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   Table of Contents - Current issue
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September-December 2020
Volume 10 | Issue 3
Page Nos. 83-198

Online since Tuesday, September 22, 2020

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EDITORIAL  

COVID-19 pandemic: Medical education is clinging on a knife's edge! p. 83
Md Anwarul Azim Majumder
DOI:10.4103/AIHB.AIHB_88_20  
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INVITED COMMENTARY Top

Ongoing initiatives to improve the prescribing of medicines across sectors and the implications p. 85
Brian Godman
DOI:10.4103/AIHB.AIHB_90_20  
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REVIEW ARTICLES Top

Teaching anatomy and dissection in an era of social distancing and remote learning Highly accessed article p. 90
Keerti Singh, Uma Gaur, Kiana Hall, Keisha Mascoll, Damian Cohall, Md Anwarul Azim Majumder
DOI:10.4103/AIHB.AIHB_87_20  
Anatomy is one of the fundamental and core basic medical sciences in medical education. It forms the basis for physiology and subsequently pathophysiology to understand the aetiology of diseases, followed by the treatment in medical curricula. The traditional mechanism and gold standard for teaching anatomy in the medical curricula is cadaveric dissection in a small-group teaching environment. This type of teaching also develops compassion and empathy in training medical professionals. The onset of COVID-19 pandemic has limited the ability of faculty and students to function in this educational space as social/physical distancing guidelines, and the halting of cadaveric donation programmes has been implemented as safeguard measures against the transmission of the virus. Anatomists and other teaching staff within the discipline have been limited significantly to the use of technology-enhanced learning (TEL). TEL has been used in teaching environments prior and subsequent to the onset of COVID-19 to supplement cadaveric dissection, especially in medical programmes with limited cadaveric resources. While TEL is not interchangeable with cadaveric dissection, it appears to be a near and potentially medium–long-term solution to remote anatomy teaching during the COVID-19 pandemic. A blended hands-on approach with virtual reality three-dimensional experience can also be adopted in anatomy teaching during the neo-normal period.
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Environmental pollution and cancers in India p. 95
Manigreeva Krishnatreya, Amal Chandra Kataki
DOI:10.4103/AIHB.AIHB_51_20  
Environmental pollution poses a risk of cancer to the vulnerable population. With more and more industrialisation and migration of people to the cities, a large number of Indian people are at an increased risk of developing cancer. Pollution in many places and cities across the country are reaching hazardous levels. Thus, there is a need to review the rising cancer incidences, changing cancer trends and environmental pollution in the country. The issue of environmental pollution must be addressed sooner than later to mitigate the risk of cancer to India's vulnerable individuals. This brief review summarises the environmental pollution trends, most recent evidences of changing cancer burden and types in the country highlighting the underlying pollution trends in India, since economic liberalisation which began in early 1990s and its impact on cancer risk two and half decades later.
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COVID-19 pandemic: Can boosting immune responses by maintaining adequate nutritional balance reduce viral insults? Highly accessed article p. 99
Mohammed S Razzaque
DOI:10.4103/AIHB.AIHB_75_20  
The impact of nutrition on immunity is an intense area of research. Malnutrition is linked to a higher risk of microbial infections, while severe infections usually lead to a nutritional imbalance in affected patients. The nutritional status has an impact on the severity of the ongoing SARS-CoV-2 infection. Studies conducted on small number of patients have shown the benefits of maintaining optimal Vitamin (B12 and D) and mineral (zinc and magnesium) balance in reducing the intensity of COVID-19. Although consuming a balanced diet with a healthy lifestyle is always desirable, the importance of such practice is even more meaningful during the COVID-19 pandemic. Keeping an optimal balance of vitamins and minerals through healthy dietary habits helps to maintain a robust immune system that is essential to combat invading microbial pathogens, including SARS-CoV-2.
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ORIGINAL ARTICLES Top

A study to assess the utilisation of health services by pregnant women in rural area of Vadodara district p. 103
Medha Wadhwa, Subhasish Chatterjee
DOI:10.4103/AIHB.AIHB_38_20  
Introduction: A healthy society is indicated by not merely the absence of disease or low mortality/morbidity status but rather the different dimensions of health of the population of a society. The sound maternal health status is always the intention of any nation as it reflects many dimensions of the society. However, in India, there is a huge gap in the services offered and utilised at rural and urban areas. The considerable efforts by government by which the foundation of healthcare sector of the nation be made strong cannot deliver the fruitful results. The present study aims to assess the utilisation of maternal health services and the factors associated with it.Methodology: The present study was undertaken in Waghodia taluka of Vadodara district. The Waghodia taluka has four primary health centres (PHCs). The duration of the study was 9 months. The proportionate stratified sampling was used to assess the utilisation of maternal health services in four PHCs. The sample of the study was 1333. The study design was a prospective cohort study as the sample were followed up to determine their category of utilisation of antenatal care services. The data were analysed using SPSS version 21. Results: Nearly 65.3% of the pregnant women have utilised the antenatal services in an ideal manner, 28.5% in the moderate utilisation category and 6.2% in the undesirable category. There is an association between the predisposing factors such as age of respondent, education of respondent and her husband, occupation of respondent and her husband and level of autonomy of the respondent. The need factors are also statistically significantly associated with the category of utilisation of antenatal services. The majority of the pregnant women with hypertension and diabetes are utilising the services in an ideal manner. Conclusion: The majority of the pregnant women in rural area of Vadodara are utilising the antenatal services in an ideal manner, but the focus should be on the pregnant women who are unable to utilise these services properly. The proper utilisation of antenatal services by the pregnant women would help in the sustainable development of our country.
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Evaluation of the effect of perforan (Hypericum perforatum) on premenstrual syndrome severity of physical and behavioural symptoms in patients with premenstrual syndrome: A clinical randomised trial p. 110
Nasim Khademi, Haniyeh Abbassinya, Farahnaz Heshmat, Mahdis Naafe, Abolfazl Mohammadbeigi
DOI:10.4103/AIHB.AIHB_16_20  
Background: Premenstrual syndrome (PMS) is an extensive group of emotional, behavioural and physical symptoms that occur before menstruation. It has a negative impact on activities of daily living, social activities, sexual functioning and quality of life. This study aimed to evaluate the effect of perforan (Hypericum perforatum) on the severity of physical and behavioural symptoms associated with PMS. Materials and Methods: In a triple-blind clinical trial, 93 students with PMS were randomly divided into two groups, including perforan and control (placebo) groups, and followed for three subsequent cycles. They took capsules daily in the first cycle for 1 month, and in the second and third cycles, they took capsules from 8 days pre-menstruation to 2 days post-menstruation and recorded the severity of physical and behavioural symptoms using a PMS questionnaire. Statistical analyses were performed using SPSS version 20. Repeated measures ANOVA, Chi-squared tests and independent t-tests were used to compare the mean scores of the two groups. Results: The data showed that there were no significant differences between the two groups before the intervention (P > 0.05). Nevertheless, the severity of physical and behavioural symptoms of PMS was significantly lower in the perforan group than the control group. This was the case 1, 2 and 3 months after consumption of perforan (P < 0.001). Moreover, a significant difference between the two groups in the decrease of PMS scores was observed by repeated measurement tests (P < 0.001). Conclusion: Perforan significantly reduces the severity of physical and behavioural symptoms of PMS. Therefore, perforan could be effective in the treatment of physical and behavioural symptoms of patients with PMS. Nevertheless, future studies are necessary to confirm these results.
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Prognostic role of pre-chemotherapy platelet counts in patients with non-small cell lung cancer treated with first-line chemotherapy at IRD SMS medical college Jaipur p. 115
Kalim Khan, Bhaskara Kurup Latha Parvathi, Gulab Singh Yadav, Suresh Koolwal
DOI:10.4103/AIHB.AIHB_36_20  
Introduction: Lung cancer remains the most common cause of cancer death worldwide. The difference in outcome among patients with same clinical stage of disease suggests that advanced non-small cell lung carcinoma (NSCLC) is heterogeneous disease. The patient's heterogeneity is leading to need for identification of prognostic factors for survival. The analysis of these factors will be helpful in advising individuals, choosing treatment, understanding disease and optimising results of chemotherapy. Aim: To study the relationship between pre-chemotherapy platelet count and tumour response in NSCLC patients. Methodology: This was a hospital-based descriptive study. All patients are cytological and/or histological confirmed NSCLC. We divided patients in two group, patients with normal platelet count and patients with thrombocytosis. Platinum-based chemotherapy was started to patients after pre-chemotherapeutic evaluation. After 3rd and 6th cycles of chemotherapy, patients were evaluated for radiological response as per RECIST criteria. Results: Total 70 patients were enrolled in the study. Those patients who showed progressive disease after 3rd cycle and 6th cycle had higher mean platelet count (4.33 ± 1.21 lakh and 4.14 ± 0.30 lakh, respectively) compared to those patients who showed complete response and partial response. In this study, 78.57% patients with thromboytosis died, while 35.71% patients with normal platelet count died after 6 months of follow-up. Conclusions: The study suggests that pre-chemotherapy thrombocytosis can be considered as a potential negative independent factor for survival and tumour response in patients of NSCLC. Awareness of association between prognostic factor including pre-chemotherapy platelet count and NSCLC may benefit disease outcome.
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Comparative clinical evaluation of intrathecal bupivacaine heavy, bupivacaine with magnesium sulphate and bupivacaine with neostigmine for infraumbilical surgeries – A clinical study p. 120
Jitendra Kushwaha, Surendra Raikwar, Sandeep Rathore
DOI:10.4103/AIHB.AIHB_74_20  
Aim: This study aims to assess the anaesthetic effects of adjuvant therapies with neostigmine or magnesium sulphate compared with bupivacaine intrathecally, alone in patients undergoing infraumbilical surgeries under subarachnoid block. Materials and Methods: After approval from the Institutional Ethics Committee and informed written consent from patients, the present study was carried out in 90 patients of ASA Class I and II, aged between 18 and 50 years, of either sex (M and F), scheduled for elective infraumbilical surgeries. The selected patients were randomly divided into three equal groups of 30 patients. Group I patients received bupivacaine heavy (0.5%) 3 ml (15 mg) +0.5 ml normal saline. Group II patients received bupivacaine 3 ml (5 mg) with preservative-free magnesium sulphate 0.5 ml (50 mg). Group III patients received bupivacaine (3 ml) with neostigmine 0.5 ml (25 μg). The parameters assessed were the duration of sensory and motor blockade, quality of block, perioperative haemodynamic effects and duration of post-operative analgesia. Results: Addition of 50 mg of magnesium sulphate significantly increases the duration of sensory block in Group II (397.67 ± 14.003) as compared to Group III (188.67 ± 23.887) and Group I (183.10 ± 8.185), duration of motor block in Group II (213.67 ± 13.767) as compared to Group III (164.67 ± 23.154) and Group I (177.30 ± 7.312), duration of analgesia in Group II (349.00 ± 22.453) as compared to Group III (327.83 ± 31.61) and Group I (241.33 ± 16.399). Haemodynamic parameters were stable in both Groups I and II. Quality of block was much better in Group II (3.83 ± 0.40) as compared to Group III (3.49 ± 0.68) and Group I (2.83 ± 0.79). Conclusion: According to the results obtained from the present study, it is concluded that addition of 50 mg of magnesium sulphate as an adjuvant to intrathecal bupivacaine is better in view of the duration of sensory and motor blockade, quality of block and duration of analgesia (requirement of rescue analgesia) without any significant increase in adverse effects.
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Awareness about yoga and its benefits among undergraduate and post-graduate dental students p. 125
Prasad Nadig, Monali Shah
DOI:10.4103/AIHB.AIHB_44_20  
Introduction: Students of all professional courses are under stress amongst which dental and medical curriculum is rated as highest. Many studies have indicated that the students experienced a reduction in stress and anxiety levels after inclusion of regular practice of yoga and can have a significant change in the lifestyle of a dentist by allowing them to maintain their health as well as relieving them from their day-to-day stress. Considering the long-term effects of the dental profession on one's health, it is crucial to know the awareness levels about yoga and its benefits amongst dental undergraduate and post-graduate students towards ensuring physical, mental and psychological well-being.Methodology: Google Forms were created where section one was for informed consent; the section two consisted of the questionnaire. It consisted of four items to assess the student's knowledge about awareness and benefits about yoga. The statistical analysis was done after collecting all the responses. Results: The total number of students participated was 206. Among 206 students, 35% had the habit of doing yoga and 65% did not have the habit of doing yoga. Ninety-two percent of the students had the knowledge of benefits of yoga; 6% had no knowledge of benefits of yoga. Conclusion: Ninety-two percent of the students had the knowledge of benefits of yoga, but only 35% had the habit of doing yoga. Based on the findings of the study, a sensitisation program on benefits of yoga shall be planned in small groups and the students should be motivated to take up yoga in their daily life.
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Comparative evaluation of remineralising efficacy of bioactive glass agent and nano-hydroxyapatite dentifrices on artificial carious lesion in primary teeth: An in vitro study p. 129
Jayesh R Khandelwal, Seema Bargale, Bhavna Haresh Dave, KS Poonacha, Pratik B Kariya, Srushti Vaidya
DOI:10.4103/AIHB.AIHB_85_20  
Introduction: The phenomenon of reversal of incipient or early enamel caries forms an important part of prevention leading to apparent repair of the lesion. Recently, novel biomaterials such as the bioactive glass (BAGs) and nano-hydroxyapatite (n-HAP) crystal have been introduced as remineralising agents. Aim: This study aimed to evaluate and compare the remineralising efficacy of BAG agent and nano-hydroxyapatite (NHA) dentifrices on artificial carious lesion in primary teeth. Methodology: Thirty human extracted primary teeth were selected for the study, and the specimens were randomly divided into Group A: BAGs agent toothpaste group and Group B: n-HAP toothpaste group. The surface microhardness of the teeth was measured using a Vickers microhardness tester at the baseline and after demineralisation and remineralisation. The statistical analysis was done using independent t-test for intergroup comparison and paired t-test for intragroup comparison. Results: On intergroup comparison, microhardness differences of baseline to exposure to dentifrice between the two groups showed that microhardness differences of baseline to exposure to dentifrice were higher in Group B with a t value of −2.158 and was statistically significant (P < 0.001). On intragroup comparison of the mean values of baseline microhardness and microhardness after exposure to dentifrices, the mean values of baseline microhardness were higher in both the groups with a difference of 14.3 and 20.45 in Group A and Group B, respectively. Conclusion: Both BAG and NHA toothpastes were considered to be effective for the remineralisation of caries-like lesions of primary teeth. The remineralising efficacy of n-HAP toothpastes was found to be slightly higher than that of BAGs toothpastes, which was statistically significant.
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Prebiotic prophylaxis of abdominal bloating in mechanically ventilated patients fed through nasogastric tubes: A randomised clinical trial p. 134
Zaher Khazaei, Leili Moayed, Golnaz Sharifnia, Elham Goodarzi, Azam Zarghi
DOI:10.4103/AIHB.AIHB_50_20  
Objective: Enteral nutrition is the first choice of nutritional support of patients undergoing mechanical ventilation. Gastrointestinal disorders, especially abdominal bloating, are commonly seen in this group of patients. Given the prevalence of bloating and its perceived severity, the lack of an effective method for the control or treatment of this problem during mechanical ventilation is urgently felt. Materials and Methods: This double-blind, randomised, controlled clinical trial was conducted on 60 mechanically ventilated patients divided in two groups (n = 30). The study group received fenugreek seed (FS) powder by gavage twice a day besides the routine care. The control group only received routine care. Abdominal bloating, consisting of abdominal pain intensity, abdominal circumference, vomiting, frequency deification, bowel sounds and gastric residual volume, was measured at the baseline and every day for 5 days. Results: By the end of study, abdominal bloating decreased significantly in the study group compared to controls (P < 0.05). Conclusion: Given that even a slight reduction in symptoms can produce positive public health consequences, daily diet with FSs is recommended for critically ill patients.
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Comparative evaluation of the masticatory efficiency of complete dentures with bio-engineered teeth and conventional denture teeth using electromyography – A randomised crossover clinical study p. 139
Ninad N Bhatt, Ronak Patel, Jalak Patel, Tamanna Chhabra, Rajesh Sethuraman, Sarvesh Patel
DOI:10.4103/AIHB.AIHB_33_20  
Background and Objective: Resorption of residual ridge is common problem related to edentulous mandible. One of the main causes of resorption of denture-supporting structures is traumatic or excessive force transmitted through the prosthesis. The resilient-layer and occlusal-reactive dentures are clinical attempts developed for impact reduction and distribution of the masticatory load to the edentulous ridge. Bio-engineered posterior denture teeth which was used in this study have resilient silicone material lining which lead to cushioning effect and reduced the force transmitted to the basal bone. This study was done to assess and compare the masticatory efficiency of complete dentures with bio-engineered teeth and conventional denture teeth using electromyography (EMG) analysis. Methodology: The present study was conducted on 09 completely edentulous patients who reported to the department of prosthodontics and crown and bridge. Two Groups Were Made: Group A - conventional denture and Group B - denture with bio-engineered teeth. All the patients were randomly allotted to Group A or B using random allocation software, after 3 months EMG recording was done, and then, all the patients were provided another set of denture, other than the group in which they had allocated previously. EMG recording was done again after 3 months of providing the denture of other group. Results: Paired t-test showed no statistically significant difference in EMG reading of left masseter (P = 0.514), right masseter (P = 0.545), left temporalis (P = 0.954), and right temporalis (0.944) between both the groups. Conclusion: Both the dentures did not show any statistically significant difference in terms of EMG activity, which indicates that the masticatory efficiency of bio-engineered teeth denture is comparable to that of conventional denture.
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Cognitive impairment in patients with schizophrenia: A comparative study from western Rajasthan p. 144
Nikita Dhaka, Arpit Koolwal, Aditi Agarwal, Ankit Awasthi, Ghanshyam Das Koolwal
DOI:10.4103/AIHB.AIHB_47_20  
Introduction: Cognitive impairment is the core feature of schizophrenia (SCZ). The affected individuals exhibit wide-ranging deficits involving multiple domains of cognitive functioning. These deficits are associated with poor functional outcome and residual disability in patients. Substantial literature exists on cognition in SCZ; however, few studies have been carried out on this subject in India and in particular in Rajasthan. Objective: The objective was to evaluate cognitive functions in SCZ patients and to compare these with healthy controls. Materials and Methods: This cross-sectional study was conducted at the psychiatry department of a tertiary care institution on fifty schizophrenic patients and matched healthy controls who fulfilled the inclusion criteria. Diagnosis was made by DSM-V criteria, and symptom severity was determined by the Positive and Negative Symptom Scale. After seeking sociodemographic details, all participants were administered Postgraduate Institute Battery of Brain Dysfunction to assess their cognitive functioning. Data collected were subjected to suitable statistical analysis (mean, standard deviation and Chi-square test). Results: Majority of the schizophrenic patients (56%) were under 35 years of age, were males (70%), were from urban background (66%) and were married (70%). Schizophrenic patients performed poorly on all domains of cognitive functioning, including memory, performance and verbal intelligence and perceptuo-motor skills. Conclusion: The present study reiterated the previous findings of wide-spread, multidomain cognitive impairment in schizophrenic patients. The resultant cognitive profile has important implications for the aetiology and treatment of this major psychiatric disorder.
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Correlation of lactate dehydrogenase levels with outcome in patients with pre-eclampsia p. 149
Balgopal Singh Bhati, Nooren Mirza, Praveen Kumar Choudhary
DOI:10.4103/AIHB.AIHB_46_20  
Background: Pregnancy causes profound anatomical, physiological and metabolic changes in maternal tissues. Lactate dehydrogenase (LDH) is an intracellular enzyme. Hence, the present study was undertaken for assessing and correlating LDH levels with outcome in patients with preeclampsia. Materials and Methods: A total of 60 pregnant women with pre-eclampsia (PE) were included in the present study. Among these 60 patients, 30 patients were mild PE while the remaining 30 patients were of severe PE. Another set of 30 subjects of normotensive pregnancy were included as controlled group. Blood samples were obtained from all the subjects and were sent to laboratory where auto-analyser was used for the evaluation of serum LDH levels. Follow-up was done and outcome was recorded in all the patients. All the results were recorded into Microsoft excel sheet and were analysed by SPSS software. Results: Mean LDH levels amongst subjects of normotensive group, mild PE group and severe PE group was found to be 169.2 IU/L, 338.4 IU/L and 629.7 IU/L, respectively. Non-significant results were obtained while comparing the mean gestational age of the patients divided on the basis of mean LDH levels. Significant results were obtained while comparing the neonatal complications and neonatal mortality amongst patients divided on the basis of LDH levels. Conclusion: Significant alteration of LDH levels occurs in PE patients. In addition, higher levels of LDH levels are significantly associated with worse outcome in PE patients.
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Analytical study to determine the impact of jaundice in pregnancy on maternal and perinatal outcome p. 153
Richa Tiwari, Prachi Kushwaha, Archana Meravi
DOI:10.4103/AIHB.AIHB_63_20  
Background: Jaundice in pregnancy carries a grave prognosis for both the foetus and the mother, and is responsible for 12% of maternal deaths. Liver disease is a rare complication of pregnancy, but when it occurs it may do so in a dramatic and tragic fashion for both the mother and infant. Materials and Methods: Data were collected as prospective Hospital based observational study at tertiary care centre. After the preliminary assessment with regard to the inclusion and exclusion criteria, informed consent was obtained from all patients. Thorough history was taken and physical examination was done. Demographic details of each patient were obtained. Relative investigations were done. Results: Out of 300 patients, 287 were healthy and alive and 13 patients died. The maternal mortality was 4.33%. Out of the total 13 maternal deaths, 4 cases died due to hepatic encephalopathy, 3 due to disseminated-intravascular coagulation and 3 due to sepsis with multiorgan failure. Mortality was due to HELLP- Hemolysis Elevated Liver enzymes and Platelet count in two cases and due to acute fatty liver in one case. In 126 (42%) cases, the mode of delivery was lower segment caesarean section, 138 (46%) cases had normal vaginal delivery, while 36 (12%) cases had undergone abortion. A total of 114 (38%) cases delivered full-term live baby and 78 (26%) cases delivered preterm live baby. Full-term intrauterine foetal death (IUFD) was seen in 15 (5%) cases and preterm IUFD was seen in 69 cases (23%). There was neodeath in 24 (8%) babies. The total perinatal mortality was 36.0%. Conclusion: The present study shows that although liver dysfunction is infrequently seen in pregnancy, it can result in severe maternal and foetal compromise. Jaundice in pregnancy should be managed as a team with the collaboration of the department of obstetrics, internal medicine, gastroenterology, anaesthesia and critical care so that early diagnosis and aggressive management can prevent and reduce foeto–maternal morbidity and mortality.
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Analytical study to evaluate maternal morbidity and perinatal outcome among pregnant women with severe anaemia at tertiary care centre: A hospital-based study p. 158
Archana Meravi, Prachi Kushwaha, Indu Khare
DOI:10.4103/AIHB.AIHB_60_20  
Background: Anaemia during pregnancy is a global public health challenge facing the world today. It is estimated that around 2 billion people, 30% of the world population, are affected with the majority coming from the developing world.Aim: The present study was conducted to assess perinatal outcomes and associated morbidity factors among anaemic pregnant women.Materials and Methods: The present study was a hospital-based observational study that was conducted in the Department of Obstetrics and Gynaecology, Sultania Zanana Hospital, Gandhi Medical College, Bhopal, Madhya Pradesh, India and included all the pregnant women in the third trimester of pregnancy with haemoglobin level <7 who were admitted between January 2016 to December 2017.Results: A total of 500 cases were enrolled for the study. The present study revealed that anaemia was significantly associated with co-morbidities, 25.4% women had pre-eclampsia, 7.6% had jaundice, 3.6% had heart disease and 4.8% had the intercurrent infection. Out of 500 anaemic women 216 women had severe maternal morbidity this was found to be significant (P = 0.016), 59 women had eclampsia in their antenatal period, septicaemia was found in 63 women, 32 had a pulmonary embolism. In this study, maternal morbidity among anaemic pregnant women (ICD-10) were found to be significant in the puerperal period, among 500 study participants, 41 women had puerperal pyrexia. 319 (63.8%) delivered the baby with low birthweight, 144 (28.8%) had full-term delivery, 34 (6.8%) were stillborn and 03 (0.6%) patients were undelivered. There was a statistically significant difference found in fetal outcome according to the urban or rural locality (P = 0.001). Conclusion: Low education level, gravidity and inter-pregnancy intervals are the main risk factor. We recommend educational awareness programme to be conducted amongst pregnant women to improve their knowledge regarding the causes and prevention of anaemia for a better antenatal and perinatal outcome.
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A study to assess the periodontal status of eunuchs residing in Central Gujarat, India: A cross-sectional study p. 162
Pulkit Kalyan, Bhavna Dave, Neeraj Deshpande, Darpan Panchal
DOI:10.4103/AIHB.AIHB_52_20  
Introduction: The extent of periodontal tissue destruction can be assessed using pocket depth which also indicates the condition of the extent of the local inflammation. There are so many social stigmas associated with eunuchs community that these people do not come out in open and even if they come out in open, they often resort to various debilitating lifestyle habits that affect their general well-being and oral health in a negative sense. The objective of the present study is to assess the periodontal status among the eunuchs residing in Central Gujarat and to analyse the association between the periodontal status of eunuchs residing in Central Gujarat and various demographic variables. Methodology: The survey was conducted in Central Gujarat, and data were collected through primary source using the WHO Oral Health Assessment Form for Adults (2013) to assess the periodontal status and loss of attachment. Clinical examination was performed by using a plane mouth mirror and Community Periodontal Index Probe (WHO probe) (CPI) probe under adequate natural/artificial light. Results: Out of 384 eunuchs, the mean value of periodontal pocket depth among the eunuchs is 3.12 ± 0.89; clinical attachment loss is 2.88 ± 0.74. The difference in the periodontal pocket depth and clinical loss of attachment was statistically insignificant indicating that there is no difference in periodontal pocket depth and clinical loss of attachment across all the age groups and education status of eunuchs. Conclusion: The results of the current study showed poor periodontal status among eunuch population in Central Gujarat. The periodontal condition helps estimate the oral condition of this population. These estimates are important for the future planning of dental services among eunuch community.
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Correlation of inter-occlusal distance and gonial angle in dentate and edentulous patients in Gujarati population p. 166
Miloni Mayank Bhatt, Dipti Shah, Kalpesh Vaishnav, Pankaj Patel, Zeba Harsolia, Richa Dangi
DOI:10.4103/AIHB.AIHB_129_19  
Background: The amount of interocclusal distance in any individual is mainly an expression of muscle function, its equilibrium, and gravity. In some medically compromised patients, it is difficult to determine the interocclusal distance. Aim: This study aims to evaluate the correlation of interocclusal distance and corresponding gonial angle on the lateral profile of dentulous individuals in lateral cephalograms in Gujarati population and correlation of these values for edentulous individuals. Material and methods: A total of 100 individuals were involved in this study within age group of 20-35 years. Interocclusal distance was determined by the difference between the readings of vertical dimension of rest and vertical dimension of occlusion in dentulous individuals.Gonial angle was calculated with the help of cephalometric radiographs and the two were correlated. Results: Range of gonial angle and interocclusal distance were obtained and the mean of the values was derived. A strong correlation was found to exist.Conclusion: By applying the processes of linear regression to the paired results, a formula was obtained which may be used to predict the best value of one variable for any given value of the other. Thus, in an edentulous case, where the value of the interocclusal distance measurement is unknown and difficult to determine, a method is provided for predicting its best value by the determination of the patient's gonial angle through cephalometric analysis.
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A study of modified DECAF score in predicting hospital outcomes in patients of acute exacerbation of chronic obstructive pulmonary disease at SMS Medical College, Jaipur p. 171
Sushant Sharma, Kalim Khan, Gulab Singh Yadav, Suresh Koolwal
DOI:10.4103/AIHB.AIHB_35_20  
Background: The value of Modified DECAF Score as a clinical prediction tool that can accurately risk stratify all patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is needed to be assessed. Aim: The aim of this study is to evaluate the prognostic effect of the Modified DECAF score in predicting outcomes in AECOPD. Materials and Methods: A hospital-based descriptive type of observational study done on 160 patients admitted with AECOPD at the Institute of Respiratory Diseases, SMS Medical College, Jaipur. Modified DECAF score was calculated for each patient, and the individual parameters used in calculating the score were recorded. Modified DECAF score has five variables (baseline dyspnoea extended Medical Research Council Dyspnea Grade 5a or 5b, Eosinopenia (<50 cells/mm3), Consolidation, Acidemia (pH < 7.30), frequency of hospitalisations in last 1 year (2 or more), a maximum score of 6.Results: Patients could be stratified according to mortality rates observed with Modified DECAF scores into low risk (scores 0–2), intermediate risk (score 3) and high risk (scores 4–6) groups. Mortality was close to 70% in the high-risk group; it was about 7% in the intermediate risk group, whereas no deaths were recorded in the low-risk group. Conclusion: We concluded that the Modified DECAF score is sensitive and specific in predicting in-hospital mortality in AECOPD patients. Further research is required to quantify its impact on clinical practice, for example, in the identification of patients for palliative care or early supported discharge services or for escalation of therapy.
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Periodontal status of 33–44-year-old male bodybuilders and its relationship with protein supplement intake: An observational comparative study p. 176
Fawaz Pullishery, Abdulrahman Mohammed Dada, Mohammed Roshdy Aboelaza, Mohamed Abdelmegid Shalaby
DOI:10.4103/AIHB.AIHB_58_20  
Background: Periodontal disease is a highly prevalent oral disease that affects more than half of the global adult population. The role of protein supplements (PSs) in bodybuilding has been studied extensively, but there are no studies done that assessed periodontal health and its relationship of protein intake among bodybuilders. This study aims to assess the periodontal status in 35–44-year-old bodybuilders in the Kingdom of Saudi Arabia. Materials and Methods: A cross-sectional comparative study was conducted in the city of Jeddah among 35–44-year-old male bodybuilders and non-bodybuilders. Bodybuilders were identified and recruited from different fitness and gymnasium centres that satisfied the inclusion criteria. A pre-tested and validated questionnaire was used for collecting the information. Periodontal status was assessed using the Community Periodontal Index (CPI) and loss of attachment (LOA). Results: The CPI scores were comparatively lesser (11.34 ± 4.6) in bodybuilders than non-bodybuilders and it was statistically significant (P < 0.05). There were no significant differences in CPI scores between tobacco users and non-users among bodybuilders. The prevalence of periodontal pockets of 4–5 mm in non-body builders was 80.7% and in bodybuilders, it was 49.1% (odds ratio = 4.33 (1.865–10.085), P < 0.001). A positive correlation was observed between average PSs intake and periodontal pocket of 4–5 mm (r = 0.335, P < 0.05); frequency of PS intake and 4–5 mm pockets (r = 0.494, P < 0.001); duration of PS (r = 0.438, P < 0.001). Conclusion: The periodontal health was significantly better in bodybuilders despite the smoking status, and this cannot be only attributed to PS intake. There could be a relationship with protein intake, but there is a need for wider interventional studies in a prospective manner.
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Expression of apelin among the individuals of chronic periodontitis, with and without type ii diabetes mellitus: A study using enzyme-linked immunosorbent assay p. 182
Tanvi Hirani, Santosh Kumar, Viral Patel, Sagar Hirani, Irfan Mohammed, Deepak Shishoo
DOI:10.4103/AIHB.AIHB_84_20  
Background: This is the first study showing the co-relationship of apelin among chronic periodontitis (CP) and type 2 diabetes mellitus (T2DM). CP has an anti-inflammatory and anti-glycaemic role in our system. In the future, a localised therapeutic dose of apelin can be used to lower the severity of periodontal disease by reducing the inflammation. The objective of the present study is to investigate the levels of serum apelin from patients with CP, CP + T2DM, and healthy individuals. Materials and Methods: This study included 180 individuals that were equally divided into three groups. Group A consisted of healthy individuals, Group B with CP, and Group C with CP + T2DM. Probing pocket depth (PPD) and serum Apelin (AP) were measured. Serum apelin expression was determined using enzyme-linked immunosorbent assay. Statistical analysis was performed using SPSS software. Results: The highest apelin was in CP + T2DM group (24.0 ± 3.78 ng/dl) followed by CP (15.4 ± 2.01 ng/dl) and healthy individuals (7.6 ± 1.18 ng/dl). There was a significant increase in serum apelin (P ≤ 0.05) in Group C individuals. Similarly, PPD was significantly increased in individuals with CP + T2DM. Conclusion: Expression of significant apelin in patients with CP and T2DM suggests a possible role for these adipokines in inflammation and glucose level regulation. In the future, it may be used as a therapeutic agent in curing periodontitis.
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Efficacy of preemptive oral doses of acetaminophen and celecoxib for post-operative pain management after open-flap debridement: A randomised controlled study p. 188
Santosh Kumar, Pratik Kamlesh Sanghavi, Parth Narendra Patel, Palak Hitesh Sonvane, Para Rakesh Dave, Vani Udaybhai Gor, Irfan Mohammed
DOI:10.4103/AIHB.AIHB_83_20  
Background: Open-flap debridement therapy often leads to frequent pain postoperatively. It has been reported that open-flap debridement causes pain in 79% of patients. The preemptive approach focuses on preventing post-operative analgesic flare and blocking the occurrence of hyperalgesic states. This study aimed to compare the preemptive analgesia of oral celecoxib with oral acetaminophen after surgical open-flap debridement. Materials and Methods: A randomised, double-blinded, placebo-controlled research was conducted to study the patients presenting with an open-flap debridement under local anaesthesia. A total of forty patients were randomised to receive open-flap debridement, and either celecoxib or acetaminophen was prescribed. Visual analogue scale (VAS) pain score was noted every 2, 4, 6, 8, 10 12 and 20 h post-surgery. Consumption of analgesics was also recorded postoperatively. Results: The average age and weight of the patients in the celecoxib group were 35.85 ± 8.32 and 54.75 ± 8.90 kg, respectively. The average age and weight of the patients in the acetaminophen group were 36.8 ± 8.71 and 53.15 ± 9.90 kg, respectively. The mean VAS pain score at 4 h was 2.6 ± 1.14 and 4.9 ± 1.20 for celecoxib and acetaminophen groups, respectively. The mean post-operative analgesic drug consumption in the celecoxib group was 0.60 ± 0.87 and 1.30 ± 0.80 in the acetaminophen group. Conclusion: Celecoxib shows a significant preemptive analgesic effect, thereby reducing the use of post-surgical analgesics after open-flap debridement. Hence, pre-surgical single dose of celecoxib can be used to minimise the post-operative analgesic use.
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CASE REPORT Top

Early childhood tooth bud removal practice (“Ibyinyo”): preventable dental damage p. 193
Nsabimana Evariste, Muhire Valens, Uwayezu Donat, Eleana Stoufi, Mohammed S Razzaque
DOI:10.4103/AIHB.AIHB_25_20  
Tooth bud removal called Ibyinyo is the practice of removing the developing tooth buds, usually done on an infant, typically performed by traditional healers who believe that this practice will reduce fever and diarrhoea in children. This practice is most prevalent in East-African countries, including Rwanda. These procedures are mostly performed in non-sterile conditions using basic sharp instruments. We will discuss the case of a 10-year-old female patient who was presented at the dental clinic, with two malformed permanent canine teeth. Clinical examination revealed malformed enamel and elongated permanent right maxillary canine tooth left mandibular canine tooth with crown malformation. She was also presented with retained (primary) left maxillary lateral incisor tooth and missing left maxillary canine tooth. In addition, the ectopic eruption of left maxillary central incisor tooth and missing permanent right mandibular canine tooth were noted. All these complications resulted from tooth bud removal that the patient had experienced in her early childhood. Her malformed right maxillary and left lower mandibular canine teeth were reshaped, using composite filling materials, to improve her appearance aesthetically. Ibyinyo is preventable damage, done out of ignorance and superstitious practices that can be stopped by growing social awareness. Therefore, educating parents through community-based campaigns on the detrimental consequences of early childhood tooth bud removal through Ibyinyo practice might be helpful to eradicate this harmful and unnecessary practice.
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LETTER TO EDITOR Top

Periodontal connections to the coronavirus disease 2019: An unexplored novel path? p. 197
Muhammad Saad Shaikh, Mohid Abrar Lone, Russell Kabir, Ehsanul Hoque Apu
DOI:10.4103/AIHB.AIHB_72_20  
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