A Retrospective Study to find out Factors Affecting Maternal Mortality in a Tertiary Care Hospital in Ahmedabad City, Gujarat

Background : Data pertaining to preventable causes of maternal mortality are valuable in each set up to design interventional steps for the significant reduction of the maternal mortality ratio. Objectives : (1) To study the trend on Maternal Mortality Rate (MMR); (2) To find out the factors for the Maternal Mortality. Material and Methods : A retrospective cross-sectional study of maternal death was conducted in the Obstetrics Department of Tertiary Care Hospital of Ahmedabad city. The data of total 9 years from 1st April 2013 to 31st January 2021 were taken in the study. Epidemiological factors and causes affecting maternal mortality were assessed through pretested questionnaire that includes parity, duration between admission and mortality etc. Results: Maternal Mortality Rate (MMR) was 180.2 per 1 lac live births during the study period. Young mothersaged 20 to 30 years (78.5%), and rural residence (76.6%), multiparous mothers (66.7%)were at risk for Maternal Mortality. Obstetric haemorrhage (25.8%) was the most common cause whereas COVID-19 pandemic later on were indirect causes contributing to Maternal Mortality. Conclusion: Great Care should be taken for high-risk pregnancy like young age, multiparous women and also of postpartum women. Postpartum haemorrhage was the commonest direct cause of Maternal Mortality. Strengthening of existing obstetric care facilities, facility for easy transport, appropriate referral linkages are keys to reduce Maternal Mortality to further extent

Proportion of Consanguineous Marriages in Community and Factors Affecting Pregnancy Outcome : A Hospital based Study in Ahmedabad City, Gujarat

Objectives : To find out (i) the proportion and the types of consanguinity and (ii) its correlation with fetal loss, neonatal deaths, complication related to obstetric and congenital abnormalities. Methods : All the delivered women at Tertiary Care Hospital were included in the cross sectional study during the study period. Total sample size was 6775. Information regarding educational status, occupation, consanguinity and pregnancy outcome was collected. Results : 17% consanguinity was found in selected people and among these marriages, 59.8% were between first cousins. There was highly significant difference observed between the consanguineous status of women and pregnancy outcome (Congenital malformations, abortion, Intrauterine death). Conclusion: The incidence of congenital abnormalities, Intrauterine Device (IUD) and abortion was found higher in Consanguineous marriages. There is a need to improve public awareness regarding problems related to Consanguineous marriages

Assessment of core capacities for antimicrobial stewardship practices in indian hospitals: Report from a multicentric initiative of global health security agenda

Introduction: Antimicrobial-resistant HAI (Healthcare associated infection) are a global challenge due to their impact on patient outcome. Implementation of antimicrobial stewardship programmes (AMSP) is needed at institutional and national levels. Assessment of core capacities for AMSP is an important starting point to initiate nationwide AMSP. We conducted an assessment of the core capacities for AMSP in a network of Indian hospitals, which are part of the Global Health Security Agenda-funded work on capacity building for AMR-HAIs. Subjects and Methods: The Centers for Disease Control and Prevention's core assessment checklist was modified as per inputs received from the Indian network. The assessment tool was filled by twenty hospitals as a self-administered questionnaire. The results were entered into a database. The cumulative score for each question was generated as average percentage. The scores generated by the database were then used for analysis. Results and Conclusion: The hospitals included a mix of public and private sector hospitals. The network average of positive responses for leadership support was 45%, for accountability; the score was 53% and for key support for AMSP, 58%. Policies to support optimal antibiotic use were present in 59% of respondents, policies for procurement were present in 79% and broad interventions to improve antibiotic use were scored as 33%. A score of 52% was generated for prescription-specific interventions to improve antibiotic use. Written policies for antibiotic use for hospitalised patients and outpatients were present on an average in 72% and 48% conditions, respectively. Presence of process measures and outcome measures was scored at 40% and 49%, respectively, and feedback and education got a score of 53% and 40%, respectively. Thus, Indian hospitals can start with low-hanging fruits such as developing prescription policies, restricting the usage of high antibiotics, enforcing education and ultimately providing the much-needed leadership support.

Prevalence and risk-factors of early childhood caries among 2–6-year-old Anganwadi children in Nellore district, Andhra Pradesh, India: A cross-sectional survey

The objective of this study is to study the prevalence and associated risk determinants of early childhood caries (ECC) among preschool children. Materials and Methods: A cross-sectional descriptive study was designed to assess the ECC prevalence and associated risk factors among preschool children in Anganwadi of Nellore district using a standardized questionnaire. Results: A total of 550 study participants of age 2–6 years are enrolled in this cross-sectional study. Mean age of the participants was 4.39 ± 0.89 years. Most of the study participants (38%) were in the age of 5 years. When gender wise comparison was made girls represented 62% and boys 38% of the total population. When the risk factors were assessed for their association with caries experience, socioeconomic status, mother's schooling at child's birth, duration of using bottle, and bottle feeding while sleeping and plaque scores showed significant association with caries experience. Conclusion: ECC was more prevalent among 5-year-old children as compared to other age groups and moreover demographic factors such as mother's occupation, education, socioeconomic status, developmental characteristics such as enamel hypoplasia, feeding habits like prolonged and nocturnal bottle feeding and clinical parameters like plaque scores showed significant correlation with ECC.

Accuracy Of Single Progesterone Assay To Predict Early Pregnancy Outcome

OBJECTIVE: To study the accuracy of estimation of single serum progesterone level in predicting early pregnancy outcome in symptomatic women with inconclusive USG MATERIALAND METHODS: 70 women with gestational age less than 12 weeks fulfilling the inclusion criteria were included in the study. RESULTS: Out of 70 women, the follow up scan revealed 33 viable pregnancies and 37 non-viable pregnancies. Mean serum progesterone was significantly higher in viable pregnancy group (16.318± 7.29 ng/ml), compared with non-viable pregnancy group (8.07± 5.878ng/ml) and the association was found to be statistically significant with a ‘p’ value of 0.0001. Serum progesterone of 10ng/ml has sensitivity of 72.97% in predicting a non-viable pregnancy and specificity of 81.81% in predicting viable pregnancy. CONCLUSION: Single serum progesterone value of less than 10ng/ml can be a useful test in predicting early pregnancy failure in symptomatic patients with inconclusive USG.

Pediatric Melioidosis in Southern India.

Melioidosis in children is increasingly detected from the coastal region of Southern India during monsoon. We present 11 cases of melioidosis, ranging from localized to disseminated, treated successfully, barring one death. It calls for awareness and upgrading laboratory facilities for better diagnosis and management of pediatric melioidosis.

Effect of chlorhexidine, povidone iodine, and ozone on microorganisms in dental aerosols: Randomized double-blind clinical trial.

Objective: Dental handpieces, ultrasonic scalers, air polishers, air abrasion units produce the most visible aerosols. The objective of this study was to assess the effect of chlorhexidine (CHX), povidone iodine (PI), and ozone (OZ) on the microorganisms in dental aerosols. Materials and Methods: A total of 60 patients were included in this study, they were randomly assigned into three groups and were subjected to scaling before and after rinsing with 0.2% CHX, 1% PI or irrigation with OZ. Blood agar plates were used to collect the gravitometric settling of aerosols and were sent for aerobic and anaerobic culture. Results: The results demonstrated high percentage reduction of aerobic and anaerobic colony forming units (CFUs) in all three groups. In aerobic CFUs, CHX showed the highest reduction (57%) at mask position whereas at chest position and at 9 ft, PI showed higher CFU reductions (37% and 47%, respectively). In anaerobic CFUs, CHX showed the highest percentage of reduction at chest level (43%) and at 9 ft (44%). Conclusion: CHX, PI and OZ showed similar effects in reducing aerobic and anaerobic CFU's at the chest mask and at 9 ft. OZ can be used as a preprocedural agent, considering its beneficial effects.

Detection of odoriferous subgingival and tongue microbiota in diabetic and nondiabetic patients with oral malodor using polymerase chain reaction.

Background: Halitosis has been correlated with the concentration of volatile sulfur compounds (VSCs) produced in the oral cavity by metabolic activity of bacteria colonizing the periodontal pockets and the dorsum of the tongue. It has been assumed that there is a relationship between periodontal disease and diabetes mellitus. Objectives: The aim of the study was to assess the malodor using the organoleptic method and tanita device; to quantify odoriferous microorganisms of subgingival plaque and tongue coating, such as P. gingivalis (Pg), T. forsythia (Tf), and F. nucleatum (Fn) using polymerase chain reaction (PCR) in nondiabetic and diabetic chronic periodontitis patients. Patients and Methods: Thirty chronic periodontitis patients (with and without diabetes) with 5-7 mm pocket depth, radiographic evidence of bone loss, and presence of oral malodor participated in this study. Subjective assessment of mouth air was done organoleptically and by using a portable sulfide monitor. Tongue coating was also assessed. Results: The scores of plaque index, gingival index, gingival bleeding index, VSC levels, and tongue coating between the nondiabetic and diabetic patients were not significant (P>0.5). In nondiabetic patients, Fn was found to be significantly (P<0.5) more in tongue samples, whereas Pg and Tf have not shown significant values (P>0.5). In diabetic patients, Fn and Tf have shown significant (P<0.5) an increase in subgingival and tongue samples, respectively, whereas Pg has not shown significant difference between subgingival and tongue samples. Interpretation and Conclusion: The results confirm that there is no difference in clinical parameters between nondiabetic and diabetic periodontitis patients, but the odoriferous microbial profiles in tongue samples of diabetic patients were found to be high. However, there is a weak positive correlation between VSC levels, clinical parameters, and odoriferous microbial profiles.

Melanin: A scavenger in gingival inflammation.

Background: One of the major direct or indirect targets of ultraviolet exposure of skin is the melanocyte or the melanin -forming cell. Epidermal melanocytes act as a trap for free radicals. Based on the protective role of melanocytes in medical literature, the role of melanin pigmentation in gingiva needs to be elucidated. Periodontal pathogens and their products demonstrate the ability to induce the generation of reactive oxygen species. Hence purpose of this study was to unravel the protective role of melanin (if any) against the gingival inflammation. Materials and Methods: A total of 80 subjects; 20 in each group were selected. The selection of subjects regarding gingival pigmentation was based on Dummett's scoring criteria 0, 3. A complete medical, dental history and an informed consent were obtained from the patients. After evaluation of clinical parameters the GCF was collected using microcapillary pipettes at the selected sites. IL-1β levels were quantitated using ELISA. Results: In non-pigmented healthy and gingivitis groups, there was a positive correlation between plaque index, gingival index and bleeding index versus IL-1β level: indicating an increase in the biochemical mediator of inflammation corresponding to an increase in the clinical parameters of inflammation. Also a positive correlation was found between the gingival index and bleeding index versus the IL-1β levels in the pigmented healthy group. The pigmented gingivitis groups showed a negative correlation between the plaque index, gingival index and bleeding index. Conclusions: The clinical markers of inflammation such as gingival index, bleeding index was of low numerical value in pigmented group than in the non-pigmented group, supposedly due to the protective action of melanin. The negative correlation of clinical markers of inflammation to the IL-1β levels in the pigmented gingivitis group could possibly be attributed to the protective role of melanins.

The use of ozonated water and 0.2% chlorhexidine in the treatment of periodontitis patients: A clinical and microbiologic study.

Background: The development of periodontal disease has been thought to be associated with several restricted members of the oral anaerobic species, such as black-pigmented Porphyromonas species and Actinobacillus actinomycetemcomitans (Aa), in the subgingival environment. Apart from bacteria, certain viruses and fungi that are associated with periodontal disease are also present in the subgingival plaque . Materials and Methods: A randomized, double-blind, crossover split-mouth design was performed. A total of 16 patients suffering from generalized chronic periodontitis were selected for the study. The study period of 18 days was divided into two time-intervals, i.e. baseline (0 days) to 7 th day, with a washout period of 4 days followed by a second time interval of 7 days. The use of ozone and chlorhexidine gluconate (CHX) irrigation was randomized. Both the patient and the clinician evaluating the clinical parameters were blinded regarding the type of irrigation used. Results: The interpretation of clinical and microbial data is from baseline to 7 th day. A higher percentage of plaque index (12%), gingival index (29%) and bleeding index (26%) reduction was observed using ozone irrigation as compared to chlorhexidine. The percentile reduction of Aa (25%) using ozone was appreciable as compared to no change in Aa occurrence using chlorhexidine. By using O 3 and chlorhexidine, there was no antibacterial effect on Porphyromonas gingivalis (Pg) and Tannerella forsythensis. The antifungal effect of ozone from baseline (37%) to 7 th day (12.5%) was pronounced during the study period, unlike CHX, which did not demonstrate any antifungal effect. Conclusion: Ozone may be considered as an alternative management strategy due to its powerful ability to inactivate microorganisms. Also, there is growing evidence that ozone can be employed as a useful therapeutic agent in both dentistry and medicine.

Ventilator-associated pneumonia with Col-S strains: a successful comeback of colistin!

Emergence of multi and pan-drug resistant Gram-negative bacteria causing nosocomial infections in intensive care settings has become a challenge for clinicians. The mortality rate of ventilator-associated pneumonia (VAP) is known to increase when the initial microbiological diagnosis and antimicrobial therapy are inappropriate. We present a case of a 18-year-old man, who after being admitted following an accident, had developed VAP due to multi-drug resistant Pseudomonas aeruginosa and Acinetobacter spp. and had a downhill clinical course despite broad-spectrum antibiotic treatment. The strains were found to be Col-S, as the susceptibility was tested. Colistin was instituted, with remarkable recovery. It is imperative to diagnose VAP with multi-drug resistant strains as early as possible; colistin, the 'last resort' antibiotic, if instituted with proper monitoring at the right time, can be life saving.

The diagnostic and prognostic implications of silver-binding nucleolar organizer regions in periodontal lesions.

BACKGROUND: The periodontal lesions with cellular proliferation can be assessed by various methods. One of the most recent methods to determine the proliferative activity is silver-staining nucleolar organizer region (AgNOR) staining. The purpose of the present study was to evaluate, if AgNOR count can act as a proliferative marker and can aid in the diagnosis and prognosis of periodontal lesions. MATERIALS AND METHODS: For this study, subjects with healthy gingival status, non-neoplastic lesions, neoplastic lesions, and plaque-induced gingivitis were included. Following the provisional diagnosis of clinical entity, biopsies were taken from the respective selected sites for histopathological diagnosis. In plaque-induced gingivitis cases, a second biopsy was taken from the selected sites 3 weeks following scaling. After histological confirmation, one more section was prepared, which was subjected to AgNOR staining, and AgNOR numbers were counted by individual and cluster counts and statistically analyzed. RESULTS: Results showed the highest AgNOR count in neoplastic lesions. Non-neoplastic lesions showed a higher AgNOR count as compared to clinically healthy gingiva. Plaque-induced gingivitis showed a considerable reduction in AgNOR count after treatment. CONCLUSION: Results of this study confirmed that AgNOR count reflects the cellular proliferation and has a limited diagnostic value. However, the prognostic value of AgNOR for periodontal lesions is dependable.

Assessment of periodontal status in dental fluorosis subjects using community periodontal index of treatment needs.

BACKGROUND: Periodontitis is multifactorial in nature. The various determinants of periodontal disease are age, sex, race, socioeconomic status and risk factors including tobacco usage and oral hygiene status. However, there is inconsistent epidemiological data on the periodontal status of subjects living in high-fluoride areas. The aim of the study was to investigate the effect of dental fluorosis on the periodontal status using community periodontal index of treatment needs (CPITN), as a clinical study. The purpose of this study is to determine the periodontal status using CPITN index in a population aged between 15 and 74 years residing in the high fluoride areas of Davangere district. The possible reasons for the susceptibility of this population to periodontal disease are discussed. MATERIALS AND METHODS: 1029 subjects, aged between 15 and 74 years suffering from dental fluorosis were assessed for their periodontal status. Clinical parameters recorded were OHI-S to assess the oral hygiene status, Jackson's fluorosis index to assess the degree of fluorosis and CPITN index to assess the periodontal status where treatment need was excluded. RESULTS: Gingivitis and periodontitis were more common in females (65.9% and 32.8%,respectively) than in males (75.1% and 24.2%, respectively). Periodontitis was significantly more common in females. As the age advanced from 15 to 55 years and above, gingivitis reduced from 81.0 to 42.9% and periodontitis increased steadily from 18.0 to 57.1%, which was significant. Periodontitis was high in subjects with poor oral hygiene (81.3%), compared to those with good oral hygiene (14.5%), which was significant. As the degree of fluorosis increased, severity of gingivitis reduced and periodontitis increased, i.e, with A degree fluorosis, gingivitis was 89.4% and periodontitis 8.5%, but with F degree fluorosis the former was 64% and the latter 35.8%, which was statistically significant. CONCLUSION: The results suggest that there is a strong association of occurrence of periodontal disease in high-fluoride areas. The role of plaque is well understood in contrast to the effect of fluorides on periodontal tissues. It goes a long way to reason out fluoride as an important etiological agent in periodontal disease.

The detection of eight putative periodontal pathogens in adult and rapidly progressive periodontitis patients: an institutional study.

PURPOSE: Periodontal disease is a commonly prevalent problem faced alike by both the developed and third world countries but showing wide variations in prevalence and severity across different geographical areas. The purpose was to identify Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Ekinella corrodens (Ec), Campylobacter rectus (Cr), Bacteroides forsythus (Bf), Treponema denticola (Td) and Fusobacterium nucleatum (Fn) in Indian adult periodontitis and rapidly progressive periodontitis patients. MATERIALS AND METHODS: Paper points were used to collect the sample from 28 sites in both adult periodontitis and rapidly progressive periodontitis (8 healthy/20 diseased sites) patients and DNA analysis done. The categorical data was analysed by Fishers exact test and difference in the clinical parameters was tested by Mann-Whitney test. RESULTS: In healthy sites of adult and rapidly progressive periodontitis patients, Aa, Ec, Bf and Aa, Pg, Pi, Td, Fn were detected respectively. However, when diseased and healthy sites were compared in both adult periodontitis and rapidly progressive periodontitis patients respectively, only Pg( P =0.004), Cr( P =0.04), Fn( P =0.014) and Pg( P =0.002), Cr( P =0.02), Fn( P =0.008) were statistically significant. CONCLUSION: The prevalence of the microorganisms correlate with the clinical parameters like probing depth and bleeding on probing as seen in the Japanese and Western periodontitis patients' population.

Sino-orbital aspergillosis in a diabetic patient.

Sino-orbital aspergillosis in a 61-year-old male with uncontrolled non-insulin dependent diabetes mellitus presented with three months history of left ear pain, left side headache with mucopurulent nasal discharge and one week history of progressive swelling and pain with difficulty in opening of the left eye and sudden loss of vision. In spite of surgical debridement and medical management with amphotericin B and itraconazole his visual outcome was poor and the infection was unabated at one month follow up.

Clinical evaluation of an ionic tooth brush on oral hygiene status, gingival status, and microbial parameter.

It has long been recognised that the presence of dental plaque leads to gingivitis and periodontal disease, as well as dental caries. Today tooth brushing is the most widely accepted method of removing plaque. Hence this present clinical study was undertaken to evaluate the effectiveness of an ionic toothbrush on oral hygiene status. For this study, 20 dental students in the age group of 18-20 years were included. All the subjects after undergoing dental prophylaxis were then provided with ionic toothbrushes, either active (equipped with lithium battery) or inactive (without lithium battery). Plaque index and gingival bleeding index were examined at 7th, 14th, and 21st day. Microbial assessment was done for detection of colony forming units (CFU) from the plaque samples which were collected on 0 day and 21st day, both before brushing and after brushing. Results shown a significant reduction in all the parameters and the reduction was more significant in active and inactive ionic toothbrush users. It was concluded that both active and inactive ionic toothbrushes reduced the plaque index and gingival bleeding index scores significantly and active ionic tooth brushes were more effective as compared to inactive ionic toothbrushes. There was no soft tissue trauma following the use of both type of toothbrushes, which showed that ionic toothbrushes were equally safe for regular long-term use.

Detection and measurement of oral malodour in periodontitis patients.

BACKGROUND & OBJECTIVES: Malodour has been correlated with the concentration of volatile sulphur compounds produced in the oral cavity by metabolic activity of bacteria colonizing the periodontal sites and the dorsum of the tongue. The aim of this study was to detect malodour in mouth air organoleptically and using a portable sulphide monitor and to correlate it with the clinical parameters, halitosis linked toxins and BANA, using tongue and subgingival plaque samples. The halitosis grading is also correlated with the microbial colonies of the subgingival plaque sample. METHODS: 20 patients with chronic periodontitis with 5-7 mm pocket depth, radiographic evidence of bone loss and presence of oral malodour participated in this study. Assessment of mouth air was done organoleptically and by using a portable sulphide monitor. The clinical parameter, plaque index (PI), gingival index (GI), gingival bleeding index (BI), were obtained from all the areas. Samples for BANA and to detect halitosis linked toxins were taken from the dorsal surface of the tongue and periodontal pockets ranging 5-7 mm. Halitosis related microbial colonies were identified using anaerobic culturing from the subgingival plaque. RESULTS: The scores of PI, GI, BI and sample that tested positive for halitosis linked toxins and with the halitosis grading were not significant. The presence of tongue coating and the halitosis grading and toxin levels were significant. BANA has shown to be non contributory due to technical problems. Anaerobic culture has shown to identify Streptococcus, Bacteroides, Fusobacterium, Porphyromonas and Prevotella colonies. INTERPRETATION & CONCLUSION: The results confirmed that there was no correlation between the clinical parameters, halitosis linked toxins and halitosis grading. The microbial colonies have shown to correlate with the presence of oral malodour.

Comparative assesment of gingival thickness using transgingival probing and ultrasonographic method.

A decided attitude of expectation among many patients has given a new perspective to regenerative and plastic periodonta surgery. With authors emphasizing on the importance of gingival thickness, attempts are being made to obtain necessary information atraumatically and rapidly. Hence in the present study an attempt has been made to compare the two methods of assessing gingival thickness i.e transgingival probing and ultrasonographic method and also assess the gingival thickness in relation to central incisor lateral incisor and canine in Indian population. The gingival thickness was assessed in patients with healthy gingiva by both the methods. It was observed that transgingival probing method significantly over estimated the thickness of gingiva than the ultrasonographic method and the thickness of gingiva varies with morphology of the crown. It was concluded that compared to transgingival probing ultrasonographic method assesses gingiva thickness more accurately, rapidly and atraumatically.