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   Table of Contents - Current issue
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January-March 2023
Volume 13 | Issue 1
Page Nos. 1-158

Online since Friday, January 6, 2023

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EDITORIAL  

Childhood tuberculosis - An emerging health challenge for Bangladesh Highly accessed article p. 1
Kona Chowdhury, Mainul Haque
DOI:10.4103/aihb.aihb_171_22  
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REVIEW ARTICLES Top

The beginning of a new era: Artificial intelligence in oral pathology Highly accessed article p. 4
C Nandini, Shaik Basha, Aarchi Agarawal, R Parikh Neelampari, Krishna P Miyapuram, R Jadeja Nileshwariba
DOI:10.4103/aihb.aihb_137_21  
Intelligence is one of the vital qualities of the human brain, and it has been sometimes defined as the capacity to learn and understand new things, the ability to apply knowledge to manipulate one's environment or to think abstractly. When a machine is trained to learn and perform tasks in such a humanoid manner, it is referred to as the 'Artificial intelligence (AI)'. AI is likely to transform the way we live and work. The exponential growth of knowledge in the field of AI and its branches in the past decade has created new opportunities for its utilisation in the field of healthcare, including pathology. Successful application of these powerful tools in pathology and medicine requires cross-disciplinary literacy, including basic knowledge and understanding of concepts that have traditionally been unfamiliar to pathologists. This review provides definitions and basic knowledge of AI and its component branches such as machine learning, artificial neural networks and deep learning. This review also throws light on the possible applications of AI and the associated challenges in mainstream oral pathological research and diagnosis.
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An evidence-based review on host modulatory agents in treatment of peri-implant disease p. 10
Mudra Andharia, Jasuma Rai, Monali Shah, Priyanka Sonavane
DOI:10.4103/aihb.aihb_153_21  
Antimicrobials have traditionally been the only chemotherapeutic option for treating periodontitis and peri-implant disorders. With a growing understanding of the host–pathogen interactions in periodontal pathogenesis, novel therapeutic options for periodontitis and peri-implant disorders are developed by focusing on the host response with host-modulating drugs. When employed as host-modifying agents, a variety of sub-antimicrobial dose doxycycline (SDD), bisphosphonates and non-steroidal anti-inflammatory drugs were found to be successful in both experimental animal research and human trials. The current state and future prospects of host modulatory agents used to treat peri-implant disease are discussed in this evidence-based review.
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A mini-review of pathological voice recognition Highly accessed article p. 17
Mohammad Ali Saghiri, Chun Kai Tang, Ali Mohammad Saghiri, Elham Samadi
DOI:10.4103/aihb.aihb_151_22  
The aim of this review is to examine various pathological conditions that impact the voice and how these features can be used in their diagnosis. An electronic search of PubMed and Google Scholar was performed for the articles published between January 2000 and July 2022 using the keywords found in the Medical Subject Headings database along with PubMed regarding diseases affecting voice. Our preliminary search result identified 608 articles using the keywords mentioned below. Among those, 12 articles met the inclusion criteria set for this review. Voice analysis can prove to be the missing link in the study and early detection of diseases. Using multiple voice attributes to cross-reference and diagnose conditions has excellent potential to fasten the process and significantly improve the diagnosis and treatment of various diseases.
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ORIGINAL ARTICLES Top

Distribution of alveolar bone defects associated with periodontitis: A demographic study p. 23
Shivani V Sachdeva, Amit Mani, Mangesh B Phadnaik, Harish Saluja
DOI:10.4103/aihb.aihb_96_21  
Introduction: Periodontal disease is one of the most widespread diseases of humankind. It is a chronic destructive infectious disease that involves the resorption of bone supporting the teeth. The purpose of this study was to analyse the prevalence and distribution of different forms of bone defects amongst different demographics in the Indian population. Materials and Methods: The study population comprised 44 patients of different age groups with moderate and severe periodontitis chronic periodontitis. A total sample of 1041 teeth were explored surgically and classified into suprabony, infrabony, inter-radicular and other bone defects. This study focuses on the differences in the distribution of various bone defects between different groups of age and gender. Results: Amongst 1041 teeth, the prevalence of bone defects was 97%. Craters and intrabony defects were almost equal for the age groups of 31–40 years and 41–50 years. However, in the age group of 51–60 years, craters comprised 33.3%, and intrabony defects comprised 66.7%. Males had two times more 3-wall defects than females. Conclusion: The present study reveals that there is a need for applying epidemiological principles to periodontal bone defects in order to better understand the natural history of periodontal disease and eradicate the factors responsible for their commencement and progression. The following research article has been presented at the 2nd international congress of the World Academy of Growth Factors and Stem Cells in Dentistry 25–27 October 2018.
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Subjective assessment of bonded fixed lingual retainers: A questionnaire survey p. 30
Narayan B Kulkarni, Vinaykumar D Shah
DOI:10.4103/aihb.aihb_122_21  
Aims: This study aimed to assess the patients' subjective assessment of bonded fixed lingual retainers after completion of active orthodontic treatment. Objective: A questionnaire comprising 11 questions evaluated the patients' experience with bonded fixed lingual retainer. Materials and Methods: The content was validated by a group of seven experienced orthodontists. The questionnaire survey was run using Google Forms, responded by 45 (50.6%) males and 44 (49.4%) females between the ages ranging from 19 to 42 years. Their responses were rated on a Visual Analogue Scale as applicable. Cronbach's alpha test was utilised for assessing the reliability, and the Chi-square test was used for the quantitative variables. Results: 33.7% of individuals were most comfortable, and 2.2% had severe discomfort during retainer placement. 6.6% of individuals had severe difficulty maintaining oral hygiene in the upper arch and 4.4% in lower teeth and gums, respectively. 2.2% had severe difficulty in speech. 85.4% had no tongue ulceration. 37.1% of respondents had a very good overall experience with fixed bonded lingual retainer, 59.5% had mild problems and only 1.1% had severe problems with a very bad experience. Conclusions: The study concluded that the overall experience of respondents with fixed lingual bonded retainer had mild problems. It was comfortable for most of the patients in maintaining oral hygiene with mild difficulty in speech and chewing. The cause of failure of the retainer was mainly due to bond failure or broken wire in the retainer.
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Mental foramen morphometrics on cone-beam computed tomography determines sexual dimorphism p. 36
Satarupa Chanda, Reema Manoj, Vasavi Santosh, Arvind Shetty, Mandavi Waghmare, Hemant Bhutani
DOI:10.4103/aihb.aihb_168_21  
Introduction: Identification of humans during a lifetime, as well as acknowledgment even after death, is an inalienable right and forms the core of human dignity. A pivotal step in the identification of human remains is sex determination, as age and stature discernment depends on it. Determination of sex from unknown skeletal remains is extremely challenging, especially when fragmented bony remains are available. Among the various morphological landmarks of the mandible, the mental foramen is considered to be one of the most stable that can be used in sex authentication. Hence, it was used to identify a sexual dimorphism in a mixed Indian population in the present study. Materials and Methods: Two-hundred cone-beam computed tomography (CBCT) scans were selected from the archival database and analysed for the present study using morphometric features of the mental foramen i.e., the measurement of: The distance from the superior border of the mental foramen to the inferior border of the mandible (SLM), The distance from the inferior border of the mental foramen to the inferior border of the mandible (ILM) and the distance from the superior border of the mental foramen to the inferior border of the mental foramen (VD). Results: Females showed a caudal positioning of mental foramen toward the base of the mandible as compared to males. A statistically significant difference was noted in the dimensions of SLM, ILM and VD, with all the three distances being larger in males when compared to females. Logistic regression analysis showed an overall significance of P < 0.0001 and a prediction score of 89%. Conclusion: Mental foramen morphometrics on CBCT enables sex determination in the Indian population with a predictive score of 89%.
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Decision-making in septal deviations: Septoplasty for anterior septal deviations and submucosal resection for posterior deviations: Is it a practical method? p. 42
Rathod Sunil Kumar, Harish Swamy Dharmagadda, Kathyayani Burugula
DOI:10.4103/aihb.aihb_178_21  
Introduction: Classification of septal deviations is varied, but their application in selecting the type of septal surgery is not decisive. Classifying the septal deviations and using it to decide the choice of surgery was reviewed. The aim of the study is to review the use of classification of septal deviations into anterior and posterior to select septoplasty and submucosal resection (SMR), respectively. Materials and Methods: Thirty-four patients with anterior deviated nasal septum were grouped as Group A. Another 34 patients with posterior septal deviation were grouped as Group B. In Group A, patients were aged between 18 years and 47 years with a mean age of 34.28 ± 2.30 years. In Group B, they were aged between 19 and 48 years, with a mean age of 35.25 ± 3.05 years. The male-to-female ratio of the total 68 patients was 1.4:1. Nasal obstruction symptom evaluation (NOSE) score Grade 4 and 5 was noted in 31 (45.48%) patients in Group A and 33 (48.52%) patients in Group B. Right side deviation was noted in 15 (22.05%) of the Group A patients and 20 (29.41%) of the Group B patients. Results: All patients with anterior deviation were subjected to septoplasty, and patients with posterior deviation were subjected to classical SMR surgery. The results were assessed and analysed using the response of recovery in the nasal obstruction NOSE score and the two groups were correlated using Pearson's Correlation coefficient calculator. The R score was 0.9942, and the P value was 0.0001 (P taken as significant at < 0.05). Conclusion: It was observed by the results that deciding the type of surgery as per the direct nasal endoscopy findings whether it was anterior or posterior deviation was easy, practical, and definite final outcome results could be expected at the end.
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The clinical manifestations and outcomes in neonates infected with COVID-19 in the West of Iran p. 48
Fatemeh Eghbalian, Ensiyeh Jenabi, Saeid Bashirian, Salman Khazaei, Maryam Shokouhi, Behnaz Basiri, Mohammad Kazem Sabzehei, Shobo Sheikhahmadi, Homa Babaei, Mazyar Vakiliamini, Nahid Jafari, Maryam Jafari
DOI:10.4103/aihb.aihb_4_22  
Introduction: So far, no study has been conducted in Iran on the effect of COVID-19 on neonates. Therefore, the present cross-sectional study has been evaluated to determine the clinical manifestations and outcomes in neonates infected with COVID-19 in the west of Iran. Materials and Methods: The present cross-sectional study was conducted among neonates infected with COVID-19 in six provinces of Hamadan, Kermanshah, Kurdistan, Ilam, Zanjan and Lorestan, located in the west of Iran, from 1 March to 1 July 2020. In these neonates, the polymerase chain reaction test was positive. The data were collected by a checklist and were analysed using SPSS Statistics Software. Result: During the study period, 16 neonates infected with COVID-19 were identified including Kurdistan Province with five cases, Hamadan Province four cases, Kermanshah with three cases, and Lorestan and Zanjan provinces with two cases. Neonate gender of them had equal distribution. Two (15.38%) of them needed CPR after delivery. The delivery method for 9 (56.25%) was vaginal, and one of them died during the study period. The medical care used for these neonates was as follows: 87.5% were hospitalized in the intensive care unit and antibiotics were used for 68.75%. 12.5% underwent COVID-19-specific treatment, and for 25%, a ventilator was used. The laboratory findings in neonates infected with COVID-19 showed that in 18.75%, blood urea nitrogen has increased. 46.15% of neonates reported lymphocytopenia. The blood haematocrit and haemoglobin decreased by 31.35% and 56.25%, respectively. Conclusion: The coronavirus disease 2019 has occurred among neonates, but they seemed to have a milder disease course and better prognosis than adults. Findings showed that there is a possibility of vertical intrauterine transmission from pregnant mothers to newborns.
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To evaluate and compare the microtensile bond strength of dentine with the use of two-step and one-step adhesives: An ex vivo study p. 53
Niharika Patel, Aruna Kanaparthy, Rosaiah Kanaparthy
DOI:10.4103/aihb.aihb_10_22  
Introduction: In the evolving world of adhesive dentistry, there has always been controversy regarding the adhesive system to be used for superior clinical performance, and clinicians often find themselves in a dilemma with so many products on the market. It, therefore, becomes necessary to know the various properties of different adhesive systems and their comparative analysis. Materials and Methods: Thirty, intact, non-carious and unrestored human mandibular premolars, which were extracted for orthodontic purposes were taken for the study. Teeth were divided into two groups A and B having 15 teeth in each group. The inclusion criteria were that the teeth should be non-carious, unrestored and should have been extracted for orthodontic purposes. Excluded teeth were those with caries, restorations, attrition, cracks and developmental defects. The teeth were embedded in resin, occlusal enamel was removed and the teeth were restored with composite resin using two different approaches for bonding. Teeth of Group A were bonded using single bond and teeth of Group B were bonded using Clearfil S3 Bond and were then sectioned to produce beams with an approximate cross-sectional area of 4 mm × 4 mm. These sections were mounted to a custom acrylic jig and subjected to microtensile bond strength testing using a universal testing machine with a cross head speed of 1 mm/min and stressed to de-bonding of the composite resin from the tooth. Results: Data were subjected to statistical analysis and evaluated using the analysis of variance test and Tukey's test which showed that single bond or two-step adhesive showed higher microtensile bond strength to dentine. Conclusion: The two-step single bond performed better than the one-step Clearfil S3, but the result was statistically non-significant.
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Deep learning approach to detect high-risk oral epithelial dysplasia: A step towards computer-assisted dysplasia grading p. 57
C Nandini, Shaik Basha, Aarchi Agarawal, R Parikh Neelampari, Krishna P Miyapuram, R Jadeja Nileshwariba
DOI:10.4103/aihb.aihb_30_22  
Introduction: Oral epithelial dysplasia (OED) is associated with high interobserver and intraobserver disagreement. With the exponential increase in the applicability of artificial intelligence tools such as deep learning (DL) in pathology, it would now be possible to achieve high accuracy and objectivity in grading of OED. In this research work, we have proposed a DL approach to epithelial dysplasia grading by creating a convolutional neural network (CNN) model from scratch. Materials and Methods: The dataset includes 445 high-resolution ×400 photomicrographs captured from histopathologically diagnosed cases of high-risk dysplasia (HR) and normal buccal mucosa (NBM) that were used to train, validate and test the two-dimensional CNN (2DCNN) model. Results: The whole dataset was divided into 60% training set, 20% validation set and 20% test set. The model achieved training accuracy of 97.21%, validation accuracy of 90% and test accuracy of 91.30%. Conclusion: The DL model was able to distinguish between normal epithelium and HR epithelial dysplasia with high grades of accuracy. These results are encouraging for researchers to formulate DL models to grade and classify OED using various grading systems.
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Clinical evaluation and parental and child satisfaction with restoration of primary teeth using zirconia and stainless steel crowns: A randomised clinical study p. 61
Rohan Bhatt, Dipti Shah, Megha Patel, Srushti Khurana
DOI:10.4103/aihb.aihb_43_22  
Introduction: Full-coronal restoration is the choice of treatment for restoring pulpally treated tooth or tooth with multiple surface involvement. In paediatric dentistry, semi-permanent stainless steel crowns (SSCs) are considered gold standard, but with increasing need of aesthetics, zirconia crowns have started gaining importance. Hence, this study was conducted to evaluate the clinical performance of SSCs and zirconia crowns and to compare the child satisfaction and parental ratings of impact of treatment using these preformed crowns. Materials and Methodology: This study was a part of randomised controlled trial performed on 60 children of 4–8 years old. The primary molars were cemented with either SSCs or zirconia crowns and were evaluated clinically at baseline, 6-month and 12-month follow-up for crown retention, crown fracture, gingival and debris index, wear, marginal integrity and recurrent caries. The trials also evaluated parental satisfaction and child satisfaction based on five-point Likert scale at the end of 12-month follow-up. The data were analysed using Chi-square test for categorical data and independent sample t-test for quantitative data. Results: Both the crowns were 100% retentive at 12-month follow-up. Fair debris score and mild gingivitis were reported in 3% with SSC at 6–12 months. One zirconia crown fractured at 12 months. Fifty-four per cent of parents in zirconia and 57% in SSC stated that the crowns improved masticatory function. Children reported a mean Likert score of 3.0 for SSC and 4.89 for zirconia which was highly significant. Conclusion: Both the crowns increased the overall health of crowned tooth and were fully retentive for the studied duration. However, zirconia crowns were more gingival friendly and had an edge over SSC in terms of aesthetics.
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A correlational study on neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in bronchial asthma p. 68
Rabia Tahseen, Mohammad Parvez, G Sravan Kumar, Parveen Jahan
DOI:10.4103/aihb.aihb_44_22  
Introduction: Inflammation is an integral component of bronchial asthma associated with hyperresponsiveness and chest tightness. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been proven as independent inflammatory markers in various conditions. This study is an effort to evaluate the correlation between these two markers in asthma. Materials and Method: With the approval of the Ethical Committee, Osmania Medical College, Hyderabad, 194 subjects were enrolled for the current study. Out of which, 122 were proven asthmatics diagnosed by pulmonologist and 72 non-asthmatic healthy volunteers. Blood samples were collected from all the individuals and subjected to complete blood count. NLR and PLR were calculated and analysed for each study group. The continuous data were expressed as mean ± standard deviation and Student's t-test. The correlation analysis was performed between the various groups. Results: A statistically significant difference was noted with respect to NLR and PLR between asthma patients and non-asthmatic healthy controls (P = 0.0001). NLR alone varied significantly between responders (mild asthmatics) and poor responders (moderate asthmatics) of the patient group. Further, a positive correlation was noted between NLR and PLR in all the categories, with the highest value in the poor responders. The results are indicative of strong interdependency of NLR and PLR in a condition with higher inflammation. Conclusion: Future studies are warranted to explore this relation in understanding the disease severity/drug response to monitor or to identify the better drug target.
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Comparison of the effects of midazolam, dexamethasone, ondansetron and propofol on the prevention and control of opioid-induced pruritus after spinal anaesthesia with bupivacaine combined with fentanyl in femoral fracture surgery p. 73
Hesameddin Modir, Esmail Moshiri, Mehran Azami, Amirreza Modir
DOI:10.4103/aihb.aihb_45_22  
Introduction: The present study set out to compare the effects of midazolam, dexamethasone, ondansetron and propofol on the prevention and control of opioid-induced pruritus after spinal anaesthesia with bupivacaine and fentanyl as adjuvants in femoral fracture surgery. Materials and Methods: This double-blind clinical trial study was conducted on 136 patients who were scheduled for orthopaedic surgery in Valiasr Hospital of Arak. The patients were randomly divided into four groups (ondansetron, midazolam, dexamethasone and propofol) with a block randomisation pattern. Blood pressure, heart rate, oxygen saturation, the incidence of pruritus, nausea, vomiting and sedation level were monitored and recorded intraoperatively and postoperatively in recovery and every 2 h until 12 h postoperatively. Data were then analysed with SPSS 20. Results: From 10 min to 60 min, blood pressure was lower in the midazolam group, while it was lower in the propofol group from 60 min to 105 min. In general, blood pressure in the midazolam group was lower than that in the other groups (P = 0.001). Furthermore, pruritus was observed less in the midazolam group than in the other groups (P < 0.05). Sedation level was higher in the midazolam group than in the other groups (P < 0.05). Conclusion: Midazolam reduced pruritus and increased sedation in patients. On the other hand, a decrease in blood pressure was observed in the midazolam group, which did not require any special treatment. According to the results of the present study, after midazolam, propofol and dexamethasone, and finally ondansetron, respectively, were effective in controlling pruritus after spinal anaesthesia, but the efficacy and effectiveness of midazolam were higher than that in the other groups. As such, this drug is recommended to be used in such procedures. Of course, it should be mentioned that the final decision depends on the patients' physical conditions and the anaesthesiologist's discretion.
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A novel convolutional neural network–Fuzzy-based diagnosis in the classification of dental pulpitis p. 79
Rahulsinh Bhupendrasinh Chauhan, Tejas V Shah, Deepali H Shah, Tulsi Jaduvirsinh Gohil
DOI:10.4103/aihb.aihb_50_22  
Introduction: This study presents a computer-aided decision-making system based on the convolutional neural network (CNN)–fuzzy approach. According to the literature, there is a lack of coherence amongst dentists in diagnosing reversible or irreversible pulpitis. As a result, the goal of this research is to assist dentists in accurately diagnosing pulpitis. Materials and Methods: A rigorous algorithm that relies on CNN-fuzzy logic has been designed to handle inaccurate and ambiguous values of dental radiographs, as well as signs and symptoms of pulpitis. To begin, the probability of cavity for each class was determined using an independently designed CNN approach, which was then applied in combination with symptoms associated with pulpitis to a fuzzy knowledge base with 665 rules and the Mamdani inference algorithm to diagnose pulpitis and make recommendations to the dentist. Results: The CNN-fuzzy approach's results are compared to the dentists' recommendations. With the assistance of five professional dentists, the sensitivity, specificity, precision, accuracy, f1 score and Matthews correlation coefficient are calculated from 100 randomly generated sample cases. The CNN-fuzzy approach has a 94% accuracy, which is 7% higher than expert prediction. It is observed that the proposed approach produces results that are consistent with the dentists' diagnoses. Conclusion: The accuracy of the proposed computer-aided decision-making system for pulpitis increases dentists' confidence in diagnosing reversible and irreversible pulpitis and reduces false diagnoses due to ambiguous values of dental radiographs, signs and symptoms.
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Comparing the bleeding control effect of labetalol, remifentanil and dexmedetomidine during craniotomy; A randomised clinical trial p. 87
Mahdi Nikoohemmat, Hesameddin Modir, Esmail Moshiri, Aidin Shakeri
DOI:10.4103/aihb.aihb_61_22  
Introduction: Blood loss management in craniotomy is essential for a patient's haemodynamic stability and a significantly better view of the surgical site. The study aimed to address the comparative efficacy of labetalol (LAB), remifentanil (REM) and dexmedetomidine (DXM) on the bleeding control during the craniotomy procedure. Materials and Methods: In a double-blind trial, ninety patients eligible for undergoing craniotomy were recruited and assigned to DXM, LAB and REM groups by the block-randomised method. The vital signs, including heart rate (HR), mean arterial pressure, and oxygen saturation (SaO2) after induction and during the hypotension phase every 15 min until the end of surgery and at recovery and certain time points (2, 4 and 6 h post-operative), were recorded. The amount of bleeding, surgeon satisfaction and dose of propofol used, side effects and haemoglobin level before and 12 h after surgery were registered. Data analysis was conducted using the SPSS software by one-way analysis of variance, repeated measurement test and Chi-square test at a significance level of 0.05. Results: No significant difference was found in vital signs, including SaO2, blood pressure, HR, duration of surgery, extubation time and the amount of propofol consumed, side effects and haemoglobin level (P > 0.05). Nevertheless, the DXM group showed a prolonged recovery time (P = 0.018), less bleeding (P = 0.001) and the highest surgeon satisfaction (P = 0.001) when compared with other groups. Conclusion: Our results showed that DXM helps increase surgeon satisfaction and reduce bleeding while increasing the recovery time. Overall, it does, however, have improved performance without any side effects, based on which DXM can hence be recommended to be used to control bleeding during craniotomy.
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Assessment of total and soluble fluoride content in commercial dentifrices and mouthwashes available in the Indian market: An in vitro study p. 92
Akanksha Haresh Keswani, Parthkumar Kamleshbhai Thakkar, Anuj Vasantray Mansata, Jill J Shah, Anil Manubhai Patel, Kena Kalpesh Shah
DOI:10.4103/aihb.aihb_63_22  
Introduction: Dental caries is the most common dental problem across the globe. Due to the increase in the use of refined sugars and lack of fluoride exposure, dental caries is becoming a serious issue for public health. The present study was conducted to determine the total fluoride (TF) concentration and soluble fluoride concentration in different dentifrices and mouthwashes available in the Indian market. Materials and Methods: Ion-specific electrode and fluoride ion metre were used to determine the soluble fluoride, as well as the TF concentration of seven dentifrices and five mouthwashes, and the findings were recorded in particle per million of fluoride. Descriptive statistic was used, and mean ± standard deviation of TF and soluble fluoride content of dentifrices and mouthwashes were reported. Results: Nine samples contained sodium fluoride and three samples contained sodium monofluorophosphate Na MFP as the fluoride compound. The TF and soluble fluoride levels showed variations from the fluoride concentration mentioned on the packaging. Conclusions: This study found that the concentration of total soluble fluoride and TF was lower than the fluoride level mentioned on the packaging.
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Effect of COVID-19 on patients health-seeking behaviour in Zulfi City p. 96
Bader Almehmadi, Thamer Mohammed Althewaikh, Abdulwahab Abdulaziz ALhussain, Abdulaziz Hamoud Bin Saqyan, Majed Fahad Alosaimi, Bandar Alhayden, Khalid Eltohami Medani, Waqas Sami
DOI:10.4103/aihb.aihb_67_22  
Introduction: During the ongoing COVID-19 pandemic, all perspectives of life were affected by the situation, and as a result, all health services worldwide were overwhelmed, which led to the exhaustion of hospital beds and intensive care units, workforce and resources. This research was done to determine the health-seeking behaviour during the COVID pandemic COVID-19 in the Al Zulfi area and its relation to the monthly number of patient visits to primary health centre before and after the pandemic and the roles and regulations for health-care services. Materials and Methods: This was an observational, cross-sectional study to study the effect of the COVID-19 pandemic on patients' health-seeking behaviour in Zulfi city. Results: Results were obtained from 567 participants; the finding was a decline in the number of patients visiting the health facilities by 65.6% compared in 2019. There were more declines in males than in females (18.5% vs. 15.9%, respectively). Conclusion: Despite the strong impact of COVID-19 on healthcare, the Kingdom of Saudi Arabia is one of the strongest countries in facing this pandemic, providing the best care, educating society and minimizing losses. Under these circumstances, patients' visits to health centres in Zulfi decreased, complications appeared for some patients who rescheduled their appointments, healthcare became electronic, and the patients were satisfied with those services.
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Evaluation of gene-xpert in paediatric tuberculous meningitis cases: A hospital-based study p. 100
Sweta Muni, Anand Kumar Gupta, Deepak Pankaj, Rakesh Kumar, Shailesh Kumar, Namrata Kumari
DOI:10.4103/aihb.aihb_69_22  
Introduction: Tuberculous meningitis (TBM) is the infection of Mycobacterium tuberculosis (MTB) among extra-pulmonary organs. The diagnosis of TBM can be considered a double sword in low-resource settings. On one side, there is poor access to health-care services, limited diagnostic capacity, and poor affordability. These factors hamper early treatment initiation while in high-resource settings, clinical suspicion towards TBM is considered minimal, and this lack of recognition many times leads to treatment delay. Xpert MTB/RIF test has come up as the diagnostic rescue with overall sensitivities exceeding 80% and specificity up to 100%. Materials and Methods: An observational study was done on 368 children up to 14 years of either gender with suspected TBM in 18 months. This whole duration was consumed in the planning of the study, obtaining ethical clearance, data collection, data analysis and report writing. Cerebrospinal fluid was collected by lumbar puncture. Samples from all patients underwent testing based on GeneXpert, Ziehl–Neelsen (ZN) stain and mycobacteria growth indicator tube (MGIT) culture. IBM Statistical Package for the Social Sciences (SPSS version 22) was used for data analysis. Results: A total of 321 patients were included in the analysis. The male-to-female ratio was 1.55, thus showing a male preponderance. The majority belonged to Hinduism. The median age was 7.5 years. Based on clinical assessment and radiology, 48 patients were diagnosed with confirmed and probable TBM. Overall, the sensitivity of Gene Xpert, ZN smear and MGIT was 68.75%, 4.2% and 75.0%, respectively. Rifampicin sensitivity of the isolated organism was reported, and it was found that 18 out of 33 patients, implying 54.5% of patients were resistant to rifampicin. Conclusion: Till today, TBM poses a life-threatening situation despite advances made in the diagnosis have been achieved. In this context, Gene Xpert represents a step forward.
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Efficacy of lopinavir/ritonavir plus interferon beta compared to hydroxychloroquine in the treatment of COVID-19: A retrospective observational study p. 107
Motahareh Amirizadeh, Fatemeh Shafie Sarvestani, Farid Khorrami, Omid Safa, Parivash Davoodian, Mehdi Hassaniazad, Boshra Akhlaghi, Mohammad Fathalipour
DOI:10.4103/aihb.aihb_70_22  
Introduction: Although a long time past since COVID-19 was broken out, it is hard to determine which pharmacological combination regimen is more efficacious. The present study aimed to evaluate the efficacy of lopinavir/ritonavir (LPV/r) plus interferon (IFN) beta-1a regimen compared to the hydroxychloroquine (HCQ) regimen in moderately ill patients with COVID-19. Methods: A multiple-centre retrospective observational case-controlled study was performed between March and September 2020, including adults with confirmed COVID-19. The patients were categorised into age- and sex-matched two groups; LPV/r plus IFN beta-1a (n = 102) and HCQ (n = 298) regimens. Clinical outcomes and mortality rates were compared between the groups. Results: LPV/r plus interferon (INF) beta-1a regimen had improved none of the clinical outcomes and mortality rate compared to the HCQ regimen. The length of stay (LOS) in the hospital and the need for oxygen therapy were slightly worse in the LPV/r plus INF beta-1a regimen (4.73 ± 2.93 days, 63%) than in the HCQ group (3.74 ± 3.30 days, 48.3%). No statistically significant difference was observed between the two groups in care of intensive care unit (ICU) admission, LOS in ICU, the need for non-invasive ventilation and the need for invasive mechanical ventilation as well as in-hospital mortality rate. Conclusions: LPV/r plus IFN beta-1a regimen did not show any meaningful improvement in clinical outcomes or mortality compared to the HCQ regimen. Larger randomised controlled trials are needed to assess the efficacy of this combination further.
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Frozen Shoulder in Patients with COVID-19 p. 113
Homa Naderifar, Salman Khazaei, Hossein Saremi
DOI:10.4103/aihb.aihb_77_22  
Introduction: Because COVID-19 with extrapulmonary manifestations is likely to lead to the development of musculoskeletal disorders in susceptible individuals due to immunological mechanisms, it is possible to see more frozen shoulder cases during the COVID-19 pandemic. Therefore, this study was performed to evaluate the relationship of frozen shoulder and COVID-19. Materials and Methods: This study was a cross-sectional study from September 2020 to February 2021; patients who were referred to our shoulder clinic with stiffness and shoulder pain and diagnosed with adhesive capsulitis (AC) were evaluated for COVID-19 involvement. Shoulder range of motion was assessed as passive range of motion of forwarding flexion, internal rotation and external rotation in the arm at the side and 90° abduction. The visual analogue scale was also used to assess pain intensity. SPSS software was used for analysis, and Chi-square test was used for qualitative data analysis and a t-test was used for quantitative data. Results: Seventy-two patients with frozen shoulders were included in the study; the results showed that AC occurs at a younger age in patients with COVID-19 infection (P < 0.039); the mean age of all patients was 52.73 ± 8.68. The severity of pain was higher in patients with COVID-19 (P = 0.012). Furthermore, regarding the duration of referral in terms of months, it was shown that people with COVID-19 were referred in a shorter period after the onset of shoulder symptoms and there was a significant difference in terms of referral time and pain between the two groups (P < 0.01). Regular activity had a lower rate in patients with COVID-19 infection and the difference was significant in patients with and without COVID-19 (P < 0.029). Conclusion: Due to younger age, greater pain and faster visit of patients with a frozen shoulder after COVID-19, it is recommended to look for frozen shoulder in all COVID-19-infected patients by a complete clinical examination. This is more important in patients without regular physical activity.
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The association between body mass index and lifestyle with academic performance of college of medicine students, Majmaah University, Saudi Arabia p. 118
Elsadig Yousif Mohamed, Waqas Sami, Abdalah Emad Almhmd, Sultan Homdi K Alenazy, Abdulrahman Ghayeb Alrashidi, Bassam Mashhi Aldhafeeri, Abdulaziz Nasser Binmuhareb
DOI:10.4103/aihb.aihb_79_22  
Introduction: Obesity rates have risen rapidly in both industrialised and developing countries, across all age groups and genders. The researchers wanted to see if there was a link between body mass index (BMI) and lifestyle and academic performance among College of Medicine students at Majmaah University in Saudi Arabia. Materials and Methods: Male and female students studying at college of medicine who were registered for the academic year 2020–2021 studying in levels 2–6 were included in this cross-sectional study. A total of 269 participants were chosen as part of the sample. A pretested questionnaire was used to collect the information. Results: Males made up more than half of the participants (153, or 56.6%), with the majority (245, or 91.1%) being between the ages of 17 and 24 years. Participants' BMIs ranged from 15.2 to 43.2, with an average SD of 24.5 5.3. One hundred and fifty (55.8%) of the kids were of average weight. The statistical research indicated a link between cumulative grade point average (CGPA) and BMI. In comparison to the rest, normal-weight participants had a higher CGPA. Conclusion: Being a male, younger age, high family income, second-year level and parents' education are all linked to strong academic achievement, according to the study. Normal weight, nutritional and sleeping habits are also linked to good academic performance.
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Audit of quality indicators of cytology: An institutional study p. 124
Snigdha Sinha, Subhashish Das, R Kalyani
DOI:10.4103/aihb.aihb_99_22  
Introduction: At present, clinical laboratories play a vital role in diagnosing and providing quality treatment. Various quality control (QC) and quality assurance (QA), including the pre-analytical and post-analytical variables, were taken into consideration for the internal quality indicators in the department of cytopathology of our institution. The aim of this study is to evaluate the importance of QC and QA parameters in the routine work of the cytopathology laboratory. Materials and Methods: This is a prospective cross-sectional study of 24 months duration. A total of 15,520 were evaluated for quality parameters. Results: A total of 15,520 cytology cases were evaluated. The cyto-histo correlation, non-conformities, TAT, Repeats and redo's, critical value, quality of staining and revised report rate were noted and identified with relevant statistical analysis. Conclusion: Routine QC and QA will ensure better diagnostic services and promote accreditation of laboratory activities.
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Comparative evaluation of diagnostic efficacy of cell block versus aspiration cytology p. 130
Nikhil Chaudhary, Subhashish Das, Snigdha Sinha
DOI:10.4103/aihb.aihb_98_22  
Introduction: Fine-needle aspiration cytology (FNAC) has certain disadvantages despite being the most commonly used procedure in the initial diagnosis of any swelling. In such cases, a cell block (CB) study can be a valuable adjunct to smears for establishing a more definitive cytopathological diagnosis. Therefore, this study was conducted to evaluate the efficacy of CB with FNAC and to compare the findings of the CB and FNAC with histopathology as the gold standard. Materials and Methods: The study was conducted in the department of pathology at our institute. All the cystic/solid lesions sent for fine-needle aspiration, which yielded sufficient material for the CB, were studied along with detailed clinical history. Results: Out of 66 cases of FNAC and CB, 35 cases were sent for histopathology. The mean age of the patients was 41.36 years, and female patients were more in number (73%). Benign lesions (71.4%) were more than malignant ones (29.6%). The CB section had more thyroid lesions (31%). The diagnostic accuracy of FNAC was found to be 94.28%, while that of CB was 97.14%. Conclusion: Although FNAC is the first line of investigation for mass lesions, and still, to make the best possible use of an aspirate, smears should be used together with CB preparation to provide the best possible morphological and histological diagnosis.
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Analysis of the interferon lambda 3 and 4 gene single nucleotide polymorphisms and vaccine response against COVID-19 p. 135
Zen Hafy, Ziske Maritska, Susilawati , Ella Amalia, Veny Larasati, Soilia Fertilita
DOI:10.4103/aihb.aihb_113_22  
Introduction: Assessing how various COVID-19 vaccines work against SARS-CoV-2 in different individuals is pivotal to planning better management and coping with the pandemic. Single nucleotide polymorphisms (SNPs) are one of the contributing factors to the immune response. This study investigated interferon lambda 3 and 4 (IFNL3/4) gene polymorphism and their association with an individual's immune response after receiving COVID-19 vaccines. Materials and Methods: An exploratory laboratory study to identify SNPs rs1297860 and rs368234815 in IFNL3/4 genes in Indonesian who have received two shots of CoronaVac and further evaluate its association with the COVID-19 vaccine response. The immune response was reflected from the serum titres of SARS-CoV-2 IgG (anti-spike IgG level), quantified using the SARS-CoV-2 IgG II Quant assay, where the IFNL3/IFNL4 SNPs identified using polymerase chain reaction restriction fragment length polymorphism. Results: From March to August 2021, this study recruited 46 eligible and healthy persons. None of the subjects in this study have the assumed associated genotypes (TT in IFNL3 or DG/DG in IFNL4). There was also no significant difference in the Mean Fold Rise of anti-spike IgG level between individuals with IFNL3 rs12979860 C/T polymorphism (CT genotype) and those with the homozygous common (wild-type) genotype (TT genotype) (U = 358; P > 0.05). Conclusion: The frequency of IFNL3/4 polymorphisms in this study population was low. Furthermore, the IFNL3/4 polymorphisms do not affect immune response (anti-spike IgG level) in individuals receiving two shots of the COVID-19 vaccine in this study.
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Audit of prostate cancer diagnosis using P63 and prostate-specific antigen immunostains at a tertiary care hospital in South-East Nigeria p. 139
Darlington C Amadi, Chinedu Onwuka Ndukwe, Christopher C Obiorah, Cornelius Ozobia Ukah
DOI:10.4103/aihb.aihb_139_22  
Introduction: Prostate cancer (CaP) is a leading cancer diagnosis and cause of cancer-related deaths among Nigerian men, and the accuracy of the pathologic diagnosis is critical for optimal patient care. This study aims to define the relative proportional accuracy of the histological diagnosis of prostatic cancer with hematoxylin and eosin (H and E) slides at Federal Medical Centre (FMC) Owerri, Nigeria. It also seeks to determine Gleason's grading and grade group pattern of CaP in our hospital. Materials and Methods: This study is a 5-year retrospective study reviewing all the H and E slides of prostatic Tru-Cut biopsies that were already diagnosed as cancer at FMC Owerri. These diagnoses were read and confirmed using their morphological appearance on light microscopy. Those that were suspicious, especially those that were diagnosed with well-differentiated adenocarcinoma (Gleason 3 + 3) and poorly differentiated carcinoma (Gleason 5 + 5), were sent for immunohistochemical studies. The well-differentiated carcinomas were stained for basal cells using P63, whereas poorly differentiated carcinomas were stained with prostate-specific antigens to confirm tissue of origin. These are to differentiate them from benign mimickers and metastatic carcinomas, respectively. Results: The age range of the patients was between 50 and 99 years, with a mean age of 72.84 years and peak age in the 70–79 years of age group. Using immunohistochemistry on the specimens which fitted into the criteria for immunohistochemistry, this study showed the relative proportional accuracy of the histological diagnosis of prostatic cancer using H and E to be 95.55% and the positive predictive value of H and E to be 0.83. With respect to International Society of Urological Pathology (ISUP) group grading, high-grade cancers predominated, and the most predominant grade is 5. Conclusion: H and E stain has high diagnostic accuracy (95.55%), but a 4.45% diagnostic error using H and E is quite significant. Immunohistochemistry, therefore, should act as a most valuable adjunctive, which significantly increases the diagnostic accuracy of prostatic carcinoma diagnosis.
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Association study of Melanocortin-4 Receptor (rs17782313) and PKHD1 (rs2784243) variations and early incidence of obesity at the age of maturity p. 144
Yasaman Ansari, Mojgan Asadi, Iman Salahshouri Far, Nahid Pashaie, Nafise Noroozi, Mahsa M Amoli
DOI:10.4103/aihb.aihb_160_22  
Introduction: Obesity is primarily caused by the dysfunction of the energy homeostasis system. Numerous studies have reported an association between obesity and the rs17782313 variant near the melanocortin-4 receptor (MC4R) gene. In addition, the PKHD1 gene regulates the expression of fibrocystin. This gene is primarily expressed in the kidney and plays a role in fat and glucose metabolism. However, the interaction between PKHD1 polymorphisms and birth weight has not yet been investigated. This study showed the association between the rs17782313 variant near the MRC4 gene and rs2784243 in the PKHD1 gene amongst Iranian cases with obesity before maturity. Methods: One hundred and eleven Iranian patients and 100 healthy individuals aged 5 years and over were selected from the Tehran Moheb-e-Yas Hospital. Polymerase chain reaction-restriction fragment length polymorphism and sequencing methods were used for genotyping the genetic variants. A Chi-square test was applied to determine the association between rs17782313 and food intake and rs2784243 and birth weight. Results: The rs17782313 variant was associated with high food intake (P = 0.04), while the rs2784243 variant was associated with increased birth weight (P = 004). Conclusion: The MC4R rs17782313 and PKHD1 rs2784243 variants may contribute to food intake and early obesity. Moreover, a novel association was suggested between PKHD1 rs2784243 and birth weight.
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Physical activity: An effective way to enhance population well-being p. 151
Md Wasek Salam, Rabeya Yousuf, Md Mushtahid Salam, Mainul Haque
DOI:10.4103/aihb.aihb_107_22  
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Obesity and overweight: A global public health issue Highly accessed article p. 154
Md Mushtahid Salam, Rabeya Yousuf, Md Wasek Salam, Mainul Haque
DOI:10.4103/aihb.aihb_106_22  
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Application of metaverse and immersive technology in cancer care p. 157
Namrata Dagli
DOI:10.4103/aihb.aihb_180_22  
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