scholarly journals A prospective study to evaluate the etiologies and parameters of voice assessment in patients of vocal cord paralysis

2017 ◽  
Vol 3 (4) ◽  
pp. 962
Author(s):  
Anagha A. Joshi ◽  
Vijaykumar Singh ◽  
Sana Zehra N. Rajani
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Palsy ◽  
Voice Assessment ◽  
Maximum Phonation Time ◽  
Significant Difference ◽  
Assessment Measures ◽  
Group 2 ◽  
Single Standard ◽  
A Prospective Study ◽  
Group 1

<p class="abstract"><strong>Background:</strong> Evaluation of voice disorders are performed using multiple approaches but there is no single standard method. Our study compared the various voice assessment measures and their clinical relevance for unilateral vocal cord palsy (uVCP).</p><p class="abstract"><strong>Methods:</strong> 30 patients of uVCP were assessed and followed up on day 15, 30 and 90 of diagnosis. At each visit, perceptual analysis of voice, grade (G), rigid 70<sup>0 </sup>Hopkins laryngoscopy to measure the phonatory gap (PG), maximum phonation time (MPT), and voice handicap index (VHI) were noted.  </p><p class="abstract"><strong>Results:</strong> The results were analysed in two ways, one on the basis of improvement in VHI and the other on the basis of PG. When two groups (‘improved group 1’ and ‘unimproved group 1’) were formed and compared on the basis of VHI; MPT, Grade and ‘change in PG’ of the improved group showed a significant difference as compared to the unimproved group. Whereas when two groups (‘improved group 2’ and ‘unimproved group 2’) were formed and compared on the basis of improvement in PG, none of the parameters of the improved group showed a significant difference as compared to the unimproved group.</p><p><strong>Conclusions:</strong> All parameters correlate well with VHI than with PG, hence VHI alone can be sufficient to assess the improvement in voice. Although rigid laryngoscopy is essential initially for diagnosis, it need not be necessary to for further evaluation for improvement in voice.</p>

scholarly journals Intraoperative Neuromonitoring in Thyroid Surgery: An Efficient Tool to Avoid Bilateral Vocal Cord Palsy

2020 ◽  
pp. 014556132090632
Author(s):  
Kinyas Kartal ◽  
Nurcihan Aygun ◽  
Mustafa Fevzi Celayir ◽  
Evren Besler ◽  
Bulent Citgez ◽  
...  
Keyword(s):  
Vocal Cord ◽  
Thyroid Surgery ◽  
Health Care Professionals ◽  
Surgical Techniques ◽  
Vocal Cord Palsy ◽  
Intraoperative Neuromonitoring ◽  
Efficient Tool ◽  
Group 2 ◽  
Neural Monitoring ◽  
Group 1

Objectives: This study aimed to analyze the effects of intraoperative neuromonitoring (IONM) on the prevalence of vocal cord palsy (VCP) in thyroid surgery. Methods: Data from 493 patients (839 nerves at risk [NAR]) who underwent thyroid surgery between July 2014 and May 2016 were retrospectively evaluated. The patients were divided into 2 groups: Group 1 (G1) consisted of patients who underwent surgery without IONM, whereas group 2 (G2) consisted of patients who underwent surgery with IONM. The surgical techniques were identical, and experienced surgeons performed the procedures in both groups. Intraoperative neuromonitoring was performed in compliance with the International Neural Monitoring Guidelines. Results: In total, 211 patients (170 female, 41 male) with 360 NAR were included in G1, and 282 patients (220 female, 62 male) with 479 NAR were included in G2. The number of VCP per NAR in G1 and G2 was 33 (9.2%) and 27 (5.6%), respectively ( P = .005). The number of transient VCP per NAR in G1 and G2 was 27 (7.5%) and 23 (4.8%; P = .230), respectively. The number of permanent VCP per NAR in G1 and G2 was 6 (1.7%) and 4 (0.8%; P = .341), respectively. Bilateral VCP was detected in 4 (2.7%) patients in G1, whereas there was no patient with bilateral VCP in G2 ( P = .033). Conclusions: Intraoperative neuromonitoring may decrease the incidence of total VCP and prevent the development of bilateral VCP, which has unfavorable results for both patients and health-care professionals.

scholarly journals Antibacterial-Coated Suture in Reducing Surgical Site Infection in Breast Surgery: A Prospective Study

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Enora Laas ◽  
Cécile Poilroux ◽  
Corinne Bézu ◽  
Charles Coutant ◽  
Serge Uzan ◽  
...  
Keyword(s):  
High Risk ◽  
Breast Surgery ◽  
High Risk Group ◽  
Microbial Colonization ◽  
Suture Materials ◽  
Significant Difference ◽  
Axillary Lymphadenectomy ◽  
Group 2 ◽  
A Prospective Study ◽  
Group 1

Background. To reduce the incidence of microbial colonization of suture material, Triclosan- (TC-)coated suture materials have been developed. The aim of this study was to assess the incidence of suture-related complications (SRC) in breast surgery with and without the use of TC-coated sutures.Methods. We performed a study on two consecutive periods: 92 patients underwent breast surgery with conventional sutures (Group 1) and 98 with TC-coated sutures (Group 2). We performed subgroups analyses and developed a model to predict SRC in Group 1 and tested its clinical efficacy in Group 2 using a nomogram-based approach.Results. The SRC rates were 13% in Group 1 and 8% in Group 2. We found that some subgroups may benefit from TC-coated sutures. The discrimination obtained from a logistic regression model developed in Group 1 and based on multifocality, age and axillary lymphadenectomy was 0.88 (95% CI 0.77–0.95) (). There was a significant difference in Group 2 between predicted probabilities and observed percentages (). The predicted and observed proportions of complications in the high-risk group were 38% and 13%, respectively.Conclusion. This study used individual predictions of SRC and showed that using TC-coated suture may prevent SRC. This was particularly significant in high-risk patients.

The Effect of the Mother’s Participation in Therapy on Children with Vocal Fold Nodules

2021 ◽  
pp. 000348942110024
Author(s):  
Nevreste Didem Sonbay Yılmaz ◽  
Cansu Afyoncu ◽  
Nuray Ensari ◽  
Muhammet Yıldız ◽  
Özer Erdem Gür
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Post Treatment ◽  
Voice Therapy ◽  
Maximum Phonation Time ◽  
Significant Difference ◽  
Pre Treatment ◽  
Group 2 ◽  
Vocal Fold Nodules ◽  
Group 1

Objectives: Vocal fold nodules (VFN) are a bilateral epithelial thickening of the membranous vocal folds. In this study, children with VFN and their mothers took part in voice therapy. We then compared acoustic analyzes and subjective evaluations to those in previous literature to determine whether voice therapy is more effective for children with VFN when their mothers also take part in therapy. Methods: Children aged eight to 12 years who were diagnosed with bilateral VFN between January 2018 and January 2020 were included in this study. Participating children diagnosed with bilateral VFN were divided into two groups based on the wishes and cooperation of their families. Group 1 consisted of 16 patients; Group 2 included 17 patients. The children in Group 1 received voice therapy alone; children in Group 2 took part in therapy with their mothers. For all participants, the average fundemental frequency (F0), jitter percentages, shimmer percentages, maximum phonation time (MPT) and s/z ratios were measured. Pediatric voice handicap index (p-VHI) values were calculated as well. Results: The two groups’ measures pre-treatment and post-treatment were compared. Except for p-VHI, no significant difference was observed between the two groups. However, p-VHI post-treatment was significantly lower in Group 2 than in Group 1. Conclusions: Involving the families and even teachers of children with VFN in voice therapy can increase the effectiveness of therapy. The family’s involvement increases the child’s motivation in therapy. The mother’s presence during therapy, supporting the child or even doing the work with the child, can be a very important source of motivation for the child, who may already be tired from school and other activities. Thus, the mother’s involvement increases the child’s compliance with and interest in therapy.

scholarly journals A Prospective Study to Evaluate the efficacy of Isopropyl Alcohol Irrigations to Prevent Cerumen Impaction

2012 ◽  
Vol 91 (3) ◽  
pp. E25-E28 ◽  
Author(s):  
Herbert Silverstein ◽  
Benjamin J. Wycherly ◽  
Yadiel Alameda ◽  
Mark J. Van Ess
Keyword(s):  
Prospective Study ◽  
Crossover Study ◽  
Isopropyl Alcohol ◽  
Initial Evaluation ◽  
Safety And Efficacy ◽  
Significant Difference ◽  
The Mean ◽  
Group 2 ◽  
A Prospective Study ◽  
Group 1

We conducted a prospective crossover study to assess the safety and efficacy of 70 % isopropyl alcohol delivered from a squeezable bottle with a specially designed tip as a weekly irrigant to reduce cerumen accumulation. Twenty patients were divided into 2 groups of 10 (20 ears in each group). The patients in group 1 instilled 70% isopropyl alcohol once a week for 2 months; this was followed by 2 months of no ear cleaning. The patients in group 2 performed the opposite routine. At each visit (0, 2, and 4 mo), cerumen accumulation was graded on a scale of 0 to 4, indicating 0, 25, 50, 75, and 100% occlusion, respectively. After the accumulation was graded, a cerumenectomy was performed. At the initial evaluation, the mean occlusion scores were 3.1 for group 1 and 3.3 for group 2—not a statistically significant difference. After the first 2 months of the study, there was a significant difference in occlusion scores between groups 1 and 2 (0.75 and 1.55, respectively; p (p = 0.38). At study's end, there were also significant differences within each group between occlusion scores obtained during the treatment and nontreatment periods (group 1: p 0.02; group 2: p.

scholarly journals To study duration of viral clearance in COVID 19 patients: A Prospective study from Bangalore, India

2021 ◽  
Vol 12 (8) ◽  
pp. 1-4
Author(s):  
Swetha Rajoli ◽  
Avinash Hanbe Rajanna ◽  
Sumesh Yadav
Keyword(s):  
Hospital Stay ◽  
Viral Clearance ◽  
Duration Of Hospital Stay ◽  
Study Duration ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Indian Setting ◽  
A Prospective Study ◽  
Group 1

Background: COVID-19 infection, which first reported as a cluster of pneumonia from Wuhan, China, in December 2019, has rapidly emerged as a global pandemic. During the early course of the pandemic. The duration of infectious virus replication is an important factor for clinicians. There is a significant correlation between the duration of SARS-CoV-2 virus clearance and the prognosis of COVID-19. Aims and Objective: To study Duration of viral clearance in COVID 19 patients, admitted in an Indian setting. Materials and Methods: The prospective single-center study considered adults patients of both the gender, diagnosed with COVID-19 infection by RT-PCR technique. Necessary demographic and clinical data were collected and selected subjects were followed-up until discharge or death. Based on the number of days required for viral clearance, the subjects were classified as: group 1: ≤ 14 days, group 2: 15-28 days, and group 3:>28 days. Results: The study included 536 patients it was found that mean duration required for viral clearance was around 8.98±3.54. Mean ages noted for group1, 2 and 3(based on viral clearance) were 37.57±13.65 years, 37.12±13.73 years and 49.50±23.56 years respectively. There was a significant difference between mean age of group 1 and 2, as well as group 1 and 3. Moreover, the distribution of patients across different age group was found to be statistically significant (P<0.05). Significant difference was noted between three groups with respect to the comorbidity status (P<0.0001). The COVID-related symptoms dyspnea and cough were more prominent in group 3 (P<0.05). TLC which is statistically significant (p<0.05), lower the TLC more the duration of viral clearance and more the duration of hospital stay. Conclusion: The mean days of viral clearance noted in COVID subjects is around 8.98±3.54 days. There was a significant difference between mean age of group 1 and 2, as well as group 1 and 3. However, there is no statistically significant correlation between duration of hospital stay and inflammatory markers except TLC which is statistically significant (p<0.05), lower the TLC more the duration of viral clearance and more the duration of hospital stay.

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

RISKS OF ANEMIA DEVELOPMENT IN DONORS ACCORDING TO INHERITED PREDISPOSITION AND REGULARITY OF BLOOD DONATION

2020 ◽  
pp. 72-83
Author(s):  
I.M. Vorotnikov ◽  
V.A. Razin ◽  
I.M. Lamzin ◽  
M.N. Sokolova ◽  
M.E. Khapman ◽  
...  
Keyword(s):  
Blood Donors ◽  
Blood Donation ◽  
Hla Antigens ◽  
Hla Typing ◽  
Main Role ◽  
Inherited Predisposition ◽  
Group 2 ◽  
Student’S T ◽  
A Prospective Study ◽  
Group 1

Anemia is one of the most common complications of blood donation. Thus, the objective of the paper was to assess the risks of anemia development in donors according to the regularity of donation and inherited predisposition. Materials and Methods. The authors carried out a prospective study, which included 241 blood donors, using random sampling and case-control techniques. Depending on blood donation frequency, the donors were divided into 2 groups: Group 1 consisted of 122 people (51.5 %) frequently donating blood; Group 2 included 119 people (48. 5 %) rarely donating blood. We studied the initial indicators of a general blood test and the same indicators a year after the first blood donation. Additionally, we performed HLA typing of donors. Statistica v. 8.0 software package (Stat Soft Inc., USA) was used for statistical analysis. To compare two independent samples, we used a nonparametric Mann-Whitney U-test and a parametric Student’s t-test (depending on the type of distribution). To assess anemia risks, the odds ratio was calculated. Results. One year after the first blood donation, anemia was diagnosed in 13 people (10.6 %) in Group 1 and in 7 people (5.9 %) in Group 2 (p=0.179). A11 and B7 HLA antigens did not increase anemia risks in group 1 (OS=1.257 (95 % CI 0.318–4.973) and OS=0.240 (95 % CI 0.051–1.134, respectively). HLA-antigens A11 and B7 did not increase anemia risks in Group 1 (OR=1.257 (95 % CI 0.318-4.973) and OR=0.240 (95 % CI 0.051–1.134), respectively). In group 2, antigen-A11 was also an insignificant factor (OS=2.902 (95 % CI 0.606-13.889)) for anemia development. Whereas, antigen-B7 increased anemia risks by 14 times (OS=14.364 (95 % CI 1.644-124.011)). Conclusion. In rare blood donors, it is the genetic factor that plays the main role in anemia development. High prevalence rates of anemia in frequent blood donors are probably determined by other factors. Keywords: anemia, blood donors, HLA typing. Механизмы развития анемий и факторы, их индуцирующие, остаются до конца не изученными. Целью исследования стало изучение риска развития анемии у доноров крови в зависимости от частоты донации и наличия наследственной предрасположенности к развитию анемии. Материалы и методы. Проведено проспективное исследование, выполненное методами случайной выборки и «случай-контроль», в которое вошел 241 донор крови. В зависимости от частоты сдачи доноры были поделены на 2 группы: группу 1 составили 122 чел. (51,5 %), часто сдающие кровь; группу 2 – 119 чел. (48,5 %), редко сдающих кровь. Изучались исходные показатели общего анализа крови и через год от начала донации. Дополнительно проводилось HLA-типирование доноров. Статистический анализ осуществлялся с применением программы Statistica v. 8.0 (Stat Soft Inc., США). Для сравнения двух независимых выборок использовался непараметрический U-критерий Манна–Уитни и параметрический t-критерий Стьюдента (в зависимости от типа распределения). Для оценки риска возникновения анемии рассчитывалось отношение шансов. Результаты. Через год с момента первой сдачи крови в группе 1 выявлено 13 чел. (10,6 %) с анемией, в группе 2 – 7 чел. (5,9 %) (р=0,179). Наличие HLA-антигенов А11 и B7 не повышало риск развития анемии в группе 1 (ОШ=1,257 (95 % ДИ 0,318–4,973) и ОШ=0,240 (95 % ДИ 0,051–1,134 соответственно). В группе 2 наличие гена А11 также являлось незначимым фактором (ОШ=2,902 (95 % ДИ 0,606–13,889), присутствие гена В7 в 14 раз повышало риск развития анемии (ОШ=14,364 (95 % ДИ 1,664–124,011). Выводы. Высокий риск развития анемии у редко сдающих кровь доноров обусловливается генетическими факторами. Высокая распространённость анемии у часто сдающих кровь доноров, вероятно, определяется другими факторами. Ключевые слова: анемия, доноры крови, HLA-типирование.

Tuberculosis of the meninges and central nervous system. Experience of clinical diagnostics in St. Petersburg for 50 years

MedAlliance ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 14-24
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Medical Errors ◽  
Clinical Diagnostics ◽  
Lethal Outcome ◽  
Significant Difference ◽  
Group 2 ◽  
Allergic Vasculitis ◽  
Tuberculosis Meningitis ◽  
Group 1

The clinic and diagnostics of tuberculosis meningitis (TM) in 926 patients treated in St. Petersburg hospitals in 1965–1994 (group 1) and in 1995–2018 (group 2) is presented. The TM clinic is demonstrated to be determined by the form of tuberculosis and its characteristic generalization nature in the presence of repeated waves of bacteremia and allergic vasculitis of greater or lesser severity. There is clinical peculiarity of TM in primary pulmonary tuberculosis and its early large-focal and late miliar generalization, as well as in hematogenous tuberculosis. In patients of the 1st and 2nd groups the TM clinic shows in some respects a noticeable similarity, in others — a significant difference. Despite the typical symptoms, early diagnosis of TM took place in less than 20% of patients. Clinical examples illustrating the unusual development of TM, contrasting with its usual course, are given. A number of objective and subjective factors contributing to the adverse evolution of TM and its lethal outcome are discussed. These include the peculiarity of modern tuberculosis, especially when associated with HIV infection, as well as medical errors associated with ignorance of the pathogenesis of tuberculosis and failure to comply with the minimum examination for tuberculosis.

Two Adhesive Systems-effect on Adhesion to Tooth Structure

2019 ◽  
Vol 70 (7) ◽  
pp. 2608-2613
Author(s):  
Larisa Simona Deac ◽  
Kamel Earar ◽  
Adela Loredana Colceriu Burtea ◽  
Alexandra Stefania Berghe ◽  
Aurora Antoniac ◽  
...  
Keyword(s):  
Adhesive Systems ◽  
Hybrid Layer ◽  
Tooth Structure ◽  
Selective Etch ◽  
Etch And Rinse ◽  
Significant Difference ◽  
Wisdom Teeth ◽  
Group 2 ◽  
Self Etch ◽  
Group 1

This study evaluates and compares by dye penetration method and SEM photomicrographs the sealing obtained using two different classes of adhesive systems (etch-and-rinse and self-etch with selective etching) with SDR (Dentsply) bulk fill composite. 84 class V cavities were prepared on oral and vestibular face of 42 intact, freshly extracted wisdom teeth. The cavities were randomly divided in two groups and restored: Group 1 with prime &bond one select (Dentsply) and SDR (Dentsply) and Group 2 with prime&bond one Etch&Rinse (Dentsply) and SDR (Dentsply). Prime&bond one Select (Dentsply) is a single component adhesive and can be used in self etch mode, in selective enamel etch mode, or in etch-and-rinse mode. We chosen for this study the selective etch of the enamel mode. Prime&bond one Etch Rinse (Dentsply) is a universal etch-and-rinse one-bottle dental adhesive, designed to be used in two steps. The bulk fill composites are commonly used in modern dentistry due to their properties of low polymerization shrinkage and curing in layer of 4 mm depth, offering the practitioner a fast clinical procedure with good results. The results showed a good sealing at enamel and dentin margins with no statistically significant difference between adhesives, even though the mean of enamel infiltration was smaller for Group1. Furthermore the results show that there were differences between the two groups, for the infiltrations at the enamel, the values of microleakage being arithmetically higher for Group 1, but with no statistically difference between the two groups.SEM images showed for both groups a good adhesion surface with the tooth, but the hybrid layer of the total-etch adhesives is different from the hybrid layer formed by self etch adhesives, in terms of thickness, uniformity. In conclusion both adhesive systems have equivalent sealing qualities and can be successfully used with SDR.

Reducing Gingivitis Remotely using the iGAM mHealth app (part 2): Prospective Observational Study (Preprint)

2020 ◽  
Author(s):  
Guy Tobias ◽  
Assaf B Spanier
Keyword(s):  
Oral Health ◽  
Tooth Loss ◽  
Prospective Observational Study ◽  
Dental Clinics ◽  
Significant Difference ◽  
Observational Cohort ◽  
Group 2 ◽  
And Behavior ◽  
Oral Hygiene Habits ◽  
Group 1

BACKGROUND Gingivitis is a non-painful, inflammatory condition that can be treated with home remedies. Left untreated gingivitis can lead to tooth loss. Periodic dental examinations are important for early diagnosis and treatment of gum diseases. In order to contain the spread of the corona virus, governments, including in Israel, have restricted movements of their citizens which has caused routine dental checkups to be postponed. OBJECTIVE This study aimed to examine the ability of an mHealth app- iGAM to reduce gingivitis. METHODS A prospective observational cohort study was performed, 160 unpaid participants were divided into 2 equal groups and downloaded the iGAM app. Group 1 photographed their gums weekly for eight weeks. Group 2 photographed their gums at the time of recruitment and 8 weeks later. After photo submission, the participants received the message "It is recommended to read the information contained within the app regarding maintaining oral hygiene habits". A single blinded researcher examined the images and scored them according to the Modified Gingival Index (MGI). RESULTS The average age of group 1 was 26.77 (S.D. ± 7.43), and 28.53 (S.D. ± 10.44) for group 2. The majority were male (74.7% in group 1 vs. 66.7% in group 2), most participants described themselves as "secular", most were "single", non-smokers (74.7% vs. 78.4%) and did not take medications (85.3% vs. 78.4%). 126 subjects completed the study. A statistically significant difference (P <.001) was found in the dependent variable (MGI) in a linearly negative manner. As time passed, the gum condition improved, there were significantly lower gingivitis scores in group 1 (M = 1.16, S.D. ± 1.18) compared to group 2 (M = 2.16, S.D. ± 1.49), after eight weeks. Those with more recent dental visits had a lower MGI (p = .037). No association was found between knowledge and behavior, most participants were familiar with the recommendations for maintaining oral health, yet they only performed some. CONCLUSIONS A dental selfie taken once a week using an mHealth app (iGAM) reduced the signs of gingivitis and promoted oral health. During the current pandemic where social distancing recommendations may be causing people to avoid dental clinics, this app can remotely promote gum health. CLINICALTRIAL The protocol was approved by Hadassah research ethics committee (IRB, 0212-18-HMO)

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