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On Sep 2018




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Prof. Somashekhar Nimbalkar
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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
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On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Saraswati Dental College
Lucknow
On Sep 2018




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Calcutta National Medical College & Hospital , Kolkata




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C.S. Ramesh Babu,
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Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




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"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : February | Volume : 17 | Issue : 2 | Page : ZC01 - ZC04 Full Version

Prevalence of White Spot Lesions in Patients Treated with Passive Self-ligation Orthodontic Appliances: A Retrospective Study


Published: February 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/58306.17405
Kavitha Ramsundar, Ravindra Kumar Jain, Nivethigaa Balakrishnan

1. Postgraduate Student, Department of Orthodontics, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India. 2. Professor, Department of Orthodontics, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India. 3. Reader, Department of Orthodontics, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India.

Correspondence Address :
Ravindra Kumar Jain,
Professor, Department of Orthodontics, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India.
E-mail: ravindrakumar@saveetha.com

Abstract

Introduction: White Spot Lesions (WSLs), also known as “white opacity,” are the result of the demineralisation occurring on tooth surfaces in patients undergoing fixed orthodontic treatment. In addition to the various other factors, development of WSLs can also be influenced by the type of brackets and ligation employed.

Aim: Evaluating the prevalence of WSL among patients who underwent fixed orthodontic treatment with passive self-ligation mechanotherapy.

Materials and Methods: This retrospective study was conducted using photographic records of patients who received orthodontic treatment using a passive self-ligation system at Saveetha Dental College in Chennai, Tamil Nadu, India. The records of 97 patients in the age range of 10-30 years who received orthodontic treatment using the Damon self-ligating system regardless of gender were obtained from April 2016 to April 2021. The presence of WSL was investigated retrospectively before and after treatment. Modified Gorelick’s scale was used for scoring the lesions. Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) software version 17.0 and paired t-tests were done.

Results: Data of total of 97 subjects (45 females (46.39%) and 52 males (54.63%), mean age: 17.70±5.72 years) undergoing orthodontic treatment with self-ligation brackets was included in the study. The overall prevalence percent of WSLs in the study was 71.13%. The prevalence of WSLs among females was 70.5% and in males, it was 73%. There was no statistical significance for association between gender and severity of WSLs and there was a statistical significance for association of age group and severity of WSLs in upper lateral incisors and canines (p<0.05).

Conclusion: The most commonly involved teeth were upper central incisors and second premolars, and the overall WSLs incidence in subjects undergoing passive self-ligation therapy was 71.9%. No influence of the gender was noted and severe lesions were commonly noted in maxillary lateral incisors of young individuals.

Keywords

Enamel caries, Enamel demineralisation, Fixed orthodontic therapy, White opacity

The WSLs are areas of initial enamel demineralisation seen commonly in subjects undergoing fixed orthodontic treatment (1). Presence of fermentable carbohydrates in combination with poor oral hygiene and a variety of host factors like low salivary volume and consumption of a sugary diet can contribute to progress of these early lesions (2),(3). The presence of any appliances around the tooth surface will attract plaque and increase in the number of plaque retention sites, making tooth cleaning more difficult (4). The incidence of WSLs in orthodontic patients varies between 2% and 96% (5),(6). The incidence and prevalence rates of WSL with fixed orthodontic treatment were 45.8% and 68.4%, respectively, according to the findings of this meta-analysis by Sundararaj D et al., (7). According to Lucchese A and Gherlone E, significant decalcification occurred just six months after orthodontic bonding (8). According to Julien KC et al., roughly 25% of patients developed WSL during therapy depending on fluorosis, treatment length, prior WSLs, and oral hygiene (9). The labio-gingival region of the lateral incisors is the most common site for WSLs whereas the maxillary posterior segments are the least prevalent sites with males being impacted more than females (10).

Appliance design, notably the ligation process for archwires are other elements that influence the build-up of dental plaque (11). Self and conventional ligation treatments have been evaluated in few published studies to see how they affect dental plaque retention and microbial flora (12),(13). The patient’s age at the start of treatment and oral hygiene were also key factors for the development of WSLs according to Richter AE et al., (14). Prolonged treatment duration has an effect on the incidence of WSLs (15). Detection of WSLs qualitatively and quantitatively can be done with various methods [16-25].

Damon passive self-ligation brackets are used very commonly in practice to treat borderline cases without involving extraction of teeth (26). It is important to assess whether the bracket design, method of ligation and treatment protocols influences the incidence of WSLs, hence this study was proposed. Existing literature reports on comparison of WSLs prevalence between conventional and self-ligation (27),(28). The present study was aimed to study the WSLs prevalence in subjects treated with passive self-ligation and also report on individual teeth prevalence and other factors like age and gender which can influence the prevalence.

Material and Methods

This retrospective study was conducted using photographic records of patients who received orthodontic treatment using a passive self-ligation system at Saveetha Dental College in Chennai, Tamil Nadu, India. The time period for which data was considered was between April 2016 to April 2021 and the time period for planning and execution of data analysis and interpretation was between June 2021 to September 2021.Ethical clearance to conduct this study was obtained from the scientific Review Board of the hospital (IHEC/SDC/ORTHO-2007/22/524).

Inclusion criteria: Complete data of patients of both gender from 10-30 years of age undergoing orthodontic treatment with self-ligation brackets, with good quality standardised photographs of both before and after extraction was included in the study.

Exclusion criteria: Incomplete records, retreatment cases, subjects treated with other fixed orthodontics appliances, enamel hypoplasia, WSLs before treatment fluorosis, stains and demineralisation before orthodontic treatment were excluded from the study.

Sample size calculation: It was done using data from a previous research, and a sample of 97 people was obtained with a significance of 0.05 and 95% power (9). The study sample comprised 97 subjects in the age category of 10-30 years who met the selection criteria.

Study Procedure

The presence of WSLs was investigated retrospectively in photographs of patients taken before and after treatment. This retrospective study involved records of patients treated with Damon self-ligation appliance in the age range of 10-30 years at T0 (pre-treatment). As oral hygiene maintenance and incidence of WSLs may differ between children and adults (29), the study subjects were divided into two age groups: 10-17 years (children) and 18-30 years (adults). The average treatment time was 18±3 months and the incidence of WSLs was noted only in all erupted permanent teeth which were bonded in the course of treatment. So if a patient’s treatment begun at 10 years, the incidence of WSLs was recorded only at the end of treatment (T1) and only permanent teeth were analysed at T1.

All photographs were taken by a single professional photographer who was attached with the department and who took photographs for all ortho patients using a DSLR camera (Canon 600D, Tokyo, Japan), 90 MM Tamron macro lens and Godox ring flash. Camera settings were as follows, Aperture-f/25, Shutter Speed-1/200 and IS0-100. For the scoring WSLs, modified Gorelick’s scale by Årtun J and Brobakken BO was used (29). Score 0-no white spot formation, Score 1-WSLs involving less than one-third of the vestibular enamel surface area outside the area covered by bracket and bonding material, Score 2-WSLs involving more than one-third but less than two-thirds of the vestibular enamel surface area in question and Score 3-WSLs involving more than two-thirds of the vestibular enamel surface area in question.

Examination, scoring and calibration of WSLs was done by 1 examiner (KR) and to check the intra-operator reliability, the same operator examined 10 patient records randomly again after a week. Then intra-rater reliability test value was 0.813 indicating significant agreement with Kappa statistics test.

Statistical Analysis

The scores were tabulated and statistical analysis was performed using SPSS software (version 17.0 SPSS. Inc., Chicago, IL, United States of America). Chi-square test was done to check the association of both age groups and gender for severity of WSLs.

Results

Photographs of a total of 97 subjects undergoing orthodontic treatment with self-ligation brackets 45 females (46.39%) and 52 males (54.63%) in the age group of 10-17 years {63 subjects (64.94%)} and 18-30 years {34 subjects (35.05%)} were examined for WSLs.

(Table/Fig 1) depicts the gorelicks’ scoring for severity of WSLs and Chi-square association p-values for both genders. (Table/Fig 2) depicts Gorelick’s scoring for severity of WSLs and Chi-square association p-values for both age groups 10-17 years and 18-30 years. A very high overall prevalence of 69 (71.13%) was noted. Maxillary central incisors and second premolar teeth were most commonly affected with WSLs; there was no statistical significance for association between gender and severity of WSLs. Upper first premolars were least commonly affected in females and most commonly affected teeth were second premolars. In females, maxillary lateral incisors were most severely affected with WSLs. In males, maxillary central incisors were most commonly affected teeth, mandibular lateral incisors reported with mild WSLs, mandibular central incisors with moderate and mandibular second premolars had severe WSLs but none of these were statistically significant. The association between age group and severity was significant for upper laterals and canines (p-value <0.05). Maxillary lateral incisors had severe WSLs and canines had mild WSLs in the 10-17 years age group (p-value >0.05).

Discussion

Passive self-ligation excludes the use of elastomeric modules or ligature wires leading to better oral hygiene maintenance (30), which in turn may influence the incidence of WSLs. Hence, this study was proposed to report the influence of ligation on WSL incidence. All subjects included in this study were treated with a passive self-ligation system without extracting teeth and were evaluated for presence and severity of WSLs on photographs employing the modified Gorelicks scale. A very high overall prevalence of 71.13% was noted. The most commonly involved teeth were maxillary central incisors and second premolars and there was no association between severity of WSLs and the gender of the subjects. Severe WSLs were commonly seen in subjects in the younger age group.

Akin M et al., evaluated the occurrence of WSLs in patients treated with self-ligation and conventional ligation systems using Gorelick’s original scale on photographs. In their study, subjects on self-ligation brackets had a WSL prevalence of 46% whereas in the present study, it is 71.13%. This disagreement can be due to differences in sample size, oral hygiene maintenance and duration of treatment. They reported that gender had no effect on the development of the WSLs score during therapy in the self-ligation group which was in agreement with the present study. They reported significant associations between development of new WSLs, age at treatment starting and oral hygiene scores but these parameters were not assessed in the present study (27).

The present study reported on WSLs incidence in individual teeth rather than just reporting on overall prevalence as given by Akin M et al., Verma P and Jain RK had reported WSLs prevalence of 21.34% in subjects treated for 12-24 months with conventional ligation [27,28], but in the present study, a higher prevalence rate of WSLs for passive self-ligation therapy treated for a similar duration was noted. According to a study by Khalaf K, the occurrence of WSLs in subjects undergoing orthodontic treatment with conventional ligation was more in maxillary anterior teeth than mandibular anteriors, the maxillary canines and lateral incisors were the most severely affected teeth (15) and these findings are in consensus with the present study as the authors noted most severe lesions in maxillary lateral incisors when using passive self-ligation. Chapman JA et al., reported that the prevalence of WSLs was higher in the younger age group which was in agreement with the present study (31).

The present study does not report a comparison of self-ligating brackets with conventional ligation brackets as reported by Tiwari A and Jain RK (32). In this study, a comparison of WSLs formation between self-ligating brackets and conventional pre-adjusted straight wire brackets was attempted and they found that enamel demineralisation occurred regardless of the technique of ligation (32). They also found that the level of oral hygiene of the patients rather than the type of bracket or ligation used was the most important factor in the development of WSLs (33). Comparative evaluation of similar studies from the literature has been done in (Table/Fig 3) (6),(15),(27),(32),(34).

Limitation(s)

Because this was a retrospective study, it was impossible to examine factors that could have influenced the study’s results, such as all patients’ dental hygiene maintenance. Furthermore, each patient’s oral hygiene practices would have been unique, making it impossible to examine them.

Conclusion

An overall prevalence of WSLs noted in subjects undergoing orthodontic treatment with passive self-ligation system was 71.13%. Maxillary central incisors and 2nd premolar teeth were most commonly affected with WSLs. No gender related differences were noted and younger individuals developed severe WSLs in upper lateral incisors. Long-term prospective research with uniform oral hygiene regimens, age groups, genders, and orthodontic treatment duration can be planned in the future.

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DOI and Others

DOI: 10.7860/JCDR/2023/58306.17405

Date of Submission: Jun 07, 2022
Date of Peer Review: Jul 12, 2022
Date of Acceptance: Oct 17, 2022
Date of Publishing: Feb 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 19, 2022
• Manual Googling: Aug 23, 2022
• iThenticate Software: Oct 15, 2022 (5%)

ETYMOLOGY: Author Origin

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