa concanensis leaves (200 mg/kg, i.p) was studied for its anti-convulsant effect on MES and PTZ-induced seizures in Swiss albino mice. In MES seizures, suppression of tonic hind limb extension was noted. In PTZ seizures, abolition of the convulsions was noted. Results : The ethanolic extract of the leaves of Moringa concanensis (200 mg/kg, i.p) significantly (P < 0.001) abolished the hind limb extension induced by MES. The same dose also significantly (P < 0.001) protected the animals from PTZ-induced tonic convulsions. Conclusion : The data suggests that the ethanolic extract of Moringa concanensis leaves may produce its anti-convulsant effects via multiple mechanisms since it abolished the hind limb extension induced by MES as well as abolished seizures produced by PTZ.

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The nasoalveolar molding (NAM) technique is a new approach to presurgical infant orthopedics that reduces the severity of the initial cleft alveolar and nasal deformity. This technique facilitates the primary surgical repair of the nose and lip to heal under minimal tension, thereby reducing scar formation and improving the esthetic result. NAM technique is the nonsurgical, passive method of bringing the gum and lip together by redirecting the forces of natural growth. NAM has proved to be an effective adjunctive therapy for reducing hard and soft tissue cleft deformity before surgery. This paper reviews the basic principles of NAM therapy, various types of appliances used in this therapy, protocol followed, and a critical evaluation of the advantages and disadvantages of this technique. Universally authors have agreed the positive outcome of NAM for better esthetics after cleft lip and palate (CLP) repair, but the long-term effects of this therapy are yet to be substantiated. Despite a relative paucity of high-level evidence, NAM appears to be a promising technique that deserves further research.

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