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   Table of Contents - Current issue
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September-December 2018
Volume 8 | Issue 3
Page Nos. 131-208

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EDITORIAL  

Dear stress, let's break up… p. 131
Santosh Kumar
DOI:10.4103/AIHB.AIHB_51_18  
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REVIEW ARTICLE Top

DNA vaccine: Methods and mechanisms p. 132
Saber Soltani, Abbas Farahani, Mahsa Dastranj, Navid Momenifar, Parviz Mohajeri, Amir Darb Emamie
DOI:10.4103/AIHB.AIHB_74_17  
Infectious diseases are the biggest cause of mortality and morbidity in humans, especially in poor and developing countries. For many years, no new vaccine has been developed, which indicates the limitations of the development of common vaccines, including destruction and inactivation of the vaccine, weakened vaccines toxoids known as first-generation vaccines. Types of vaccines including: (1) First-generation vaccines, (2) second-generation vaccines or recombinant vaccines, (3) third-generation vaccines (gene vaccine). The study on DNA vaccines first began in the 1990s, when the plasmid DNA is injected into the skin or muscle was reported to induce antibody responses to antigens. Since DNA vaccines are easily designed and manufactured, they are easier to preserve them, and they are inexpensive, as one of the most desirable types of vaccine. However, more clinical trials are needed to prove the immune responses that immune to DNA vaccine in humans. Information on the vaccination method, adjuvant and the genetic structure of the vaccine is still not complete.
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ORIGINAL ARTICLES Top

Comparison of haemodynamic parameters and recovery characteristics between sevoflurane and desflurane in patients undergoing day-care surgical procedure p. 140
Palak A Chudasama, Milan V Mehta
DOI:10.4103/AIHB.AIHB_27_18  
Background: Smooth and rapid induction, optimal operating conditions and rapid recovery with minimal side effects such as nausea, vomiting, bleeding and post-operative pain are the characteristics of ideal anaesthetic. Objectives: The objective of the study was to compare the haemodynamic parameters and recovery characteristics of desflurane with sevoflurane. Materials and Methods: This was a prospective study conducted from January to December 2016. Using convenient sampling technique, a total of 40 adult patients of American Society of Anesthesiologists (ASA) physical status Grade I or II, aged between 18 and 60 years, of either sex, who were scheduled for elective day-care surgeries of <2 h duration under general anaesthesia were selected for the study after informed consent. All the patients were randomly allocated into one of the two groups using computer-generated random number table. Group I received induction with sevoflurane, while Group II was induced desflurane. Results: The baseline demographic analysis showed that the two groups did not differ significantly in age, weight, sex, ASA grade and operative times. During the course of surgery, heart rate was significantly low in Group II at 25, 30, 40 and 45 min than in Group I. Systolic and diastolic blood pressure was significantly low in group Desflurane as compared to sevoflurane. Group I showed significantly higher time for spontaneous eye opening and recalling names and recognising surroundings and post-operative complications compared to Group II. Conclusion: Desflurane has significantly better haemodynamic stability, post-operative recovery and less post-operative complications compared to sevoflurane.
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Spatio-Temporal analysis of brucellosis in Hamadan Province, West of Iran: 2009–2015 p. 145
Salman Khazaei, Manoochehr Karami, Abolfazl Mohammadbeigi, Erfan Ayubi, Masoud Shojaeian, Kamyar Mansouri, Behzad Amiri, Shahrzad Nematollahi
DOI:10.4103/AIHB.AIHB_12_18  
Background: Regarding the geographical variations of the disease and recent changes of ecosystems, this study aimed to investigate the geographic patterns and trends of human brucellosis in Hamadan province, west of Iran. Methods: This is a cross-sectional study on brucellosis cases recorded by provincial authorities of brucellosis national surveillance system at Hamadan University of Medical Sciences from March 2009 to March 2015. Cochran–Armitage test and Poisson regression models were used to obtain standardised rates for the disease. Results: Of all 9318 recorded cases, 62.83% were female and 81% were rural residents. The observed number of cases exceeded expected in almost all of the cities, except for Hamadan, Bahar and Asadabad. Conclusion: The clusters of disease occurrence were more evident in areas of the province with better agriculture coverage. This finding provides more in-depth clues to detect special transmission routes and would help mobilise educational and preventive measures for specific occupational groups.
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Role of chronobiology in determining the distribution of non-communicable diseases across geographies-thinking beyond diet p. 150
Sunil Kumar Raina, Ambika Maria, Manoj Kumar Gandhi
DOI:10.4103/AIHB.AIHB_3_18  
Background: Over the last few years, it is being realised that the increasing burden of non-communicable diseases (NCDs) may be linked to some macro-level determinants. Material and Methods: The present systematic review uses data distributed across geographies to explore the role played by chronobiology. Results: The paper is based on the role of these factors in affecting the prevalence of diabetes, hypertension and dementia. The paper uses extensive empirical scrutiny, covering areas across a state and applying the outcome of these to generate a hypothesis. Conclusion: Our results though initial indicate that change in chronotype appears to contribute to an increase in NCDs.
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The four-dimensional ultrasonography effects on changes of foetal and maternal heart rate: Are these interventions safe? p. 155
Mahdis Naafe, Fatemeh Saafi, Hormoz Haddad Larijani, Mehri Jamilian, Bahman Sadeghi, Abolfazl Mohammadbeigi
DOI:10.4103/AIHB.AIHB_26_18  
Background and Objectives: Ultrasonography is one of the prenatal diagnostic methods, which is applied to detect any genetic diseases, defects, and anomalies. This study aimed to evaluate the changes in foetal heart rate (FHR) and maternal heart rate due to four-dimensional (4D) ultrasonography immediately after ultrasound imaging. Materials and Methods: This descriptive study was conducted on the foetus of pregnant women who were referred to the ultrasound clinic for undergoing a (4D) ultrasonography. After filling out the demographic forms, the baseline FHR was measured at the beginning of the 2D and 4D ultrasonography. All haemodynamic parameters were recorded at the end of the combined ultrasound imaging. Data were compared before and after ultrasonography using paired t-test and correlation coefficient in SPSS software. Analysis of covariance (ANCOVA) was used to adjust the effect of baseline heart rate in foetus and sonography. Results: The mean duration of combined 2D and 4D ultrasound imaging was 1249.8 ± 257 s. Moreover, the mean 4D ultrasound duration was 246.1 ± 83.3. A significant decrease were observed in maternal heart rate following the combined ultrasonography (P < 0.001), while the changes in FHR were not significantly different after the ultrasound imaging (P = 0.394). The ANCOVA showed that sonography was not related factors for change in FHR (β = 0.006, 95% confidence interval [CI]: 0.011–0.024, P = 0.467) while the base FHR (β = 0.659, 95% CI: 0.482–0.836, P < 0.001) was directly associated with FHR change. Conclusion: The 4D ultrasonography was not effective factor on the FHR and it seems that the ultrasound imaging is a safe diagnostic method for FHR. However, we recommended long-term studies to evaluate the effect of the 4D ultrasound imaging on preterm labour, post-partum complications, and mental problems.
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Prevalence and co-relates of hypertension among Gaddi (Agro Pastoralist) tribal's at high altitude in North-West India p. 159
Sunil Kumar Raina, Mitasha Singh, Vishav Chander, Sujeet Raina
DOI:10.4103/AIHB.AIHB_78_17  
Introduction: An extensive search on PubMed reveals the paucity of data on hypertension among agro-pastoralist (Nomadic) tribal population in India. Studies among nomadic tribal's living at high altitudes provide an interesting epidemiological window to study human adaptation to changing living conditions. Materials and Methods: A total of 420 agro-pastoralist participants above the age of 20 years were evaluated for blood pressure using a stratified simple random technique in agro-pastoralist villages located at high altitude. Results: Out of a total of 420 individuals studied, 44 (males: 28; females: 16) were identified as hypertensive yielding a crude prevalence of 10.5%. The prevalence was higher in males (28/261; 10.7%) as compared to females (16/159; 10.1%). The proportion of hypertension was observed to be significantly higher among 51–60 years of age group (18.2%) as compared to other age groups (P = 0.03). Conclusions: The Gaddi (agro-pastoralist) tribal's diet-style may be the probable reason for a lower prevalence of hypertension among them.
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Multi-detector computed tomographic evaluation of tibial plateau fractures with review of Schatzker's classification of tibial plateau fractures p. 164
Mohd Ilyas, Anchal Gupta, Shwait Sharma, Ghanshyam Dev
DOI:10.4103/AIHB.AIHB_60_17  
Objective: The main objective of the study was to assess the role of multi-detector computed tomographic (MDCT) evaluation of the tibial plateau fractures. Materials and Methods: Fifty-one patients with tibial plateau fractures were subjected to MDCT. The images were reconstructed via three-dimensional algorithms and maximum intensity projection and volume rendered technique reconstructions using syngo.via software (Siemens Healthcare, Germany). The fractures were classified according to Schatzker's Classification. Results: The most common type of tibial plateau fracture in the current study was found to be type I followed by type II and the least common being type V. Conclusion: MDCT helps in accurate classification of the tibial plateau fractures, which helps in selecting the best treatment modality for a particular class of tibial plateau fracture.
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Endocrinopathy complications and the role of serum ferritin as a marker of endocrinopathy prediction in patients with beta-thalassemia major p. 169
Seyed Kamal Eshaqh-hosseini, Tohid Jafari-Koshki, Shahram Arsang-Jang, Javad Shapouri
DOI:10.4103/AIHB.AIHB_18_18  
Background: This study aimed to estimate the prevalence of complications and in β-thalassemia patients, to identify its related risk factors and to determine the optimal thresholds of serum ferritin and disease duration as a predictor of the endocrine disease. Materials and Methods: A total of 140 patients with β-thalassemia major, 65 (46.4%) male with a mean age of 21.4 ± 7.5 (range 8–39) years were enrolled in this study. Logistic regression and receiver operating characteristic curve were used to estimate the diagnostic power of ferritin level and determine the optimal cut points. Results: The serum ferritin level was 3395 ± 2611 μg/L with stable trend across the last 5 years. Puberty delay was the most common complication with the prevalence of 33.6%. There was a significant association between ferritin levels and hypocalcaemia (odds ratio [OR] = 1.29, P = 0.001), short stature (OR = 1.04, P < 0.001) and puberty delay (OR = 1.02, P = 0.002). A >2100 μg/L and >3400 μg/L optimal cut-off values of serum ferritin level for puberty delay was 2100 area under the curve (AUC = 0.78, P = 0.004) and 3400 for short stature (AUC = 0.74, P < 0.0001). Conclusions: Progressive deterioration of endocrine dysfunction and inadequacy of chelation therapy in older patients are endocrine complications amongst beta-thalassemia major patients that need more attention. Prosperous control of the ferritin levels before puberty with deferoxamine appeared to be an effective treatment to prevent and reduce diabetes and hypothyroidism. The serum ferritin >1500 μg/L along with early second decade of illness is the best predictor for the development the endocrinopathy.
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Molecular characteristics of extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae isolates in the West of Iran p. 175
Parviz Mohajeri, Sahar Kavosi, Toraj Esmailzadeh, Abbas Farahani, Mahsa Dastranj
DOI:10.4103/AIHB.AIHB_20_18  
Background: Klebsiella pneumoniae causes community and nosocomial infections. Drug treatment of extended-spectrum beta-lactamases (ESBLs) by K. pneumoniae isolates is costly, long, and sometimes problematic. Objectives: The aim of this study was to determine the antibiotic resistance patterns and the occurrence of bla CTX-M, bla TEM and bla SHV genes in the third-generation cephalosporin-resistant K. pneumoniae isolated from urinary tract infection in Kermanshah region, Iran. Materials and Methods:Fifteen K. pneumoniae isolates were collected and confirmed by the analytical profile index-20E system. Phenotypic confirmatory test was performed using combination disk method. The genes of bla CTX-M, bla TEM and bla SHV were investigated by polymerase chain reaction. SPSS version 20 (IBM, Chicago, IL, USA) was used for sample analysis. Results: Resistant isolates to ampicillin and imipenem represented 96% and 4%, respectively, which were the highest and lowest resistance. Seventeen (34%) out of the 50 isolates were ESBL producers by the synergy test. The prevalence of bla CTX-M, bla TEM and bla SHV among these isolates was 88% (n = 15), 70% (n = 12) and 58% (n = 10), respectively. Conclusions: Our research showed a possibility of the spread of multidrug-resistant ESBL-producing isolates. Monitoring control of risk factors and drug-resistant patterns with the use of phenotypic and/or genotypic analyses are very important to prevent the occurrence and dissemination of resistant strains due to ESBL-producing K. pneumoniae in hospital settings.
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A classification analysis of musculoskeletal complaints and its association with anxiety, depression and psychological distress: Results from a large-scale cross-sectional study of adult Iranian population p. 180
Maryam Yazdi, Awat Feizi, Ammar Hassanzadeh Keshteli, Hamid Afshar, Peyman Adibi
DOI:10.4103/AIHB.AIHB_13_18  
Objectives: The current study aimed to classify study population in homogenous groups based on musculoskeletal complaints and investigate the association of common psychological disorders with musculoskeletal complaints in a large sample of Iranian adults. Methods: Using data from a cross-sectional sample of adult Iranian population (n = 4762), individuals were classified in meaningful subgroups based on their musculoskeletal complaints and the association of common psychological disorders with musculoskeletal complaints was investigated in identified classes using structural equation mixture model. Musculoskeletal complaints score extracted through eight items concerning site-specific or widespread musculoskeletal symptoms. Psychological distress was measured by General Health Questionnaire (GHQ-12). Depression and anxiety were measured using Persian validated version of the Hospital Anxiety and Depression Scale (HADS). Results: Two classes characterised by high (15.5%) and low (84.5%) levels of musculoskeletal complaints, were identified using structural equation mixture modeling. All musculoskeletal symptoms had a higher prevalence among participants allocated to 'high musculoskeletal complaints' class compared to 'low musculoskeletal complaints' class. Severe fatigue and back pain were the most reported complaints. Anxiety, depression and psychological distress were positively associated with musculoskeletal complaints score in identified classes, controlling for sex and age. Anxiety showed a stronger association with musculoskeletal complaints score compared to depression and psychological distress. Conclusions: Musculoskeletal complaints can be summarised in a categorical and dimensional structure in the adult study population. Common psychological disorders including anxiety, depression and psychological distress are significantly associated with musculoskeletal complaints. These findings could be useful for dealing with prevention and treatment programmes.
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Epidemiology and trend of hepatitis B infection in Hamadan Province during 2011–2016 p. 186
Salman Khazaei, Arash Mofarrah-Zat, Shahrzad Nematollahi, Mohammad Mirzaei, Abolfazl Mohammadbeigi, Seyyed Jalal Bathaei, Manoochehr Solgi
DOI:10.4103/AIHB.AIHB_24_18  
Background: Hepatitis B virus (HBV) is a major public health problem worldwide. The objective of this study was to investigate the epidemiological pattern and to analyse the trend of hepatitis B infection in Hamadan province over 7 successive years (2011–2016). Materials and Methods: This cross-sectional study was conducted on the recorded HBV cases (n = 1132) by the Deputy of Health affiliated to Hamadan University of Medical Sciences during 2011–2016. Cochran–Armitage test was used to investigate the changes in trend of the infection according to demographical and clinical characteristics. Incidence rates of HBV were estimated by districts for 2016. Results: Overall, 708 (62.54%) were male and 733 (64.75%) were urban dwellers; the highest proportion of the cases (41.17%) belonged to the age group of 25–44 years. There was a significant decreasing trend of HBV incidence in 15–24 years of age group (P for trend = 0.038). Overall, incidence rate of HBV infection in Hamadan province was 7.59/100,000 in 2016, while southern counties had higher incidence rates as compared to northern parts. Conclusion: Our results showed that HBV was prevalent in the age group of 25–44 years. In spite of effective vaccination programmes against hepatitis B, the increasing trend of HBV in southern parts of the province and reduced trend of hepatitis B in the northern counties should be further explored to find the role of other risk factors in the HBV process and the reporting system.
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Antibacterial property of eugenol and eugenol-free zinc oxide cements incorporated with various concentrations of sodium fluoride p. 190
Aastha , Keshav Kumar Gautam, KN Raghavendraswamy, Anil Kumar Gujjari, Meenakshi Sharma
DOI:10.4103/AIHB.AIHB_31_17  
Background: Restoring tooth by fixed partial dentures involves tooth reduction to reproduce the dental anatomy in the prosthesis. This process brings about the exposure of millions of dentinal tubules which serves as potential passageways for the diffusion and colonisation of bacteria. Aim: To evaluate and compare the antibacterial property of eugenol and eugenol-free zinc oxide cements incorporated with various concentrations of sodium fluoride. Materials and Methods: Circular specimens of zinc oxide eugenol (ZOE) and eugenol-free zinc oxide cements were prepared with and without incorporation of sodium fluoride at various concentrations. The antibacterial property of the cement specimens was evaluated against Streptococcus mutans using disc diffusion method. Zone of inhibition which was formed under anaerobic conditions after a period of 48 h was recorded. Results: The difference in antibacterial property of ZOE cements and eugenol-free zinc oxide cements containing sodium fluoride was statistically highly significant at all the concentrations of sodium fluoride. Eugenol-free zinc oxide did not show any antibacterial property at all. The different percentages of fluoride concentrations, that is, 1% and 2%, did not show significant difference statistically. Conclusion: Eugenol-free zinc oxide cement did not have any antibacterial effect with or without fluoride. Eugenol-containing zinc oxide cement with sodium fluoride had maximum antibacterial properties. Eugenol-containing zinc oxide cement exhibited antibacterial properties of its own.
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The Association between sleep quality and well-being amongst allied health sciences students in a public university in Malaysia p. 195
Nurul Hazirah Mohd Zaid, Nor Azlina A Rahman, Mainul Haque
DOI:10.4103/AIHB.AIHB_22_18  
Background: According to researches, low sleep quality may lower the well-being of the students directly. One of the known components of well-being is satisfaction with life. Hence, this study is done to address if there is any relationship between sleep quality and well-being by measuring the quality of sleep and satisfaction with life. Purpose: This study was done to identify the association between quality of sleep and well-being amongst Allied Health Sciences students in a public university in Malaysia. Aside from that, it was also completed to compare the sleep quality and well-being between the different study programs, years of study and genders of the students. Materials and Methods: The study design chosen for this study was a cross-sectional study. A total of 120 students from the years 1, 2, 3 and 4 of the six study programs in the Allied Health Sciences faculty were selected by convenience sampling. The students were required to answer one set of questionnaires consisting of the consent form, information sheet, sociodemographic data, Pittsburgh Sleep Quality Index (PSQI) and Satisfaction with Life Scale (SWLS). The questionnaire was analysed by incorporating Kruskal–Wallis test, ANOVA, independent t-test and Pearson correlation test. Results: This research found that there was no significant difference of PSQI and SWLS scores between different study programs (P = 0.250 and P = 0.106, respectively), years of study (P = 0.162 and P = 0.704, respectively) and genders (P = 0.070 and P = 0.201, respectively) in the faculty. The results, however, indicated that there was a significant fair negative correlation between PSQI and SWLS amongst the students (P < 0.001; r = −0.416). Conclusion: This study amongst Allied Health Sciences students can be safely concluded that there was no difference in sleep quality and satisfaction with life between audiology, dietetic, biomedical science, physiotherapy, optometry and radiography students, neither between the years 1, 2, 3 and 4 nor between male and female students. On the other hand, better sleep quality was significantly associated with better satisfaction of life, hence the well-being of the students.
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Comparative evaluation of marginal seal integrity of three bulk-fill composite materials in Class II cavities: An In vitro study p. 201
Megha C Patel, Rohan K Bhatt, Disha A Makwani, Lipee D Dave, Vijeta S Raj
DOI:10.4103/AIHB.AIHB_19_18  
Aim: The aim of this study is to compare marginal sealing of three different bulk-fill composite restorations of Class II cavities under in vitro conditions. Materials and Methods: Thirty human extracted pre-molars were divided into three groups of 10 each. Class II cavities were prepared and restored using Filtek Bulk Fill (Group I), Tetric N-Ceram Bulk Fill (Group II) and X-tra Fil Bulk Fill (Group III) composite materials. Depth of dye penetration along the lateral walls of each specimen was evaluated under stereomicroscope, and marginal gap was evaluated under scanning electron microscope. Statistical Analysis Used: In a one-way ANOVA study, statistical analysis will be done using non-parametric, Kruskal–Wallis rank-sum analysis and Chi-square test for categorical data. For all statistical analysis, probability levels of P < 0.05 will be considered statistically significant. Results: Stereomicroscopy showed no dye penetration in 90%, 70% and 30% of restorations in Groups I, II and III, respectively. The mean width of marginal gap (μm) was 1.691, 3.076 and 4.546 in Groups I, II and III, respectively. Conclusions: Under the limitation of in vitro study, Filtek Bulk Fill composite material showed least microleakage and better marginal adaptation.
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CASE REPORT Top

Fibrodysplasia ossificans progressiva mimicking as fibroma with hypospadias p. 206
Varun Kaul, Gurmeet Kaur Sethi, Harshvardhan Gupta, Lokesh Lakhwad, Sunil Kumar Raina
DOI:10.4103/AIHB.AIHB_4_18  
Fibrodysplasia ossificans progressiva (FOP) is a rare disease characterised by recurrent painful episodes of swelling in soft tissue and the occurrence of tumours in subcutaneous and muscular tissues. It causes severe disability and has an autosomal dominant penetration. We report a child with diffuse heterotopic ossification with characteristic hallux valgus of both the toes who was diagnosed inadvertently as multiple cutaneous fibromatosis before presenting to us. A very rare genetic syndrome was characterised on the basis of clinical manifestations and diagnosed in a peripheral tertiary institute. A diffuse soft-tissue enlargement is not always cancer and calcification therein may be FOP.
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