Prevalence of dental fluorosis and dental caries in fluoride endemic areas of Rohtak district, Haryana

Objectives: This study investigates the estimation of the fluoride concentration in drinking water in Rohtak district, Haryana, and quantifies its effect on the prevalence of dental fluorosis and dental caries. Materials and Methods: A cross-sectional survey was conducted among 1262 school children in endemic fluoride areas of Haryana. Using simple random sampling, thirty villages from five blocks of Rohtak districts were selected, and children 6–12 years of age were examined. A questionnaire survey form was filled out to record the demographic details of the samples. Dental caries was recorded according to DMFT (D = Decayed, M = Missing due to caries only, F = Filled, T = Teeth)/deft index (d = decayed, e = extracted due to caries, f = filled, t = teeth). Assessment of Dental Fluorosis was done according to Dean's Fluorosis index, modified in 1942. The data were analyzed using SPSS version 19, and nonparametric tests were used to assess the significance. Results: The study participants included 615 males and 647 females among which Mean DMFT in the area of study ranged from 0.32 to 1.90. Mean deft in the area of study ranged from 0.34 to 1.91. The fluoride concentrations in groundwater are in the range of 0.532–8.802. Out of 1262 children examined, 655 (51.90%) children were having dental fluorosis. 607 (48.10%) of the subjects were free from fluorosis. 16.09%, 13.39%, 9.11%, and 8.16% and 5.15% were having questionable, very mild, mild, moderate, and severe form of fluorosis, respectively. Conclusion: It can be concluded that in Rohtak district, the fluoride levels in drinking water and the prevalence of dental fluorosis are high, so requiring an urgent need to improve the quality of water and institute de-fluoridation of drinking water in affected areas to lower the burden of dental fluorosis in the community.

Female sterilization failure, consequences and further contraception: a review of cases over ten years

Objective: To study the socio-demographic profile and etiological factors responsible for failure of tubal ligation. Their outcome and further adopted methods of contraception.Methods: This was a retrospective observational study done in a tertiary care centre from January 2009 to December 2018. All cases who came with sterilization failure were reviewed including their demographic patterns, previous methods used and the contraception choices adopted after procedural failure.Results: Over a period of ten years, out of a total of 157 cases of sterilization failure 43.33% (n=68) were laparoscopic interval ligation, 42.60% (n=67) were laparoscopic ligation with termination of pregnancy, 10.20% (n=16) were sterilization done along with lower segment cesarean section and 1.9% (n=3) were mini-laparotomy (minilap) done in postpartum period. Only 63.05% (n=99) got repeat sterilization procedure done despite previous failure. Out of 157 cases, in 50.9% (n=80) recanalization was found, tuboperitoneal fistula was responsible in 5.7% (n=9) women, slipped fallope ring was found in 5.7% (n=9) women, wrong application of fallope ring was seen in 1.9% (n=3) and 35.6% (n=56) did not opted for religation.Conclusion: Failures of sterilization procedures do exist especially in laparoscopic ligation. Counseling prior to adoption of this method, risk of failure and other noninvasive options of contraception must be discussed.

Survey of Usage and Type of Topical Anesthesia among Dentists of Tricity

Introduction: Local anaesthesia injection is widely acceptedas the gold standard for pain management during variousdental procedures. Intra-oral topical anaesthesia not onlyreduces the pain of injection prick but also several minordental procedures can be carried out under topical anaesthetic.Study aimed to determine the usage, type & effectiveness ofvarious topical anaesthetics used for minor dental proceduresin pediatric patients.Material and Methods: A self-structured, closed endedquestionnaire was emailed to 100 private dental practitionersin the tricity and were asked to fill and mail it back.Results: 59% dentists responded, out of them 70.7%routinely used topical anesthetic. 64.8% used Lidocaine gelfor administration of local anesthesia. 24.1% used topicalanesthetic for extraction of nearly exfoliating deciduous teeth.42.6% responded that the effect of topical anesthetic wasachieved between 30 seconds to 1 minute.Conclusion: All the dentists were aware of using topicalanesthetic and the most preferred delivery system was gel.

Prediction of severe adverse maternal outcome in women admitted in obstetric ward using physiological and biochemical parameters

Background: To study physiological and biochemical parameters to predict serious adverse maternal outcomes and to develop risk score using above parameters.Methods: This prospective study was conducted in 500 high risk pregnant women attending tertiary care teaching hospital. We noted physiological and biochemical parameters as soon as they were available .The primary outcome measures was “severe adverse maternal outcome(SAMO)” in form of one or more among  mortality, near miss morbidity and ICU admissions.Results: Out-off 500 women, severe adverse maternal outcomes were seen in 158 (31.6%) women. Most common cause of near miss maternal morbidity was hypertensive disease of pregnancy (62.7%) followed by major obstetric hemorrhage (18.9%). There were 33(6.6%) ICU admission, 23 (4.6%) maternal death and 153 (30.6%) near miss maternal morbidity. The most common cause of maternal death in our study was obstetric hemorrhage. The significant variables after multivariate analysis [temp, pulse, urine protein] were used  to devise a Maternal early warning score (MEWS) based on physiological parameters at score value of  ≥1/6 was found to have  sensitivity of 70% and specificity of 82% in predicting SAMO with AUROC of 0.76. The significant laboratory parameters after multivariate analysis were blood urea, serum creatinine, serum bilirubin and liver enzymes. The obstetric risk score (Maternal risk prediction score MRPS) which incorporated of these laboratory parameters in addition to physiological parameters has sensitivity of 82% and specificity of 75% with AUROC 0.79 value ≥ 2/18.Conclusions: The addition of laboratotory parameters to physiological variables improves performance of risk score to predict SAMO.

Fatal outcome in acute fatty liver of pregnancy and review of literature

Acute fatty liver of pregnancy (AFLP) is an uncommon life-threatening disorder of pregnancy seen commonly in third trimester. When not diagnosed at right time it can lead to hepatic failure, encephalopathy, coagulopathy, maternal and fetal mortality. The clinical symptoms and signs are nonspecific, and it needs to be identified early in order to prevent poor outcome. The gold standard for diagnosis of AFLP is liver biopsy, which is difficult in an acute setting and in abnormal coagulation profile hence the diagnosis is usually based on clinical criteria   Early termination of pregnancy and good intensive care support are the mainstay of management. The authors here presented a case report where even early delivery and good critical care failed to prevent maternal mortality. Review of literature regarding etiopathogenesis, management and recurrences of AFLP are also discussed.